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Melbourne-Chambers R, Clarke D, Gordon-Strachan G, Tapper J, Tulloch-Reid MK. The UWIMONA Pediatric Epileptic Seizure Screening Questionnaire was equivalent to clinical assessment in identifying children with epilepsy. J Clin Epidemiol 2015; 68:988-93. [PMID: 25861709 DOI: 10.1016/j.jclinepi.2014.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 07/28/2014] [Accepted: 10/14/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the validity and reliability of a screening questionnaire administered to parents/caregivers to detect behaviors suggestive of epileptic seizures in children. STUDY DESIGN AND SETTING We developed a 10-item questionnaire, which was administered to 120 parents/caregivers of children attending hospital-based clinics/pediatric neurologists' offices. Receiver operating characteristic (ROC) curve analysis was used to assess the discriminant ability of the questionnaire and determine cutoff points. Questionnaire sensitivity and specificity were compared with clinical assessment by a pediatrician and pediatric neurologist. The questionnaire was readministered to 25 parents/caregivers after 1 month to assess reliability. RESULTS The 120 children had the following characteristics: 58% with epilepsy, 55% male, mean (standard deviation) age 8.1 (3.2) years. A positive response to ≥1 item had the highest sensitivity (89%) and specificity (91%), with a ROC area under curve of 0.91 (95% confidence interval: 0.86, 0.97). The validity of the questionnaire was similar to the clinical evaluation by the pediatric neurologist and pediatrician. The Spearman correlation coefficient for the total score from repeat administration of the questionnaire was 0.95 (P < 0.01). CONCLUSION The UWIMONA Pediatric Epileptic Seizure Screening Questionnaire is a valid and reliable screening instrument and performed similarly when compared with evaluation by an experienced clinician.
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Affiliation(s)
- Roxanne Melbourne-Chambers
- Department of Child and Adolescent Health, Faculty of Medical Sciences, The University of the West Indies, Mona, Kingston 7, Jamaica.
| | - Dave Clarke
- Dell Children's Comprehensive Epilepsy Program, Dell Children's Medical Center of Central Texas, 1301 Barbara Jordan Blvd, 200. Austin, Texas 78723
| | - Georgiana Gordon-Strachan
- Mona Office for Research and Innovation, The University of the West Indies, Mona, Kingston 7, Jamaica
| | - Judy Tapper
- Bustamante Hospital for Children, Arthur Wint Drive, Kingston 5, Jamaica
| | - Marshall K Tulloch-Reid
- Epidemiology Research Unit, Tropical Medicine Research Institute The University of the West Indies, 7 Ring Road, Mona, Kingston 7, Jamaica
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Kiani R, Tyrer F, Jesu A, Bhaumik S, Gangavati S, Walker G, Kazmi S, Barrett M. Mortality from sudden unexpected death in epilepsy (SUDEP) in a cohort of adults with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2014; 58:508-520. [PMID: 23647577 DOI: 10.1111/jir.12047] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/02/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND People with intellectual disability (ID) and epilepsy are more likely to die prematurely than the general population. A significant number of deaths in people with epilepsy may be potentially preventable through better seizure control, regular monitoring and raising awareness among patients and carers. The aim of this project was to study mortality from sudden unexpected death in epilepsy (SUDEP) in adults with ID. METHODS All adults (≥20 years old) living in Leicester city, Leicestershire and Rutland, UK, with ID between 1993 and 2010 were identified using the Leicestershire Intellectual Disability Register database. People with and without ID who died during the same period were identified using death certificate data from the Office for National Statistics (ONS). Deaths from probable and definite SUDEP were identified. Additional information on adults with ID who had died from probable or definite SUDEP was obtained from case notes and post-mortem reports, where available. Cases of probable and definite SUDEP in adults with ID were compared with the general population using standardised mortality ratios (SMRs). RESULTS A total of 898 adults with ID had died over the 18-year study period. Of these, 244 deaths (27%) occurred in people with ID who had a diagnosis of epilepsy. Twenty-six people with ID died from probable or definite SUDEP, which was the second most common cause of death among adults with ID and epilepsy. All-cause specific SMRs were 2.2 [95% confidence interval (CI): 2.0-2.4] and 2.8 (95% CI: 2.5-3.1) for men and women with ID respectively. SMRs were 3.2 (95% CI: 2.7-3.8) and 5.6 (95% CI: 4.6-6.7) for men and women with epilepsy and ID respectively. During the same study period, 83 adults without ID had died of probable or definite SUDEP. The SMRs for SUDEP in patients with ID were 37.6 for men (95% CI: 21.9-60.2) and 52.0 for women (95% CI: 23.8-98.8). We found that in the majority of ID cases there was little detailed documentation on the circumstances surrounding deaths, no communication with patients/carers about risk of SUDEP and an absence of post-mortem reports or carers' referral for bereavement counselling. CONCLUSION The authors believe that a comprehensive risk management under a multiagency/multidisciplinary framework should be undertaken for all adults with ID and epilepsy in day-to-day clinical practice to reduce mortality in people with ID.
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Affiliation(s)
- R Kiani
- Adult Learning Disability Service, Leicestershire Partnership NHS Trust, Leicester, UK; Department of Health Sciences, University of Leicester, Leicester, UK
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Kralj-Hans I, Goldstein LH, Noble AJ, Landau S, Magill N, McCrone P, Baker G, Morgan M, Richardson M, Taylor S, Ridsdale L. Self-Management education for adults with poorly controlled epILEpsy (SMILE (UK)): a randomised controlled trial protocol. BMC Neurol 2014; 14:69. [PMID: 24694207 PMCID: PMC3976555 DOI: 10.1186/1471-2377-14-69] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 03/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Teaching people with epilepsy to identify and manage seizure triggers, implement strategies to remember to take antiepileptic drugs, implement precautions to minimize risks during seizures, tell others what to do during a seizure and learn what to do during recovery may lead to better self-management. No teaching programme exists for adults with epilepsy in the United Kingdom although a number of surveys have shown patients want more information. METHODS/DESIGN This is a multicentre, pragmatic, parallel group randomised controlled trial to evaluate the effectiveness and cost-effectiveness of a two-day Self-Management education for epILEpsy (SMILE (UK)), which was originally developed in Germany (MOSES).Four hundred and twenty eight adult patients who attended specialist epilepsy outpatient clinics at 15 NHS participating sites in the previous 12 months, and who fulfil other eligibility criteria will be randomised to receive the intervention (SMILE (UK) course with treatment as usual- TAU) or to have TAU only (control). The primary outcome is the effect on patient reported quality of life (QoL). Secondary outcomes are seizure frequency and psychological distress (anxiety and depression), perceived impact of epilepsy, adherence to medication, management of adverse effects from medication, and improved self-efficacy in management (mastery/control) of epilepsy.Within the trial there will be a nested qualitative study to explore users' views of the intervention, including barriers to participation and the perceived benefits of the intervention. The cost-effectiveness of the intervention will also be assessed. DISCUSSION This study will provide quantitative and qualitative evidence of the impact of a structured self management programme on quality of life and other aspects of clinical and cost effectiveness in adults with poorly controlled epilepsy. TRIAL REGISTRATION Current Controlled Trials: ISRCTN57937389.
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Affiliation(s)
- Ines Kralj-Hans
- Department of Clinical Neuroscience PO 43, Institute of Psychiatry, King’s College London, Denmark Hill Campus, London SE5 8AF, UK
| | - Laura H Goldstein
- Department of Psychology PO 77, Institute of Psychiatry, King’s College London, Denmark Hill Campus, London SE5 8AF, UK
| | - Adam J Noble
- Department of Psychological Sciences, Institute of Psychology, Health & Society, The Whelan Building, University of Liverpool, Liverpool L69 3GL, UK
| | - Sabine Landau
- Department of Biostatistics PO 20, Institute of Psychiatry, King’s College London, Denmark Hill Campus, London SE5 8AF, UK
| | - Nicholas Magill
- Department of Biostatistics PO 20, Institute of Psychiatry, King’s College London, Denmark Hill Campus, London SE5 8AF, UK
| | - Paul McCrone
- Department of Health Service & Population Research PO 24, Institute of Psychiatry, King’s College London, Denmark Hill Campus, London SE5 8AF, UK
| | - Gus Baker
- Department of Clinical Pharmacology, University of Liverpool, Liverpool L69 3 BX, UK
| | - Myfanwy Morgan
- Division of Health and Social Care Research, School of Medicine, King’s College London, 7th Floor Capital House, 42 Weston Street, London SE1 3QD, UK
| | - Mark Richardson
- Department of Clinical Neuroscience PO 43, Institute of Psychiatry, King’s College London, Denmark Hill Campus, London SE5 8AF, UK
| | - Stephanie Taylor
- Barts & The London School of Medicine and Dentistry, Centre for Health Sciences Blizard Institute, Abernethy Building, 2 Newark Street, London E1 2AT, UK
| | - Leone Ridsdale
- Department of Clinical Neuroscience PO 43, Institute of Psychiatry, King’s College London, Denmark Hill Campus, London SE5 8AF, UK
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Shankar R, Jalihal V, Walker M, Laugharne R, McLean B, Carlyon E, Hanna J, Brown S, Jory C, Tripp M, Pace A, Cox D, Brown S. A community study in Cornwall UK of sudden unexpected death in epilepsy (SUDEP) in a 9-year population sample. Seizure 2014; 23:382-5. [PMID: 24630808 DOI: 10.1016/j.seizure.2014.02.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 02/12/2014] [Accepted: 02/14/2014] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Epilepsy-related death, particularly sudden unexpected death in epilepsy (SUDEP), is underestimated by healthcare professionals. One argument that physicians use to justify the failure to discuss SUDEP with patients and their families is that there is a lack of evidence for any protective interventions. However, there is growing evidence of potentially modifiable risk factors for SUDEP; although large-scale trials of interventions are still lacking. We determined the main risk factors associated with SUDEP in a comprehensive community sample of epilepsy deaths in Cornwall UK from 2004 to 2012. METHODS We systemically inspected 93 cases of all epilepsy and epilepsy associated deaths which occurred in Cornwall between 2004 and 2012 made available to us by the HM Cornwall coroner. These are the deaths where epilepsy was a primary or a secondary cause. RESULTS 48 cases met the criteria for SUDEP and we elicited associated relevant risk factors. Many findings from our study are comparable to what has been reported previously. New points such as most of the population had increase in either or both seizure frequency/intensity within six months of death and majority did not have an epilepsy specialist review in the last one year to demise were noted. CONCLUSION This study is the first epidemiological study in England occurring in a whole population identifying systemically all deaths and the first large scale review in UK of SUDEP deaths since 2005. Being a community based study a key issue which was highlighted was that in the SUDEPs examined many might have been potentially preventable.
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Affiliation(s)
- Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, United Kingdom; Exeter Medical School, United Kingdom.
| | - Virupakshi Jalihal
- Cornwall Partnership NHS Foundation Trust, United Kingdom; MS Ramaiah Medical College and Hospitals, India
| | | | - Richard Laugharne
- Cornwall Partnership NHS Foundation Trust, United Kingdom; Exeter Medical School, United Kingdom
| | | | | | | | | | - Caryn Jory
- Cornwall Partnership NHS Foundation Trust, United Kingdom
| | - Mike Tripp
- Cornwall Partnership NHS Foundation Trust, United Kingdom
| | | | - David Cox
- Cornwall Partnership NHS Foundation Trust, United Kingdom
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Shankar R, Cox D, Jalihal V, Brown S, Hanna J, McLean B. Sudden unexpected death in epilepsy (SUDEP): Development of a safety checklist. Seizure 2013; 22:812-7. [DOI: 10.1016/j.seizure.2013.07.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 07/25/2013] [Accepted: 07/27/2013] [Indexed: 10/26/2022] Open
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Brown S, Shankar R, Cox D, M. McLean B, Jory C. Clinical governance: risk assessment in SUDEP. ACTA ACUST UNITED AC 2013. [DOI: 10.1108/cgij-12-2012-0045] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ridsdale L, McCrone P, Morgan M, Goldstein L, Seed P, Noble A. Can an epilepsy nurse specialist-led self-management intervention reduce attendance at emergency departments and promote well-being for people with severe epilepsy? A non-randomised trial with a nested qualitative phase. HEALTH SERVICES AND DELIVERY RESEARCH 2013. [DOI: 10.3310/hsdr01090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ObjectivesTo (1) describe the characteristics and service use of people with established epilepsy (PWE) who attend the emergency department (ED); (2) evaluate the economic impact of PWE who attend the ED; (3) determine the effectiveness and cost-effectiveness of an epilepsy nurse specialist (ENS)-led self-management intervention plus treatment as usual (TAU) compared with TAU alone in reducing ED use and promoting well-being; (4) describe patients' views of the intervention; and (5) explore their reasons for attending the ED.DesignNon-randomised trial with nested qualitative study.SettingThe EDs of three inner London hospitals. The EDs each offer similar services and support a similar local population, which made a comparison of patient outcomes reasonable.ParticipantsAdults diagnosed with epilepsy for ≥ 1 year were prospectively identified from the EDs by presenting symptom/discharge diagnosis. We recruited 85 of 315 patients with 44 forming the intervention group and 41 the comparison group.InterventionIntervention participants were offered two one-to-one outpatient sessions delivered by an ENS who aimed to optimise self-management skills and knowledge of appropriate emergency service use. The first session lasted for 45–60 minutes and the second for 30 minutes.Main outcome measuresThe primary outcome was the number of ED visits that participants reported making over the 6 months preceding the 12-month follow-up. Secondary outcomes were visits reported at the 6-month follow-up and scores on psychosocial measures.ResultsIn the year preceding recruitment, the 85 participants together made 270 ED visits. The frequency of their visits was positively skewed, with 61% having attended multiple times. The mean number of visits per participant was 3.1 [standard deviation (SD) 3.6] and the median was two (interquartile range 1–4). Mean patient service cost was £2355 (SD £2455). Compared with findings in the general epilepsy population, participants experienced more seizures and had greater anxiety, lower epilepsy knowledge and greater perceived stigma. Their outpatient care was, however, consistent with National Institute for Health and Clinical Excellence recommendations. In total, 81% of participants were retained at the 6- and 12-month follow-ups, and 80% of participants offered the intervention attended. Using intention-to-treat analyses, including those adjusted for baseline differences, we found no significant effect of the intervention on ED use at the 6-month follow-up [adjusted incidence rate ratio (IRR) 1.75, 95% confidence interval (CI) 0.93 to 3.28] or the 12-month follow-up (adjusted IRR 1.92, 95% CI 0.68 to 5.41), nor on any psychosocial outcomes. Because they spent less time as inpatients, however, the average service cost of intervention participants over follow-up was less than that of TAU participants (adjusted difference £558, 95% CI –£2409 to £648). Lower confidence in managing epilepsy and more felt stigma at baseline best predicted more ED visits over follow-up. Interviews revealed that patients generally attended because they had no family, friend or colleague nearby who had the confidence to manage a seizure. Most participants receiving the intervention valued it, including being given information on epilepsy and an opportunity to talk about their feelings. Those reporting most ED use at baseline perceived the most benefit.ConclusionsAt baseline, > 60% of participants who had attended an ED in the previous year had reattended in the same year. In total, 50% of their health service costs were accounted for by ED use and admissions. Low confidence in their ability to manage their epilepsy and a greater sense of stigma predicted frequent attendance. The intervention did not lead to a reduction in ED use but did not cost more, partly because those receiving the intervention had shorter average hospital stays. The most common reason reported by PWE for attending an ED was the lack of someone nearby with sufficient experience of managing a seizure. Those who attended an ED frequently and received the intervention were more likely to report that the intervention helped them. Our findings on predictors of ED use clarify what causes ED use and suggest that future interventions might focus more on patients' perceptions of stigma and on their confidence in managing epilepsy. If addressed, ED visits might be reduced and efficiency savings generated.Trial registrationCurrent Controlled Trials ISRCTN06469947.FundingThis project was funded by the NIHR Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 1, No. 9. See the HSDR programme website for further project information.
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Affiliation(s)
- L Ridsdale
- Institute of Psychiatry, King's College London, London, UK
| | - P McCrone
- Institute of Psychiatry, King's College London, London, UK
| | - M Morgan
- Institute of Psychiatry, King's College London, London, UK
| | - L Goldstein
- Institute of Psychiatry, King's College London, London, UK
| | - P Seed
- Division for Women's Health, King's College London, London, UK
| | - A Noble
- Institute of Psychiatry, King's College London, London, UK
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Shorvon SD, Goodridge DMG. Longitudinal cohort studies of the prognosis of epilepsy: contribution of the National General Practice Study of Epilepsy and other studies. Brain 2013; 136:3497-510. [DOI: 10.1093/brain/awt223] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Van de Vel A, Cuppens K, Bonroy B, Milosevic M, Jansen K, Van Huffel S, Vanrumste B, Lagae L, Ceulemans B. Non-EEG seizure-detection systems and potential SUDEP prevention: State of the art. Seizure 2013; 22:345-55. [DOI: 10.1016/j.seizure.2013.02.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 02/14/2013] [Accepted: 02/16/2013] [Indexed: 01/21/2023] Open
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Cardamone L, Salzberg MR, O'Brien TJ, Jones NC. Antidepressant therapy in epilepsy: can treating the comorbidities affect the underlying disorder? Br J Pharmacol 2013; 168:1531-54. [PMID: 23146067 PMCID: PMC3605864 DOI: 10.1111/bph.12052] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 10/24/2012] [Accepted: 10/29/2012] [Indexed: 12/20/2022] Open
Abstract
There is a high incidence of psychiatric comorbidity in people with epilepsy (PWE), particularly depression. The manifold adverse consequences of comorbid depression have been more clearly mapped in recent years. Accordingly, considerable efforts have been made to improve detection and diagnosis, with the result that many PWE are treated with antidepressant drugs, medications with the potential to influence both epilepsy and depression. Exposure to older generations of antidepressants (notably tricyclic antidepressants and bupropion) can increase seizure frequency. However, a growing body of evidence suggests that newer ('second generation') antidepressants, such as selective serotonin reuptake inhibitors or serotonin-noradrenaline reuptake inhibitors, have markedly less effect on excitability and may lead to improvements in epilepsy severity. Although a great deal is known about how antidepressants affect excitability on short time scales in experimental models, little is known about the effects of chronic antidepressant exposure on the underlying processes subsumed under the term 'epileptogenesis': the progressive neurobiological processes by which the non-epileptic brain changes so that it generates spontaneous, recurrent seizures. This paper reviews the literature concerning the influences of antidepressants in PWE and in animal models. The second section describes neurobiological mechanisms implicated in both antidepressant actions and in epileptogenesis, highlighting potential substrates that may mediate any effects of antidepressants on the development and progression of epilepsy. Although much indirect evidence suggests the overall clinical effects of antidepressants on epilepsy itself are beneficial, there are reasons for caution and the need for further research, discussed in the concluding section.
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Affiliation(s)
- L Cardamone
- Department of Medicine (RMH), University of Melbourne, Melbourne, Victoria, Australia
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Valente KDR, Busatto Filho G. Depression and temporal lobe epilepsy represent an epiphenomenon sharing similar neural networks: clinical and brain structural evidences. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:183-90. [DOI: 10.1590/s0004-282x2013000300011] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Indexed: 11/22/2022]
Abstract
The relationship between depression and epilepsy has been known since ancient times, however, to date, it is not fully understood. The prevalence of psychiatric disorders in persons with epilepsy is high compared to general population. It is assumed that the rate of depression ranges from 20 to 55% in patients with refractory epilepsy, especially considering those with temporal lobe epilepsy caused by mesial temporal sclerosis. Temporal lobe epilepsy is a good biological model to understand the common structural basis between depression and epilepsy. Interestingly, mesial temporal lobe epilepsy and depression share a similar neurocircuitry involving: temporal lobes with hippocampus, amygdala and entorhinal and neocortical cortex; the frontal lobes with cingulate gyrus; subcortical structures, such as basal ganglia and thalamus; and the connecting pathways. We provide clinical and brain structural evidences that depression and epilepsy represent an epiphenomenon sharing similar neural networks.
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Abstract
Among people with epilepsy, there is a 20-fold higher risk of dying suddenly and unexpectedly compared with the general population. This phenomenon is called sudden unexpected death in epilepsy (SUDEP) and the term is used when sudden death occurs in an otherwise reasonably healthy person with epilepsy and the autopsy is unrevealing. In most cases, SUDEP occurs during sleep and is unwitnessed. Risk factors for SUDEP include the presence or number of generalized tonic-clonic seizures (GTCS), nocturnal seizures, young age at epilepsy onset, longer duration of epilepsy, dementia, absence of cerebrovascular disease, asthma, male gender, symptomatic aetiology of epilepsy and alcohol abuse. Suggested factors predisposing to SUDEP have included long-QT-related mutations, impaired serotonergic brain stem control of respiration, altered autonomic control and seizures with a pronounced postictal suppression and respiratory compromise. Final events that may lead up to SUDEP are a postictal CNS shutdown with pronounced EEG suppression, ictal or postictal apnoea, and ictal cardiac arrhythmia. It is unknown whether antiepileptic drugs (AEDs) modify the risk for SUDEP. Studies have consistently found that the presence or number of GTCS is associated with an increased risk for SUDEP. Since continued presence of GTCS clearly necessitates the use of AEDs, both factors must be taken into account to determine whether one or both increases the risk for SUDEP. Some studies suggest that AEDs, such as lamotrigine and carbamazepine, may increase the risk of SUDEP, but rarely adjust for GTCS. Other studies, which have found that AEDs are associated with a decreased SUDEP risk, either adjust for the number of GTCS or are meta-analyses of randomized clinical trials. Studies assessing the impact of AEDs on the risk for SUDEP are limited because SUDEP is a rare event, making randomized clinical trials impossible to conduct. Observational studies focus on whether or not an AED was prescribed. When postmortem AED concentrations are assessed they are usually low or absent, perhaps due to sampling in deceased individuals, making it difficult to fully resolve whether AEDs increase or decrease SUDEP risk. Despite these caveats, the evidence suggests that AEDs are not associated with an increased risk for SUDEP on a population level, although some individuals may be susceptible to effects of AEDs. Recent evidence from a meta-analysis of randomized clinical trials of adjunctive AEDs at efficacious doses provides strong support for AED treatment as mono- or polytherapy to increase seizure control and protect against SUDEP in patients with refractory epilepsy. For patients for whom seizure control is unattainable, supervision or monitoring may prevent SUDEP, though this has never been formally tested.
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Affiliation(s)
- Dale C Hesdorffer
- Gertrude H. Sergievsky Center and Department of Epidemiology, Columbia University, 630 West 168th Street, P & S Unit 16, New York, NY, USA.
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Schulze-Bonhage A. Pharmacokinetic and pharmacodynamic profile of pregabalin and its role in the treatment of epilepsy. Expert Opin Drug Metab Toxicol 2012. [DOI: 10.1517/17425255.2013.749239] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Ridsdale L, Virdi C, Noble A, Morgan M. Explanations given by people with epilepsy for using emergency medical services: a qualitative study. Epilepsy Behav 2012; 25:529-33. [PMID: 23159376 DOI: 10.1016/j.yebeh.2012.09.034] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 09/25/2012] [Accepted: 09/26/2012] [Indexed: 10/27/2022]
Abstract
Half of the people with epilepsy (PWE) in the UK experience seizures and 13-18% attend emergency medical services (EMS) annually. The majority of attendances are regarded as clinically unjustified. This study describes PWE explanations for using EMS. A nested qualitative study, part of a larger study based in three South London hospitals, was conducted. Semi-structured interviews were recorded, transcribed, and analyzed thematically. A seizure alone was not the main explanation for attending EMS; knowledge, experience, and confidence of those nearby on what to do and seizure context were important. Additionally, fears of sudden death held by the PWE and others were reported. From the patients' perspective, use of EMS is regarded as appropriate when they are away from home or someone nearby lacks knowledge of seizure management. Hospitals could provide regular group sessions on seizure management for PWE and their significant others, in which fears are discussed and evaluated.
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Affiliation(s)
- Leone Ridsdale
- Institute of Psychiatry, King's College London, London SE5 8AF, UK.
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Gaitatzis A, Sisodiya SM, Sander JW. The somatic comorbidity of epilepsy: A weighty but often unrecognized burden. Epilepsia 2012; 53:1282-93. [DOI: 10.1111/j.1528-1167.2012.03528.x] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Nicholas JM, Ridsdale L, Richardson MP, Ashworth M, Gulliford MC. Trends in antiepileptic drug utilisation in UK primary care 1993-2008: cohort study using the General Practice Research Database. Seizure 2012; 21:466-70. [PMID: 22608976 DOI: 10.1016/j.seizure.2012.04.014] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 04/27/2012] [Accepted: 04/29/2012] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To describe changes in utilisation of antiepileptic drugs (AED) by people with epilepsy in the United Kingdom during 1993-2008. METHODS Cohort study of 63,586 participants with epilepsy and prescribed AEDs from 434 UK family practices. Prescriptions for different AEDs and AED combinations were evaluated by calendar year, gender and age group. RESULTS Total follow-up was 361,207 person-years, with 282,080 person-years treated with AEDs and 79,126 person-years untreated. AED monotherapy accounted for 72.6% of treated person years of follow-up. Carbamazepine and valproates were among the most commonly used medications throughout 1993-2008. Phenytoin accounted for 39.5% of treated person-years in 1993 declining to 18.3% by 2008. Use of barbiturates declined from 14.3% in 1993 to 6.0% in 2008. In contrast between 1993 and 2008 there were substantial increases in the use of lamotrigine (2.0% to 17.0%) and to a lesser extent levetiracetam (0% to 8.6%). Newer AEDs were more frequently prescribed to younger participants, especially women aged 15-44 years, while older adults were more likely to be prescribed longer established AEDs. In 1993, 201 different AED combinations were prescribed, increasing to 500 different combinations in 2008. Combinations of sodium valproate and carbamazepine were frequent throughout, while sodium valproate and lamotrigine was frequent in 2008. CONCLUSIONS Utilisation of newer AEDs in UK primary care has increased between 1993 and 2008 with increasing use of diverse combinations of AEDs. The data quantify exposure to AEDs relevant to planning analytical pharmaco-epidemiological studies, as well as providing information to inform prescribing policies.
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Affiliation(s)
- Jennifer M Nicholas
- King's College London, Department of Primary Care and Public Health Sciences, UK
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Clinical Predictors of Mortality in Adults with Intellectual Disabilities with and without Down Syndrome. Curr Gerontol Geriatr Res 2012; 2012:943890. [PMID: 22666243 PMCID: PMC3361991 DOI: 10.1155/2012/943890] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 11/26/2011] [Accepted: 02/22/2012] [Indexed: 01/08/2023] Open
Abstract
Background. Mood, baseline functioning, and cognitive abilities as well as psychotropic medications may contribute to mortality in adults with and without Down Syndrome (DS). Methods. Population-based (nonclinical), community-dwelling adults with intellectual disabilities (IDs) were recruited between 1995 and 2000, assessed individually for 1–4 times, and then followed by yearly phone calls. Results. 360 participants (116 with DS and 244 without DS) were followed for an average of 12.9 years (range 0–16.1 years as of July 2011). 108 people died during the course of the followup, 65 males (31.9% of all male participants) and 43 females (27.6% of all female participants). Cox proportional hazards modeling showed that baseline practical skills, seizures, anticonvulsant use, depressive symptoms, and cognitive decline over the first six years all significantly contributed to mortality, as did a diagnosis of DS, male gender, and higher age at study entry. Analysis stratified by DS showed interesting differences in mortality predictors. Conclusion. Although adults with DS have had considerable improvements in life expectancy over time, they are still disadvantaged compared to adults with ID without DS. Recognition of potentially modifiable factors such as depression may decrease this risk.
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Smithson WH, Hukins D, Colwell B, Mathers N. Developing a method to identify medicines non-adherence in a community sample of adults with epilepsy. Epilepsy Behav 2012; 24:49-53. [PMID: 22494797 DOI: 10.1016/j.yebeh.2012.02.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 02/19/2012] [Accepted: 02/20/2012] [Indexed: 11/18/2022]
Abstract
The aim is to propose a simple way of identifying patients at risk of antiepileptic drug (AED) non-adherence during epilepsy review (a scheduled consultation to review the patient and their condition). The use of a multi-modal approach to the problem of non-adherence is necessary because of the limitations of existing methods. A mixed methodology was developed in a nested study using a case record review to calculate the medicine possession ratio (MPR) from the AED medication records of a community sample, a literature review and a consensus panel to develop a questionnaire to address how people manage their epilepsy, particularly medicine management, and how to collect information about non-adherence through stated findings in keeping with non-adherent behavior. Results show that a medicine record can be used to estimate the MPR (<80% indicates non-adherence) and that an open and non-confrontational consultation style can be fostered by using key questions within the consultation to identify those at risk of non-adherence.
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Affiliation(s)
- W Henry Smithson
- Academic Unit of Primary Medical Care, Medical School, Sheffield, UK.
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69
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Grigg-Damberger MM. Sudden Unexpected Death in Epilepsy: What Does Sleep Have to Do With It? Sleep Med Clin 2012. [DOI: 10.1016/j.jsmc.2012.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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70
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Affiliation(s)
- Orrin Devinsky
- Department of Neurology, NYU Langone School of Medicine, New York, NY 10016, USA.
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71
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Landmark CJ, Johannessen SI. Safety aspects of antiepileptic drugs-focus on pharmacovigilance. Pharmacoepidemiol Drug Saf 2011; 21:11-20. [DOI: 10.1002/pds.2269] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 08/22/2011] [Accepted: 09/19/2011] [Indexed: 11/10/2022]
Affiliation(s)
- Cecilie Johannessen Landmark
- Institute of Pharmacy and Biomedical Sciences; Faculty of Health Sciences; Oslo Norway
- Akershus University; College of Applied Sciences; Oslo Norway
| | - Svein I. Johannessen
- The National Center for Epilepsy; Sandvika Norway
- Department of Pharmacology; Oslo University Hospital; Oslo Norway
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