Adult People With Epilepsy Research Articles

Prevalence and associated factors of psychiatric comorbidities in epilepsy in the Casablanca-Settat region of Morocco: A cross-sectional study.

To determine the estimated prevalence of anxiety, depression, and anxiety-depression syndrome (ADS) and to identify the associated factors in Moroccan people with epilepsy (PWE). A cross-sectional study was conducted among adult PWE (June 2021-December 2022) in the Casablanca-Settat region. PWE were interviewed by completing a questionnaire collecting sociodemographic and clinical data. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). Out of 21 points, a score ≥8 is in favor of considerable anxiety/depression symptoms and a sum of the two scores ≥15 indicates the presence of ADS. Data were analyzed using Statistical Package for Social Sciences (SPSS) 21.0. p-values ≤0.05 were considered statistically significant and logistic regression was performed to determine the associated factors. Among 294 PWE, the median age was 39 years (interquartile range [IQR]: 25.75-54.00). The median anxiety, depression, and ADS scores were 8 (IQR: 5.00-10.00), 7 (IQR: 4.00-10.00), and 15 (IQR: 10.00-20.00), respectively. Anxiety, depression, and ADS were revealed in 51.4%, 44.9%, and 51.0% of PWE, respectively. Depression was the only predictor for anxiety (aOR = 24.20; 95%CI: 12.45-47.01). Antiseizure polytherapy (aOR = 3.35; 95%CI: 1.72-6.54) and anxiety (aOR = 24.04; 95%CI: 12.12-47.67) were the factors associated with depression. The risk of ADS was increased by female gender (aOR = 2.83; 95%CI: 1.68-4.78), antiseizure polytherapy (aOR = 2.75; 95%CI: 1.62-4.65), structural epilepsy (aOR = 1.73; 95%CI: 1.01-2.94), and the presence of concomitant conditions with epilepsy (aOR = 1.96; 95%CI: 1.16-3.31). Our study reports high psychiatric comorbidity prevalence in epilepsy, which supports the bidirectional link hypothesis. Associated factors found are important in the prognosis and prevention. The neural mechanisms underlying epilepsy tend to expose PWE to psychiatric disorders. Our study aims to quantify the rate of psychiatric comorbidities and their predictive factors in Moroccan PWE. The estimated prevalences of significant symptoms of anxiety, depression, and ADS were 51.4%, 44.9%, and 51.0%, respectively. Depression was the predictor of anxiety. Antiseizure polymedication and anxiety were the associated factors with depression. The risk of SAD was increased by female gender, antiseizure polymedication, structural epilepsy, and concomitant diseases with epilepsy. Our results are important for considering the psychiatric aspect of PWE and improving their care and quality of life.

Antiseizure medication adherence and epilepsy surgery attitude in people with epilepsy in Morocco: A cross-sectional study

We determine the proportion of non-Antiseizure Medication Adherence (non-AMA) and refusal attitude towards Epilepsy Surgery (ES) and their associated factors in Moroccan People With Epilepsy (PWE). A cross-sectional study was conducted (December 2021-December 2022) among adult Moroccan PWE. PWE were interviewed for their reactions to AMA and the ES attitude. Their medical files were processed to complete their sociodemographic and clinical data. Data were analyzed by the Statistical Package for Social Sciences (SPSS) software 21.0. A Chi-square test was performed to compare variables and multivariate logistic regression was used to highlight associations. Statistical tests were considered significant at a p-value ≤ 0.05 for a Confidence Interval (CI) of 95 %. The median age of our sample (n = 294) was 38 years (IQR: 25.00–55.00). Non-AMA was noted in 24.5 % with indifference as the main reason (55.6 %). ES refusal was found in 33.3 %, attributed mostly to apprehension (61.2 %). In the multivariate analysis, male sex (aOR = 1.94; 95 %CI: 1.03–3.64) and the existence of a family history of epilepsy (aOR = 1.96; 95 %CI: 1.02–3.75) were the factors associated with the non-AMA, whereas the use of allopathic treatments (aOR = 2.32; 95 %CI: 1.20–4.51), exclusively focal or generalized (not combined) seizures (aOR = 2.66; 95 %CI: 1.36–5.21) and the combination of a generic with the originator ASM (aOR = 2.64; 95 %CI: 1.12–6.18) were the predictive factors with the ES refusal attitude. The proportions found of non-AMA and ES refusal were relatively low compared to other studies, which may indicate the effort that medical staff have devoted recently to raising awareness of the importance of PWE’s therapeutic involvement.

Determinants of felt-stigma in adolescents with epilepsy: Is it the same story?

PurposeThe present study aimed to investigate previously researched variables in adult people with epilepsy (PWE), which include felt stigma, perceived overprotection, concealment of epilepsy, and epilepsy-related concerns for adolescents with epilepsy (AWE). Another goal was to determine the reported levels of these variables and explore the relationships among them, as well as their associations with demographic and clinical factors. Additionally, we also investigated whether clinical and demographic variables create significant changes in these variables. Lastly, we aimed to determine the variables that predict felt-stigma in AWE. MethodsOn hundred and nineteen AWE aged between 10 and 18 were included in the study by using convenience sampling. Participants received the scales and demographic information form either in face to face meeting or via a Zoom session. ResultsNearly half of the participants stated high level of felt stigma, perceived overprotection and concealment of epilepsy, while more than half reported concerns about their future/occupational prospects. Also, felt stigma had significant relations with concealment of epilepsy and concerns related to epilepsy. Early adolescents were under more risk for perceived overprotection, while late adolescents had higher concerns related to future/occupation. Females reported more felt stigma. Finally, felt stigma was predicted by concealment, concerns related to future/occupation, and concerns related to social life. ConclusionThe variables that explain the felt-stigma in AWE appear to be quite similar to those in adult PWE.

Rehabilitation of cognition and psychosocial well-being - a better life with epilepsy (ReCaP-ABLE): a protocol for a randomized waitlist-controlled trial.

Despite advances in the understanding of cognitive dysfunction among people with epilepsy (PWE), evidence for cognitive rehabilitation in epilepsy (CoRE) remains scarce. We present the protocol of a randomized waitlist-controlled trial (ClinicalTrials.gov ID NCT05934786) of a psychological-behavioral intervention aiming to ameliorate quality of life as well as cognitive functioning in a mixed PWE sample. The study is set at Vilnius University Hospital Santaros Klinikos and will offer adult PWE six individual and two group sessions led by a certified psychologist and directed toward improving memory, attention, self-regulation, mood and quality of life. The trial is expected to address major gaps in the literature by providing novel evidence on the effectiveness of CoRE in patients with genetic generalized epilepsies, the importance of epilepsy-specific factors for the response to CoRE, the impact of CoRE on long-term memory as well as its maintenance effects.

Safety and adverse events following COVID-19 vaccination among people with epilepsy: A cross-sectional study.

Epilepsy is a non-communicable disease costing a massive burden globally. It is known that there is increased prevalence of morbidity and mortality following COVID-19 infection among people with epilepsy (PWE). However, there is limited information about the adverse events following COVID-19 immunization among PWE. Hence, this study aimed to assess the safety and adverse events following immunization (AEFI) of various COVID-19 vaccines among PWE fromour centre, focusing on neurological AEFI. This cross-sectional study recruited 120 adult PWE from the Neurology Clinic of the Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Consent-taking was conducted via synchronous or asynchronous approaches, followed by a phone call interview session. The interview collected socio-demographic information, epilepsy-related variables, and vaccination-related variables. Univariate analysis and multiple logistic regression analysis were done to confirm factors associated with the AEFI of COVID-19 vaccination. Among all types of COVID-19 vaccines, most of the PWE received the Cominarty® COVID-19 vaccination (52.5%). Overall, local AEFI was the quickest to develop, with an average onset within a day. PWE with normal body mass index (BMI) had a higher risk of developing both local and systemic AEFI compared to those underweight and obese PWE (OR: 15.09, 95% CI 1.70-134.28, P=0.02). COVID-19 vaccines are safe for PWE. AEFI among PWE are similar to those of the general population following COVID-19 vaccination. Therefore, clinicians should encourage PWE to take COVID-19 vaccines.

COVID-19 vaccination hesitancy and safety among adult people with epilepsy in eastern China

ObjectiveThis study assesses the hesitancy and safety of vaccination administration for the novel 2019 Coronavirus Disease (COVID-19) among adult people with epilepsy (PWE). MethodsWe recruited adult PWE who visited the outpatient epilepsy clinic from August 2021 to February 2022. We administered a structured questionnaire and a face-to-face interview regarding demographic factors, epilepsy characteristics, and relevant vaccine issues to all patients. Factors related to receiving a vaccine and epilepsy-related events after vaccination were then analyzed. ResultsA total of 501 PWE were surveyed; 288 were unvaccinated and 213 were vaccinated. Patients without jobs (OR: 0.59; 95% CI: 0.37–0.95, p = 0.03) were less likely to receive the vaccine compared to students or those with jobs. Other factors associated with vaccination were a higher number of anti-seizure medications (OR: 0.72; 95% CI: 0.55–0.95, p = 0.02) and a lower pre-vaccine seizure frequency (OR: 2.21; 95% CI: 1.06–4.59, p = 0.03). Of the 213 vaccinated patients, 10 (4.70%) reported at least one local and/or systemic side effect. Most patients (92.50%) did not report worse seizures within one month of vaccination. Poor ASM adherence (OR: 15.06; 95% CI: 1.75–129.87, p = 0.01) and fatigue/stimulant drinks such as caffeine (OR: 50.59; 95% CI: 7.57–337.94, p < 0.01) were significantly associated with seizure worsening within one month of receiving the COVID-19 vaccination. ConclusionAlmost two-fifths of patients with adult PWE have received a COVID-19 vaccine. Attention should be paid to educating epilepsy patients without jobs on the significance and safety of the vaccine. There was a low risk of seizure worsening in the short term after vaccination in PWE.

Anxiety, depression, and psychosocial adjustment in people with epilepsy.

Effect of psychological disorders on social functioning in people with epilepsy (PWE) is not extensively reported. We evaluate psychosocial functioning in PWE attending an outpatient clinic and aim to understand the differences in psychosocial functioning between anxiety, depression, and coexisting anxiety and depression in PWE. A prospective evaluation of psychosocial functioning of 324 consecutive adult PWE attending outpatient epilepsy clinic was done using self-reported Washington Psychosocial Seizure Inventory. The study population was divided in four groups - without psychological disorders, anxiety, depression, and both anxiety and depression. The mean age of study population was 25.90 ± 6.22 years. Anxiety was noted in 73 (22.5%), depression in 60 (18.5%), and both anxiety and depression were seen in 70 (21.6%) and the rest had normal psychosocial function. There were no significant differences across all the four sub-groups for sociodemographics. Psychosocial functioning did not differ significantly between PWE with normal psychosocial function and PWE with anxiety alone. However, psychosocial functioning scores were worse in PWE with depression and PWE with both anxiety and depression when compared to PWE with normal psychosocial function. In the present study of PWE attending an outpatient epilepsy clinic, one-fifth of PWE had both anxiety and depression. Psychosocial functioning in PWE with anxiety was similar to otherwise healthy/normal PWE, whereas PWE with depression showed poor psychosocial functioning. Role of psychological interventions on psychosocial aspects of epilepsy should be studied extensively in future.

The Relationship Between Depression and Anxiety Symptoms of Adult PWE and Caregivers in a Tertiary Center.

BackgroundAlthough several studies have emphasized the association between epilepsy and psychiatric disorders, fewer have investigated the impact of epilepsy on caregivers' emotional status, mainly in adult people with epilepsy (PWE). Here we investigated depressive symptoms, suicidal ideation, and anxiety symptoms in a large group of adult PWE and their caregivers.MethodsWe analyzed symptoms of depression [with the Beck Depression Inventory-II (BDI-II)], suicidal ideation (with BDI-II item 9), and anxiety symptoms (with the Beck Anxiety Inventory) in a large group of adult PWE [N = 548 (60% women; median age 41)] and caregivers [N = 191 (72% women; median age 47)] from a Brazilian tertiary center, considering sociodemographic and clinical aspects. We also applied the Liverpool Adverse Events Profile to assess anti-seizure drugs adverse events.ResultsWhile the presence (p = 0.026) (and intensity, p = 0.007) of depressive symptoms and suicidal ideation (p = 0.02) were higher in PWE compared to caregivers, the proportion of clinical anxiety symptoms (p = 0.32) (and the intensity, p = 0.13) was similar in both groups. Although the rates of suicidal ideation were higher in focal epilepsy (20%), both generalized genetic epilepsy and caregivers also presented elevated frequencies (11%) of suicidal ideation. The analyses of 120 patient-caregiver dyads revealed that the intensity of depressive symptoms in PWE (but not anxiety) correlated with the intensity of depressive (r = 0.35; p < 0.001) and anxiety (r = 0.25; p = 0.01) symptoms in their caregivers. In the multivariate analyses of PWE, focal epilepsy (compared to GGE) was associated with clinical depressive symptoms (odds ratio, OR 2.1) and suicidal ideation (OR 3.2), while recurrent seizures (compared to the seizure-free group) were associated with suicidal ideation (OR 2.6) and anxiety symptoms (OR 2.1). Also, caregivers with anxiety symptoms were 8 times more likely to exhibit depressive symptoms, and those with depressive symptoms were 8 times more likely to present anxiety symptoms.ConclusionOur study suggests that specific attention for the caregivers' mental health is as essential as PWE. There is an urgent need for more studies involving caregivers to identify their emotional distress and provide adequate treatment.

Use of complementary and alternative medicine among adult with epilepsy - experiences from a single epilepsy center in Malaysia

Complementary and alternative medicine (CAM) usage were reported in Europe, the United States of America and monoethnic Asian countries such as Korea and Taiwan. However, limited literature is available on the variability of CAM usage patterns among people with epilepsy (PWE) in a multi-racial country in particular Malaysia. This cross-sectional study assessed the prevalence, types, predictors and impact of CAM use among adult PWE and their adherence to anti-epileptic drugs (AEDs) treatment.140 patients were recruited, with a median age of 37.5 (IQR,28.0-51.5) years, majority female, had secondary or lower education level, earn &lt;USD1077 and seizure frequency of &lt;1 per month. One quarter (25.7%) used CAM for seizure control, of which 94.4% adhered to AEDs treatment while on CAM. Common CAM used were prayers, traditional herbal remedies, massage, and acupuncture. Only 33.3% have discussed CAM usage with their physician. The main reason for CAM usage was patients’ willingness to try other alternatives for seizure control. Although most patients had not used CAM, 20.2% were receptive to using CAM as concomitant treatment. Buddhists were more open to CAM while Muslims uses CAM selectively and avoid amulets, acupuncture, chiropractic, Ayurveda, yoga, and reiki. Logistic regression analysis showed Buddhist’s religion (OR,11.01), Muslims (OR,4.04), ≥1 seizure per month (OR,3.85) and monthly income of ≥USD1077 (OR,2.92) as the predictors for CMA usage. CAM use is common in Malaysia, especially among Buddhists and Muslims, with higher socio-economic status, and uncontrolled seizures. CAM is mostly used to complement but not in replacement of AEDs.

Seizure phobia: A distinct psychiatric disorder among people with epilepsy

ObjectiveEpilepsy is characterized by unpredictable attacks. Hence, people with epilepsy (PWE) may develop anxious anticipation of upcoming seizures. Seizure phobia is an anxiety disorder wherein seizure anticipatory situations trigger fear, accompanied by avoidance behaviors. Research on seizure phobia among PWE is scarce. Therefore, we aimed to describe the diagnosis of seizure phobia and its association with demographic, psychiatric and neurological variables. MethodsThis is a cross-sectional study of adult PWE in a tertiary epilepsy outpatient clinic. Data were collected from semi-structured interviews, demographic questionnaires and medical records. Patients with and without seizure phobia were compared in terms of sociodemographic, psychiatric, and neurological variables. A logistic regression analysis was performed to identify variables that predicted seizure phobia. ResultsAmong 69 PWE included in the study, 19 (27.5%) were diagnosed with seizure phobia. In comparison with PWE without seizure phobia, PWE with seizure phobia were predominantly female (84.2% vs 44.2%, p = 0.005), and had more comorbid anxiety disorders (84.2% vs 34.9%, p = 0.01), past major depressive episode (MDE) (63.2% vs 20.9%, p = 0.003), and post-traumatic stress disorder (26.3% vs 7%, p = 0.05). There was a significant association between seizure phobia and comorbid psychogenic non-epileptic seizures (36.8% vs 11.6%, p = 0.034). However, no significant association was found with epilepsy-related variables. A multivariate logistic regression model indicated anxiety and a past MDE as predictive factors for seizure phobia (R2 = 0.43). ConclusionSeizure phobia is a distinct psychiatric entity among PWE. Further research is required to understand its etiology, risk factors, and potential interventions for these patients.

Epilepsy and quality of life: what does really matter?

To assess quality of life (QoL) in adult people with epilepsy (PWE) and identify the main factors affecting it. We enrolled consecutively 122 PWE. They were interviewed for a careful collection of demographic and clinical data. Patients completed dedicated questionnaires for the assessment of the quality of life (Quality of Life in Epilepsy Scale-31) (Q31) as well as psychosocial features: depressive symptoms (DS) (Beck Depression Inventory-II/BDI-II), difficulties of emotion regulation (Difficulties of Emotion Regulation Scale/DERS), and stigma related to epilepsy (Stigma Scale of Epilepsy/SSE and Jacoby's Stigma Scale/JSS). The results of Q31 and their subscales were correlated with clinical details of PWE, as well as the other scores. A stepwise multiple regression analysis was applied to identify the main factors affecting QoL. Quality of life is inversely correlated mostly with psychosocial features, as DS, emotion dysregulation, and stigma perception, as well as with epilepsy-related factors, as the seizure frequency and number of antiseizure medications (ASMs). The combination of DS, perceived stigma, and number of ASMs best explained the QoL. Worse features of QoL were detected in females and in patients with age of epilepsy onset in adulthood. Quality of life in adult PWE is predominantly affected by psychosocial factors more than epilepsy-related ones. These findings suggest that effective epilepsy management requires more than seizure control, and early detection of psychological dysfunction and tailored interventions to improve the QoL should be considered.

Validation of the Swedish version of the Beliefs about Medicines Questionnaire, based on people with epilepsy

TitleValidation of the Swedish version of the Beliefs about Medicines Questionnaire, based on people with epilepsy. PurposeThe aims of the study were to explore the latent structure of the Swedish Beliefs about Medicines Questionnaire (BMQ), to investigate its reliability and to identify the extent to which individual factors among people with epilepsy (PWE), as well as their general beliefs about medication, predict their beliefs about their specific anti-seizure drugs (ASDs). MethodsOne-hundred and fifty six included study participants diagnosed with epilepsy and with a well-established neurological follow-up completed an array of rating scales. Included were the Swedish BMQ, which captures beliefs about medicines, scales for symptoms of anxiety and depression and sense of self-efficacy, as well as a general questionnaire regarding their social situation in general. Statistical analysis included Principal Component Analyses (PCA) and hierarchical multiple regression analysis. ResultsThe PCA revealed a two-factor structure for each of the BMQ-subscales with acceptable (BMQ-G) to high (BMQ-S) internal consistency. The only individual factor that predicted variance in beliefs about medication was patient gender, where levels of both anxiety and depression were elevated in women. ConclusionThe Swedish BMQ exhibits psychometric features indicating its reliable use in adult PWE. Our results suggest that the BMQ provides information about the patients’ view of their medication regardless of their general mood and that women hold stronger beliefs of concern beyond influence from their levels of depression and anxiety.

Recalling the COVID-19 lockdown: Insights from patients with epilepsy

PurposeThe purpose of our study was to explore health changes among people with epilepsy (PWE) during a national COVID-19 lockdown in the context of patients’ clinical characteristics and their experience of receiving epilepsy-related medical services. MethodsA questionnaire was distributed for adult PWE both online and at a tertiary epilepsy center after the end of a national lockdown in Lithuania. PWE were asked to evaluate their health status during the lockdown and estimate changes in their seizure patterns. Additional questions concerned the accessibility and quality of epilepsy-related consultations. ResultsThe study sample consisted of 143 PWE (59 [41.3%] male, mean age 35.1 ± 13.4 years), 94 (65.7%) completed the survey in person, 49 (34.3%) – online. A deterioration in reported physical and mental health during lockdown was observed (Z = −4.604, p < 0.0001 and Z = −4.253, p < 0.0001, respectively) and 22 (15.4%) PWE reported seizure exacerbation. In an ordinal logistic regression model (analysis of data from all participants), baseline seizure frequency (b = 0.413, p = 0.031), reported physical health before lockdown (b = −0.462, p = 0.031) and the ease of proper antiepileptic drug (AED) use during the imposed restrictions (b = −0.535, p = 0.006) were statistically significant variables associated with changes in seizure frequency. The latter were not affected by modifications in AED use (Mann–Whitney U = 1127.0, p = 0.307) irrespective of the data collection method.With teleconsultations being predominant during the lockdown, an overall decline in the quality of epilepsy-related consultations was observed (Z = −2.895, p = 0.004). Among all participants, 46 (32.2%) lost an epilepsy-related consultation or medical service because of the lockdown. This loss was found to be associated with seizure exacerbation (Mann–Whitney U = 1622.5, p = 0.046). ConclusionOur study indicates that a national COVID-19 lockdown may have led to worse seizure control and health status in some PWE. Easy access to AEDs and their appropriate use may be especially useful to prevent seizure exacerbation during strict COVID-19 restrictions. The quality and accessibility of remote epilepsy-related consultations was suboptimal and may require further improvement during disruption of in-person services.

Gender Differences in Associated and Predictive Factors of Anxiety and Depression in People With Epilepsy.

PurposeComorbid anxiety and depression in people with epilepsy (PWE) are highly prevalent and contribute to low quality of life (QOL) and may even lead to poor outcomes of epilepsy. Among the various factors that affect these negative emotional comorbidities, possible gender differences remain poorly understood and are often neglected. This research aimed to determine whether there are discrepancies in the incidence and influence factors of anxiety and depression between men and women with epilepsy in a hospital in northwest China.MethodsA total of 158 adult PWE (female: N = 65; 41.1%) completed self-report questionnaires, including the Self-rating Anxiety Scale (SAS), the Self-rating Depression Scale (SDS), the Chinese version of the Quality of Life in Epilepsy-31 (QOLIE-31) inventory and the Pittsburgh Sleep Quality Inventory (PSQI). The comparison between male and female PWE was made by regression analysis.ResultsFor the prevalence of anxiety and depression in PWE, no gender difference was found in this study. However, the moderating factors of psychiatric comorbidities were significantly different between men and women: male PWE with comorbid anxiety were more likely to be affected by sleep quality, while anxiety symptoms in female PWE were closely associated with the frequency of seizures. Education years and QOL social function were significant indicators of depression in male PWE but not in female PWE. The important and common predictor for anxiety and depressive symptoms in PWE was QOL energy/fatigue, with male patients being more affected.ConclusionFor the PWE included in this study, the incidence of comorbid anxiety and depression in PWE was similar for men and women, but the moderating factors affecting comorbid anxiety and depressive disorders differed between genders: male PWE were more likely to be affected by psychosocial factors, while female PWE were more influenced by epilepsy itself. This exploration suggests that gender-specific health care should be considered in epilepsy therapy to improve the psychiatric condition and QOL of PWE, and different treatments should be conducted for male and female PWE to prevent negative emotional comorbidities.

Overprotection and determinants of overprotection in adults with epilepsy

PurposeTo examine the perceived overprotection of adult people with epilepsy (PWE) by using a specifically developed novel scale. The study also investigated whether perceived overprotection is associated with particular demographic or clinical variables. MethodsThis cross-sectional study is based on responses from 200 adult PWE. The participants completed a clinical-demographic questionnaire, the perceived overprotection scale, felt-stigma scale, concealment of epilepsy scale and epilepsy concern scale. ResultsOne-way ANOVA results show that perceived overprotection was significantly greater among participants with lower income and levels of education. The highest number of affirmative responses in the perceived overprotection scale were related to going out alone and being given fewer family responsibilities due to epilepsy. Hierarchical regression results show that concerns related to social life and to future and occupation were significant predictors of high perceived overprotection. ConclusionPsycho-social factors, specifically concerns, seem to be more important than epilepsy-related variables in explaining perceived overprotection in adult PWE.

Attention-deficit hyperactivity disorder in adults with epilepsy

PurposeWe investigated the prevalence of attention-deficit hyperactivity disorder (ADHD) in adult people with epilepsy (PWE). We hypothesized that ADHD is common among adult PWE and, some clinical factors may be associated with ADHD. MethodsIn this cross-sectional study, 200 adult PWE referred to our neurology clinic at Shiraz, Iran were recruited (consecutively sampled). Validated Persian versions of Adult ADHD Self-Report Scale (ASRS v1.1) and Addenbrooke's Cognitive Examination-Revised (ACE-R) tests were used. We performed univariate analyses and also a logistic regression analysis. ResultsEighty-two patients (41%) were male, and 118 (59%) were female. Seventy patients (35%) had a positive screen for ADHD. There was a significant association between cognitive function and the prevalence of positive screening for ADHD in the whole group; 19 (18%) of the patients with a normal cognition, 23 (42%) of those with mild impairment, and 28 (70%) of those with severe cognitive impairment screened positive for ADHD (p = 0.0001). One hundred and five patients had normal cognition and were studied separately. Nineteen patients (18%) had screened positive for ADHD. Attention-deficit hyperactivity disorder was not associated with any of the tested variables in these patients. ConclusionAbout one-fifth of adults with epilepsy and normal cognitive function may have a positive screen for ADHD. Routine screening of all PWE for early detection and appropriate management of ADHD would be a reasonable approach.

Risk factors for suicidal tendency in adult patients with epilepsy in China

ObjectiveThe major cause of premature mortality in people with epilepsy (PWE) is suicide. Actual data on the risk of suicidal tendency in adult PWE in China are scarce. In our study, associations between possible risk factors and suicidal tendency in adult PWE in China were investigated. MethodsPeople with epilepsy (n = 251) were recruited, and their demographic and clinical characteristics were evaluated. Suicide risk was examined using the suicidality module (SM) of the Mini International Neuropsychiatric Interview (MINI) Plus Chinese Version 5.0.0. ResultsSuicidal tendency was present in 36 (14.3%) of the 251 PWE. On the basis of the results of univariate analyses, family relationship (P < 0.001), age at epilepsy onset (P = 0.037), seizure-free period (P = 0.041), seizures/month (P = 0.015), depressive disorders (P < 0.001), and number of antiepileptic drugs (AEDs) (P = 0.017) were associated with suicidal tendency. Multivariate analysis revealed that moderate or poor family relationships (odds ratio (OR): 6.468, 95% confidence interval (CI): 2.418–17.300) and depressive disorders (OR: 3.548, 95% CI: 1.575–7.995) were associated with high odds of suicidal tendency. ConclusionSuicidal tendency is common among adult PWE. This study reveals that family relationships and depressive disorders are independent risk factors for suicidal tendency among adult PWE. Therefore, while maintaining treatment of epilepsy, more attention should be directed to the social support and mental state of PWE to prevent suicide.

Belief in medication and adherence to antiepileptic drugs in people with epilepsy: a cross-sectional study from rural India

Aim of the study: This study was aimed to assess belief in medication and non-adherence to antiepileptic drugs (AEDs) in people with epilepsy (PWE) from rural India. And furthermore to study the demographic and seizure attributes influencing the adherence.Materials and methods: Present cross-sectional study included 230 adult PWE. Adherence level was assessed by using validated Morisky–Green test and patient’s beliefs towards usage of AEDs by utilizing Beliefs about Medicine Questionnaire (BMQ).Results: On the Morisky–Green scale, 57% patients were reported non-adherent to treatment: 49.6% had moderate and 7.4% had low adherence levels. Non-adherence was considerably associated with lower socioeconomical status (p<.001), severity of seizures (p<.001), and duration of epilepsy (p<.041). The connection between seizures recurrence and non-adherence was measurably noteworthy (p<.001). Non-adherent patients had more concern about the potential adverse effects of AEDs (p<.0013).Conclusions: Beliefs about medicines are a contributing factor to adherence towards AEDs and more concern was common among non-adherent patients. The reinforcement of epilepsy services in rural and underserved areas can be done by providing a regular, uninterrupted, and free supply of AEDs on monthly basis in the government hospitals. There is a need for awareness and educational programs by healthcare professionals at different levels, to support and encourage positive beliefs, and discourage myths against AEDs in order to increase patient’s adherence.

Development of the perceived stigma scale and the concealment of epilepsy scale for the Turkish population

The aim of this study was to develop two culture-specific scales to measure the level of felt stigma, and level of concealment of Turkish adult people with epilepsy (PWE). For this purpose, a 10-item felt-stigma scale and a 17-item disclosure of epilepsy scale were developed and then applied to 200 adult PWE. After item and factor analyses of the stigma scale, the 10 items with a one-factor solution explained 45.6% of the variance with a 0.86 internal consistency value. Higher scores represent higher felt stigma. The concealment of epilepsy scale has 17 items loaded on one factor, which explained 45.1% of the variance. Cronbach's alpha coefficient was found to be 0.92. The higher the score, the higher the concealment of illness by the participant. For convergent validity, the relationship between stigma and disclosure scales was examined, and a positive significant relation (r=0.64, p<0.000) was found.

Epilepsy, stigma, and family

Epilepsy is surrounded by prejudice and stigma. Little is known about the perception of stigma by cohabiting relatives (CR) of people with epilepsy (PWE). The study investigated whether the Stigma Scale of Epilepsy (SSE) scores of 90 CR and 148 adult PWE were related to the PWE's clinical aspects and QOLIE-31 at a significance level of p<0.05. The SSE scores of the CR were equivalent to those of PWE dyads (ICC=0.385, p=0.001). Cohabiting relatives of PWE with depressive disorder perceived more stigma (t-test: p=0.038). Higher perceived stigma by PWE was significantly related to exclusively generalized seizures (p=0.005), longer disease duration (p=0.002), and higher perception of stigma by CR in the linear regression model. Both PWE and CR have high perception of stigma, which is related to clinical aspects. Higher perceptions of stigma by PWE and CR are associated with worse QoL in PWE.