Improvement in seizure control and quality of life in medically refractory epilepsy patients converted from polypharmacy to monotherapy

Background: The classic ketogenic diet is the main non-pharmacological treatment for refractory epilepsy; however, adherence is often challenging. The low glycemic index diet (LGID) is less strict, almost equally effective, and associated with improved adherence. Little is known about the quality of life of children treated with LGID. The objective of this study was to explore changes in the quality of life of children with epilepsy transitioning to the LGID. Methods: Patients on LGID and their parents filled out Pediatric Quality of Life Epilepsy Module questionnaires; one while being on the LGID, and one retrospectively for the time prior to starting the LGID. Results: Data was collected from five children ages 3-13 and their parents. Complete seizure control was seen in two children, >50% seizure reduction in one, and no change in two children. Parental reported quality of life while on the LGID increased with two participants but decreased in all child self reports. Conclusions: Although the LGID led to improved seizure control in three out of five patients, the child-reported quality of life decreased in all children. Larger prospective studies are warranted to reliably assess the impact of the LGID on the quality of life in children with epilepsy.

Download Full-text

Efficacy of Vagal Nerve Stimulation in Children with Medically Refractory Epilepsy

Neurosurgery ◽

10.1097/00006123-200012000-00016 ◽

2000 ◽

Vol 47 (6) ◽

pp. 1353-1358 ◽

Cited By ~ 118

Author(s):

Ravish V. Patwardhan ◽

Benjamin Stong ◽

E. Martina Bebin ◽

Jan Mathisen ◽

Paul A. Grabb

Keyword(s):

Quality Of Life ◽

Seizure Frequency ◽

Nerve Stimulation ◽

Refractory Epilepsy ◽

Vagal Nerve ◽

Seizure Type ◽

Seizure Reduction ◽

Medically Refractory Epilepsy

ABSTRACT OBJECTIVE The effects of vagal nerve stimulation (VNS) on seizure frequency and quality of life were analyzed retrospectively in children with medically refractory epilepsy. METHODS Thirty-eight children aged 11 months to 16 years underwent implantation of vagal nerve stimulators. Age of seizure onset, duration of epilepsy, and seizure type and frequency were recorded preoperatively. Age at implantation, length of follow-up, seizure type and frequency, and change in quality of life (QOL) were recorded postoperatively. Changes in QOL were assigned a QOL score by the caretakers on a visual analog scale of −1 (much worse) to +1 (much improved). RESULTS The median follow-up period was 12 months (range, 10–18 mo). Eleven (29%), 15 (39%), 5 (13%), and 7 (18%) children had greater than 90% reduction, 50 to 90% reduction, less than 50% reduction, and no reduction in seizure frequency, respectively. For all children, seizure reduction by seizure type was as follows: atonic (80%), absence (65%), complex partial (48%), and generalized tonicoclonic (45%). The mean change in QOL score was 0.61. Eighty-six percent of the children had QOL scores of 0.5 (improved) or higher. Follow-up of at least 6 months was associated with greater seizure reduction (P = 0.05) and higher QOL score (P < 0.01). Seizure reduction was greater in children with onset of epilepsy after 1 year of age (P < 0.05). The age of the child and duration of epilepsy were not associated with greater or lesser degrees of seizure reduction. CONCLUSION VNS provided improvements in seizure control for the majority of children regardless of age. QOL was improved in the majority of children with VNS. VNS should be considered for children with medically refractory epilepsy who have no surgically resectable focus.

Download Full-text

Psychiatric and psychosocial morbidity 1 year after epilepsy surgery

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2020.114 ◽

2020 ◽

pp. 1-8

Author(s):

S. Patel ◽

M. Clancy ◽

H. Barry ◽

N. Quigley ◽

M. Clarke ◽

...

Keyword(s):

Quality Of Life ◽

Surgical Treatment ◽

Epilepsy Surgery ◽

Refractory Epilepsy ◽

Post Surgery ◽

Axis I ◽

Patients With Epilepsy ◽

The Impact

Abstract Objectives: There is a high rate of psychiatric comorbidity in patients with epilepsy. However, the impact of surgical treatment of refractory epilepsy on psychopathology remains under investigation. We aimed to examine the impact of epilepsy surgery on psychopathology and quality of life at 1-year post-surgery in a population of patients with epilepsy refractory to medication. Methods: This study initially assessed 48 patients with refractory epilepsy using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Hospital Anxiety and Depression Scale (HADS) and the Quality of Life in Epilepsy Inventory 89 (QOLIE-89) on admission to an Epilepsy Monitoring Unit (EMU) as part of their pre-surgical assessment. These patients were again assessed using the SCID-I, QOLIE-89 and HADS at 1-year follow-up post-surgery. Results: There was a significant reduction in psychopathology, particularly psychosis, following surgery at 1-year follow-up (p < 0.021). There were no new cases of de novo psychosis and surgery was also associated with a significant improvement in the quality of life scores (p < 0.001). Conclusions: This study demonstrates the impact of epilepsy surgery on psychopathology and quality of life in a patient population with refractory surgery. The presence of a psychiatric illness should not be a barrier to access surgical treatment.

Download Full-text

PGR-3Long-Term Outcome Following Late Seizure Control in a Child with Early Onset Medically Refractory Epilepsy and Intellectual Disability Neuroimmunological Disease

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acw040.03 ◽

2016 ◽

Vol 31 (6) ◽

pp. 571-571

Author(s):

P Fastenau

Keyword(s):

Intellectual Disability ◽

Early Onset ◽

Seizure Control ◽

Refractory Epilepsy ◽

Term Outcome ◽

Medically Refractory Epilepsy

Download Full-text

The effects of epileptic seizures upon quality of life

Journal of Epilepsy and Clinical Neurophysiology ◽

10.1590/s1676-26492009000300003 ◽

2009 ◽

Vol 15 (3) ◽

pp. 110-113 ◽

Cited By ~ 5

Author(s):

Priscila Camile Barioni Salgado ◽

Fernando Cendes

Keyword(s):

Quality Of Life ◽

Seizure Frequency ◽

Seizure Control ◽

Epileptic Seizures ◽

Anxiety And Depression ◽

Co Morbidity ◽

Item Quality ◽

Patients With Epilepsy ◽

And Control

OBJECTIVE: understand the psychological considerations of the relationship between the effect of seizures upon the patients' perception of seizure control, depression, anxiety and quality of life (QoL). METHODS: 151 adult patients with epilepsy diagnosed for over two years were interviewed and responded the 31-Item Quality of Life in Epilepsy (QOLIE-31), the Trait Form of the State/Trait Anxiety Inventory (STAI II) and the Beck Depression Inventory (BDI). RESULTS: 45 patients were depressed (29.8%) and 29 (19.2%) had anxiety. Depression scores ranged from 0 to 49 (M=7.4; SD=8.9) and anxiety scores ranged from 19 to 69 (M=41.5, SD=11.9). Total QoL score was correlated to seizure control (p<0.001), perception of epilepsy control (p<0.001), anxiety (p<0.001), and depression (p=0.003). The perception of epilepsy control was correlated to seizure control (p<0.001), seizure frequency (p=0.001), anxiety (p<0.001) and depression (p<0.001). Seizure control was associated to anxiety (p=0.033) and depression (p<0.001). There was co-morbidity between anxiety and depression (p<0.001). CONCLUSION: This study highlights the importance of the seizure frequency and control to the evaluation of perception of epilepsy control and shows that anxiety and depression in epilepsy are predicted by seizure-related (seizure frequency and control) and psychosocial aspects (perception of control and QoL) together.

Download Full-text

Evaluation of the Effects of Clobazam on Seizure Control and Quality of Life in Children With Lennox-Gastaut Syndrome: A Pilot Study

Journal of Child Neurology ◽

10.1177/0883073819836534 ◽

2019 ◽

Vol 34 (8) ◽

pp. 432-439 ◽

Cited By ~ 1

Author(s):

Arie Weinstock ◽

Nitin Agarwal ◽

Osman Farooq ◽

Zaheer Cheema ◽

Deanna Hamilton ◽

...

Keyword(s):

Quality Of Life ◽

Pilot Study ◽

Seizure Control

Download Full-text

Long-term health-related quality of life in 262 patients with brain arteriovenous malformation

Neurology ◽

10.1212/wnl.0000000000008196 ◽

2019 ◽

Vol 93 (14) ◽

pp. e1374-e1384

Author(s):

Anni Pohjola ◽

Elias Oulasvirta ◽

Risto P. Roine ◽

Harri P. Sintonen ◽

Ahmad Hafez ◽

...

Keyword(s):

Quality Of Life ◽

Arteriovenous Malformation ◽

Refractory Epilepsy ◽

Analysis Of Covariance ◽

Postoperative Treatment ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

Bleeding Episodes

ObjectiveTo discover the health-related quality of life (HRQOL) of patients with treated arteriovenous malformation (AVM), we used the self-applicable HRQOL instrument, the 15D, and analyzed the scores in both in the whole study population and specified cohorts.MethodsThe 15D questionnaires were mailed to adult patients with AVM alive in 2016 (n = 432) in our database. Patients with completely eradicated AVM (n = 262) were included in a subsequent analysis. The results were compared with those of the general population standardized for age and sex. Subgroup analyses were conducted for epilepsy, number of bleeding episodes, location of the lesion, modified Rankin Scale score, and Spetzler-Ponce classification (SPC) using independent-samples t test or analysis of covariance. Tobit regression was used to explain the variance in the 15D score.ResultsPatients had impaired HRQOL compared to the reference population (p < 0.0001). Deep location, multiple bleeding episodes, and refractory epilepsy were associated with impaired HRQOL. Patients in SPC A and B had similar posttreatment 15D scores, whereas those in class C had an impaired HRQOL. Significant explanatory variables in the regression model were age, sex, number of bleeding episodes, refractory epilepsy, and SPC.ConclusionsWith careful patient selection, patients in SPC B can reach as favorable HRQOL as those in SPC A provided the operation is successful. Multiple bleeding episodes should be prevented with effective treatment aiming at complete AVM obliteration. The postoperative treatment of patients with AVM should focus on preventing depressive symptoms, anxiety, and epileptic seizures. We encourage other research groups to use HRQOL instruments to fully understand the consequences of neurologic and neurosurgical diseases on patients' HRQOL.

Download Full-text

Quality of Life Measurements in Epilepsy

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100020898 ◽

1996 ◽

Vol 23 (S2) ◽

pp. S3-S5 ◽

Cited By ~ 2

Author(s):

David Chadwick

Keyword(s):

Quality Of Life ◽

Health Status ◽

Social Functioning ◽

Seizure Control ◽

Well Being ◽

General Health Status ◽

Life Issues ◽

Disease Specific ◽

Quality Of Life Measurements

ABSTRACT:In the treatment of the patient with epilepsy not only seizure control but quality of life issues are important aspects of management. Aspects that have an impact on the quality of life include seizure frequency and severity, social functioning, psychological well-being, disease specific measures, and general health status.

Download Full-text

Surgery for low-grade glioma infiltrating the central cerebral region: location as a predictive factor for neurological deficit, epileptological outcome, and quality of life

Journal of Neurosurgery ◽

10.3171/2013.5.jns122235 ◽

2013 ◽

Vol 119 (2) ◽

pp. 318-323 ◽

Cited By ~ 37

Author(s):

Philippe Schucht ◽

Fadi Ghareeb ◽

Hugues Duffau

Keyword(s):

Quality Of Life ◽

Return To Work ◽

Seizure Control ◽

Extent Of Resection ◽

Low Grade Glioma ◽

Neurological Deficits ◽

Main Concern ◽

Low Grade ◽

Who Grade

Object A main concern with regard to surgery for low-grade glioma (LGG, WHO Grade II) is maintenance of the patient's functional integrity. This concern is particularly relevant for gliomas in the central region, where damage can have grave repercussions. The authors evaluated postsurgical outcomes with regard to neurological deficits, seizures, and quality of life. Methods Outcomes were compared for 33 patients with central LGG (central cohort) and a control cohort of 31 patients with frontal LGG (frontal cohort), all of whom had had medically intractable seizures before undergoing surgery with mapping while awake. All surgeries were performed in the period from February 2007 through April 2010 at the same institution. Results For the central cohort, the median extent of resection was 92% (range 80%–97%), and for the frontal cohort, the median extent of resection was 93% (range 83%–98%; p = 1.0). Although the rate of mild neurological deficits was similar for both groups, seizure freedom (Engel Class I) was achieved for only 4 (12.1%) of 33 patients in the central cohort compared with 26 (83.9%) of 31 patients in the frontal cohort (p < 0.0001). The rate of return to work was lower for patients in the central cohort (4 [12.1%] of 33) than for the patients in the frontal cohort (28 [90.3%] of 31; p < 0.0001). Conclusions Resection of central LGG is feasible and safe when appropriate intraoperative mapping is used. However, seizure control for these patients remains poor, a finding that contrasts markedly with seizure control for patients in the frontal cohort and with that reported in the literature. For patients with central LGG, poor seizure control ultimately determines quality of life because most will not be able to return to work.

Download Full-text