3 articles
Adult epilepsy generates a burden that extends beyond seizure counts and includes adverse treatment effects, role restriction, emotional distress, and the social devaluation attached to the diagnosis. The methodological problem is not the absence of patient-reported measures, but the heterogeneity with which disease-specific quality-of-life and stigma instruments are selected, interpreted, and combined in adult studies.
A structured narrative methodological review was conducted using PubMed/MEDLINE, Scopus, Web of Science, Embase, Cochrane Library, and the institutional repository of the Nicolae Testemițanu State University of Medicine and Pharmacy. The synthesis focused on the Quality of Life in Epilepsy Inventory family, especially the 89-, 31-, 31-P, and 10-item forms, the adolescent 48-item comparator, and adult epilepsy stigma measures such as the Epilepsy Stigma Scale (ESS) variants, the Stigma Scale of Epilepsy (SSE), and the Epilepsy Self-Stigma Scale (ESSS). Special attention was given to publications from the Republic of Moldova and Romania because regional evidence is sparse but clinically relevant.
QOLIE-31 emerged as the most defensible adult comparative instrument because it balances breadth, feasibility, and international comparability. QOLIE-31-P was particularly useful for patient-centred and real-world designs, while QOLIE-10 served primarily as a screening instrument and QOLIE-89 retained value for comprehensive psychometric work. The 48-item version was methodologically informative but remained adolescent-oriented rather than a primary adult endpoint. Across the stigma literature, ESS, SSE, and ESSS were clearly not interchangeable because they capture overlapping but distinct constructs, including perceived stigma, felt stigma, and internalized self-stigma.
The working hypothesis was supported across international, regional, and Moldovan sources: the greater the clinical and psychosocial severity of epilepsy, the lower the epilepsy-specific quality of life. Seizure frequency, uncontrolled or drug-resistant epilepsy, polytherapy, adverse medication effects, depression, anxiety, and stigma were the most recurrent determinants of lower scores. For adult studies intended for Moldovan settings and the MJHS submission, QOLIE-31 or QOLIE-31-P, combined with one clearly defined stigma scale and a standardized set of severity variables, offers the strongest methodological balance.
In attempt to find an answer regarding the possible scenarios of epilepsy evolution in women of reproductive age (e.g. worsening, remission, antiepileptic drug resistance, status epilepticus occurence), preferably - objective, based on simple, replicable, observable indicators that can be included in a mathematical probability estimation model, could significantly improve their quality of life and increase the effectiveness of prescribed treatments.
Bidirectional, cohort, descriptive-analytical study, conducted between 2016-2020. Primary data were collected in the Diomid Gherman Institute of Neurology and Neurosurgery, the State Hospital of Republic of Moldova and the Excellence Private Medical Institution. Out of 366 unique parameters, which were recorded in the 159 patients enrolled in the study at each visit (total, 4 documentation visits over 5 years period), 10 parameters were selected for multivariate analysis, considered relevant for predicting clinically significant outcomes. Criteria for parameter relevance were: reaching p≤0.1 in univariate analysis, easy documentation. Subsequently, testing for multicollinearity (calculation of variance inflation factor) and the contribution of each parameter in the formula was performed using the Akaike informativeness criteria. The performance of the developed predictive models was expressed by the area under the ROC curve, positive and negative prognostic power. Statistical analysis: GraphPad Prism, v. 9 trial (Graph Pad Software, Boston, USA).
Age at onset of the disease 14.0±6.3 years; age at first referral to specialist 24.0±7.2 years. The developed predictive model, based on 3 parameters (depressive state, annual frequency of seizures, presence of brain lesions on MRI) has a positive predictive value of 83%, negative of 62%, with an area under the ROC curve of 0.72 (95%CI = 0.56 to 0.88) and a probability of occurrence of 96%.
Depressed patients with documented structural lesions on MRI and a high frequency of epileptic seizures have a progressive, significant risk (an OR of 5.3-24.0) of developing resistance to antiepileptic drugs.
Peripheral biomarkers have numerous uses in the treatment, prognosis, and pharmacovigilance of epilepsy. Unfortunately, no peripheral biomarker has demonstrated proven efficacy, although several options are being investigated. In this article, we want to analyze the main areas in which peripheral biomarkers can present their usefulness, including participation in the processes of inflammation, dysfunction of the blood-brain barrier, changes in metabolism, hormones, and growth factors.
Publications on diagnostic biomarkers of epilepsy were reviewed. References were identified by PubMed, MEDLINE and Scopus search until June 2022, with various combinations of the terms – „epilepsy”, „seizures”, „epileptogenesis”, „biomarkers”, „neuroimaging”, „inflammation”, „status epilepticus”, „prognosis”. A qualitative and analytical study was performed focused on primary studies published in 2020-2022. More than 85 sources were identified and 33 were selected for analysis from the PubMed, MEDLINE, and Scopus online databases. 12 articles, 5 clinical trials, 2 meta-analyses, 7 reviews, and 7 systematic reviews were identified.
Screening articles from online databases according to the search criteria, we found 258 titles on molecular and cellular biomarkers in epilepsy highlighted. The final bibliography included 33 sources that summarized that biomarkers of epileptogenesis are expensive and difficult to research, but the identification of biomarkers specific to the entire epileptogenic process, in close proximity to neuronal damage, have demonstrated the possibility of predicting the risk of seizures, epilepsy and resistance to treatment.
Epilepsy remains a continuous area of research; a special role is occupied by specific biomarkers of great clinical importance, being necessary for the prognosis of the disease, the risk of neurological sequelae, refractory to anti-epileptic drugs. Thus, their identification could have a significant impact on the clinical course of the disease.