Effects of intensive psychological intervention on treatment compliance,psychological status,and quality of life of patients with epilepsy

BACKGROUND Epilepsy is a nervous system disease characterized by recurrent attacks,a long disease course,and an unfavorable prognosis.It is associated with an enduring therapeutic process,and finding a cure has been difficult.Patients with epilepsy are predisposed to adverse moods,such as resistance,anxiety,nervousness,and anxiety,which compromise treatment compliance and overall efficacy.AIM To explored the influence of intensive psychological intervention on treatment compliance,psychological status,and quality of life(QOL)of patients with epilepsy.METHODS The clinical data of 105 patients with epilepsy admitted between December 2019 and July 2023 were retrospectively analyzed,including those of 50 patients who underwent routine intervention(control group)and 55 who underwent intensive psychological intervention(research group).Treatment compliance,psychological status based on the Self-Rating Anxiety Scale(SAS)and Depression Scale Self-Rating Depression Scale(SDS)scores,hope level assessed using the Herth Hope Scale(HHS),psychological resilience evaluated using the Psychological Resilience Scale,and QOL determined using the QOL in Epilepsy-31 Inventory(QOLIE-31)were comparatively analyzed.RESULTS Treatment compliance in the research group was 85.5%,which is significantly better than the 68.0%of the control group.No notable intergroup differences in preinterventional SAS and SDS scores were identified(P>0.05);however,after the intervention,the SAS and SDS scores decreased significantly in the two groups,especially in the research group(P<0.05).The two groups also exhibited no significant differences in preinterventional HHS,Connor-Davidson Resilience Scale(CD-RISC),and QOLIE-31 scores(P>0.05).After 6 months of intervention,the research group showed evidently higher HHS,CD-RISC,tenacity,optimism,strength,and QOLIE-31 scores(P<0.05).CONCLUSION Intensive psychological intervention enhances treatment compliance,psychological status,and QOL of patients with epilepsy.

Dynamic expression of P-glycoprotein in the CA1,CA3 and dentate gyrus of the rat hippocampus following lithium-pilocarpine-induced status epilepticus

Epileptic seizures induce overexpression of P-glycoprotein in the blood-brain barrier. However, it is unclear whether hippocampal neurons also overexpress P-glycoprotein following seizure. This study confirmed that the clinical manifestation, pathological characteristics and electroencephalography in the rat model of lithium-pilocarpine-induced mesial temporal lobe epilepsy were consistent with clinical reports of mesial temporal lobe epilepsy in humans.Immunohistochemistry staining demonstrated that P-glycoprotein positive staining was found in neurons in the pyramidal layer of the hippocampus. Westem blot assay and real-time polymerase chain reaction revealed that P-glycoprotein overexpression was exhibited in the CA1, CA3, and dentate gyrus of the hippocampus at 24 and 60 days following model induction, but no significant dffierence was detected in the same region at various time points. These results indicate that seizures led to overexpression of P-glycoprotein in neurons of the hippocampus, but no evidence was found for a positive association between P-glycoprotein expression and seizure frequency.

A Descriptive Analysis of Prognostic Indicators in Patients with Non-Convulsive Status Epilepticus in a Tertiary Hospital Population

Background: Non-convulsive status epilepticus (NCSE) is defined as a change in mental state of at least 30 minutes associated with continuous or nearly continuous epileptiform discharges. Identification of prognostic indicators can guide decision making surrounding the use of poorly established treatment interventions in this heterogeneous population. Methods: We identified 66 consecutive inpatients with NCSE. Data surrounding clinical, electrographic, and treatment factors were collected via a retrospective systematic review of medical records and electronic EEGs, and were correlated with discharge outcome (return to baseline, new disability, or death). Results: Of all subjects, 21% returned to baseline, 26% acquired new disability, and 53% died, of whom half had anoxic encephalopathy. On univariate analysis, seventeen variables correlated significantly with death, although multivariate logistic regression analysis subsequently identified only comatose state and number of life threatening comorbidities as independent predictors of mortality. Of survivors, comatose state, critical care environment, length of hospital stay, and acute symptomatic seizures predicted new disability, with the latter two showing independent significance. Following exclusion of cases with anoxic encephalopathy, the use of an anaesthetic infusion was also an independent predictor of mortality. Conclusions: NCSE is associated with variable morbidity and mortality. While one fifth of our NCSE patients returned to baseline, those comatose with acute structural/metabolic seizures, anaesthetic infusions, and life threatening comorbidities were unlikely to survive without disability at discharge.

Status Epilepticus and Coma in Pregnancy. Management Dilemma in a Resource Limited Setting (Monatele, Cameroon): Case Report

Epilepsy is a leading neurological condition characterized by recurrent seizures and affecting more than 50 million people worldwide. Status epilepticus (SE) is a neurological emergency associated with a high mortality rate and long-term cognitive sequelae. In pregnancy, status epilepticus poses a tremendous threat to both mother and fetus. We report a case of status epilepticus in pregnancy complicated by coma, where obstetrical ultrasound revealed fetal demise in utero followed by rapid maternal deterioration and demise later. There was management challenge of a comatose pregnant mother in very poor and deteriorating hemodynamic state with fetal demise in a low economic and limited resource setting.

The ketogenic diet for paediatric patients with super-refractory status epilepticus in febrile infection-related epilepsy syndrome

Objective:To investigate the effect and safety of ketogenic diet(KD)for the treatment of paediatric patients with super-refractory status epilepticus(SRSE)in febrile infection-related epilepsy syndrome(FIRES).Method:From January 1,2015 to October 31,2017,ten critically ill paediatric patients with SRSE in FIRES were included in this study and treated with KD.The treatment effects of KD were evaluated by using continuous encephalography(CEEG)and amplitude-integrated electro-encephalography(aEEG).Results:All 10 patients fulfilled the diagnostic criteria of SRSE in FIRES and achieved ketosis within 24–72 h following the administration of KD.CEEG and aEEG were monitored for several weeks to assess the efficacy of KD on status epilepticus(SE).SE was contained in 8 patients within 2 to 19 days after initiation of KD,and KD was discontinued in the other 2 patients.One of the 10 patients demonstrated severe adverse effects.Conclusion:KD may be an alternative and safe treatment option in critical paediatric patients with SRSE in FIRES.

nfluence of Marital Status on the Quality of Life of Chinese Adult Patients with Epilepsy

Background： Epilepsy is a chronic disorder characterized by recurrent seizures and has significant psychological and social consequence for everyday living. Epilepsy affects various aspects of ones＇ social life. The present study aimed to investigate the influence of marital status on the quality of life of adult Chinese patients with epilepsy. Methods： This study surveyed 805 Chinese adults who have been clinically diagnosed with epilepsy for longer than 1 year in 11 hospitals in Beijing. In this survey, 532 （66.1%） participants were married. All of them completed the case report form with enquiries on demographic data, social factors, and illness. The marriage status of adult epileptic quality of life was the dependent variable, and demographic data and clinical data were independent variables, analyzed through the multiple linear regression analysis methods. The patients＇ quality of life was assessed using the Quality of Life in patients with Epilepsy-31 items （QOLIE-31） questionnaire, the Patient Health Questionnaire-9 items （PHQ-9）, and the Generalized Anxiety Disorder-7 items （GAD-7）. Results： The PHQ-9 and GAD-7 scores in the unmarried group （PHQ-9 = 6.0 and GAD-7 = 5.0） were significantly higher than that of the married group （PHQ-9 = 4.0 and GAD-7 =3.0）. The scores of married adult patients with epilepsy on QOLIE （61.8 ±15.3） and social function （70.9 ± 22.7） were higher than the scores of the unmarried patients aged between 20 and 44 years. The scores of married adult epileptics on the QOLIE （58,4 ± 14.6） and the energy/fatigue （62.1 ± 20.4） were higher than the scores of the unmarried patients （QOLIE = 58.4 ± 14.6 and the energy/fatigue = 62.1 ±20.4） aged between 45 and 59 years. For the adult epilepsy patients, depression, anxiety, seizures within the last year, disease course, medical expense category, and marriage＊ age are negatively correlated with the quality of life. Occupation, educational level, and average monthly income are closely related to the quality of life. Conclusions： Married adult epileptic patients have better quality of life than that of unmarried adult patients in young and middle-aged age groups. Unmarried adult patients with epilepsy are more anxious and depressed than married adult patients.

nfluence of Occupational Status on the Quality of Life o Chinese Adult Patients with Epilepsy

Background： Epilepsy is one of the most common serious neurological disorders. The present study aimed to investigate the influence of occupational status on the quality of life of Chinese adult patients with epilepsy. Methods： This study surveyed 819 subjects clinically diagnosed with epilepsy for more than 1 year in 11 hospitals in Beijing; 586 were employed （71.55%）. All subjects completed the case report form with inquiries on demographic data, social factors, and illness. The patients＇ quality of life was assessed using the quality of life in patients with epilepsy-31 items （QOLIE-31） questionnaire. Results： The QOLIE-31 score in the employed group was significantly higher than that in the unemployed group. Furthermore, the scores in all the sections （overall quality of life, energy/fatigue, emotional well-being, seizure worry, cognition, social function, and medication effects） of the employed group were higher than those of the unemployed group. Both the employed and unemployed groups achieved the highest difference in social function. The QOLIE-31 score of students was higher than those of farmers and workers. Both the students and workers scored higher in the quality of life compared with the adult peasants living with epilepsy. The students and farmers showed significant differences in QOL1E-31 score, cognition, emotional well-being, overall quality of life, energy/fatigue, and social function. In contrast, no significant difference was noted in seizure worry and medication effects across the three different kinds of occupation. Conclusion： Occupational status might affect the quality of life of Chinese adult patients with epilepsy, and social function is the most important contributing factor.

Characterization of the Expression of the ATP-Gated P2X7 Receptor Following Status Epilepticus and during Epilepsy Using a P2X7-EGFP Reporter Mouse

Mounting evidence suggests that the ATP-gated P2X7 receptor contributes to increased hyperexcitability in the brain.While increased expression of P2X7 in the hippocampus and cortex following status epilepticus and during epilepsy has been repeatedly demonstrated,the cell type-specific expression of P2X7 and its expression in extra-hippocampal brain structures remains incompletely explored.In this study,P2X7 expression was visualized by using a transgenic mouse model overexpressing P2X7 fused to the fluorescent protein EGFP.The results showed increased P2X7-EGFP expression after status epilepticus induced by intra-amygdala kainic acid and during epilepsy in different brain regions including the hippocampus,cortex,striatum,thalamus and cerebellum,and this was most evident in microglia and oligodendrocytes.Colocalization of P2X7-EGFP with cell type-specific markers was not detected in neurons or astrocytes.These data suggest that P2X7 activation is a common pathological hallmark across different brain structures,possibly contributing to brain inflammation and neurodegeneration following acute seizures and during epilepsy.

Calculation and management of ketogenic diet parenteral nutrition in super-refractory status epilepticus

Super-refractory status epilepticus(SRSE)is an important neurological emergency associated with high mortality and morbidity and poses a heavy economic burden on patients.Ketogenic diet parenteral nutrition(KD-PN)is ketogenic diet therapy provided through parenteral administration and may be an adjuvant treatment for these who cannot accept enteral diet.However,the calculation and management of KD-PN presents a challenge for clinicians.This review focuses on the practical aspects of KD-PN therapy for treatment of SRSE,including the dietary composition,potential drug-diet interactions,and monitoring during KD-PN treatment.As with all SRSE treatments,KD-PN has many adverse effects,like hyperlipemia,hepatotoxicity,metabolic acidosis,insufficient ketosis or hyper-ketosis,and propofol infusion syndrome.We summarize monitoring and treatment methods in our review.This review provides some practical aspects for treatment of SRSE.

Anterior temporal lobectomy improved mood status and quality of life in Chinese patients with mesial temporal lobe epilepsy:a single-arm cohort study

Background: Many studies have emphasized that selective resection of epileptic lesions in temoral lobe is associated with better preservation of cognition function;whether this applies to patients with refractory mesial temporal lobe epilepsy (MTLE) remains unknown. The objective of this study was to evaluate changes in cognitive functions, mood status, and quality of life after anterior temporal lobectomy in patients with refractory MTLE. Methods: This single-arm cohort study assessed cognitive function, mood status, and quality of life, as well as electroencephalography findings, in patients with refractory MTLE who underwent anterior temporal lobectomy at Xuanwu Hospital from January 2018 to March 2019. Pre- and post-operative characteristics were compared to evaluate the effects of surgery. Results: Anterior temporal lobectomy significantly reduced the frequencies of epileptiform discharges. The overall success rate of surgery was acceptable. Anterior temporal lobectomy did not result in significant changes in overall cognitive functions (P > 0.05), although changes in certain domains, including visuospatial ability, executive ability, and abstract thinking, were detected. Anterior temporal lobectomy resulted in improvements in anxiety and depression symptoms and quality of life. Conclusions: Anterior temporal lobectomy reduced epileptiform discharges and incidence of post-operative seizures as well as resulted in improved mood status and quality of life without causing significant changes in cognitive function.

Chinese expert recommendations on ketogenic diet therapy for super-refractory status epilepticus

Super-refractory status epilepticus(SRSE)is a serious and life-threatening neurological condition.Ketogenic diet(KD)is a diet characterized by high fat,low carbohydrate,and moderate protein.As KD shows effectiveness in controlling seizures in more than half of SRSE patients,it can be a treatment option for SRSE.Currently,KD treatment for SRSE is based on personal experience and observational evidence has been published.In the context of a lack of a validated guideline,we convened a multicenter expert panel within the China Association Against Epilepsy(CAAE)Ketogenic Diet Commission to work out the Chinese expert recommendations on KD for SRSE.We summarize and discuss the latest clinical practice of KD for SRSE in critical care settings.Recommendations are given on patient selection,the timing of KD,diet implementation,and follow-up.More research data are needed in this area to support better clinical practice.

Status epilepticus in patients with genetic generalized epilepsy:a case series study

Background Genetic generalized epilepsy(GGE)accounts for nearly one-third of all epilepsies.The feature of status epilepticus(SE)in patients with GGE has been rarely studied.We aimed to determine the electroclinical characteristics of SEin patients with GGE.Methods In this retrospective study,nine patients with GGE were enrolled at Xijing Hospital,Xi'an,China from May 2014 to May 2020.SE was confrmed by 24-h video-EEG recording.The demography,clinical manifestation,brain MRI and SEpatternwereanalyzed.Results Of the nine patients in the study,seven were female.The mean age of the patients at the time of inclusion was 16.8 years(range 7-31 years),and the mean age at the onset of epilepsy was 10.9 years(range 6-17 years).The follow-up time ranged from 3 months to 6 years.Myoclonic absence status was identified in four patients showing eyelid myoclonia with absence and one patient showing perioral myoclonia with absences.Myoclonic SE was identi-fied in three patients showing juvenile myoclonic epilepsy.Autonomic SE was found in one patient with eyelid myo-clonia with absence.SE was terminated by oral midazolam in four patients.In the other five patients,SE terminated spontaneously.Conclusions The seizure type of SE in patients with GGE is often consistent with their major symptoms.Oral mida-zolam may be an option to terminate SE in patients with GGE.

Effect of adenovirus-mediated overexpression of PTEN on brain oxidative damage and neuroinflammation in a rat kindling model of epilepsy

Background:Epilepsy is a chronic and severe neurological disorder.Phosphatase and tensin homolog deleted on chromosome ten(PTEN)-deficient mice exhibit learning and memory deficits and spontaneous epilepsy.The aim of this study was to investigate the role of PTEN in brain oxidative damage and neuroinflammation in a rat model of epilepsy.Methods:An adenovirus(Ad)-PTEN vector was constructed,and status epilepticus(SE)was induced in 41 model rats using lithium chloride-pilocarpine.Thirty-six SE rats were then allocated into the Ad-PTEN,Ad-LacZ,and SE groups,those were administered intracerebroventricular injections of Ad-PTEN,Ad-enhanced green fluorescent protein,and phosphate buffer saline,respectively.The normal group was comprised of healthy Sprague-Dawley rats.Nissl staining was conducted to evaluate neuronal damage,and immunohistochemistry was conducted to observe the morphology of cells in the hippocampal CA1 region and the distribution of ionized calcium-binding adaptor molecule 1(Iba1)and ED1(rat homologue of human CD68).Levels of apoptosis-related proteins,inflammatory-related factors,and oxidative stress-related markers(reactive oxygen species[ROS],glutathione[GSH],superoxide dismutase[SOD],and malondialdehyde[MDA])were measured.Comparisons between multiple groups were conducted using oneway analysis of variance(ANOVA),and pairwise comparisons after ANOVA were conducted using the Tukey multiple comparisons test.Results:After SE induction,PTEN expression in the rat brain exhibited a four-fold decrease(P=0.000)and the expression of both Iba1 and ED1 increased.Furthermore,significant neuronal loss,oxidative damage,and neuroinflammation were observed in the SE rat brain.After intracerebroventricular injection of Ad-PTEN,PTEN expression exhibited a three-fold increase(P=0.003),and the expression of both Iba1 and ED1 decreased.Additionally,neurons were restored and neuronal apoptosis was inhibited.Furthermore,ROS and MDA levels decreased,GSH level and SOD activity increased,and neuroinflammation was reduced.Conclusion:Our study demonstrated that brain oxidative damage and neuroinflammation in SE rats were ameliorated by intracerebroventricular injection of Ad-PTEN.

Ketogenic dietary therapy in adult status epilepticus:current progress and clinical application

Status epilepticus(SE)is a common fatal neurological disease with high morbidity and mortality,Even if a large proportion of patients might be relieved from anti-seizure medications,sedatives and anesthetics,some still remain out of control.The ketogenic dietary(KD)has been proven useful in patients refractory to medications and/or who have failed to respond to surgical intervention.Recently,KD has shown beneficial therapeutic effects in children with SE,but studies in adults have rarely been reported.In this paper,we review the efficacy and utility of KD in adult SE patients and highlight its application for clinical reference and management.

Social support for and features of Chinese adults with epilepsy

Background:The lack of social support for adults with epilepsy(AWEs)is receiving increased attention,as it may result in low quality of life.This study was aimed to confirm the demographic characteristics of and clinical factors associated with social support for AWEs.Methods:AWEs were consecutively recruited from our hospital.The 10-term Social Support Rating Scale(SSRS)was used to measure social support.A linear regression analysis with stepwise selection was performed to analyze the independent variables associated with social support for AWEs.Results:In total,165 AWEs were consecutively included in the present study.Linear regression analysis showed that the marital status(t=-3.550,β=-0.272,P=0.001),the age at onset(t=2.545,β=0.192,P=0.012),and the QOLIE-31 score(t=3.144,β=0.221,P=0.002)were independent variables associated with social support for AWEs.Conclusions:Our findings suggest that the poor social support is associated with childhood onset of epilepsy and the unmarried status.This study also confirmed a negative influence of low social support on quality of life in AWEs.

Status epilepticus in scleromyxedema

Scleromyxedema is a rare dermatologic disorder,characterized by erythematous or yellowish lichenoid waxy papules.Neurological manifestations are rare but well-recognized.A 51-year-old woman,diagnosed with scleromyxedema,was admitted to the hospital with status epilepticus,caused by brain lesions,as disclosed in a brain magnetic resonance imaging(MRI).The patient was treated with anticonvulsants and corticosteroids and gradually recovered fully.A complete remission of the lesions was shown in a follow-up brain MRI.In cases with scleromyxedema and the presence of neurological manifestations,we need to pay attention to central nervous system involvement,especially when combined with brain MRI lesions,and treat the patient appropriately.

Arterial spin labeling perfusion MRI applications in drug‑resistant epilepsy and epileptic emergency

Epilepsy affects all age groups and is one of the most common and disabling neurological disorders worldwide.Drug-resistant epilepsy(DRE),status epilepticus(SE),and sudden unexpected death in epilepsy(SUDEP),which are associated with considerable healthcare costs and mortality,have always been difficult to address and become the focus of clinical research.The rapid identification of seizure onset and accurate localization of epileptic foci are crucial for the treatment and prognosis of people with DRE,SE,or near-SUDEP.However,most of the conventional neuroimaging techniques for assessing cerebral blood flow of people with epilepsy are restricted by time consumption,limited resolution,and ionizing radiation.Arterial spin labeling(ASL)is a newly powerful non-contrast magnetic resonance imaging technique that enables the quantitative evaluation of brain perfusion,characterized by its unique advantages of reproducibility and easy accessibility.Recent studies have demonstrated the potential advantages of ASL for the diagnosis and evaluation of epilepsy.Therefore,in this review,we discussed the complementary value of ASL in evaluating and characterizing the basic substrates underlying refractory epilepsy and epileptic emergencies.