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

Wang, Yuena; Hou, Dongyu; Wu, Xiaohua; Qiu, Lili; Chen, Hong; Xin, Jianxia; Yan, Zhirong; Sun, Meiling

doi:10.1590/1414-431X20209000

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Brazilian Journal of Medical and Biological Research

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Research Article • Braz. J. Med. Biol. Res. 53 (9) • 2020 • https://doi.org/10.1590/1414-431X20209000 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

Refractory temporal lobe epilepsy and mesial temporal sclerosis; Cortico-amygdalohippocampectomy; Caregiver intensive education program; Anxiety; Depression; Quality of life

Themes	Description of contents
1. Basic knowledge
	(i) causes and pathophysiology of epilepsy and different types of seizures
	(ii) prevalence and incidence of epilepsy
	(iii) famous people with epilepsy and what they had achieved
	(iv) important diagnostic tests including electroencephalography and magnetic resonance imaging
	(v) pre-seizures symptoms, post-seizures developments, and occurrence
	(vi) importance of an accurate observation, documentation, and description of seizures
2. Therapy
	(i) major aspects of therapy, such as current treatments, aims of therapy, the need for active cooperation
	(ii) therapy efficacy assessment
3. Drug management
	(i) overview of antiepileptic drugs (AEDs)
	(ii) options of drugs
	(iii) guidelines for pharmacotherapy
	(iv) importance of long-term, regular medicine use
	(v) administration of adverse events by AEDs
4. Prognosis
	(i) chances of entering remission
	(ii) chances and risks of discontinuation of AEDs after achieving seizures control
	(iii) possibilities and strategies in the case of continuing seizures
5. Prevention
	(i) recognition and avoidance of individual seizures-provoking factors
	(ii) attention should be paid to the precursors before seizures
6. Seizures management
	(i) better ways to cope with epilepsy
	(ii) safety treatment measures after epileptic seizures of patients
	(iii) necessary equipment to prevent accidents
7. Appropriate exercise
	(i) influence of epilepsy on the personality of patients
	(ii) persist in exercise and matters needing attention in exercise
8. Psychological care
	(i) influence of epilepsy on the personality of patients
	(ii) symptoms of stress
	(iii) coping with anxiety or depression
	(iv) building confidence for patients
9. Psychosocial support
	(i) importance of family companionship, understanding, and care
	(ii) importance of recognition and acceptance form friends and social contacts
10. Lifestyle
	(i) development a healthy and nutritious diet for patients
	(ii) strategies to help patients quit smoking and drinking
11. Social activity and life
	(i) meaningful social activities contributing to keep patients optimistic and positive
	(ii) support for professional life
12. Relationships
	(i) overview of relationships
	(ii) management of relationships after epilepsy occurrence

Characteristics	CIEP group (n=45)	Control group (n=45)	P value
Patients
Age at surgery (years), mean±SD	37.9±10.9	40.3±12.3	0.330
Gender, n (%)			0.290
Female	22 (48.9)	27 (60.0)
Male	23 (51.1)	18 (40.0)
Marital status, n (%)			0.512
Married	30 (66.7)	27 (60.0)
Single	15 (33.3)	18 (40.0)
Highest education, n (%)			0.296
Primary school or less	10 (22.2)	11 (24.4)
High school	18 (40.0)	21 (46.7)
Undergraduate	15 (33.3)	8 (17.8)
Graduate or above	2 (4.5)	5 (11.1)
Employment status, n (%)			0.803
Employed	34 (75.6)	35 (77.8)
Unemployed	11 (24.4)	10 (22.2)
Age at epilepsy onset (years), mean±SD	10.5±7.8	11.7±6.9	0.431
Disease duration (years), mean±SD	27.4±9.2	28.6±9.5	0.553
Family history of epilepsy, n (%)	10 (22.2)	10 (22.2)	1.000
Family history of psychiatric disorders, n (%)	6 (13.3)	5 (11.1)	0.748
Complications, n (%)
Hypertension	5 (11.1)	6 (13.3)	0.748
Hyperlipidemia	4 (8.9)	5 (11.1)	0.725
Diabetes	2 (4.5)	2 (4.5)	1.000
Seizure frequencies (times per month), mean±SD	5.6±1.7	6.0±1.7	0.277
Presence of febrile seizures, n (%)	3 (6.6)	7 (15.6)	0.180
Presence of left-sided MTS, n (%)	28 (62.2)	30 (66.7)	0.660
Disorganized VEEG background activity, n (%)	9 (20.0)	13 (28.9)	0.327
Asymmetric VEEG background activity, n (%)	9 (20.0)	10 (22.2)	0.796
Contralateral slow-waves on VEEG, n (%)	10 (22.2)	12 (26.7)	0.624
Contralateral epileptiform discharges on VEEG, n (%)	10 (22.2)	13 (28.9)	0.468
Caregivers
Age (years), mean±SD	45.0±11.6	43.8±10.0	0.588
Gender, n (%)			0.673
Female	25 (55.6)	23 (51.1)
Male	20 (44.4)	22 (48.9)
Highest education, n (%)			0.680
Primary school or less	6 (13.3)	3 (6.6)
High school	18 (40.0)	22 (48.9)
Undergraduate	16 (35.6)	16 (35.6)
Graduate or above	5 (11.1)	4 (8.9)
MMSE score, mean±SD	28.8±0.6	28.6±0.7	0.227

Items	CIEP group (n=45)	Control group (n=45)	P value
HADS-A score, mean±SD	7.0±3.1	7.1±3.7	0.878
Anxiety patients, N (%)	20 (44.4)	19 (42.2)	0.832
Anxiety severity, N (%)			0.302
Mild	16 (35.6)	12 (26.7)
Moderate	2 (4.5)	5 (11.1)
Severe	2 (4.5)	2 (4.5)
HADS-D score, mean±SD	6.4±3.0	6.5±3.3	0.788
Depression patients, N (%)	12 (26.7)	12 (26.7)	1.000
Depression severity, N (%)			0.781
Mild	8 (17.8)	8 (17.8)
Moderate	4 (8.9)	2 (4.5)
Severe	0 (0.0)	2 (4.5)
QOLIE-31 score, mean±SD	53.1±13.9	53.4±12.8	0.931

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[1] Correspondence: Meiling Sun: <meidenglanf@163.com>