Comparative study of clinical profile and presumptive stressful life events in patients of psychogenic non epileptic seizure and epileptic seizure: a cross sectional study

Background:Psychogenic Non Epileptic Seizure (PNES) is one of the most common conditions to be mistaken for epilepsy. No clinical feature is pathognomic of PNES, but some help in distinguishing it from epileptic seizure. Role of psychologically stressful events has been considered central to the pathogenesis of PNES and used in differentiating it from epileptic seizure. The purpose of present study was to compare the clinical profile and number of stressful life events in the two patient groups in Indian population.  Methods:50 new patients of epileptic seizure and PNES each, aged 16 to 60 visiting the psychiatric and neurology OPD were selected. Detailed history and physical examination was carried out to exclude any medical illness. Diagnosis was made based on clinical history given by an eye witness and EEG recording. Brain imaging (CT/MRI) was conducted, to rule out any secondary causes of seizure. General health questionnaire 12, and presumptive stressful life event scale was applied on all patients. SPSS 19 was used for data analysis. Chi square was used for categorical data and Man Whitney U test for continuous data.  Results:There were significantly more females in the PNES group (P = 0.001) and significantly more illiterate (P = 0.004) .There were no significant difference with regard to the age of onset, marital status. Also there was no statistically significant difference between the two group with regard to number of stressful life event (P = 0.330).  Conclusion:Stressful life event should not bias a clinician towards making a diagnosis of PNES.

High burden and frailty: association with poor cognitive performance in older caregivers living in rural areas

Introduction: Older caregivers living in rural areas may be exposed to three vulnerable conditions, i.e., those related to care, their own aging, and their residence context. Objective: To analyze the association of burden and frailty with cognition performance in older caregivers in rural communities. Method: In this cross-sectional survey, 85 older caregivers who cared for dependent elders were included in this study. Global cognition (Addenbrooke's Cognitive Examination – Revised; Mini Mental State Examination), burden (Zarit Burden Interview) and frailty (Fried's frailty phenotype) were assessed. All ethical principles were observed. Results: Older caregivers were mostly women (76.7%); mean age was 69 years. Cognitive impairment was present in 15.3%, severe burden in 8.2%, frailty in 9.4%, and pre-frailty in 52.9% of the older caregivers. More severely burdened or frail caregivers had worse cognitive performance than those who were not, respectively (ANOVA test). Caregivers presenting a high burden level and some frailty degree (pre-frail or frail) simultaneously were more likely to have a reduced global cognition performance. Conclusion: A significant number of older caregivers had low cognitive performance. Actions and resources to decrease burden and physical frailty may provide better cognition and well-being, leading to an improved quality of life and quality of the care provided by the caregivers