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Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology
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Page 1: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Clinical Epilepsy: Syndromes, Causes, and Effects

Russell M. Bauer, Ph.D.

Department of Clinical & Health Psychology

Page 2: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

2

Seizures vs Epilepsy

Definition: the clinical manifestation of an abnormal and excessive excitation of a population of cortical neurons

Incidence: approximately 80/100,000 per year

Lifetime prevalence: 9% (1/3 benign febrile convulsions)

Definition: a tendency toward recurrent seizures unprovoked by systemic or neurologic insults

Incidence: approximately 45/100,000 per year Approximately 181,000 people will experience seizures or develop epilepsy each year

Point prevalence: 0.5-1% (2.5 million)14 years or younger

13% 15 to 64 years

63%65 years and older

24%

Cumulative risk of epilepsy through 74 years old: 1.3% - 3.1%

Seizures Epilepsy

Page 3: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

3

Partial (focal) Seizures• Simple Partial Seizure

– no loss of awareness

• Complex Partial Seizure– Impaired consciousness/ level of awareness (staring)– Clinical manifestations vary with origin & degree of spread

– Presence and nature of aura

• Temporal lobe: smell, epigastric sensation, deja vu

– Automatisms (manual, oral)

– Other motor activity

Frontal: bicycling and fencing posture

– Duration (typically 30 seconds to 3 minutes)

– Amnesia for event

• Partial Seizure with Secondary Generalization

Page 4: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Localization of Partial Seizure Focus

70%70% 10%10%

20%20%

Page 5: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Temporal Lobe Complex Partial Seizure

Rhythmic 5-7 Hz theta from the mesial temporal lobeRhythmic 5-7 Hz theta from the mesial temporal lobe

Page 6: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

6

Primarily Generalized Seizures• Absence

– Typical (3 Hz spike and wave)– Atypical (2.5 to 4.5 Hz spike and wave, polyspike)– Brief staring (<30sec); automatisms rare; not post-ictal confusion

• Myoclonic– Brief, shock-like muscle contractions

- Head- Upper extremities

– Usually bilaterally symmetrical– Consciousness preserved– Precipitated by awakening or falling asleep– May progress into clonic or tonic-clonic seizure– May be associated with a progressive neurolgic deterioration– Juvenile Myoclonic Epilepsy (JME)

• Polyspike wave• Onset late adolescence• Chromosome 6p

– Progressive Myoclonic Epilepsies

• Atonic/ Tonic/ Tonic-Clonic

Page 7: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Absence Seizure3 Hz spike and wave

Page 8: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Seizure vs Epilepsy

Seizures

CardiovascularDrug relatedSyncopeMetabolic (glucose, Na, Ca, Mg)Toxic (drugs, poisons)PoisonInfectiousFebrile convulsionsNonepileptic seizuresAlcohol/drug withdrawalSubstance abusePsychiatric disordersSleep disorders (parasomnias, cataplexy)

Nonepileptic Epilepsy(recurrent seizures)

Idiopathic(primary)

Symptomatic(secondary)

Page 9: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

9

Epidemiology of Seizures and Epilepsy

0

10

20

30

4050

60

70

80

90

0 10 20 30 40 50 60 70 80Age

Inci

den

ce p

er 1

00,0

00

Partial

Generalized tonic-clonic

Primary Generalized

Epilepsy: Incidence Rates by Seizure TypeEpilepsy: Incidence Rates by Seizure Type

Data from Rochester, Minn (1935-1979). Adapted with permission from Annegers JF. In: The Treatment of Epilepsy: Principles and Practice. 2nd ed. Baltimore, Md: Williams & Wilkins; 1997:165-172.

Hauser et al, 1992

Ramsay RE, et al. Neurology. 2004;62(5 suppl 2):S24-S29

Hemorrhage2%

Head Trauma7%

Other*19%

Atherosclerosis

15%

Cerebral Infarct

33%

Unknown24%

CHI5%Con

4%

Id85%

D1%

N4%

V1%

Inf0%

.* Includes known etiologies such as arteriovenous malformation and venous angioma.

Page 10: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Seizure Precipitants

Low (less often high) blood glucose

Low sodium

Low calcium

Low magnesium

Stimulant or other proconvulsant toxicity (i.e., cocaine)

Sedative (i.e., valium or alcohol) withdrawal

Severe sleep deprivation

Page 11: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

EEG Abnormalities

•Background abnormalities

-Significant asymmetries and/or degree of slowing inappropriate for clinical state

•Transient abnormalities associated with seizures

-Spikes (< 70 m sec)

-Sharp waves (~70 – 200 msec)

-Spike-wave complexes

•May be focal, lateralized or generalized

Page 12: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

EEG Abnormalities

Page 13: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Treatment of New Onset Epilepsy

Kwan P, Brodie MJ. N Engl J Med 2000; 342: 314-9.

Sz -fre e w/ 1st AED47%

Sz -fre e w/ 3rd AED/Polythe rapy

4%

Sz -fre e w/ 2nd AED13%

Re fractory/Pharm acore si stan t

36%

S z-free w/ 1st AED

S z-free w/ 2nd AED

S z-free w/ 3rd AED/Polytherapy

Refractory/Pharmacoresistant

Page 14: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Kwan and Brodie. NEJM 2000; 342: 314-319.Mohanraj and Brodie. Epil Behav 2005; 6: 382-387

Page 15: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Kwan and Brodie. NEJM 2000; 342: 314-319.Mohanraj and Brodie. Epil Behav 2005; 6: 382-387

Page 16: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Rational Use of AEDs: All PrescriptionsMarket Dynamics for All Indications and Epilepsy

TOPAMAX14.8%

TRILEPTAL8.0%

LAMICTAL8.1%

GABITRIL1.8%

ZONEGRAN2.1%

KEPPRA4.7%

NEURONTIN60.6%

0

50000000

100000000

150000000

200000000

250000000

300000000

350000000

400000000

450000000

Second Gen. AEDs First Gen. AEDs

27%

44%

9%

5%

15%

Epilepsy

Psychiatric d/ o's

Pain disorders

Headache/ migraineOther

0

10

20

30

40

50 Carbamazepine Depakote DRDepakote ER Depakote sprinklesKeppra LamictalNeurontin PhenytoinTopomax Trileptal

AE

D P

resc

rip

tio

n V

olu

me

(%)

AE

D P

resc

rip

tio

n V

olu

me

(%)

Age Group (years)PharMetrics. April 2002 to June 2003. Source: IMS NPA, Dec. 2003MAT 03/2004

0-17 18-34 35-44 45-54 55-64 0-17 18-34 35-44 45-54 55-64 >>65 65

Page 17: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

“All substances are poisons; there is none which is not a poison. The right dose differentiates a poison from a remedy.”

Paracelsus (1493-1541)

Page 18: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Summary of Serious and Non-serious Adverse Events of the Newer AEDs

AED Serious Adverse Events Nonserious Adverse Events

Gabapentin None Weight gain, peripheral edema, behavioral changes

Lamotrigine Rash, including Stevens Johnson and toxic epidermal necrolysis (increased risk for children, also more common with concomitant valproate use and reduced with slow titration); hypersensitivity reactions, including risk of hepatic and renal failure, DIC, and arthritis

Tics and insomnia

Levetiracetam None Irritability/behavior change

Oxcarbazepine Hyponatremia (more common in elderly), rash None

Tiagabine Stupor or spike wave stupor Weakness

Topiramate Nephrolithiasis, open angle glaucoma, hypohidrosis (predominantly children)

Metabolic acidosis, weight loss, language dysfunction

Zonisamide Rash, renal calculi, hypohidrosis (predominantly children)

Irritability, photosensitivity, weight loss

Page 19: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Rational Use of AEDsSo Why Should Prescribing Practices Change?

Patients often required long term (or lifetime) treatment due to driving status

State of Florida *15A-5.004 Neurological Guidelines for Applicants with Seizures (*the following changes to the seizure guidelines became effective in August 1992 and have been used as policy since that date)

1. Applicants and licensed drivers should be seizure free for a period of 2 years before being approved for licensing; but if under regular medical supervision, may apply at the end of 6 months for review by the Medical Advisory Board. “Petit mal” or absence seizures and partial seizures with complex symptomology will also follow these guidelines. The isolated seizure with a normal EEG may be reviewed after 3 months.

2. Applicants and licensed drivers who have been approved after 6 months seizure free may be required to submit follow-up reports at the end of 1 year from the date of approval.

3. Applicants and licensed drivers who have a chronic recurring seizure disorder (or who have been treated for such for 1 year) and medications have been discontinued will not be licensed to drive during the period of drug withdrawal and for a period of 3 months following complete cessation of treatment. If the patient has seizures during this period, licensing may be considered after a 3 month seizure free interval upon return to adequate therapy.

4. If there is a question about the seizure type or the medications the applicant of licensed driver is on, it is the prerogative of the Medical Advisory Board to question the treating physician further in an effort to clarify the nature of the seizures.

5. Blood levels below therapeutic levels are to be considered on an individual basis.

6. Applicants and licensed drivers with only chronic nocturnal seizures will be considered on an individual basis.

7. Applicants and licensed drivers with syncopal episodes who have no clear diagnosis established will be considered on an individual basis

Page 20: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Treatment/Evaluation Sequence for Pharmacoresistent Epilepsy

1st Monotherapy AED Trial

2nd Monotherapy AED Trial

Epilepsy Surgery/VNS Therapy/Neuropace Evaluation

Resective Surgery Stimulator Therapy

3rd Monotherapy/Polytherapy AED Trial

Polytherapy AED Trials

4%

13%47%

36%

Sz-free with 1st AED

Sz-free with 2nd AED

Sz-free with 3rdAED/P olytherapyP harmacoresistant

Kwan P, Brodie MJ. NEJM;342:314-319.

Strongly consider videoEEG Monitoring

Epilepsy

Psychogenic, migraine, syncope, sleep disorders, movement disorder’s, etc.

Non-epileptic

Page 21: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Other Treatments of Epilepsy

• Medical– Experimental AED trials– Ketogenic diet

• Surgical– Resective– Multiple Subpial Transection– Vagal Nerve Stimulator

• Experimental– Thalamic Stimulators– Stereotactic Radiosurgery– Responsive Neurostimulators

Page 22: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Evaluation for Surgery- Neuroimaging

MRI -hippocampal volumetrics

greater than ~0.5cc difference increases chances for seizure remission

-1.5 mm coronal cuts with sequences sensitive to gray-white differentiation and to gliosis

-inversion recovery/high resonance for cortical dysplasia

PET

Ictal/interictal SPECT

MR SpectroscopyDecreased NAA (due to neuronal loss)

Normal to high Cho and Creatine (represents astrocytosis)

Page 23: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Epilepsy Surgery- Neuroimaging

Ganglioglioma Dysembryoplastic Neuroepithelial Tumor

AVM Cavernous AngiomaCortical Dysplasia

Hippocampal atrophy in temporal lobe epilepsy

Page 24: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Evaluation for Surgery- Subdural Grid Electrodes

Page 25: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Left Anterior Temporal Loectomy

Page 26: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Factors Affecting Adaptation in Epilepsy

Seizure-Related

Variables

Treatment-Related

Variables

Non–Seizure-Related

Variables

Page 27: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Factors Affecting Cognitive Function in Epilepsy

Seizure-Related

Variables

Treatment-Related

Variables

Non–Seizure-Related

Variables

Page 28: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

What Seizure Related Factors May Affect Cognition in Epilepsy?

EpileptiformActivity

SeizureSyndrome

SeizureBurden

(Duration,Frequency,

Status)

Onset Age Etiology

Page 29: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Seizure-Related Variables That May Affect Cognition and Behavior

EpileptiformActivity

SeizureSyndrome

Ageat

OnsetEtiology

SeizureBurden

(Duration,Frequency,

Status)

Page 30: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Epileptic Syndrome

• Some epilepsy syndromes are known to be associated with more adverse cognitive consequences than others. – Idiopathic Benign syndromes—e.g., BECTS

(Rolandic), absence– Adverse syndromes—e.g., Lennox-Gastaut – Variable syndromes—Localization related

epilepsies

Page 31: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Idiopathic Syndromes

Deficit Outcome

JMEMild executive

deficitsPresumed favorable

Generalized with absence or GTCS

Mild attentional deficits

Unknown

Centrotemporal spikes benign

Mild HeterogeneousMostly favorable (interictal abn)

Occipital epilepsy Mild Heterogeneous Unknown

Elger et al. (2004)

Page 32: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Adverse Syndromes

Deficit Outcome

CSWDSVariable (diffuse or

executive)Variable - duration

dependent

Landau KleffnerAuditory agnosia,

Expressive LanguageVariable – early onset

worse

West Syndrome Retardation, regression Poor, retardation

Lennox-Gastaut Retardation, declinePoor, retardation worse early onset

Elger et al. (2004)

Page 33: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Localization Related Syndromes

Deficit Outcome

FrontalExecutive function,

attention, speedUnknown

Temporal

Material-specific memory (executive 2º

gen), naming, achievement

Very slow deterioration

Parietal Occipital Unknown (variable)Unknown

(heterogeneous)

Elger et al. (2004)

Page 34: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Seizure-Related Variables That May Affect Cognition and Behavior

InterictalEpileptiform

Activity

EpilepticSyndrome

SeizureBurden

(Duration,Frequency,

Localization)

Ageat

OnsetEtiology

Page 35: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Adults with Childhood Seizure Onset

• Less Education• Decreased rates of employment• Lower rates of marriage• Poorer physical health• Increased incidence of psychiatric disorders

Jalava et al., 1997a,b,c, SillanpJalava et al., 1997a,b,c, Sillanpää (ää (1998)1998)

Page 36: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Total and Segmented Volumes(7.8 years vs. 23.3 years)

Hermann et al, Epilepsia 2002;43:1062-71

Page 37: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Total Lobar White Matter

Hermann et al, Epilepsia 2002;43:1062-71

Page 38: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Cause or Effect?

• Does white matter volume abnormality reflect neurodevelopmental abnormality associated with early insult to developing brain?

• Does early lesion affect subsequent normal development of white matter connectivity?

Page 39: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Age of Onset and Neuropsychological Outcome

Early Late Healthy(7.8 yr) (23.3 yr)

ControlsN 37 16 62FSIQ 90* 100 107Naming 47 52 55Verbal Mem 44 51 52NV Mem 46 55 62WCST PE 13 8 8

Hermann et al, Epilepsia 2002;43:1062-71

Page 40: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Childhood TLE Onset

• Generalized cognitive compromise• Reduction in cerebral volume, particularly white

matter (~6-12%)• Cerebral volume reduction not limited to temporal

lobe• Less focal impairment (e.g., memory)• Less surgical risk • Greater likelihood of functional reorganization (e.g.,

bilateral language, pathologic left handedness)

Page 41: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Seizure-Related Variables That May Affect Cognition and Behavior

EpileptiformActivity

SeizureSyndrome

SeizureBurden

(Duration,Frequency,

Localization)

Ageat

OnsetEtiology

Page 42: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Etiology• Individuals with known causes for their

epilepsy (e.g., head injuries, brain infections) typically have more detectable cognitive difficulties than those with no known etiology

Page 43: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Seizure-Related Variables That May Affect Cognition and Behavior

EpileptiformActivity

SeizureSyndrome

SeizureBurden

(Duration,Frequency,

Localization)

Ageat

OnsetEtiology

Page 44: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Seizure Burden

• Individuals with poorly controlled and severe seizures often have more detectable cognitive consequences than individuals with well-controlled and/or minor seizures

Page 45: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Cumulative Seizure Effects?(is epilepsy progressive?)

• Structural Imaging vs Behavior

• Cognitive and behavioral impairments present prior to treatment

• Newly diagnosed L TLE patients have verbal memory impairment

Äikiä, Äikiä, Epilepsy & BehaviorEpilepsy & Behavior (2001) (2001)

Äikiä , Äikiä , Epilepsy ResearchEpilepsy Research 1995;22:157-164 1995;22:157-164

Page 46: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Progressive Hippocampal Sclerosis

• Progressive hippocampal atrophy occurred only in patients with TLE and continuing seizures

• n=12 unilateral TLE• Repeat MRI=2.5-5.2 yr

Fuerst et al, Fuerst et al, Ann Neurol Ann Neurol 2003;53:413-62003;53:413-6

Page 47: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Neuropsychological Effects of Poorly Controlled Seizures

• 20 longitudinal studies in children-adults

• 12/20 reported relationship/decline

• 5/20 mixed results

• 3/20 no relationship

Dodrill, Dodrill, Epilepsy & Behavior Epilepsy & Behavior (2004)(2004)

Page 48: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Neuropsychological Effects of Seizures

• Decreased scores with higher number of seizures

• IQ lower with increased seizure frequency

• Greater performance “improvement” in controls than patients

• Losses seen beyond “memory”

Dodrill, Dodrill, Epilepsy & Behavior Epilepsy & Behavior (2004)(2004)

Page 49: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Cross-sectional TLE Neuropsychological Outcome

Jokeit et al, Jokeit et al, JNNPJNNP 1999;67:44-50 1999;67:44-50

Page 50: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Educational Attainment and Seizure Duration

Jokeit et al, Jokeit et al, JNNPJNNP 1999;67:44-50 1999;67:44-50

Page 51: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Epilepsy and Quality of Life

Page 52: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Seizures, Hypertension, Diabetes, and Seizures, Hypertension, Diabetes, and Heart Disease QoLHeart Disease QoL

Vickrey BG. Vickrey BG. Epilepsia.Epilepsia. 1994 1994;;35:597-60735:597-607

46

49

52

55

58

61

Seizure-freeAurasSeizures

Hypertension/ DiabetesHeart Disease

OverallQualityof Life

EmotionalWell-Being

SocialFunction

Role–Emotional

Energy/Fatigue

Pain Role–Physical

PhysicalFunction

HealthPerception

T-S

CO

RE

N = 166

Page 53: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Comparison of Average MonthlySeizure Rate to HRQOL

N = 194(r = -0.024,P = NS)

Gilliam F, et al. 2000Gilliam F, et al. 2000

QO

LIE

-89

Su

mm

ary

Sco

re

Average Monthly Seizure Rate0 305 15 20 25

100

0

80

60

40

20

10

Page 54: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

N = 194(r = -0.71,P<.0001)

Gilliam F, et al. 2000Gilliam F, et al. 2000

Relationship of Adverse Events to QOL Scores

20 30 40 50 60 70

100

80

60

40

20

0

QO

LIE

-89

Su

mm

ary

Sco

re

AEP Summary Score

Page 55: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Psychiatric Comorbidities

Epilepsy General Pop.(range) (range)

Depression 11%–60% 2%–4% Anxiety 19%–45% 2.5%–6.5% Psychosis 2%–8% 0.5%–0.7%

Profile of Mood States Depression Scale Score

50403020100

QO

LIE

-89

Su

mm

ary

Sco

re

100

80

60

40

20

0

r = -0.66r = -0.66p<0.0001p<0.0001

POMSPOMS

QO

LIE

-89

QO

LI E

- 89

Page 56: Clinical Epilepsy: Syndromes, Causes, and Effects Russell M. Bauer, Ph.D. Department of Clinical & Health Psychology.

Elger et al. (2004)

(non-modifiable) (modifiable)


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