Effects of the Medical Resonance Therapy Music in the complex treatment of epileptic patients

The purpose of the study was to evaluate the effectiveness of Medical Resonance Therapy Music (MRT-Music) as a psycho-physiological method for the treatment of epilepsy in severe epileptic patients, whose attacks persevered despite comprehensive drug treatments. Under investigation were frequency and severity of epileptic attacks, the subjective state, the dynamics of the inter-paroxysmal symptoms and the individual parameters of the functional asymmetry of the brain (IPFA). Frequency and severity of the paroxysms changed positively in 80 percent of the cases: frequency of attacks were reduced by 75 percent and many attacks manifested in the form of abortive variants. The paroxysmal component, the degree of amnesia and the polymorphism of the attacks were reduced. Such positive changes were 4 times less frequent in the control group. Changes in subjective state were 90 percent positive: the patients felt more healthy, were calmer, had a better mood and fewer ups and downs in mood, released tension, and reduced unrest, wrath, and irritation. The evaluation of the Minnesota Multiphasic Personality Inventory (MMPI) showed clear improvements in the inter-paroxysmal clinical picture, particularly in those parameters that characterise the general degree of sickness, psychasthenic and paranoid traits, hypochondria, aggression and depressive states. Similar positive changes in the control group were observed two times less frequently. The changes of the IPFA-values were positive in 73.3 percent of the patients (27.8 percent in controls), had differently directed shiftings, were dependent on the initial level, and were determined by the location of the epileptic focus.

Tonsillar pain mimicking glossopharyngeal neuralgia as a complication of vagus nerve stimulation: case report

An adolescent girl presented with severe, lancinating tonsillar pain exacerbated by swallowing 6 weeks after initiation of left vagus nerve stimulation for intractable epilepsy. Her symptoms mimicked those seen in glossopharyngeal neuralgia and were relieved by temporary cessation of stimulation. Gradual reinstitution of therapy with alteration in stimulus parameters resulted in improved seizure control as well as cessation of pain symptoms. Direct stimulation of the vagus nerve may result in vagoglossopharyngeal neuralgia, which, in this case, was amenable to stimulus modification.

A clinical trial with a new anticonvulsant drug, alpha-(p-aminophenyl)-alpha-ethyl glutarimide preparation 16038 (Ciba)

Derivatives of glutarimide are known to exert an effect upon the central nervous system. To name only two which are widely used for clinical purposes: Glutethimide (“Doriden”) is a sedative, Bemigride (“Megimide”) a stimulant. Preparation 16038 (Ciba) α-(p-aminophenyl)-α-ethyl glutarimide, in animal experiments had shown properties which suggested its use as an anticonvulsant, and this paper is an account of a clinical trial with the substance on in- and out-patients suffering from epilepsy.

Quality of care of children with chronic diseases in Alexandria, Egypt: the models of asthma, type I diabetes, epilepsy, and rheumatic heart disease. Egyptian-Italian Collaborative Group on Pediatric Chronic Diseases

OBJECTIVES

To evaluate the quality of care delivered to children suffering from index chronic diseases using specific indicators of health care delivery and to study the predictors of suboptimal quality of care (SQC) and its outcome on children.

DESIGN

Over a 9-month period, guidelines for optimal care were formulated. A specific questionnaire for every studied chronic disease was prepared in collaboration with the clinicians in charge of the diseased children (66% pediatricians and pediatric specialists and 34% adult specialists). The clinicians were asked to write the details of daily practice, ie, how these children were managed on a routine basis as well as in an emergency situation. A cross-sectional study was conducted over a 4-month period and included 953 children suffering from bronchial asthma (BA), childhood epilepsy (CE), type I diabetes mellitus (IDDM), and rheumatic heart disease (RHD). A systematic random sample of children was selected from children visiting the ambulatory settings of all children's hospitals. Every fourth child was selected on 2 randomly chosen days each week, while all diseased children admitted in the hospital settings of the children's hospitals during the study were included. A general form describing the impact of the diseases on the child was prepared. A network of clinicians was created in all children's hospitals; seminars were held during which the content validity of the questionnaire was tested. Items were evaluated for their internal consistency using the Cronbach alpha. According to the degree of adherence to the recent therapeutic guidelines concerning selected indicators of the quality of care specific to every disease, children were categorized as receiving optimal quality of care or SQC. These indicators were: the use of inhaled bronchodilators in acute asthmatic attacks in mild asthma and the use of the prophylactic drugs (inhaled sodium cromoglycate or inhaled beclomethasone) in moderate to severe chronic BA in between acute asthmatic attacks; compliance with antiepileptic drugs in epileptic children; regular performance of self-monitoring of blood glucose and/or urine testing in diabetic children; and compliance with prophylactic antibiotics in children suffering from RHD. The records of the outpatient clinics for ambulatory and hospitalized cases were reviewed to assess the degree of compliance with the prescribed management before the index visit. Sociodemographic characteristics and health care system-related predictors of SQC were analyzed via stepwise logistic regression analysis. The impact of illness on the child was assessed by 7 items which were: dependence on parents in domestic activities, level of activity compared with peers, mood compared with peers, level of socializing, degree of discomfort attributable to illness, level of physical disadvantage, and urinary incontinence. Factor analysis with Varimax rotation was performed on items related to the impact of illness. Parental satisfaction with care was rated as excellent, very good, fair, or poor. Information on school outcome was obtained by asking the caretakers whether the child was able to attend school regularly despite his sickness. Scholastic achievement was also rated as excellent, very good, good, and acceptable. Parents were asked whether the child had ever repeated a grade because of his sickness.

SETTING

Ambulatory and hospital settings of all children's hospitals in Alexandria, Egypt.

RESULTS

Only 52% of mild asthmatics were given inhaled bronchodilators during acute attacks and 6.84% of moderate to severe asthmatics were taking prophylactic drugs (inhaled sodium cromoglycate and/or inhaled beclomethasone) between acute attacks. Similarly, only 53 of 134 (39.6%) of diabetic children were regularly performing self-monitoring of blood glucose and/or urine testing. In contrast, in epileptic children, 121 of 173 (69.9%) were judged as being compliant by their managing clinicians and more than two

[Current management in pregnancy and epilepsy]

Modern treatments make possible uneventful pregnancy and successful delivery for most of the epileptic women. Major risks however remain the teratogenic effects of some antiepileptic drugs and the obstetric complications they may cause. This implies careful planning of pregnancy for women with epilepsy and alertness for possible unwanted or undiagnosed (in the early stages) pregnancy in epileptic women during their reproductive years. The authors summarize current opinions in drug selections, specific treatment regimens and the obstetrics problems during pregnancy and delivery in epileptic women.

[Health care systems in Nepal]

This article is the result of some preliminary journey of two Hungarian psychiatrist (one also epileptologist, other also anthropologist) to Nepal. The main aim of the research was to elaborate a community based epilepsy health care pilot project. It is shown a brief look at the modern and traditional health care systems and the severely difficult condition of the general and health infrastructure in Nepal. Some recommendations of possible help and intervention are offered for foreign (Hungarian) doctors.

Compliance and noncompliance in neuroscience

Among the responses to this month's question, the most common strategy for motivating compliance is providing information. This finding is also supported with the example from Australia, where stoke sufferers are highly compliant with any intervention aimed at prevention of future strokes. In this case, the high level of compliance and (probably) motivation can be explained by the fact that stroke is potentially fatal and highly disabling. Other important issues also were identified in the responses: (a) patients' trust and belief in healthcare professionals in terms of providing information and motivation, and (b) a lack of motivation in some patients who simply do not want to comply and prefer a certain level of seizure activity or other impairments and disabilities over the potential side effects of the treatment. This raises another question that goes beyond the concept of compliance and noncompliance: How does the system comply to the patient? I will leave this topic open, and I welcome comments for a future round of discussion here at Global Views.

[Economic aspects of epilepsy]

INTRODUCTION

The economic magnitude of epilepsy is determined by its effect on the employment status of the patients, the cost of drug treatment for them and the healthcare system and the repercussion worldwide.

DEVELOPMENT

Studies of the cost of the disease show that it has economic importance due to the sum of the direct and indirect costs caused by it. In the case of epilepsy, the results of studies in various countries led to the creation of a Commission on Economic Aspects of Epilepsy. The lack of epidemiological studies regarding epilepsy in Spain may explain the lack of publications on this subject in our country. The percentage of the total cost due to antiepileptic drugs is considerable and will probably increase in the future. The pharmaco-economic evaluation made by cost-benefit, cost-effectiveness, cost-usefulness analysis and studies to minimize costs should serve to use healthcare resources in the most effective manner and justify the rational use of the new antiepileptic drugs.

CONCLUSIONS

The economic impact of epilepsy is added to the repercussion of the disease itself on the patient and his family. The different distribution of costs in children and adults with epilepsy suggest the need for intervention at an early age to try to reduce the long term economic and personal repercussions. The pharmaco-economic evaluation of the new antiepileptic drugs will make it clear whether their considerable cost is worth paying for their greater effectivity.

Doctors' perspectives and practices regarding epilepsy

OBJECTIVE

The main aim of this study was to evaluate the knowledge, management practices and attitudes towards people with epilepsy (PWE) by a group of general practitioners (GP) and pediatrician (PD) residents.

METHODS

A cross-sectional study was carried out in three training hospitals, and had been selected 31 GP and 47 PD who agreed with the study. The collection of data was made by self-applied structured questionnaire.

RESULTS

Many respondents have positive values about PWE, and recognize prejudice in the population against them. The residents recognize in themselves and in the colleagues lack of knowledge about PWE, and that Medical School do not give enough importance to the study of PWE. The reference of PWE to the neurologist is a common practice among the doctors. Half of them are favorable to the idea of assuming the patients clinical management after an initial clientele appraisal by the neurologist.

CONCLUSIONS

The non-neurologist doctors do not feel comfortable in managing PWE due to barriers. Our doctors complain about the undergraduate medical training related to the epilepsy. Although, there is not a clear relationship between the undergraduate medical training, referral practices and satisfaction about the management of PWE. The patients care is influenced not only by knowledge, but also by doctors' attitudes. In this way, there are other barriers, perceived or not, to providing care to PWE by the generalists, and they need to be approached in the medical undergraduate curriculum and medical continuing education.

An assessment of epilepsy patients' knowledge of their disorder

PURPOSE

Patient education is an effective component of comprehensive care. Studies assessing patient's knowledge of their epilepsy are scarce. We report the first objective study evaluating knowledge of epilepsy patients referred to an American tertiary care center.

METHODS

Two hundred twenty epilepsy patients referred to an epilepsy center completed a knowledge questionnaire. The questionnaire included topics related to safety, compliance, and legal issues of driving and employment. Questionnaire scores were correlated with demographics, number of years with epilepsy, and educational background.

RESULTS

Of 220 patients, 175 were included in study analysis. Thirteen percent (n = 28) were excluded because of the diagnosis of nonepileptic seizures, and 8% (n = 17) were excluded because of having a diagnosis other than epilepsy. The average age and number of years with epilepsy was 34.7 +/- 13 and 14. 4 +/- 13.1, respectively. Neither age (r = 0.20, p </=0.01), number of years with epilepsy (r = 0.09, p = 0.2), nor years of education (r = 0.34, p </=0.01) correlated with questionnaire scores. Thirty percent believed that epilepsy is a mental disorder or contagious. Forty-one percent believed it is appropriate to place an object in a patient's mouth during a seizure to prevent injury. Two of the lowest scores, 13.6% and 47.5%, pertained to the legal issues of driving and employment, respectively.

CONCLUSIONS

Patients with epilepsy are not knowledgeable about their disorder. This is true regardless of age, educational background, or number of years with epilepsy. There is a need for educational intervention in this population, particularly related to injury prevention and the legalities of driving and employment.

The coordinated psychosocial and neurologic care of children with seizures and their families

SUMMARY

As the medical and surgical management of epilepsy continues to advance, issues associated with the quality of life of patients and their families can be addressed. Whenever associated with other handicaps, such as learning disabilities, attentional or behavioral disorders, and problems in psychological adjustment, dual-diagnosis issues must be identified. To provide comprehensive care for children with epilepsy, a team approach to psychosocial assessment and treatment must be provided and coordinated with neurologic care. When the age-related needs in the life stage of the individual and family are identified, the best possible adaptation of the patient and his or her family can be supported.

Audit of a children's epilepsy clinic

A newly established tertiary epilepsy clinic at Guy's Hospital, London was evaluated using a structured questionnaire. Fifty parents of children with epilepsy completed this questionnaire, with some contribution from the children. While a high degree of satisfaction was obtained by the parents and where appropriate the children, specific questions about additional resources implied a large number of unmet needs. This raises methodological issues about the value of open-ended questions in audit questionnaires. In addition, concerns were expressed about many areas, some of which had direct medical implications that were not always raised with the doctors. It is concluded that the service has benefited from both clinical and neuropsychological support. The audit has prompted a number of improvements, including establishing a discussion group for adolescents.

Cell replacement therapies for central nervous system disorders

In animal models, immature neural precursors can replace lost neurons, restore function and promote brain self-repair. Clinical trials in Parkinson's disease suggest that similar approaches may also work in the diseased human brain. But how realistic is it that cell replacement can be developed into effective clinical therapy?

A randomized field trial of ACINDES: a child-centered training model for children with chronic illnesses (asthma and epilepsy)

A randomized field trial of a child-centered model of training for self-management of chronic illnesses was conducted of 355 Spanish-speaking school-aged children, between 6 and 15 years old, with moderate to severe asthma and epilepsy, in Buenos Aires, Argentina. The model, based on play techniques, consists of five weekly meetings of 8-10 families, with children's and parents' groups held simultaneously, coordinated by specially trained teachers and outside the hospital environment. Children are trained to assume a leading role in the management of their health; parents learn to be facilitators; and physicians provide guidance, acting as counselors. Group activities include games, drawings, stories, videos, and role-playing. Children and parents were interviewed at home before the program and 6 and 12 months after the program, and medical and school records were monitored for emergency and routine visits, hospitalizations, and school absenteeism. In asthma and epilepsy, children in the experiment showed significant improvements in knowledge, beliefs, attitudes, and behaviors compared to controls (probability of experimental gain over controls = .69 for epilepsy and .56 for asthma, with sigma2 = .007 and .016, respectively). Parent participants in the experiment had improved knowledge of asthma (39% before vs. 58% after) and epilepsy (22% before vs. 56% after), with a probability of gain = .62 (sigma2 = .0026) with respect to the control group. Similar positive outcomes were found in fears of child death (experimental 39% before vs. 4% after for asthma, 69% before vs. 30% after for epilepsy), as well as in disruption of family life and patient-physician relationship, while controls showed no change. Regarding clinical variables, for both asthma and epilepsy, children in the experimental group had significantly fewer crises than the controls after the groups (P = .036 and P = .026). Visits to physicians showed a significant decrease for those with asthma (P = .048), and emergency visits decreased for those with epilepsy (P = .046). An 18-item Children Health Locus of Control Scale (CHLCS) showed a significant increase in internality in experimental group children with asthma and epilepsy (P < .01), while controls did not change or performed worse 12 months after the program. School absenteeism was reduced significantly for those with asthma and epilepsy (for the group with asthma, fall/winter P = .006, and spring P = .029; for the group with epilepsy, P = .011).

CONCLUSION

The program was successful in improving the health, activity, and quality of life of children with asthma and epilepsy. The data suggested that an autonomous (Piagetian) model of training is a key to this success, reinforcing children's autonomous decision making.

[Intractable epilepsy of childhood and its treatment]

This paper discusses the concept of epilepsy intractability as the criterium qualifying for the administration of polytherapy, inclusion of new antiepileptic drugs /AEDs/ and application of neurosurgical treatment. There were also diagnostic criteria and complication discussed. To define the concept of epilepsy intractability correctly and to administer appropriate treatment, it is necessary to classify the kind of seizures and their possible reasons, to apply suitable AEDs, their doses and to treat patients with them for a suitable period of time. Intractable forms of epilepsy are diagnosed at about 20-30% of patients with suitable treatment. The disease prevalence is different at particular age groups and depends also on seizure type or epileptic syndrome. Therefore, Ohtahar syndrome, West, Lennox and Gastaut syndromes, epilepsia partialis continua belong to intractable epileptic syndromes at children. There is the biggest risk of psychic disorders appearance among patients resistant to antiepileptic treatment. Moreover, long-term application of AEDs may be associated with the induction of epileptic seizures, occurrence of side and toxic symptoms. Great interest in intractable epilepsy is connected with huge progress in treatment of this disease which has resulted in introduction of many new AEDs for the last few years. Its inclusion into treatment, first as add--on therapy, and then, due to clinical examinations, also as a monotherapy, enables the improvement in seizure control and in the quality of patients' life.