Faculty Bibliography

The International League Against Epilepsy defines epilepsy as at least 2 unprovoked seizures more than 24 hours apart. It is a wide-reaching and complex illness affecting more than 70 million people worldwide and can take on a variety of forms, patterns, and severities. Geographic differences in the illness are often related to its etiology. A host of endemic illnesses and parasitic infections can lead to epilepsy syndromes. Management varies by region due to the availability of diagnostic modalities and medications. Treatment gaps in epilepsy care often are related to social and cultural factors that must also be understood.

The current study examined whether negative illness perceptions help explain the link between depression and quality of life. Seventy patients with epilepsy completed standardized self-report questionnaires measuring depression, illness perception, and quality of life (QOL). Illness perception statistically mediated the relationship between depression and QOL (Indirect effect (CI; confidence interval) = -.72, lower limit = -1.7, upper limit = -.22, p < .05). Results held with and without adjusting for potential confounding variables (age, sex, ethnicity, income, and seizure frequency) and when operationalizing depression as a continuous variable that indexed severity of symptoms or as a dichotomous variable that indexed criteria consistent with a diagnosis of major depressive disorder. This study is the first to suggest that illness perceptions may be a useful target in screening and intervention approaches in order to improve QOL among low-income, racially/ethnically diverse patients with epilepsy.

The current study examined psychosocial correlates of medication adherence in a socioeconomically and racially diverse sample of patients with epilepsy. Fifty-five patients with epilepsy completed standardized self-report questionnaires measuring depression, stress, social support, and medication and illness beliefs. Antiepileptic drug (AED) adherence was measured using the 8-item Morisky Medication Adherence Scale 36% reported poor adherence. We tested which psychosocial factors were independently and most strongly associated with AED adherence. Stress and depression were negatively correlated with adherence, while perceived social support was positively correlated with adherence (Ps<.05). When all three of these variables and relevant covariates in a multiple regression model were included, only perceived social support remained a significant predictor of adherence (P=.015). This study is one of the first to suggest the importance of targeting social support in screening and intervention approaches in order to improve AED adherence among low-income, racially/ethnically diverse patients with epilepsy.

Objetive: We report a unique case of a 60-year-old man with ictal whistling after being injured in a serious motorcycle accident. Methods: Clinical presentation, neurologic examination, neuroimaging, video-EEG (electroencephalogram) analysis, and therapeutic options were defined. A review of relevant literature was also performed. Case summary: Our patient experienced frequent complex partial seizures after the head trauma. His neurologic examination was nonfocal. Magnetic resonance imaging of the brain did not reveal any lesion. Video-EEG captured 2 stereotyped complex partial seizures with a rare ictal vocalization, ictal whistling. The ictal onset showed poorly sustained diffuse bitemporal theta-delta rhythms, which made it difficult to determine lateralization from the scalp EEG but favored possible right hemispheric onsets. Conclusions: Ictal vocalizations are common in temporal lobe epilepsy, though ictal whistling has been reported in both frontal and temporal lobe cases. The very few reported cases show a strong male predominance. Clear lateralization at ictal onset was not possible in our patient, but peri-ictal and interictal discharges suggested possible right temporal lobe focus.