Disability patterns over the first year after a diagnosis of epilepsy

Abstract

2019) Disability patterns over the first year after a diagnosis of epilespy. Clinical Neurology and Neurosurgery, 179,[60][61][62][63][64][65] Objective: To determine the patterns and predictors of disability over the first 12 months after a diagnosis of epilepsy. Patients and methods: The Sydney Epilepsy Incidence Study to Measure Illness Consequences (SEISMIC) was a prospective, multicenter, community-based study of people with newly diagnosed epilepsy in Sydney, Australia. Disability was assessed using the World Health Organization's, Disability Assessment Schedule (WHODAS) 2.0 12-item version, at baseline (i.e. within 28 days of diagnosis) and 12 months post-diagnosis. Demographic, socioeconomic, clinical and epilepsy-related data, obtained through structured interviews, were entered into multivariable linear regression and shift analysis to determine predictors of greater disability. Results: Of 259 adults (≥18 years), 190 (73%) had complete WHODAS at baseline (mean ± SD scores 4 ± 6) and follow-up (4 ± 8). After adjustment for age, sex and co-morbidity, greater overall disability at 12 months was associated with lower education (P = 0.05), economic hardship (P = 0.004), multiple antiepileptic medications (P = 0.02) and greater disability (P < 0.001) at the time of diagnosis; these variables explained 38.3% of the variance. Among the 12 WHODAS items, "being emotionally affected by health problems" was the most frequent disability problem identified at both time points (all P < 0.0001). The proportion of participants without problems in that domain improved over 12 months (from 24% to 50%, P < 0.0001), whereas the other 11 items remained relatively stable. Independent baseline predictors of a worse emotional outcome at 12 months were severe/extreme emotional distress (odds ratio [OR] 4.52, 95% confidence intervals [CI] 1.67-12.24), economic hardship (OR 2.30, 95% CI 1.24-4.25) and perceived stigma (OR 2.02, 95% CI 1.03-3.93). Conclusion: Most people report problems with emotional health after a diagnosis of epilepsy but many recover over the next 12 months. Services addressing the social and psychological impact of diagnosis may be needed to improve outcome.

Prevalence and correlates of diagnosed and undiagnosed epilepsy and migraine headache among people with severe psychiatric disorders in Ethiopia

“…After adjusting all the potential confounders, greater disability (the highest WHODAS score) was associated with increased odds of having neurological disorders when compared with lower disability (the lower WHODAS score) [OR = 1.30 (95% CI 1.02-1.66)]. Consistent with our finding a recent study found a significant and positive association between greater disability and increased risks of depression [47].…”

Anxiety and depressive symptoms in adults with new‐onset seizures: A scoping review

“…Fourteen [7][8][9][10][11][12][13][14][15][16][17][18][19][20] were cohort studies and two 21,22 were randomized controlled trials. Three 13,18,19 studies considered first seizure cohorts exclusively (Table 1), eight 17,[23][24][25][26][27][28][29] considered newly diagnosed epilepsy cohorts exclusively (Table 2), and five 21,22,[30][31][32] considered both first seizure and newly diagnosed epilepsy cohorts (Table 3). Nine studies 17,19,[21][22][23]25,[28][29][30] excluded patients with any past psychiatric diagnosis, and six 17,21,[27][28][29]32…”

“…The 16 included studies used six different validated instruments to capture anxiety and depressive symptoms in first seizure and newly diagnosed epilepsy cohorts. This included the Hospital Anxiety and Depression Scale (HADS) in eight studies, 13,17,18,[23][24][25][26]31 Generalised Anxiety and Depression (GAD-7) instrument in four studies, 21,[27][28][29] Neurological Disorders Depression Inventory for Epilepsy (NDDIE) in four studies, 21,[27][28][29] the Beck Depression Inventory (BDI) in two studies, [30][31][32] Self-Rating Depression Scale (SRDS) in one study, 19 and Brief Depression Scale (BDS) in one study. 22 Relevant cutoff scores are summarized in Tables 1-3.…”

“…The most used tool was the HADS, with all studies setting the cutoff at >7. 13,17,18,[23][24][25][26]31 The HADS is a well-established screening tool for detecting clinically significant anxiety and depression symptoms, with a clear correlation between increasing scores and symptom severity. Reported sensitivity and specificity are approximately 80%.…”

Course and impact of sleep disturbance in newly diagnosed epilepsy: A prospective registry study

“…SEISMIC is registered on the Australia New Zealand Clinical Trial Registration database, and the protocol and main results are published [14][15][16][17]. In brief, people of all ages with a new diagnosis of epilepsy were identified and enrolled through a geographically based multi-site ascertainment process in Sydney, Australia from July 2008 to December 2013.…”