Xu Ying, Neuen Dennis R, Glozier Nick, Nikpour Armin, Somerville Ernest, Bleasel Andrew, Ireland Carol, Anderson Craig S, Hackett Maree L
The George Institute for Global Health, Faculty of Medicine, University of New South Wales, 83-117 Missenden Road, Camperdown, NSW 2050, Australia; School of Public Health, Faculty of Medicine and Health, Edward Ford Building (A27) Fisher Road, University of Sydney, NSW 2006, Australia.
The George Institute for Global Health, Faculty of Medicine, University of New South Wales, 83-117 Missenden Road, Camperdown, NSW 2050, Australia; Wagga Wagga Rural Clinical School, School of Medicine Sydney, University of Notre Dame Australia, 40 Hardy Avenue, Wagga Wagga, NSW 2650, Australia.
Clin Neurol Neurosurg. 2019 Apr;179:60-65. doi: 10.1016/j.clineuro.2019.02.022. Epub 2019 Feb 28.
To determine the patterns and predictors of disability over the first 12 months after a diagnosis of epilepsy.
The Sydney Epilepsy Incidence Study to Measure Illness Consequences (SEISMIC) was a prospective, multicenter, community-based study of people with newly diagnosed epilepsy in Sydney, Australia. Disability was assessed using the World Health Organization's, Disability Assessment Schedule (WHODAS) 2.0 12-item version, at baseline (i.e. within 28 days of diagnosis) and 12 months post-diagnosis. Demographic, socioeconomic, clinical and epilepsy-related data, obtained through structured interviews, were entered into multivariable linear regression and shift analysis to determine predictors of greater disability.
Of 259 adults (≥18 years), 190 (73%) had complete WHODAS at baseline (mean ± SD scores 4 ± 6) and follow-up (4 ± 8). After adjustment for age, sex and co-morbidity, greater overall disability at 12 months was associated with lower education (P = 0.05), economic hardship (P = 0.004), multiple antiepileptic medications (P = 0.02) and greater disability (P < 0.001) at the time of diagnosis; these variables explained 38.3% of the variance. Among the 12 WHODAS items, "being emotionally affected by health problems" was the most frequent disability problem identified at both time points (all P < 0.0001). The proportion of participants without problems in that domain improved over 12 months (from 24% to 50%, P < 0.0001), whereas the other 11 items remained relatively stable. Independent baseline predictors of a worse emotional outcome at 12 months were severe/extreme emotional distress (odds ratio [OR] 4.52, 95% confidence intervals [CI] 1.67-12.24), economic hardship (OR 2.30, 95% CI 1.24-4.25) and perceived stigma (OR 2.02, 95% CI 1.03-3.93).
Most people report problems with emotional health after a diagnosis of epilepsy but many recover over the next 12 months. Services addressing the social and psychological impact of diagnosis may be needed to improve outcome.
确定癫痫诊断后最初12个月内残疾的模式及预测因素。
悉尼癫痫疾病后果测量发病率研究（SEISMIC）是一项针对澳大利亚悉尼新诊断癫痫患者的前瞻性、多中心、基于社区的研究。在基线时（即诊断后28天内）及诊断后12个月，使用世界卫生组织残疾评估量表（WHODAS）2.0的12项版本评估残疾情况。通过结构化访谈获得的人口统计学、社会经济、临床及癫痫相关数据，被纳入多变量线性回归和移位分析，以确定残疾程度加重的预测因素。
259名成年人（≥18岁）中，190名（73%）在基线时（平均±标准差得分4±6）及随访时（4±8）完成了WHODAS评估。在对年龄、性别和合并症进行调整后，12个月时总体残疾程度加重与低教育水平（P = 0.05）、经济困难（P = 0.004）、多种抗癫痫药物治疗（P = 0.02）以及诊断时残疾程度较重（P < 0.001）相关；这些变量解释了38.3%的方差。在WHODAS的12项中，“受健康问题的情绪影响”是两个时间点上最常见的残疾问题（所有P < 0.0001）。该领域无问题的参与者比例在12个月内有所改善（从24%增至50%，P < 0.0001），而其他11项保持相对稳定。12个月时情绪结果较差的独立基线预测因素为严重/极度情绪困扰（优势比[OR] 4.52，95%置信区间[CI] 1.67 - 12.24）、经济困难（OR 2.30，95% CI 1.24 - 4.25）和感知到的耻辱感（OR 2.02，95% CI 1.03 - 3.93）。
大多数人在癫痫诊断后报告有心理健康问题，但许多人在接下来的12个月内康复。可能需要提供针对诊断的社会和心理影响的服务以改善结果。
