Papers by Savvas Papacostas
Epilepsy & Behavior, 2012
This study investigated aspects of psychosocial adjustment in epilepsy patients in Cyprus. Sixty-... more This study investigated aspects of psychosocial adjustment in epilepsy patients in Cyprus. Sixty-three patients under 55 years of age with idiopathic or symptomatic epilepsy and 89 neurologically matched healthy volunteers participated. Subjects completed the State and Trait Anxiety Inventory and the Beck Depression Inventory; patients with epilepsy also completed the Epilepsy Foundation Concerns Index. Results showed that patients with symptomatic epilepsy had significantly higher scores on state and trait anxiety and depressive symptoms. Sociodemographic characteristics including gender, marital status, and education levels contributed to differences in trait and state anxiety, depressive symptom scales, autonomy concerns, and fear for seizure recurrence. Variables such as poor seizure control and use of polytherapy were associated with lower adjustment scores and reduced psychosocial outcome. Finally, patients with epilepsy scored significantly higher on depression and anxiety symptoms. The results provide further evidence on challenges patients with epilepsy face and on the need for implementing psychosocial prevention programs.
This study investigated aspects of psychosocial adjustment in epilepsy patients in Cyprus. Sixty-... more This study investigated aspects of psychosocial adjustment in epilepsy patients in Cyprus. Sixty-three patients under 55 years of age with idiopathic or symptomatic epilepsy and 89 neurologically matched healthy volunteers participated. Subjects completed the State and Trait Anxiety Inventory and the Beck Depression Inventory; patients with epilepsy also completed the Epilepsy Foundation Concerns Index. Results showed that patients with symptomatic epilepsy had significantly higher scores on state and trait anxiety and depressive symptoms. Sociodemographic characteristics including gender, marital status, and education levels contributed to differences in trait and state anxiety, depressive symptom scales, autonomy concerns, and fear for seizure recurrence. Variables such as poor seizure control and use of polytherapy were associated with lower adjustment scores and reduced psychosocial outcome. Finally, patients with epilepsy scored significantly higher on depression and anxiety symptoms. The results provide further evidence on challenges patients with epilepsy face and on the need for implementing psychosocial prevention programs.
Archives of Physical Medicine and Rehabilitation, 2008
tugal), José Luis Pais Ribeiro. Disclosure: None declared.
Archives of Physical Medicine and Rehabilitation, 2008
tugal), José Luis Pais Ribeiro. Disclosure: None declared.
Archives of Neurology, 2007
Neurodegeneration with brain iron accumulation is a rare neurodegenerative disorder characterized... more Neurodegeneration with brain iron accumulation is a rare neurodegenerative disorder characterized by iron deposition in the basal ganglia and neuroaxonal dystrophy. Familial cases with mutations in the pantothenate kinase gene are associated with a specific phenotype. In contrast, sporadic cases are heterogeneous in their clinical presentation. To describe an atypical case of sporadic late-onset neurodegeneration with brain iron accumulation. Case report of a patient who presented with psychiatric features at age 22 years followed by progressive gait disturbance, extrapyramidal symptoms, epilepsy, and corticospinal tract involvement. Magnetic resonance imaging showed iron deposition in the globus pallidus and substantia nigra. Cortical biopsy revealed Lewy bodies with predominant alpha-synuclein and less extensive tau-positive neurites. Our findings in association with previously reported cases suggest that cortical neuritic and Lewy body pathology is a feature of atypical neurodegeneration with brain iron accumulation, clinically characterized by adult onset and psychiatric symptoms. These observations raise the possibility that these cases of atypical neurodegeneration with brain iron accumulation represent a distinct clinicopathological syndrome and suggest a molecular link between iron deposition and alpha-synuclein accumulation.
Neurodegeneration with brain iron accumulation is a rare neurodegenerative disorder characterized... more Neurodegeneration with brain iron accumulation is a rare neurodegenerative disorder characterized by iron deposition in the basal ganglia and neuroaxonal dystrophy. Familial cases with mutations in the pantothenate kinase gene are associated with a specific phenotype. In contrast, sporadic cases are heterogeneous in their clinical presentation. To describe an atypical case of sporadic late-onset neurodegeneration with brain iron accumulation. Case report of a patient who presented with psychiatric features at age 22 years followed by progressive gait disturbance, extrapyramidal symptoms, epilepsy, and corticospinal tract involvement. Magnetic resonance imaging showed iron deposition in the globus pallidus and substantia nigra. Cortical biopsy revealed Lewy bodies with predominant alpha-synuclein and less extensive tau-positive neurites. Our findings in association with previously reported cases suggest that cortical neuritic and Lewy body pathology is a feature of atypical neurodegeneration with brain iron accumulation, clinically characterized by adult onset and psychiatric symptoms. These observations raise the possibility that these cases of atypical neurodegeneration with brain iron accumulation represent a distinct clinicopathological syndrome and suggest a molecular link between iron deposition and alpha-synuclein accumulation.
ABSTRACT The cost of caring for people with Alzheimer-type diseases is enormous. Caregivers exper... more ABSTRACT The cost of caring for people with Alzheimer-type diseases is enormous. Caregivers experience emotional, physical and financial stress, and their demands are central to decisions on patient institutionalization. We hereby investigate the burden experienced by caregivers of Alzheimer patients in Cyprus. We explore whether burden is related to variables such as patient psychopathology, caregiver gender, income and level of education. Moreover, we examine if there is a significant difference in the level of burden, depression, or reaction to memory and behavior problems when patients live in the community or in institutions and if the level of burden is associated with the use of different coping strategies by caregivers. Various statistical techniques are implemented for the analysis and all the conclusions are discussed. This work was partially funded by the Cyprus Research Promotion Foundation.
Aging & Mental Health, 2011
Caring for a family member with Alzheimer&amp... more Caring for a family member with Alzheimer's disease is associated with increased burden and depression. Effective coping with the hardships and demands of caring may help to sustain the caregiver and lessen the effect of the stressors. The objective of this study was to examine caregivers' coping styles and the relationship with reported levels of burden and depression. A cross-sectional correlation study was employed. One hundred and seventy-two caregivers of patients suffering from Alzheimer's type dementia participated in the study. All patients were recruited from neurology clinics. The Greek versions of four measuring instruments used were: the Memory and Behaviour Problem Checklist, the Burden Interview, the Centre for Epidemiological studies-Depression scale and the Ways of Coping Questionnaire. Positive coping is negatively correlated with burden (r = -0.20) and wishful thinking strategies were related positively (r = 0.16). The relation between depression and positive coping strategies is highly significant (p < 0.01), whereas for burden the relation is significant (p < 0.05). Regression analyses showed that positive coping strategies are the most powerful, both in terms of predicting depression levels, and also in terms of moderating the effect of burden on depression. Positive coping approaches need to be developed by caregivers so as to continue their caring role.
Journal of Advanced Nursing, 2007
Title. Caring for a relative with dementia: family caregiver burdenAim. This paper is a report o... more Title. Caring for a relative with dementia: family caregiver burdenAim. This paper is a report of part of a study to investigate the burden experienced by families giving care to a relative with dementia, the consequences of care for the mental health of the primary caregiver and the strategies families use to cope with the care giving stressors.Background. The cost of caring for people with dementia is enormous, both monetary and psychological. Partners, relatives and friends who take care of patients experience emotional, physical and financial stress, and care giving demands are central to decisions on patient institutionalization.Method. A volunteer sample of 172 caregiver/care recipient dyads participated in the study in Cyprus in 2004–2005. All patients were suffering from probable Alzheimer's type dementia and were recruited from neurology clinics. Data were collected using the Memory and Behaviour Problem Checklist, Burden Interview, Center for Epidemiological Studies-Depression scale and Ways of Coping Questionnaire.Findings. The results showed that 68·02% of caregivers were highly burdened and 65% exhibited depressive symptoms. Burden was related to patient psychopathology and caregiver sex, income and level of education. There was no statistically significant difference in level of burden or depression when patients lived in the community or in institutions. High scores in the burden scale were associated with use of emotional-focused coping strategies, while less burdened relatives used more problem-solving approaches to care-giving demands.Conclusion. Caregivers, especially women, need individualized, specific training in how to understand and manage the behaviour of relatives with dementia and how to cope with their own feelings.
Background:The burden of providing care for dementia patients falls increasingly upon families an... more Background:The burden of providing care for dementia patients falls increasingly upon families and it has been identified as a chronic stressor that places family members at risk for physical and emotional problems. Aims: To explore family burden in the care of patients with dementia in Cyprus and to look at gender differences in the area of caregiving and its consequences like burden, psychiatric morbidity and coping with caregiving difficulties. Methods:This is a cross-sectional study, with a sample of 172 primary caregivers. The questionnaire included the Memory and Behavior Problem Checklist, the Zarit Burden Interview, the Center of Epidemiological Studies Depression scale, and the Ways of Coping Questionnaire. Several statistical methods were used for data analysis, such as independent samples t-tests. One-way ANOVA, chi-square tests of independence, reliability studies and factor analysis. Results:The analysis revealed gender differences in the overall burden (p-value=0.048) and depression (p-value=0.011) where female caregivers experience higher levels compared to males. Women had a higher mean of burden in the questions included in relational deprivation (10.44 compared to 8.47 for men) and this difference is statistically significant (p=0.02). Oneway ANOVA showed that, according to kinship, there exist some highly significant differences in burden (F=6.17, p=0.003) and marginal differences in depression (F=2.74, p=0.067) with the sons being less affected by the consequences of caregiving. Regarding the ways of coping, women use mostly emotional-focused strategies like denial (p =0.09).
Otology & Neurotology, 2010
Neurogenic vestibular evoked potentials that are recorded from the scalp have so far been recorde... more Neurogenic vestibular evoked potentials that are recorded from the scalp have so far been recorded in the form of N3 (click air-conducted), N5 (tone air-conducted), and P10 (bone-conducted stimulus) waveforms. The purpose of this study is to find other vestibular waveforms obtained with air-conducted sound. The experiments were organized into 4 parts: 1) topographic scalp mapping; 2) determining the consistency in appearance of candidate vestibular waveforms; 3) further characteristics such as their relationship to vestibular evoked myogenic potentials, sensitivity to 5-kHz tone, and threshold of activation; and (D) recording of the new vestibular waveforms in a case of hearing loss. A montage was discovered, O2-P3 and O1-P4 with left and right ear stimulation respectively, that yielded a negative wave at 6 milliseconds after stimulus onset and was labeled N6. It is not a vestibular evoked myogenic potential, disappears with 5-kHz tone stimuli, has a high threshold of stimulation, and is present in a case of hearing loss. A new vestibular waveform is discovered that probably originates at or near the midbrain based on its latency. Together with the previously mentioned waves, lesions along the vestibular pathway can now be localized further.
Clinical Neurophysiology, 2010
Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system, with epi... more Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system, with epileptic seizures sometimes observed in the same patients. In this study, we used evoked responses to study the pathogenesis of epilepsy in MS. Patients with a diagnosis of definite MS and who had EPs performed (visual (VEP), brainstem auditory (BAEP) and short latency somatosensory (upper (USSEP) and lower (LSSEP))) were retrospectively included in this study. They were divided into three groups; Group I: Patients with no epilepsy and who were not taking anti-epileptic drugs (AED); Group II: Patients with epilepsy and taking AEDs; and Group III: Patients with no epilepsy who were taking AEDs for symptoms related to neuropathic pain. Three hundred and fifty-five patients were included in this study; Group I: 229 patients (64.5%), Group II: 20 patients (5.6%) and Group III: 106 patients (29.9%). The proportion of patients with abnormal BAEP and USSEP was higher in Group II. A positive association exists between the presence of epilepsy in MS patients and BAEP and USSEP abnormalities. Analysis of Group III ruled out AED use as a factor. Brainstem lesions may be the cause of epileptogenicity in MS.
We report the mortality from sporadic Creutzfeldt-Jakob disease in Cyprus for a 10-year surveilla... more We report the mortality from sporadic Creutzfeldt-Jakob disease in Cyprus for a 10-year surveillance period (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004). In that time, 5 cases were identified out of a population of 749 000, giving an incidence of 0.7 cases per million population per year. Our sporadic incidence matches that expected according to global epidemiological surveillance. No cases of variant Creutzfeldt-Jakob disease were found but 1 familial case was diagnosed. -1995 -2004 000 749 0.7
Clinical Neurophysiology, 2001
Objectives: In the present study we set out to obtain normative values for radial nerve F-waves, ... more Objectives: In the present study we set out to obtain normative values for radial nerve F-waves, with surface recording from the extensor indicis muscle.
Pharmacy World & Science, 2007
We present three unrelated cases of genetically confirmed progressive myoclonic epilepsy of the U... more We present three unrelated cases of genetically confirmed progressive myoclonic epilepsy of the Unverricht–Lundborg type who were treated with Levetiracetam as adjunctive therapy for their myoclonus. All cases responded with decrease of their myoclonus and improvement of quality of life. Two were able to return to or continue their employment. Patients tolerated the drug well without side effects reported. Levetiracetam appears to be a useful antimyoclonic agent in cases of progressive myoclonic epilepsy and should be considered for adjunctive therapy.
Journal of Clinical Neurophysiology, 1997
Pharmacy World & Science, 2007
Case We present the case of a boy with tuberous sclerosis who was referred for evaluation and tre... more Case We present the case of a boy with tuberous sclerosis who was referred for evaluation and treatment of his intractable epileptic seizures, having failed multiple anti-epileptic drug trials. He was subsequently treated with Levetiracetam that was gradually titrated to an effective dose, achieving full suppression of his seizures. Thereafter, his concomitant anti-epileptic drugs were gradually reduced and eventually discontinued. He remained on monotherapy with Levetiracetam, which continued to fully control his seizures. His EEG tracings before and after treatment are presented and compared, showing normalization of the latter. Conclusion Levetiracetam appears to be effective in treatment-resistant seizures which are symptomatic to tuberous sclerosis when used adjunctively as well as in monotherapy. This is the first report in the English literature regarding its use and efficacy in this condition.
Documenta Ophthalmologica, 2008
Objectives: To demonstrate the clinical feasibility of using surface electrodes for recording fla... more Objectives: To demonstrate the clinical feasibility of using surface electrodes for recording flash electroretinography (ERG), using the stimulation standards of the International Society for the Clinical Electrophysiology of Vision (ISCEV), without pupillary dilation. Methods: Eighteen physiologically normal volunteers were tested. Surface recording electrodes were placed over the middle third of the lower eyelid of each eye, and the reference electrode placed on the temple. The recording filters and method of stimulation for the standard flash cone, 30 Hz flicker, rod, standard combined and oscillatory responses were those recommended by the ISCEV. Four patients with a history of visual dysfunction were also examined. Results: The amplitudes of the responses were noted to have a high signal to noise ratio, allowing us to average only a few responses. The waveform configurations were almost identical to those published using other recording methods. Patients with retinitis pigmentosa and early onset retinal dystrophy had abnormal responses, whereas patients with Stargardt’s Syndrome and spasm of accommodation had responses within normal limits. Conclusions: This study has established the clinical feasibility of performing flash ERG using surface skin electrodes, with no pupillary dilation and using the stimulation standards of the ISCEV.
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Papers by Savvas Papacostas