The Effect of 5A Self-management Program on Medication Adherence of Epileptic Patients in During the COVID – 19 Pandemic

Background: Adherence to medication adherence plays a vital role in controlling the problems and complications of epilepsy. During the COVID – 19 pandemic and limitations of face-to-face education, the use of distance education can play an important role in providing education to patients. Therefore, the aim of this study is the effect of model 5A self-management training on medication adherence in epileptic patients.Methods: In this single-blind randomized controlled trial, 56 epilepsy patients referred to Shiraz Namazi Hospital were divided into intervention and control groups using random allocation. Thereafter, 5A self - management training sessions were virtually held in 5 sessions in WhatsApp application for intervention group. The data collection tool was Morisky medication adherence scale at two stages of before and two months after intervention. Data analysis was performed using SPSS 21 software.Results: The results of Wilcoxon test showed that in intervention group, the mean drug adherence in patients after intervention significantly increased compared to before intervention (p = 0.005). But in control group, this was not significant (p = 0.909). According to results of Mann-Whitney test, there was no significant difference between intervention and control groups before intervention (p = 0.632). However, by passing two months from intervention, a significant difference was found between intervention and control groups (p = 0.041).Conclusion: Based on results, the implementation of Model 5A can be effective on medication adherence in epilepsy patients. This program can be considered as a suitable method in epileptic patients in during COVID – 19 pandemic.

On-Site Biolayer Interferometry-Based Biosensing of Carbamazepine in Whole Blood of Epileptic Patients

On-site monitoring of carbamazepine (CBZ) that allows rapid, sensitive, automatic, and high-throughput detection directly from whole blood is of urgent demand in current clinical practice for precision medicine. Herein, we developed two types (being indirect vs. direct) of fiber-optic biolayer interferometry (FO-BLI) biosensors for on-site CBZ monitoring. The indirect FO-BLI biosensor preincubated samples with monoclonal antibodies towards CBZ (MA-CBZ), and the mixture competes with immobilized CBZ to bind towards MA-CBZ. The direct FO-BLI biosensor used sample CBZ and CBZ-horseradish peroxidase (CBZ-HRP) conjugate to directly compete for binding with immobilized MA-CBZ, followed by a metal precipitate 3,3′-diaminobenzidine to amplify the signals. Indirect FO-BLI detected CBZ within its therapeutic range and was regenerated up to 12 times with negligible baseline drift, but reported results in 25 min. However, Direct FO-BLI achieved CBZ detection in approximately 7.5 min, down to as low as 10 ng/mL, with good accuracy, specificity and negligible matric interference using a high-salt buffer. Validation of Direct FO-BLI using six paired sera and whole blood from epileptic patients showed excellent agreement with ultra-performance liquid chromatography. Being automated and able to achieve high throughput, Direct FO-BLI proved itself to be more effective for integration into the clinic by delivering CBZ values from whole blood within minutes.

Sleep quality and associated factors among adult patients with epilepsy attending follow-up care at referral hospitals in Amhara region, Ethiopia

Background Globally, epilepsy is the commonest neurological disorder in adults. It has significant health and economic consequences to the affected individuals and the family. There is ample evidence that epileptic patients are at increased risk of poor sleep quality than the general population. However, there is limited evidence on sleep quality among epileptic patients and associated factors in Ethiopia. Therefore, this study investigated the prevalence of poor sleep quality and associated factors among adult patients with epilepsy. Method Institutional based cross-sectional study was conducted among adult epileptic patients attending follow-up care at referral hospitals in the Amhara region. A total of 575 epileptic patients were recruited using a stratified systematic random sampling technique. An interviewer-administered semi-structured questionnaire and record review were used for data collection. To assess sleep quality the pretested Pittsburgh Sleep Quality Index (PSQI) tool was used. A binary logistic regression model was used to assess factors associated with poor sleep quality. Variables with a p-value less than 0.2 in the bivariable binary logistic regression analysis were considered for the multivariable binary logistic regression analysis. In the multivariable binary logistic regression analysis, the Adjusted Odds Ratio (AOR) with the 95% Confidence Interval (CI) were reported to declare the statistical significance and strength of association. Model fitness was assessed using the Hosmer-Lemeshow test and was adequate (p>0.05). Multicollinearity of the independent variables was assessed using the Variance Inflation Factor (VIF) and the mean VIF was less than 10. Results A total of 565 participants were enrolled in the study with a response rate of 98.3%. The prevalence of poor sleep quality among adult epileptic patients was 68.8% [95% CI: 64.8%, 72.5%]. In the multivariable binary logistic regression, being unable to read and write [AOR = 3.16, 95%CI: 1.53, 6.51], taking polytherapy treatment [AOR = 2.10, 95% CI: 1.37, 3.21], poor medication adherence [AOR = 2.53, 95%CI: 1.02, 6.23] and having poor support [AOR = 2.72, 95%CI: 1.53, 4.82] and moderate social support [AOR = 1.89, 95%CI: 1.05, 3.41] were significantly associated with higher odds of poor sleep quality. Conclusion and recommendation Poor sleep quality is a major public health concern in Ethiopia. The patient’s level of education, number of medication use, medication adherence, and social support were found significant predictors of poor sleep quality. These findings highlight improving medication adherence and social support are effective strategies to improve the sleep quality of epileptic patients. Besides, it is better to give special emphasis to those epileptic patients with a low level of education and taking polytherapy to enhance sleep quality.

An Atlas of the Quantitative Protein Expression of Anti-Epileptic-Drug Transporters, Metabolizing Enzymes and Tight Junctions at the Blood–Brain Barrier in Epileptic Patients

The purpose of the present study was to quantitatively elucidate the levels of protein expression of anti-epileptic-drug (AED) transporters, metabolizing enzymes and tight junction molecules at the blood–brain barrier (BBB) in the focal site of epilepsy patients using accurate SWATH (sequential window acquisition of all theoretical fragment ion spectra) proteomics. Brain capillaries were isolated from focal sites in six epilepsy patients and five normal brains; tryptic digests were produced and subjected to SWATH analysis. MDR1 and BCRP were significantly downregulated in the epilepsy group compared to the normal group. Out of 16 AED-metabolizing enzymes detected, the protein expression levels of GSTP1, GSTO1, CYP2E1, ALDH1A1, ALDH6A1, ALDH7A1, ALDH9A1 and ADH5 were significantly 2.13-, 6.23-, 2.16-, 2.80-, 1.73-, 1.67-, 2.47- and 2.23-fold greater in the brain capillaries of epileptic patients than those of normal brains, respectively. The protein expression levels of Claudin-5, ZO-1, Catenin alpha-1, beta-1 and delta-1 were significantly lower, 1.97-, 2.51-, 2.44-, 1.90- and 1.63-fold, in the brain capillaries of epileptic patients compared to those of normal brains, respectively. Consistent with these observations, leakage of blood proteins was also observed. These results provide for a better understanding of the therapeutic effect of AEDs and molecular mechanisms of AED resistance in epileptic patients.

Prevalence of Anxiety and Depression among Epileptic patients in selected Hospitals, Rohtak. Haryana

Background: Epilepsy is a common neurological condition associated with recurrent and unpredictable seizures associated with significant psychological and social consequences. People with epilepsy (PWE) are more vulnerable to psychiatric illnesses: rates of psychiatric illness are 9% higher among PWE than in the general population and rates of depression, 22% higher. Aim of the Study: to assess the prevalence of anxiety and depression among epileptic patients. Methodology: Non-experimental descriptive survey research design was adopted in this study. data were collected from 100 outpatients who were visiting Vashishtha Neuro Care in City Rohtak, Haryana. Convenience sampling technique was adopted to recruit samples. Data were collected through GAD – 7 Spitzer et al., (2006) and Neurological Disorder Depression Inventory for Epilepsy. (NDDI – E) David E Friedman (2009), Collected data were analysed by means of descriptive and inferential statistics. Results: An overwhelming majority of the samples mild 72 (72.00%) have mild level of anxiety. Similarly, with regard to depression an overwhelming majority of the samples mild 54 (54.00%) have mild level of depression. High correlation was there between anxiety and depression (r = 0.785). There was a statistically significant association between anxiety and residence (ꭓ2 = 7.451, ‘P’ value 0.024). Statistically significant associations were also present between depression and the demographic variables such as past history of medical illness, substance abuse and hospitalization. Conclusion: Our study findings revealed anxiety was more than depression among clients with epilepsy. There was also high correlation among the comorbidities. More attention should be paid to incorporating anxiety and depression screening and treatment into existing epilepsy programs and to revising treatment guidelines of epileptic clients.

Clinical Presentation of the Epileptic Patients at People Medical College Hospital, Nawabshah, Pakistan

Objective: study will determine clinical presentation, risk, and type of seizures in epileptic patients. Methodology: This observational study was conducted in Medicine department People Medical College Hospital (PMCH) Nawabshah from January 2020 to December 2020. 110 patients were included for study after informed permission of the patient or their relative. Male and female were selected. Known epileptic patients were included in the study, patients with false seizures were excluded from the study. Statically analysis was done by software SSPS 22 version. Results: Age ranged 18 to 60 years. All the patients included in the study epilepsy was noted. The mean age of patients was 37.40 SD 8.71 years. The minimum age was 28 years while maximum 60 years. Pearson Chi-Square Value 105.000a Asymp. Sig. (2-sided) .000, Likelihood Ratio Value 135.012 Asymp. Sig. (2-sided) .000, Linear-by-Linear Association Value 16.297 Asymp. Sig. (2-sided) .000 which were statistically significant. Conclusion: Epilepsy is treatable common neurological disease in Pakistan. quality of life can be improved by Education of the patients and their relatives, without socioeconomically burden.

Evaluation of Family functioning among parents of epileptic patients

Epilepsy has aggregate of risk characteristic’s as, age of onset, triggering factors, genetics, natural history, prognosis, and it is not a condition based on single aspect or cause. Due to social problems, family functioning of epileptic patients suffers badly. The basic purpose of the study is to investigate the role of family functioning of the parents who has epileptic patients. Methods: Across-sectional study was conducted at Muzaffargarh Hospital Neurology OPD department. Total 36 parents were enrolled. All parents of children, who have 8 to18 years of age, which are diagnosis of epilepsy, were included in current study Data was collected on a predesign questionnaire and for family functioning the Family Assessment Device (FAD) was used. Statistical analysis was performed by using the Statistical Package for Social Sciences (spss) version 26. The frequencies, proportions were calculated for Qualitative variables and Mean + SD were calculated for quantitative variables. Results: The mean age of parents was 38.58+7.55 and children were 12.31+3.34. Out of 36 participants 12(33.3%) were males whereas 24(66.7%) were females. Majority of parents were holding secondary degree 13(36.1%), were unemployed 24(66.7%), 21(58.3%) were from rural area and dealing with generalized seizure type children 24(66.7%). The average seizures frequency per month was 2.64+1.15. The families of epileptic patients were more dysfunctional, especially in terms of problem solving (2.66+0.43), behavior control (2.68+0.49), affective involvement (2.62+0.64) and also family’s faces difficulties in finding their role (2.48+0.56). Conclusion: The families of epileptic patients have more dysfunctional, especially in terms of problem solving, behavior control, affective involvement and also families faces difficulties in finding their role. Therefore educational programme focusing on the importance of family functioning should be provided so that the aspect of treatments and social life of patients get improved. Keywords: Epilepsy, Family functioning, Social Support, Family support

Clustering of Spontaneous Recurrent Seizures in a Mouse Model of Extended Hippocampal Kindling

Acute repetitive seizures or seizure clusters are common in epileptic patients. Seizure clusters are associated with a high risk of developing status epilepticus and increased morbidity and mortality. Seizure clusters are also recognizable in spontaneous recurrent seizures (SRS) that occur in animal models of epilepsy. The electrical kindling of a limbic structure is a commonly used model of temporal lobe epilepsy. Although classic kindling over the course of a few weeks does not generally induce SRS, extended kindling over the course of a few months can induce SRS in several animal species. SRS in kindled cats often occur in clusters, but the existence of seizure clusters in rodent models of extended kindling remains to be demonstrated. We explored the existence of seizure clusters in mice following extended hippocampal kindling. Adult male mice (C57BL/6) experienced twice daily hippocampal stimulations and underwent continuous 24-hour electroencephalogram (EEG)-video monitoring after ≥80 stimulations. SRS events were recognized by EEG discharges and associated motor seizures. Seizure clusters, defined as ≥4 seizures per cluster and intra-cluster inter-seizure intervals ≤ 120 min, were observed in 19 of the 20 kindled mice. Individual mice showed variable seizure clusters in terms of cluster incidence and circadian-like expression patterns. For clusters consisting of 4–7 seizures and intra-seizure intervals ≤ 20 min, no consistent changes in inter-seizure intervals, EEG discharge duration, or motor seizure severity scores were observed approaching cluster termination. These results suggested that seizure clustering represents a prominent feature of SRS in hippocampal kindled mice. We speculate that, despite experimental limitations and confounding factors, systemic homeostatic mechanisms that have yet to be explored may play an important role in governing the occurrence and termination of seizure clusters.