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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We studied 31 previously validated and newly developed generic and epilepsy-specific scales to evaluate their usefulness for assessing the impact of epilepsy and anti-epileptic drug (AED) therapy on health-related quality of life (HRQOL). Included were the MOS SF-36 Health Survey, additional measures of mental health, cognition, epilepsy-specific perception of control, behavioural problems, distress, worries and experiences, the Liverpool Epilepsy Impact and Seizure Severity scales, and a patient-completed symptom checklist. Questionnaires were completed twice by 136 patients on AED therapy in a multicentre study in the UK. Validity was assessed in relation to disease severity, defined as time since last seizure, and to patient-reported symptoms. Statistical analyses to estimate the contribution of HRQOL information of each scale relative to that of others were conducted. The 171-item questionnaire could be completed by out-patients with epilepsy with good data quality. With few exceptions, generic and epilepsy-specific measures satisfied psychometric tests of hypothesized item groupings and scale score reliability (internal consistency and test-retest reliability) and differentiated well between groups of patients differing in time since last seizure and in symptom impact, regardless of time since last seizure. However, scales differed widely in their validity in discriminating between groups of patients known to differ clinically. The SF-36 Role Physical scale best discriminated among groups differing in disease severity. The epilepsy-specific Mastery, Impact, Experience, Worry, Distress, and Agitation scales were among the 10 best measures in discriminating among groups differing in disease severity. Generic measures, especially measures of social and role functioning and mental health, were best at differentiating groups of patients differing in symptom impact. Recommendations are offered for concepts and specific scales most likely to be useful in future studies of the HRQOL burden of epilepsy and the HRQOL benefits of AED therapy.
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PMID:Advances in methods for assessing the impact of epilepsy and antiepileptic drug therapy on patients' health-related quality of life. 778 Mar 79

Epilepsy is a heterogeneous disease with variable onset and prognosis. In general, patients with epilepsy have neuropsychological impairments. Their educational and occupational achievements may be lower than might be expected for their level of cognition. Some epilepsy patients suffer emotional distress, interictal behavioral disorders, and extreme social isolation. It is obvious that epilepsy and its sequelae impact on the patient's quality of life. What is not clear is the degree to which different factors contribute and the causes for extreme variance across patients. For example, the patients' perceptions of their disease affects quality of life more than actual seizure severity, but the mechanisms underlying this effect are not known. Quality-of-life research in epilepsy is in its infancy. In the future, such research will play an important role in assessing patient suffering, demonstrating the efficacy of treatments and interventions, and influencing medical economic decisions.
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PMID:Research use of the new quality-of-life in epilepsy inventory. 834 2

Tuberous sclerosis is an inherited disease expressed clinically by the triad of mental retardation, seizures, and tuberous lesions. Facial angiofibromas, a common manifestation of tuberous sclerosis, can cause considerable cosmetic disfigurement, emotional distress, obstruction of vision, and hemorrhage. Treatment by shave excision, as the first step to remove the larger nodules, followed by dermabrasion, to smooth and sculpt the final surface, has been recommended as the most effective form of therapy. However, this method of treatment raises the question of risk for development of hypopigmentation in susceptible patients. The authors present their treatment of angiofibromas with shave excision and dermabrasion in a dark-skinned patient.
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PMID:Treatment of facial angiofibromas of tuberous sclerosis by shave excision and dermabrasion in a dark-skinned patient. 1129 29

A former civilian employee of the U.S. Army brought suit against the Army and his former supervisor, alleging that he was forced to resign his position after testing positive for the human immunodeficiency virus (HIV). The plaintiff asserted that the Army had breached his employment contract. Additionally, his supervisor had violated his right to privacy and his Fourth Amendment right to be secure in his person from unreasonable searches and seizures, and had intentionally inflicted emotional distress. In granting the defendants' motion to dismiss the suit, the District Court held that: (1) the employee served by appointment and therefore the Army could not be held liable for breach of contract; and (2) his former supervisor was not liable for breach of the plaintiff's privacy or Fourth Amendment rights.
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PMID:Plowman v. U.S. Department of the Army. 1164 81

The aim of this study was twofold: 1 - to identify a psychological profile of patients with psychogenic nonepileptic seizures (PNESs) that is possibly distinct from that of subjects affected by epileptic seizures (ESs) alone; 2 - to detect the possible differences between the clinical features and psychological profile of patients affected by PNESs alone and those of subjects in whom PNESs are associated with epileptic seizures (ES/PNES patients). We assessed the psychological profiles of 2 different groups of subjects. The first group was of 38 patients who had all developed PNESs after epileptic seizures (ES\PNES, group 1). The second group was of 31 patients with PNESs alone (PNES, group 2). We compared the psychological findings of each of these 2 groups with those of 2 control groups, composed of patients who matched groups 1 and 2 for sex, age, and educational level, but who were affected only by ESs (groups 1C and 2C). Finally, we considered possible differences between the ictal symptoms and signs of PNESs occurring in ES/PNES and in PNES patients. Both the ES/PNES group and the PNES group revealed higher percentages of Somatoform Disorders and Cluster B Personality Disorders (DSM-III-R diagnoses) than the ES patients in the control groups. The scores obtained on the Psychophysiological Distress Scale of the Cognitive Behavioural Assessment Battery (CBA) followed the same pattern. Among PNES ictal phenomena, autonomic symptoms and signs were significantly more frequent in the PNES than in the ES/PNES group. The occurrence of PNESs mimicking generalised tonic-clonic ESs (GTC-PNESs) was significantly associated with a low academic level. The results of this study suggest that the patients with PNESs alone and those affected by PNESs and ESs share the same psychological profile, which is different from that of patients with ESs alone. However, some differences between ES/PNES and PNES patients were found in the clinical semiology of their PNESs. Our findings could have implications for the diagnosis and for the treatment of patients with PNESs.
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PMID:Patients with psychogenic nonepileptic seizures, alone or epilepsy-associated, share a psychological profile distinct from that of epilepsy patients. 1263 26

This study examines the usefulness of the Brief Symptom Inventory (BSI) as a screening tool for psychological disorders in patients with epilepsy and mild intellectual disabilities. Participants were 91 residents of the Bethel Institute, Bielefeld, Germany. Cronbach's alpha was revealed to be sufficient for the composite score Global Severity Index (GSI) (0.95) and for most of the subscales (0.64-0.80). Compared with normative data, residents with epilepsy scored slightly higher on all BSI scales. Only the subscale Paranoid Ideation was especially elevated, a finding of heuristic value. Subgroups of residents with past psychiatric morbidity, on current psychotropic medication, with poor seizure control, and more epilepsy-related problems either tended toward or demonstrated higher GSI scores. These results indicate the validity of the questionnaire with the GSI as a global indicator of possible psychopathology. BSI subscales seemed to reflect predominantly the amount of emotional distress, but their potential to identify specific clinical syndromes remained unclear.
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PMID:The Brief Symptom Inventory (BSI) as a screening tool for psychological disorders in patients with epilepsy and mild intellectual disabilities in residential care. 1593 72

This qualitative study explores how children and adolescents with medically refractory seizures experience the impact of epilepsy on their quality of life (QOL) within the domains of physical, emotional/behavioral, social, and cognitive/academic function. Semi-structured, open-ended interviews were conducted with 49 participants (7-18 years old). These narratives constituted our data source. Analyses involved inductive generation of themes/subthemes and connection of these themes to generate a theoretical representation of their relationships. These themes reflected the negative impact of epilepsy on QOL: physical-excessive fatigue as a barrier to academic and social pursuits; emotional/behavioral-intermittent emotional distress heightened by epilepsy-related factors such as unpredictability of seizures; social-profound social isolation; and cognitive/academic-discontinuous, fragmented learning. Youths perceive seizures as the major barrier to their sense of normalcy, setting them apart from others. Findings provide direction for assessment and evidence for developing or enhancing clinical interventions and community/school-based programs that might mitigate some of these negative experiences.
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PMID:I just want to be normal: a qualitative study exploring how children and adolescents view the impact of intractable epilepsy on their quality of life. 1614 May 94

Coping efforts have been recognised as an important aspect of resilience following traumatic brain injury, but little is known about what constitutes effective coping in this population. This longitudinal research examined the usefulness of the Goodness-of-Fit hypothesis, drawn from the Lazarus and Folkman [(1984). Stress, appraisal and coping. NY: Springer.] theory of stress and coping, as a way of understanding coping effectiveness. The hypothesis suggests that the nature and success of specific coping strategies will be associated with the controllability of the event. If an event is relatively uncontrollable, then emotion-focused or perception-focused coping may be more effective than problem-focused coping. In contrast, a controllable event may be best managed through problem-focused coping. Ninety people with traumatic brain injury, drawn from the inpatient rehabilitation unit of a major metropolitan hospital in Australia, and their relatives participated in this longitudinal study. No support was found for the Goodness-of-Fit model, either in the short term or the long term. Although the use of problem-focused coping strategies was positively associated with short-term and long-term role functioning, it was not associated with long-term emotional well-being if the situation was perceived to be controllable. The findings suggest that the persistent use of problem-focused coping in response to the difficulties created by traumatic brain injury can be associated with emotional distress in the long term. Reasons for this finding are explored and its implications are discussed.
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PMID:Understanding adjustment following traumatic brain injury: is the Goodness-of-Fit coping hypothesis useful? 1862 42

Among the psychiatric comorbid conditions in children and adolescents with epilepsy, depression and anxiety disorders require further attention because they carry the risk of reduced quality of life and life-threatening complications (e.g., suicide). Research in recent years has shed light on both the prevalence of emotional problems in youth with epilepsy and the safety and efficacy of treatment options. A number of challenges exist in treating patients with epilepsy. This is particularly true when seizures are difficult to control and medication regimens are more complex. Some pharmaceutical options may provide assistance with both seizures and emotional distress, but care is needed when considering such treatment approaches. In addition, integration of mental health professionals into the care of patients is necessary when cases are complicated and risk factors are high. Thorough methods to accurately diagnose emotional conditions and regular monitoring of symptoms can help prevent serious problems that can negatively affect the success of children and adolescents in everyday life. Collaboration between disciplines offers the best hope for early identification and treatment of these conditions.
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PMID:Depression and anxiety in children and adolescents with epilepsy: prevalence, risk factors, and treatment. 1880 86

Emotional distress is one of the most frequently reported seizure precipitants in epilepsy, but little is known about its causes and processes. Interestingly, it is now accepted that emotional distress, such as anxiety, may be accompanied by evolutionary adaptation, or abnormal attentional vigilance toward threatening stimuli. The goal of this research was to study the link between emotional seizure precipitants and pathological attention-related biases toward threat in temporal lobe epilepsy (TLE). To this aim, patients were asked to report the extent to which seizures were elicited or not by emotional precipitants, allowing distinction of two groups: "Emo-TLE" group and "Other-TLE" group. Attentional biases were investigated by comparing patients' emotional Stroop and dot detection paradigms with those of healthy individuals (control group). We found that the Emo-TLE group was characterized by attentional bias toward threatening stimuli compared with neutral stimuli and compared with the other two groups. We thus hypothesize that attentional biases related to threat in patients with TLE may sustain emotional vulnerability and seizure occurrence.
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PMID:How do cognition, emotion, and epileptogenesis meet? A study of emotional cognitive bias in temporal lobe epilepsy. 1933 59


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