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      An intensive education program for caregivers ameliorates anxiety, depression, and quality of life in patients with drug-resistant temporal lobe epilepsy and mesial temporal sclerosis who underwent cortico-amygdalohippocampectomy

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          Abstract

          This study aimed to investigate the effect of a caregiver intensive education program (CIEP) on anxiety, depression, and quality of life (QOL) in patients with drug-resistant temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS) who underwent cortico-amygdalohippocampectomy (CAH). Ninety patients with drug-resistant TLE-MTS who underwent CAH and their caregivers were recruited and randomly allocated to the CIEP group or control group as 1:1 ratio. Caregivers received the CIEP program or routine guidance/education (control group). Anxiety/depression and QOL in patients at month (M)0, M1, M3, and M6 were assessed by the Hospital Anxiety and Depression Scale (HADS) scale and the QOL in Epilepsy Inventory-31 (QOLIE-31), respectively. Treatment efficacy at M6 was assessed by Engel classification. The HADS-anxiety score at M3 (P=0.049) and M6 (P=0.028), HADS-anxiety score change (M6-M0) (P=0.001), percentage of anxiety patients at M6 (P=0.025), and anxiety severity at M6 (P=0.011) were all decreased in the CIEP group compared with the control group. The HADS-depression score at M6 (P=0.033) and HADS-depression score change (M6-M0) (P=0.022) were reduced, while percentage of depression patients at M6 (P=0.099) and depression severity at M6 (P=0.553) showed no difference in the CIEP group compared with the control group. The QOLIE-31 score at M6 (P=0.043) and QOLIE-31 score change (M6-M0) (P=0.010) were both elevated in the CIEP group compared with the control group. In conclusion, CIEP for caregivers contributed to the recovery of anxiety and depression as well as the improvement of QOL in patients with drug-resistant TLE-MTS who underwent CAH.

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          Most cited references19

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          Proposal for revised classification of epilepsies and epileptic syndromes. Commission on Classification and Terminology of the International League Against Epilepsy.

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            Kindling and status epilepticus models of epilepsy: rewiring the brain.

            This review focuses on the remodeling of brain circuitry associated with epilepsy, particularly in excitatory glutamate and inhibitory GABA systems, including alterations in synaptic efficacy, growth of new connections, and loss of existing connections. From recent studies on the kindling and status epilepticus models, which have been used most extensively to investigate temporal lobe epilepsy, it is now clear that the brain reorganizes itself in response to excess neural activation, such as seizure activity. The contributing factors to this reorganization include activation of glutamate receptors, second messengers, immediate early genes, transcription factors, neurotrophic factors, axon guidance molecules, protein synthesis, neurogenesis, and synaptogenesis. Some of the resulting changes may, in turn, contribute to the permanent alterations in seizure susceptibility. There is increasing evidence that neurogenesis and synaptogenesis can appear not only in the mossy fiber pathway in the hippocampus but also in other limbic structures. Neuronal loss, induced by prolonged seizure activity, may also contribute to circuit restructuring, particularly in the status epilepticus model. However, it is unlikely that any one structure, plastic system, neurotrophin, or downstream effector pathway is uniquely critical for epileptogenesis. The sensitivity of neural systems to the modulation of inhibition makes a disinhibition hypothesis compelling for both the triggering stage of the epileptic response and the long-term changes that promote the epileptic state. Loss of selective types of interneurons, alteration of GABA receptor configuration, and/or decrease in dendritic inhibition could contribute to the development of spontaneous seizures.
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              Development and Cross-Cultural Translations of a 31-Item Quality of Life in Epilepsy Inventory

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                Author and article information

                Journal
                Braz J Med Biol Res
                Braz. J. Med. Biol. Res
                bjmbr
                Brazilian Journal of Medical and Biological Research
                Associação Brasileira de Divulgação Científica
                0100-879X
                1414-431X
                17 July 2020
                2020
                : 53
                : 9
                : e9000
                Affiliations
                [1 ]Department of Neurosurgery, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
                [2 ]Department of Orthopedics, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
                [3 ]Department of Endocrinology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
                [4 ]Department of Nursing, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
                Author notes
                Correspondence: Meiling Sun: < meidenglanf@ 123456163.com >
                Author information
                https://orcid.org/0000-0002-9967-9628
                https://orcid.org/0000-0003-2482-7443
                https://orcid.org/0000-0002-2420-9568
                https://orcid.org/0000-0002-5375-9817
                https://orcid.org/0000-0003-1574-6801
                https://orcid.org/0000-0002-7338-6720
                https://orcid.org/0000-0002-5981-3263
                https://orcid.org/0000-0002-9637-2196
                Article
                00602
                10.1590/1414-431X20209000
                7372948
                32696820
                803d7efb-cf04-4033-9638-0280aaea2b9c

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 22 August 2019
                : 6 January 2020
                Page count
                Figures: 5, Tables: 3, Equations: 0, References: 23
                Categories
                Research Article

                refractory temporal lobe epilepsy and mesial temporal sclerosis,cortico-amygdalohippocampectomy,caregiver intensive education program,anxiety,depression,quality of life

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