Quality of Life Issues in Epilepsy

Chapter outline There is overwhelming evidence that people with epilepsy (PWE) have a number of psychosocial difficulties which impact greatly on their quality of life [1]. To this end the chapter will summarise some definitive clinical features of the disorder and then go on to provide an overview of the types of psychosocial deficits that PWE experience and the influence of epilepsy related variables on these factors. The chapter will conclude by considering interventions that may alleviate the burden of psychosocial problems

Social cognition in epilepsy

There is a paucity of research which has investigated social cognition in epilepsy, this is surprising given the abundance of evidence that exists in relation to the difficulties that people with epilepsy (PWE) have in relation to social functioning (McCagh et al., 2009). The study of social cognition in epilepsy will lead to a greater understanding of the social cognitive deficits of the epileptic condition. This may in turn lead to more effective psychological interventions to enable the smoother functioning of people with epilepsy in society. The aim of this chapter is to provide a detailed critical review of research which has investigated socio-cognitive functioning in people with epilepsy to date. Throughout the chapter, the impact of epilepsy related variables in relation to socio-cognitive processing will be considered. The final part of the chapter will explore why people with epilepsy may have social cognitive deficits and will go on to summarise limitations in past research. The chapter will conclude by providing the rationale and aims of the author’s current research in this area and suggestions for future work

Epilepsy: Myths, Stereotypes and Stigma.

This article will discuss how epilepsy has been perceived throughout history and across different cultures. The chapter will highlight how historical conceptions of epilepsy and misrepresentation in the media have perpetuated current stereotypical perceptions of the disorder. Consequently, misconceptions about epilepsy serve to propagate discrimination and stigma toward people with the condition. The myths that surround epilepsy will be explored emphasising how misconception, discrimination and stigma affect the quality of life of people with the condition. Myths, stigma and stereotypes can result in multiple interrelated psychosocial outcomes which can impede the cohesive integration of people with epilepsy in society. The impact of these factors on important psychosocial outcomes such as self esteem, depression, anxiety, employability, opportunities for social interaction and interpersonal relationships will be discussed. The chapter will explore these outcomes highlighting how society can be effective in engendering positive attitudes towards people with epilepsy. To conclude, educational interventions aimed at people with epilepsy, their families, employers, teachers and society at large will be considered along with future research suggestions with a view to reduce the impact of stigma and improve the social functioning of people with epilepsy

Social cognition in epilepsy

Some of the psychological problems associated with epilepsy have their origins in the ability of people with epilepsy (PWE) to engage in meaningful and appropriate social interactions. PWE often report difficulties in social settings, yet there is a paucity of research investigating the socio-cognitive skills of this group. This thesis aimed to investigate these skills and relate them to the patient's perceived impact of epilepsy on their social competence. An additional objective was to see whether studying social cognition in focal epilepsy might provide some insight into the organic basis of social cognitive abilities in the normal population. The thesis consists of four separate studies which aimed to investigate social cognition and social functioning in patients with focal epilepsy. With this in mind, a test battery assessing a range of skills linked to social cognition was administered to a cross section of experimental groups (N=95). These included patients with seizure foci in the right frontal lobe (RF), left frontal lobe (LF), right temporal lobe (RT), left temporal lobe (LT) and a group with idiopathic generalised epilepsy (IGE). A normal control group (NC) and a frontal head injured (FHI) group with no epilepsy were also recruited for the study. In Studies 1 and 2 theory of mind (ToM) deficits were apparent in people with RF and LT epilepsy. These groups demonstrated impairment in the appreciation of false belief and deception at first and second order levels of intentionality. They also exhibited deficits in the appreciation of pragmatic language when attempting to infer the meaning underlying hints given by story characters. These impairments were in part attributable to deficits in narrative memory in the LT group. In Study 3 embedding problems within a social context significantly facilitated conditional reasoning in the NC, LT and RF groups but not in the other experimental groups. This finding was unexpected and suggests a double dissociation between ToM and social conditional reasoning. Study 4 investigated the extent to which socio-cognitive impairment was associated with the perceived impact of epilepsy on everyday social functioning. No statistically significant relationship between these variables was found, although a significant negative correlation between education level and impact of epilepsy was observed. Taken together the findings suggest that impairment in ToM may be a particular feature of right frontal lobe pathology and that social conditional reasoning and ToM may be functionally dissociated. PWE do not appear to have insight into their social functioning difficulties, which may well reflect underlying pathology. In light of this, future research should obtain objective measures of social competence from `significant others'. This is the only series of studies to date to assess social cognition in people with frontal lobe epilepsy (FLE) and temporal lobe epilepsy (TLE) within the same design. It is also the first time that social conditional reasoning in epilepsy has been systematically assessed and represents one of the largest lesion studies within the field of social cognition. It is hoped that some of the test material used in the thesis, may prove to be a useful and inexpensive clinical resource to help identify PWE who are at risk of reduced social competence, and in localising the site of seizure foci in patients during clinical audit, particularly where anterior foci are suspected

Illness Perception Mediates the Relationship Between the Severity of Symptoms and Perceived Health Status in Patients With Behçet Disease

Objective: The aim of this study was to investigate the relationship between psychological representations of illness, perceived health status, and self-assessment of symptom severity in patients with Behçet disease, a rare long-term incurable condition with unclear etiology. Methods: Using cross-sectional survey design, data on self-administered questionnaires on illness perception, health status, symptoms severity, and demographic characteristics were collected from 273 patients with Behçet disease (age range, 18–65 years). The data were subjected to mediation analysis to test whether cognitive and emotional components of illness perception mediate the relationship between the severity of symptoms and heath status. Results: The results support our hypotheses that cognitive components of illness perception (perceived consequences and identity of the illness) mediate the link between symptom activity and pain, whereas emotional components of the illness (emotional representations about the illness) mediate the relationship between disease activity and perceived energy level. Conclusions: The robustness of these mediation effects suggests potential directions for clinical psychologists and health care practitioners in developing support programs. We supplement our study with Open Access database containing information about type ofmedication, comorbidmood disorder, and detailed measurement of the severity of BD symptoms for sharing and accumulating multidisciplinary knowledge aiming to support the development of interventions. Addressing psychological aspects of BD will help to manage complex patients effectively

Anxiety disorders in people with epilepsy.

Anxiety disorders are frequent, though probably underdiagnosed, comorbidities in epilepsy. Epilepsy and anxiety may share common neurobiological correlates as shown in animal models and suggested by studies demonstrating anxiety disorders before the manifestation of epilepsy. Comorbid anxiety disorders have a major impact on the affected patients' quality of life and may increase the risk for suicidality. Successful treatment of the epilepsy may alleviate anxiety symptoms. Treatment of anxiety is based on selective serotonin reuptake inhibitors, benzodiazepines (although only as second-line choices), and psychotherapy. Specific AEDs (especially pregabalin) have been shown to have anxiolytic properties. This paper is aimed at reviewing anxiety disorders in patients with epilepsy discussing current scientific evidence about pathophysiology, clinical aspects, and treatment strategies

Development of the Epilepsy Risk Awareness scale (ERA scale) for people with epilepsy

Purpose: Quality of life in people with epilepsy depends on balancing protection from risks and avoiding unnecessary restrictions. The Epilepsy Risk Awareness Checklist (ERAC) was developed to summarise an individual’s safety, health care and quality of life and to facilitate communication between professionals. Although effective, the existing Checklist required quantification and shortening to increase its utility, particularly as a longitudinal tool for measuring and communicating changes over time. Methods: 5 clinical experts, 3 people with epilepsy and 5 carers assessed the importance of each item on the ERAC questionnaire in a two-round Delphi survey. The refined Epilepsy Risk Awareness scale (ERA scale) was piloted in 30 patients to obtain an overall and sub-scale score for personal safety, health care, and quality of life domains, and was compared with the validated Seizure Severity Scale and Epilepsy Self-Management Scale. Results: ERAC was shortened from 69 to 48 items to take 15–20 min for completion. Pilot results showed good internal consistency for the overall ERA scale, for the Personal Safety and Health Care subscales, but less for the Quality of Life subscale. There was strong association between ERA scale and the Epilepsy Self- Management Scale, but little relationship with Seizure Severity Scale scores, which focus on individual seizures. User ratings were high. Conclusions: The ERA scale has been shortened and quantified to provide an objective measure of the risks and safety profile in people with epilepsy. The scale will be further tested for intra-rater variability and utility

Fluid Intelligence and Psychosocial Outcome: From Logical Problem Solving to Social Adaptation

While fluid intelligence has proved to be central to executive functioning, logical reasoning and other frontal functions, the role of this ability in psychosocial adaptation has not been well characterized.Lower fluid intelligence scores were associated with physical violence, both in the role of victim and victimizer. Drug intake, especially cannabis, cocaine and inhalants and lower self-esteem were also associated with lower fluid intelligence. Finally, scores on the perceived mental health assessment were better when fluid intelligence scores were higher.Our results show evidence of a strong association between psychosocial adaptation and fluid intelligence, suggesting that the latter is not only central to executive functioning but also forms part of a more general capacity for adaptation to social contexts

Eplilepsy: Classification, aetiology and management

Abstract This chapter will outline the prevalence and incidence rates for epilepsy and the criteria for classifying seizures and epileptic syndromes. The aetiology of epilepsy and how it is managed with particular emphasis on drug therapy and the side effects associated with taking antiepileptic medication will be discussed in detail. The chapter aims to provide an account of the physiological characteristics and the theoretical and practical perspectives which underlie the condition, thereby permitting a more complete understanding of research literature in this area

Epilepsy, stereotypes, stigma and psychosocial consequences.

This chapter will discuss how epilepsy has been perceived throughout history and across different cultures. The chapter will highlight how historical conceptions of epilepsy and misrepresentation in the media have perpetuated current stereotypical perceptions of the disorder. Consequently, misconceptions about epilepsy serve to propagate discrimination and stigma toward people with the condition. The myths that surround epilepsy will be explored emphasising how misconception, discrimination and stigma affect the quality of life of people with the condition. Myths, stigma and stereotypes can result in multiple interrelated psychosocial outcomes which can impede the cohesive integration of people with epilepsy in society. The impact of these factors on important psychosocial outcomes such as self esteem, depression, anxiety, employability, opportunities for social interaction and interpersonal relationships will be discussed. The chapter will explore these outcomes highlighting how society can be effective in engendering positive attitudes towards people with epilepsy. To conclude, educational interventions aimed at people with epilepsy, their families, employers, teachers and society at large will be considered along with future research suggestions with a view to reduce the impact of stigma and improve the social functioning of people with epilepsy