Epilepsy & Behavior, a professional medical journal from Elsevier Publishing, presents original peer-reviewed reports and reviews that pertain to the behavioral aspects of epilepsy. The articles are based on laboratory and clinical research. The Epilepsy Foundation and Epilepsy & Behavior have joined in partnership to provide select content from the journal.

Articles Posted on February 7, 2008:

 

Epilepsy surgery after age 60

Data from seven patients 60 years of age and older who underwent temporal lobectomy were reviewed. Outcome was comparable to younger patients. Despite the small number of patients and retrospective nature of the study, the data support the efficacy and safety of temporal lobectomy in this age group. Copyright 2007 Elsevier Inc. All rights reserved.

Epilepsy myths: Alive and foaming in the 21st century

Many myths are perpetuated and reinforced in the portrayal of fictional characters with epilepsy in films and on television. Common cinematic treatment myths include the necessity for immediate medical intervention in the form of an ambulance crew to stop a seizure and the placing of an object in the seizing person’s mouth to prevent the person from choking on her or his tongue. Other misrepresentations include excessive ‘‘foaming’’ at the mouth during a seizure and frequent violence. We conducted an Internet-based survey to examine the prevalence of belief in these myths in the United Kingdom. We received 4605 valid responses. People who knew someone with epilepsy were significantly less likely to subscribe to all the myths than were those who had no personal knowledge of epilepsy. Seeing seizures in public appears to improve knowledge regarding appropriate first aid procedures, but does not have an impact on myths surrounding the presentation of a seizure. These results are discussed in relation to the ‘‘we see what we expect to see’’ phenomenon in relation to stereotypes surrounding epilepsy. Copyright: 2007 Elsevier Inc. All rights reserved.

The differential effect of epilepsy labels on employer perceptions: Report of a pilot study

A multimethod pilot study is described in which employers’ and human resource professionals’ perceptions of three labels used for epilepsy—epilepsy, seizure disorder, and seizure condition— were explored. Ninety-three participants were presented with a list of 10 chronic conditions or disabilities, including one of these epilepsy labels, and asked to rank-order the likelihood that a person with each condition would be hired for an assembly/production position. The participants also ranked cover letters from fictional applicants for a customer service representative position. The fictional applicants disclosed their condition using one of the three epilepsy labels. The participants then ranked which applicant would most likely be hired. Participants were also asked whether applicants should disclose their disability in a cover letter. Rasch and v2 analyses were used to analyze the results. Findings suggest that epilepsy was more positively perceived than the other two labels. Almost all of the participants stated that applicants should not disclose their disability in a cover letter. The results have important implications for employment seeking and disclosure practices. Copyright. 2007 Elsevier Inc. All rights reserved.

The effect of seizure severity on quality of life in epilepsy

Seizure severity is an important aspect of epilepsy. The relationship between seizure severity and quality of life in epilepsy, however, has been incompletely explored. With a data set of 118 women from the baseline phase of a clinical treatment trial, the relationship between seizure severity and aspects of quality of life was evaluated. Two domains of the Quality of Life in Epilepsy-31 (QOLIE-31) correlated highly significantly with seizure severity: Seizure Worry (r = _0.265, P = .004) and Social Functioning (r = _0.280, P = 0.002). Two additional domains were significantly correlated: Overall Quality of Life (r = _0.210, P = 0.023) and Cognitive (r = _0.209, P = 0.024). When the potentially confounding effect of depression, measured by the Beck Depression Inventory, was controlled for, the regression of seizure severity with QOLIE-31 Seizure Worry remained significant (P = 0.006, R2 = 0.153), as did the regression with QOLIE-31 Social Functioning (P = 0.002, R2 = 0.184) and the regression with QOLIE-31 Cognitive (P = 0.037, R2 = 0.30). These findings indicate that severe and potentially injurious seizure behaviors contribute to anxiety and socially avoidant behavior for persons with intractable epilepsy. Copyright 2007 Elsevier Inc. All rights reserved.

Assessing the true learning needs of health care professionals in epilepsy care

This needs assessment, initiated by the American Epilepsy Society (AES) in cooperation with AXDEV Group Inc. (AXDEV), used a mixed-method approach to explore the educational and clinical practice needs of health care professionals in epilepsy care and to identify significant barriers to caring for people with epilepsy. The multiphase assessment began with key informant interviews with AES educational leaders. In Phase II, 26 stakeholders, including epileptologists, neurologists, professionals in epilepsy care, and people with epilepsy, shared their experiences in epilepsy care during four focus groups at the AES annual meeting. In Phase III, a quantitative online survey based on Phase II results was distributed to 228 respondents, including epileptologists (n = 84), neurologists (n = 55), professionals in epilepsy care (n = 69), and others (n = 20). Results of the comprehensive analysis of Phase III quantitative data are presented here. They reveal the unmet needs of health care professionals in this therapeutic domain and are discussed in terms of their implications for epilepsy care. Copyright 2007 Elsevier Inc. All rights reserved.

Assessment of quality of life among the elderly with epilepsy

As the elderly represent the most rapidly growing population in the United States, it is critical that physicians are capable of managing their chronic illnesses, including epilepsy. Optimal treatment of epilepsy integrates an understanding of health-related quality of life (HRQOL), yet limited information is available to guide HRQOL issues among the elderly. This study found that seniors with epilepsy do not have poorer HRQOL compared with general epilepsy populations. However, when compared with general populations without epilepsy, seniors with epilepsy report a significantly lower HRQOL across all domains. Multiple factors may uniquely affect HRQOL among elderly populations with epilepsy: aging, comorbid conditions, and epilepsy variables. However, to our knowledge, no one instrument addresses all of these aspects. The development of HRQOL instruments specifically for an elderly population with epilepsy may be useful and needed. Copyright 2007 Elsevier Inc. All rights reserved.

Epilepsy patients’ perceptions about stigma, education, and awareness: Preliminary responses based on a community participatory approach

As individuals directly impacted by their experience of epilepsy and others’ responses to it, epilepsy patients’ opinions about education and awareness issues are needed. A community-based participatory approach was used to develop a survey of public and patient attitudes and perceptions about epilepsy, which was administered to persons with epilepsy. The majority of the 165 respondents (34% response rate) indicated they perceive misperceptions and stigma related to epilepsy in the general public, which they thought could be ameliorated through educational interventions. Respondents indicated potential avenues of educational intervention for the general public as well as for those with epilepsy, with recommended content and intervention type depending on target audience. The community-based participatory research process and the patients’ perceptions gathered through the resulting survey indicate potential activities for overcoming stigma and increasing education and awareness related to epilepsy. Copyright 2007 Elsevier Inc. All rights reserved.

Parents of children with enduring epilepsy: Predictors of parenting stress and parenting

Objective: The goals of the work described here were (1) to predict parenting stress and parenting from stressors, resources, and parental coping behaviors in parents of children with epilepsy, and (2) to determine whether parenting stress mediates the effects of these predictors on parenting.
Methods: Participants were 91 parents of children with epilepsy (mean age of children = 8 years, 5 months). Parental perceptions of stressors, resources, parental coping behaviors, parenting stress, and parenting were assessed by means of questionnaires. Regression analyses were used to analyze the unique and combined power of the predictors to predict parenting stress and parenting. Sobel tests were used to identify the mediational role of parenting stress.
Results: Evidence was found for direct effects of stressors, resources, and coping behaviors on parenting stress and parenting, with relatively large effects for stressors. The mediational role of parenting stress was largest in the domain of parental behavioral control.
Conclusions: In the context of pediatric epilepsy, parenting stress mediates both disruptive and resilient family factors for their effects on parenting. Parents of children with epilepsy may benefit from parent training programs that, to reduce parenting stress, address epilepsy education, the management of difficult child temperament, building social support networks, and the modification of inadequate parental coping behaviors. Copyright: 2007 Elsevier Inc. All rights reserved.

Sociodemographic correlates of health-related quality of life in pediatric epilepsy

In most chronic conditions, better health-related quality of life (HRQOL) is associated with higher socioeconomic status (SES) and ethnic majority status, with disadvantaged groups typically reporting lower HRQOL. In 163 children with intractable epilepsy, we evaluated the relationship between HRQOL and a broad spectrum of demographic variables (SES, parental education, gender, age, marital status, family size, and ethnic and linguistic status), in relation to known neurological and behavioral correlates of HRQOL. No demographic variable was found to be related to child HRQOL, except for marital status, where children from divorced/separated parents had lower HRQOL. However, marital status was not uniquely predictive of HRQOL when neurological and behavioral variables were taken into account. Exploratory analyses indicated that children of separated/divorced parents were more likely to have early epilepsy onset, lower adaptive/developmental levels, and worse seizure frequency, suggesting that severe epilepsy may be a risk factor for marital stress. In sum, contrary to research in other chronic conditions, sociodemographic variables in pediatric epilepsy were weak predictors of HRQOL in comparison to neurological and behavioral variables. The results are discussed with respect to epilepsy-specific determinants of HRQOL. Copyright: 2007 Elsevier Inc. All rights reserved.

Unmet mental health needs in pediatric epilepsy: Insights from providers

Eighteen pediatric neurologists and 18 pediatricians completed a 5-point Likert scale questionnaire on their knowledge of, attitudes toward, and management of the behavioral, cognitive, and psychosocial aspects of pediatric epilepsy, before and after a lecture on this topic. They also responded to questions about possible barriers to mental health care of children with epilepsy. The brief educational intervention modified the knowledge/attitudes of pediatricians compared with pediatric neurologists on the impact of epilepsy on behavior and cognition in children with epilepsy. However, there were no between-group differences in how providers perceived their competence to assess behavioral and cognitive comorbid conditions in pediatric epilepsy. Responses to open-ended questions suggested insufficient mental health coverage for and expertise on pediatric epilepsy, resistance of mental health clinicians to treat children with epilepsy, and the stigma of mental health as possible barriers to mental health care in children with epilepsy. In addition to the need for provider education about the behavioral and cognitive comorbid conditions of pediatric epilepsy, these findings emphasize the importance of examining alternative routes to increasing mental health care for children with epilepsy. Copyright: 2007 Elsevier Inc. All rights reserved.

Family function in cognitively normal children with epilepsy: Impact on competence and problem behaviors

A cross-sectional cohort of 82 cognitively normal children with epilepsy attending the pediatric neurology clinic, who were aged 6–17 years and who had a similarly aged sibling without seizures or cognitive delay, were identified. The parent was asked to complete the Family Assessment Measure III (FAM-III) as well as the Child Behavior Checklist (CBCL) for both the child with epilepsy and his or her sibling. The Overall Rating Score on FAM-III did not differ significantly from the normative mean, although families scored significantly better on the Involvement subscale and significantly worse on the Role Performance subscale. Moderate correlations were found between competence and behavior problems and family function in both children with epilepsy and their siblings. In families functioning at the highest level, both cohorts did well. In those at the lowest level, approximately half of the children in either cohort had problems. For average functioning families, behavior and competence issues were more frequent in children with epilepsy than their siblings. Copyright 2007 Elsevier Inc. All rights reserved.

Attention-deficit/hyperactivity disorder in pediatric patients with epilepsy: Review of pharmacological treatment

Attention-deficit/hyperactivity disorder (ADHD) in children with epilepsy is a common source of impairment. Based on review of Medline indexed articles, meeting abstracts, and data requested from drug manufacturers, a summary of evidence that might guide treatment and research is presented. Methylphenidate (MPH) has shown high response rates and no increase in seizures in small trials. However, low baseline seizure rates, small numbers of subjects, and short observation periods limit the power of these studies to detect increases in seizure risk. Although longer-term effects of MPH and its effects in children with frequent seizures need to be studied, the evidence available at this time best supports use of MPH for the treatment of ADHD not amenable to changes in antiepileptic drugs or improvements in seizure control. This treatment should be part of a biopsychosocial approach. Other agents show promise. Preclinical, retrospective and open-label studies on amphetamines and atomoxetine support undertaking randomized controlled studies of these agents in patients with ADHD plus epilepsy. In contrast, additional data on guanfacine and modafinil should be gathered before undertaking randomized controlled studies with these agents. Copyright: 2007 Elsevier Inc. All rights reserved.

Articles Posted on August 16, 2007:

Children with seizures exhibit preferences for foods compatible with the ketogenic diet

Although highly effective for the treatment of intractable epilepsy, the ketogenic diet is not always included in the treatment option hierarchy presented to families, in part due to perceptions that children will find the high-fat/low-carbohydrate regimen unpalatable. This study assessed if children with seizures exhibit food preferences compatible with the diet, as well as if caregivers were accurate in predicting preferences. Children aged 2–17, with (n = 29) and without (n = 30) a history of seizures, participated in a paired choice food preference assessment while parents estimated child preferences verbally. Children with seizures exhibited significantly higher preferences for fat versus carbohydrate foods compared with controls, and parents demonstrated low accuracy. Future studies could use similar assessment methods to prospectively track whether such preferences predict diet compliance and/or efficacy. Research into the underlying metabolic basis for this preference and possible related neurophysiological mechanisms in seizure etiology and treatment is warranted. Copyright 2007 Elsevier Inc. All rights reserved

Does attitude toward epilepsy mediate the relationship between perceived stigma and mental health outcomes in children with epilepsy?

Objective. The purpose of this study was to examine the extent to which children’s attitude toward epilepsy mediates the relationship between perceived stigma and the mental health outcomes of self-concept, behavioral problems, and social competence. Method. Subjects were 173 youth aged 9–14 who had been diagnosed and treated for epilepsy for at least 6 months. A secondary data analysis from a larger study was completed to test if the children’s attitude mediated the relationship between stigma and mental health outcomes using multiple regression. Results. Children’s attitude was found to mediate the relationships between stigma and self-concept and behavior problems, respectively. In contrast, attitude did not mediate the relationship between stigma and social competence. Conclusions. Results suggest that enhancing a more positive attitude toward having epilepsy might help improve problems with poor self-concept or behavior problems, but might not influence social competence. Copyright 2007 Elsevier Inc. All rights reserved.

Increased rate of treatment with antidepressants in patients with epilepsy

The risk of depressive and anxiety disorders is increased among patients with epilepsy, but it is not known whether patients are treated with antidepressants in clinical practice. In a nationwide case register linkage study, all patients who received a main diagnosis of epilepsy or osteoarthritis on first admission or outpatient contact during the period 1995 to 2000 in Denmark were identified, and rates of subsequent purchases of antidepressants were calculated. Comparisons were also made with a gender-, age-, and calendar-matched sample of the general population. Patients diagnosed with epilepsy had a 1.73 (95% CI: 1.45–2.06) times increased rate of subsequently purchasing antidepressants, compared with patients diagnosed with osteoarthritis and a 2.44 times (95% CI: 2.12–2.81) increased rate compared with the rate among the general population. It is concluded that patients with epilepsy have a moderately increased probability of being prescribed antidepressants in clinical practice. Copyright 2007 Elsevier Inc. All rights reserved.

Current approaches to the use of generic antiepileptic drugs

Generic substitution is encouraged as a cost containment strategy for the management of health care resources. However, in epilepsy, the consequences of loss of symptom control are important, and antiepileptic drugs have narrow therapeutic indices. For this reason, generic substitution may be problematic, and certain health authorities have excluded antiepileptic drugs from overall policy recommendations on generic prescribing. The absence of bioequivalence data among generic forms and the relatively broad criteria for bioequivalence with the branded drug allow differences in drug exposure to arise that may be clinically relevant and necessitate monitoring of plasma levels when switching formulations to avoid loss of seizure control or emergence of side effects. Management of these issues carries a significant cost, which should be weighed carefully against the cost savings acquired when purchasing the drug. Both physicians and patients have a right to be informed and approve before pharmacists make a generic substitution or switch between generics. Copyright 2007 Elsevier Inc. All rights reserved.

Older Articles:

Daily life in epilepsy: Patients’ experiences described by emotions
Purpose:According to the literature, emotions are closely related to health and well-being. The aim of this study was to illuminate the impact of epilepsy on daily life in young adulthood, described by the patients’ emotions. Method: Young adults, 18–27 years of age (n = 95/102), answered a questionnaire eliciting descriptions of their daily lives with epilepsy in their own words. A content analysis was performed, and the material was categorized, according to the Belief Desire Theory of Emotions. Results:The patients experienced positive (confidence, hope, harmony, and forbearance); negative (anxiety, despair, fear, resignation, indignation, sadness, insecurity, and anger); and self-evaluating emotions (being valuable, being insignificant, shame, guilt, and selfdoubt). Two different groups of patients could be identified: one group whose members regarded themselves as ‘‘healthy’’ and another group whose members regarded themselves as being ill or ‘‘handicapped’’. The ‘‘healthy’’ group was active and flexible, focusing on possibilities and planning how to handle negative emotions. The ‘‘handicapped’’ group was passive and resigned to the epilepsy in a negative way, afraid of being exposed. They focused on obstacles, and their negative emotions were also directed toward the self.Conclusion: This study pointed out the importance of paying attention to the role of emotions in the experiences and well-being of patients with epilepsy.
POSTED: June 7, 2007

Juvenile myoclonic epilepsy: A benign disorder? Personality traits and psychiatric symptoms
Purpose: Since the clinical observations published by Janz in 1957, the presence of personality irregularities in patients with juvenile myoclonic epilepsy (JME) has been described repeatedly, but never quantified using standardized assessments. The aim of the present study was to investigate whether juveniles with a short history of JME exhibit psychopathological symptoms and/or personality irregularities. Method: We used standardized assessments, the Youth Self Report (YSR) and the Weinberger Adjustment Inventory (WAI).Results: Of 38 patients who fulfilled the study entry criteria, 25 agreed to participate and completed all surveys. On the YSR, our sample exhibited twice the amount of psychiatric symptoms than age-matched norms. Furthermore, psychopathological symptoms increased with duration of JME. According to WAI results, JME significantly affected self-restraint: patients with longer disease duration showed less self-control. Conclusion: Adolescents with JME present not only with neurological abnormalities but also with significant psychopathology and personality irregularities. Our data suggest that psychological and behavioral changes are dynamic processes dependent on the progression of the disease.
POSTED: June 7, 2007

Landau–Kleffner syndrome with lateral temporal focal cortical dysplasia and mesial temporal sclerosis: A 30-year follow-up.
Purpose: Report long-term follow-up of a now 41-year-old patient previously reported in 1973 as part of a small case series, before the term Landau–Kleffner syndrome came into the literature and before CT and MRI brain scans were available, in whom we have been able to study serially the long-term residua of his language disorder, including functional MRI language mapping. Results: This case suggests that focal cortical microdysgenesis may be a cause of the Landau–Kleffner syndrome. Persistent seizures in this illustrative case may have led to the evolution of dual-temporal-lobe pathology with mesial temporal sclerosis.
POSTED: June 7, 2007

Mortality in epilepsy
Purpose: All studies report an increased mortality risk for people with epilepsy compared with the general population. Population-based studies have demonstrated that the increased mortality is often related to the cause of the epilepsy. Common etiologies include neoplasia, cerebrovascular disease, and pneumonia. Deaths in selected cohorts, such as sudden unexpected death in epilepsy (SUDEP), status epilepticus (SE), suicides, and accidents are more frequently epilepsy-related. SUDEP is a particular cause for concern in younger people, and whether and when SUDEP should be discussed with patients with epilepsy remain problematic issues. Risk factors for SUDEP include generalized tonic–clonic seizures, increased seizure frequency, concomitant learning disability, and antiepileptic drug polypharmacy. The overall incidence of SE may be increasing, although case fatality rates remain constant. Mortality is frequently secondary to acute symptomatic disorders. Poor compliance with treatment in patients with epilepsy accounts for a small proportion of deaths from SE. The incidence of suicide is increased, particularly for individuals with epilepsy and comorbid psychiatric conditions. Late mortality figures in patients undergoing epilepsy surgery vary and are likely to reflect differences in case selection. Future studies of mortality should be prospective and follow agreed guidelines to better quantify risk and causation in individual populations.
POSTED: June 7, 2007

Pattern and frequency of use of complementary and alternative medicine among patients with epilepsy in the midwestern United States
Purpose: Complementary and alternative medicine (CAM) is recognized to be commonly used by patients, yet there have been few studies regarding the scope of CAM use by patients with epilepsy. This study assessed usage and perceptions of CAM by patients with epilepsy in the midwest of the United States. Method: A 25-item survey was administered to adult patients with epilepsy, and data were collected from 228 patients. The survey collected demographics, specific CAM usage, adverse effects of CAM therapy, and perceptions of the effectiveness of CAM. Results: Thirty-nine percent reported using CAM; 25% reported using CAM specifically for their epilepsy. Prayer/spirituality was the most commonly used form of CAM (46%), followed by ‘‘mega’’ vitamins (25%), chiropractic care (24%), and stress management (16%). Conclusion: CAM use is common among midwestern patients with epilepsy, although the pattern of use may be slightly different than in other regions of the United States and elsewhere.
POSTED: June 7, 2007

The role of comorbid psychiatric conditions in health status in epilepsy
Purpose: Comorbid psychiatric conditions are highly prevalent in patients with epilepsy, yet the long-term implications across multiple mental health conditions are poorly understood. Method: We examined the association between psychiatric diagnoses and self-reported health status in veterans with epilepsy. ANCOVA models were used to derive adjusted SF-36V scores for individuals with epilepsy alone (N = 7379) or with additional psychiatric conditions (N = 6320): depression, schizophrenia, bipolar disorder, anxiety disorder, substance abuse, and posttraumatic stress disorder (PTSD). Compared with patients with epilepsy alone, scores of veterans with comorbid psychiatric diagnoses averaged 21% lower across all domains. Role Limitation scales exhibited the greatest decrement across domains. A PTSD diagnosis consistently corresponded to lower scores, followed by depression. Schizophrenia contributed the least detriment to perceived health status. Results: Comorbid psychiatric conditions impart significant emotional and physical burdens, requiring timely recognition and treatment of these disorders. Patients with epilepsy are uniquely at risk for high physical–psychiatric comorbidity profiles, with concomitant losses in perceived health status.
POSTED: June 6, 2007

Preventing depression in adolescents with epilepsy
Purpose. The goal of the work described in this article was to test the possibility of preventing depression among adolescents with epilepsy. Methods. Adolescents with newly diagnosed epilepsy (104 patients) were screened for depression. The risk for depression was increased in 30 (28.8 percent) patients (mean age 17.4, 60 percent females) who were randomized into two equal treatment groups: (1) cognitive-behavioral intervention (CBI) group and (2) treatment with counseling as usual (TAU) group. The Beck Depression Inventory (BDI), Center for Epidemiological Study on Depression (CES-D) scale, Hamilton Depression Scale (HAMD), and Quality of Life in Epilepsy Inventory (QOLIE-31) were administered at baseline and during the 9-month follow-up. Results. Initial BDI and HAMD scores for the two groups were comparable. Depression was diagnosed during follow-up in three patients in the TAU group. Subthreshold depressive disorder significantly improved at follow-up in the BCI group compared with the TAU group (P < 0.05). QOLIE-31 Total scores significantly correlated with both mood improvement and seizure-free state. Copyright 2006 Elsevier Inc. All rights reserved.
POSTED: January 22, 2006

Experiences of persons with epilepsy and their families as they look for medical and community care: A focus group study from South Carolina
Abstract: Epilepsy affects a larger number of individuals than previously thought — up to 2 percent of the population — and its effects reach further. Yet epilepsy, with its associated lingering stigma and fear, has remained in the background in terms of services and research. Traditional quantitative research often falls short when trying to describe the impact of epilepsy on the lives of individuals and their families. In the present study, focus groups were held throughout South Carolina to discuss individuals’ experiences with accessing epilepsy-related services and health care, and what life with epilepsy is like. Following qualitative data analysis, findings included two themes. One theme focuses on the ongoing search for services and help. The second theme concerns the experiences of living life with epilepsy. Also highlighted are recommendations for potential improvements in public awareness and professional training, and helpful interventions. Copyright: 2006 Elsevier Inc. All rights reserved.
POSTED: January 22, 2006

Impact of epilepsy characteristics and behavioral problems on school placement in children
Abstract: Children with epilepsy are known to be prone to educational underachievement as a result of learning and behavioral problems. This cross-sectional study evaluated the effects of the characteristics of epilepsy and behavioral problems on school placement. One hundred eighty-five children aged between 3 and 16 years with nonoccasional epileptic seizures were included; 82 were mainstreamed in regular schools and 103 were in specialized medical and educational institutions for children with epilepsy. Gender distribution and age were comparable for the two groups. Logistic regression analysis indicated a statistically significant effect for age at onset, generalized nonidiopathic epileptic syndromes, number of antiepileptic drugs and behavioral problems, as dominant factors explaining the type of school placement. No significant effect was found for the state of seizure control. By use of a parent-rated behavior questionnaire, children in special institutions were shown to have significantly more problems in the hyperactivity/attention deficit and sociability domains. Later age at onset of epilepsy was related to more depression/anxiety. Copyright 2006 Elsevier Inc. All rights reserved.
POSTED: January 22, 2006

Living Well II: A review of progress since 2003
Abstract: Epilepsy as an issue for the public health community has a relatively short history in the United States. Not since the 1970s, when Congress established the Commission for the Control of Epilepsy and Its Consequences and the publication of its formal report, ‘‘Plan for Nationwide Action on Epilepsy,’’ has significant attention been paid to the public health implications of epilepsy. In fact, until the U.S. Congress established a small epilepsy program at the Centers for Disease Control and Prevention (CDC) 12 years ago, the condition was practically invisible at all levels of organized public health. Since then, two major conferences, and the recommendations arising from them, have generated a substantially increased level of activity in research, surveillance, and the production and distribution of public education materials, as well as a national initiative to improve access to care and to prevent epilepsy’s negative social impact. Even at the state level, long devoid of any attention to epilepsy in public health planning or provision of services, things are beginning to change, and new demonstration programs designed to identify and serve vulnerable populations with epilepsy are underway. This review highlights these activities, reflects a new and heightened level of attention to epilepsy, and speculates on what may lie ahead in the ongoing effort to give epilepsy greater visibility and higher priority in the public health arena. Copyright: 2006 Elsevier Inc. All rights reserved.
POSTED: October 31, 2006

Editorial: Living Well II: A review of progress since 2003
Tony Coelho and Gregory L. Holmes: “As readers ... know all too well, epilepsy has been misunderstood, mistreated, and misinterpreted since the dawn of recorded history. As recently as the early part of the 20th century, epilepsy was theorized to be a trait shared by the most depraved criminals and the greatest geniuses. Those theories, though deeply flawed by current reasoning, added to the ages-old social burden of living with epilepsy. As we all know, that burden has varied with time, but still retains its serious effects on employment, marriage, physical function, social interaction, general well-being and mental health."
POSTED: October 31, 2006

The 2005 Judith Hoyer Lecture: Genes, pixels, patterns, and prevention
Jeffrey L. Noebels : “It is a singular honor to deliver this year’s Judith Hoyer Lecture, a special occasion that heralds the opening of the Annual Meeting of the American Epilepsy Society. By its very creation, this lecture has quickly come to symbolize a vital partnership between the US Congress, the National Institute of Neurological Diseases and Stroke (NINDS), the Epilepsy Foundation, Citizens United for Research in Epilepsy, and the American Epilepsy Society to generate and deliver a national investment in scientific research that will lead to a meaningful improvement in the lives of people affected by epilepsy. Although the partnership is longstanding, the Hoyer Lecture now represents a perfect moment in each year to summarize our progress and reflect on the distance remaining to be traveled.”
POSTED: October 31, 2006

Racial/ethnic disparities in the treatment of epilepsy: What do we know? What do we need to know?
Abstract: This article examines the current understanding of the minority disadvantage in the clinical management of epilepsy. The authors performed an online literature search using several keywords (race, ethnicity, epilepsy, treatment, and quality of life) and identified additional literature through cross-referencing/manual search. The search produced 58 items published between 1977 and 2005. Of 49 original research studies, 38 were quantitative, 7 were qualitative, and 4 used mixed methods. Three or more articles were published in Epilepsia, Epilepsy & Behavior, Epilepsy Research, Neurology, and Seizure. Research concerning racial/ethnic differences in epilepsy treatment is scarce and limited by methodology, but suggests underutilization of state-of-the-art therapies by minorities. Racial/ethnic minorities also appear to have limited knowledge about epilepsy and its treatment, experience barriers to care, lack social support, and seek alternative therapies for epilepsy. The authors propose a framework to identify the array of disparities, points of intervention, and interventions. Published by Elsevier Inc.
POSTED: October 31, 2006

Temporal lobe epilepsy as a model to understand human memory: The distinction between explicit and implicit memory
Abstract: Decades of research have provided substantial evidence of memory impairments in patients with temporal lobe epilepsy (TLE), including deficits in the encoding, storage, and retrieval of new information. These findings are not surprising, given the associated underlying neuroanatomy, including the hippocampus and surrounding medial temporal lobe structures. Because of its associated anatomicand cognitive characteristics, TLE has provided an excellent model by which to examine specific aspects of human memory functioning, including classic distinctions such as that between explicit and implicit memory. Various clinical and experimental research studies have supported the idea that both conscious and unconscious processes support memory functioning, but the role of relevant brain structures has been the subject of debate. This review is concerned with a discussion of the current status of this research and, importantly, how TLE can inform future studies of memory distinctions. Copyright: 2006 Elsevier Inc. All rights reserved.
POSTED: July 26, 2006

Memory for famous faces and the temporal pole: Functional imaging findings in temporal lobe epilepsy
Abstract: The ability to recognize, name, and provide information about famous persons is deficient in patients with temporal lobe epilepsy (TLE), although the neural basis for these deficits is not well understood. We examined the relationship of resting metabolism of the temporal poles, as determined by [18F] fluorodeoxyglucose positron emission tomography, to performance on a task of famous face recognition, naming, and generation of semantic information in 12 patients with TLE. Correlations between metabolic measures of the temporal poles and performance on the Famous Faces Task revealed strong relationships between all aspects of the Famous Faces Task and the left temporal pole, whereas Famous Faces Task correlations with the right temporal pole were not significant. These findings indicate that the left temporal pole is associated with lexical and semantic retrieval of knowledge of famous persons in patients with TLE. Further study appears warranted to elucidate the networks involved in semantic knowledge for famous faces. Copyright: 2006 Elsevier Inc. All rights reserved.
POSTED: July 26, 2006

Recognition of emotion with temporal lobe epilepsy and asymmetrical amygdala damage
Abstract: Purpose -- Impairments in emotion recognition occur when there is bilateral damage to the amygdala. In this study, ability to recognize auditory and visual expressions of emotion was investigated in people with asymmetrical amygdala damage (AAD) and temporal lobe epilepsy (TLE).
Methods -- Recognition of five emotions was tested across three participant groups: those with right AAD and TLE, those with left AAD and TLE, and a comparison group. Four tasks were administered: recognition of emotion from facial expressions, sentences describing emotion-laden situations, nonverbal sounds, and prosody.
Results -- Accuracy scores for each task and emotion were analysed, and no consistent overall effect of AAD on emotion recognition was found. However, some individual participants with AAD were significantly impaired at recognizing emotions, in both auditory and visual domains.
Conclusions -- The findings indicate that a minority of individuals with AAD have impairments in emotion recognition, but no evidence of specific impairments (e.g., visual or auditory) was found. Copyright: 2006 Elsevier Inc. All rights reserved
POSTED: July 26, 2006

Prognosis of seizure recurrence after stopping antiepileptic drugs in seizure-free patients: A long-term population-based study of childhood-onset epilepsy
Abstract: The long-term outcome with respect to seizure relapse after planned discontinuation of antiepileptic drugs (AEDs) in seizure-free patients is not well known. Relapse and its treatment outcome were evaluated in a longitudinal population-based study of 148 patients from the onset of their epilepsy to an average follow-up of 37 years. During the study, AEDs were completely discontinued by 90 patients; 58 patients remained on medication. Seizure relapse after AED discontinuation was observed in 33 (37%) of 90 patients at an average follow-up of 32 years. Among 8 of the 33 patients who elected to restart AEDs, 2 achieved 5-year terminal remission (5YTR), but only 10–19 years after restarting treatment. The other 6 patients never achieved 5YTR, and 2 of the 6 never entered a 5-year remission period during follow-up. Factors associated with failure to reach 5YTR after treatment of relapse were symptomatic etiology and localization-related epilepsy. In conclusion, drug discontinuation after seizure freedom results in relapse in one-third of patients. Reinstitution of a medication that worked for years fails to achieve control in one of four patients. These risks need to be considered, although there is no evidence that discontinuation is responsible for the poor prognosis for treatment of seizure recurrence. Copyright: 2006 Elsevier Inc. All rights reserved.
POSTED: July 26, 2006

Intractable epilepsy: A survey of patients and caregivers
Abstract: The social and health consequences associated with epilepsy are often magnified among patients with refractory epilepsy. Despite recent advances in the treatment of seizure disorders, many people with epilepsy continue to suffer from uncontrolled seizures and adverse side effects from medical therapy. This survey is the first to focus solely on the experiences, attitudes, and quality of life of a refractory epilepsy population, both those with the condition and their caregivers. To participate in this survey, respondents had to currently be experiencing seizures or troubling treatment side effects and had to have tried at least two different epilepsy medications. These survey data represent three groups of participants (n = 903): those with epilepsy who self-reported on their condition (Group 1, n = 503), the caregivers of those with refractory epilepsy (Group 2, n = 200), and those with epilepsy who had their condition reported on by a caregiver (Group 3, n = 200). This survey revealed that the negative consequences associated with epilepsy tend to be greater among those experiencing treatment side effects and a greater number of seizures. Physicians must take into account medication side effects and quality-of-life issues when treating patients with epilepsy. Copyright 2006 Elsevier Inc. All rights reserved.
POSTED: July 26, 2006

Nonepileptic seizures treatment workshop summary
Abstract: In May 2005, an international, interdisciplinary group of researchers gathered in Bethesda, MD, USA, for a workshop to discuss the development of treatments for patients with nonepileptic seizures (NES). Specific subgroup topics that were covered included: pediatric NES; presenting the diagnosis of NES, outcome measures for NES trials; classification of NES subtypes; and pharmacological treatment approaches and psychotherapies. The intent was to develop specific research strategies that can be expanded to involve a large segment of the epilepsy and psychiatric treatment communities. Various projects have resulted from the workshop, including the initial development of a prospective randomized clinical trial for NES. Copyright 2006 Elsevier Inc. All rights reserved.
POSTED: July 26, 2006

Quality of life in medication-resistant epilepsy: The effects of patient’s age, age at seizure onset, and disease duration
ABSTRACT: Objective. The goal of this study was to examine the effects of age, age at seizure onset, and duration of epilepsy on health-related quality of life (HRQOL) in patients with medication-resistant epilepsy.
Methods. We analyzed data for a sample of 99 patients with medication-resistant epilepsy drawn from admissions to the Epilepsy Monitoring Unit. Patients had completed the Quality of Life in Epilepsy—89 (QOLIE-89), Profile of Mood States (POMS), and Adverse Events Profile. Number of comorbidities and number of antiepileptic drugs were abstracted from the chart. The dependent variable was QOLIE-89 overall score. The data were analyzed using ordinary least-squares regression.
Results. The simple regression results showed no significant effect of patient’s age on QOLIE-89 (P = 0.354), whereas age at onset and duration had significant effects (P = 0.004 and P = 0.012, respectively); the higher the age at onset and the shorter the disease duration, the lower the HRQOL. After adding POMS Depression/Dejection, Adverse Events Profile, comorbidities, and antiepileptic drugs, the effects of age at onset and duration were no longer significant (P = 0.084 and P = 0.207).
Conclusions. Adult-onset epilepsy can disrupt one’s established social, economic, and psychological life, while better coping mechanisms and social support may improve HRQOL as the duration of epilepsy increases. The modest association of age at onset and disease duration with HRQOL is explained away by mood states and adverse events, which are much stronger predictors of HRQOL. Interventions to improve HRQOL in patients with medication-resistant epilepsy should, therefore, focus on treating mood disturbances and minimizing medication side effects. Copyright 2006 Elsevier Inc. All rights reserved.
Posted: May 9, 2006

Epileptic consciousness: Concept and meaning of aura
ABSTRACT: This research is based on previous publications that have analyzed certain neuropsychological phenomena that always have the same characteristic clinical features: a vivid experience of sudden onset and automatic development, accompanied by an intense sensation of strangeness. When these automatisms are accompanied by only mental symptoms, the designation paroxysmal psychic automatisms (PPAs) is proposed, and they should be interpreted as partial seizures (PSs) with a psychic content whenever they clearly exhibit the four features of suddenness, passivity, intensity, and strangeness. This interpretation is based on the existence of a wealth of scientific literature indicating an overlap between PPAs and PSs; moreover, bibliographic reviews indicate that the clinical signs just defined as characterizing PPAs are precisely those defining the epileptic consciousness. Copyright 2006 Elsevier Inc. All rights reserved.
Posted: May 9, 2006

A psychosocial view of anxiety and depression in epilepsy (PDF)
ABSTRACT: The aim of this study was to study anxiety and depression in patients with epilepsy and evaluate their relationships with neuroepilepsy and psychological variables. neuroepilepsy and psychological variables. Sixty patients and 60 healthy subjects were interviewed at the outpatient clinic for epilepsy, using the Beck Depression Inventory and State–Trait–Anxiety Inventory. The objective of the semistructured interview was to identify the patients' perception of the disease, self-concept, personal strategies, and perception of seizure control. There was a significant difference in anxiety and depression between the groups, as well as a strong relationship between perception of seizure control and depression and anxiety, independently assessed. Epilepsy was associated with disease (63.4%), mental problems (11.6%), feelings of shame, fear, worry, and low self-esteem (56.6%), and perception of stigma (26.6%). The strategies were: looking for social support, seeking medical treatment, withdrawal, denial, and spiritual support. There was a significant association between psychological symptoms and perception of seizure control, which reinforces the importance of subjective aspects involved in epilepsy. Copyright 2005 Elsevier Inc. All rights reserved.
Posted: April 26, 2006

Seizure clustering (PDF)
ABSTRACT: Seizure clusters, also known as repetitive or serial seizures, occur commonly in epilepsy. Clustering implies that the occurrence of one seizure may influence the probability of a subsequent seizure; thus, the investigation of the clustering phenomenon yields insights into both specific mechanisms of seizure clustering and more general concepts of seizure occurrence. Seizure clustering has been defined clinically as a number of seizures per unit time and, statistically, as a deviation from a random distribution, or interseizure interval dependence. This review explores the pathophysiology, epidemiology, and clinical implications of clustering, as well as other periodic patterns of seizure occurrence. Risk factors for experiencing clusters and potential precipitants of clustering are also addressed. Copyright 2005 Elsevier Inc. All rights reserved.
Posted: April 26, 2006

Teachers' knowledge about epilepsy and attitudes toward students with epilepsy: Results of a national survey (PDF)
ABSTRACT: The attitudes and epilepsy-related knowledge of teachers are an important component of the educational experiences of children with epilepsy. Unfortunately however, the exploration of teacher attitudes and knowledge has been extremely limited in the United States. This article describes a survey-based research study of the attitudes and epilepsy-related knowledge of a randomly selected national sample of 512 elementary and middle school teachers in the United States. The questionnaire included the Scale of Attitudes Toward Persons with Epilepsy (ATPE), a summated rating scale that measures both attitudes toward persons with epilepsy and knowledge about epilepsy, as well as a demographic and teaching experience survey and several additional attitude and knowledge items developed by the researchers. The results suggest that although teachers_ attitudes about epilepsy were generally positive, there were significant deficits in terms of general knowledge about epilepsy, its impact in educational settings, and the appropriate management of epilepsy and seizures in the classroom. Critical areas in which to focus remedial education and outreach efforts are identified. Copyright 2005 Elsevier Inc. All rights reserved
Posted: April 26, 2006

Risk factors for depression in patients with epilepsy (PDF)
ABSTRACT: Purpose. Symptoms of depression are present in 40 to 60 percent of patients with epilepsy. Prior research indicated significant correlat