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Cross JH, Benítez A, Roth J, Andrews JS, Shah D, Butcher E, Jones A, Sullivan J. A comprehensive systematic literature review of the burden of illness of Lennox-Gastaut syndrome on patients, caregivers, and society. Epilepsia 2024; 65:1224-1239. [PMID: 38456647 DOI: 10.1111/epi.17932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 03/09/2024]
Abstract
Fully elucidating the burden that Lennox-Gastaut syndrome (LGS) places on individuals with the disease and their caregivers is critical to improving outcomes and quality of life (QoL). This systematic literature review evaluated the global burden of illness of LGS, including clinical symptom burden, care requirements, QoL, comorbidities, caregiver burden, economic burden, and treatment burden (PROSPERO ID: CRD42022317413). MEDLINE, Embase, and the Cochrane Library were searched for articles that met predetermined criteria. After screening 1442 deduplicated articles and supplementary manual searches, 113 articles were included for review. A high clinical symptom burden of LGS was identified, with high seizure frequency and nonseizure symptoms (including developmental delay and intellectual disability) leading to low QoL and substantial care requirements for individuals with LGS, with the latter including daily function assistance for mobility, eating, and toileting. Multiple comorbidities were identified, with intellectual disorders having the highest prevalence. Although based on few studies, a high caregiver burden was also identified, which was associated with physical problems (including fatigue and sleep disturbances), social isolation, poor mental health, and financial difficulties. Most economic analyses focused on the high direct costs of LGS, which arose predominantly from medically treated seizure events, inpatient costs, and medication requirements. Pharmacoresistance was common, and many individuals required polytherapy and treatment changes over time. Few studies focused on the humanistic burden. Quality concerns were noted for sample representativeness, disease and outcome measures, and reporting clarity. In summary, a high burden of LGS on individuals, caregivers, and health care systems was identified, which may be alleviated by reducing the clinical symptom burden. These findings highlight the need for a greater understanding of and better definitions for the broad spectrum of LGS symptoms and development of treatments to alleviate nonseizure symptoms.
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Affiliation(s)
- J Helen Cross
- University College London National Institute for Health and Care Research Biomedical Research Centre Great Ormond Street Institute of Child Health, London, UK
| | - Arturo Benítez
- Takeda Pharmaceutical Company, Cambridge, Massachusetts, USA
| | - Jeannine Roth
- Takeda Pharmaceuticals International, Zurich, Switzerland
| | - J Scott Andrews
- Takeda Pharmaceutical Company, Cambridge, Massachusetts, USA
| | - Drishti Shah
- Takeda Pharmaceutical Company, Cambridge, Massachusetts, USA
| | | | | | - Joseph Sullivan
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
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Nasir M, Abebaw E, Ahmed M, Ketema DB. Clinical Characteristics, Treatment Outcome and Associated Factors of Epilepsy Among Children at Hospitals of North-West Ethiopia. Pediatric Health Med Ther 2023; 14:385-404. [PMID: 37927397 PMCID: PMC10625381 DOI: 10.2147/phmt.s436022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023] Open
Abstract
Background Epilepsy is an important cause of neurological morbidity in children and adolescents. Clinical parameters are the main diagnostic tools, especially in developing countries. Although cost-effective treatments for epilepsy are available, studies have shown that uncontrolled seizures can occur in many patients. Objective To assess clinical characteristics, treatment outcomes, and associated factors for controlled epilepsy among children with epilepsy who underwent follow-up at the Debre Markos Comprehensive Specialized Hospital, North-west Ethiopia from October 28, 2020, to April 28, 2021. Methods An institutional-based retrospective cohort study was conducted from October 28, 2020, to April 28, 2021. A total of 385 participants who fulfilled the inclusion criteria were included in the study. A pretested, structured, interviewer-administered questionnaire with a chart review was used to collect data. The data were entered into the Epi-data software version 4.4.2.1 and then exported to the Stata version 14 statistical package for analysis. Descriptive statistics were used to describe the sociodemographic and clinical characteristics, treatment profiles, and treatment outcomes of patients with epilepsy. Bivariate and multivariate analyses were used to identify factors associated with treatment outcomes. Results The most frequent type of seizure among the 385 respondents was Generalized-tonic-clonic seizures (88.1%). The proximate cause of seizures was identified in 15% of patients, of whom 45 had a perinatal history (8.8%), head injury (3.6%), and CNS infection (2.3%). One-third of patients had poor seizure control. Caregiver relationship (father AOR=0.58; 95th CI:0.35,0.97) and poor adherence (AOR=2.97; 95th CI:1.82, 4.86) were significantly associated with treatment outcome. Conclusion One-third of children with epilepsy have poor seizure control. Poor adherence to treatment is implicated in poor control. Counseling caregivers on proper treatment and adherence to anti-epileptic medication is recommended to improve treatment outcome in children.
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Affiliation(s)
- Mohammed Nasir
- Pediatrics Department, Hawassa University, Hawassa, Ethiopia
| | - Ermias Abebaw
- Pediatrics Department, ALERT Comprehensive Specialized Hospital, Addis Ababa, Ethiopia
| | - Muluken Ahmed
- Pediatrics Department, Arba Minch University, Arba Minch, Ethiopia
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Kentab AY, Al Bulayhi S, Hamad MH, Al Wadei A, Bashiri FA. Pattern and etiology of early childhood epilepsy: An Experience at a tertiary care University Center. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2022; 27:244-250. [PMID: 36252977 PMCID: PMC9749570 DOI: 10.17712/nsj.2022.4.20220001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 07/06/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To investigate seizure characteristics, types, and define the etiology of epilepsy in children aged ≤2 years using the 2017 ILAE classification. METHODS A retrospective chart review was conducted at King Khalid University Hospital, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia for children below 2 years of age diagnosed with epilepsy, and on anti-seizure medications from January 2017 - December 2018. The collected data involved detailed information on the patients' seizure, electroclinical, neuroimaging, laboratory evaluations, and underlying etiology. RESULTS One- hundred and fifty patients were included in the study and classified according to etiology into: genetic (43, 28.7%), structural (41, 27.3%), metabolic (10, 6.7%), infectious (8, 5.3%), immune-mediated (1, 0.7%) and unknown (47, 31.3%) groups. The most common seizure types were generalized epilepsy, among which generalized tonic-clonic seizures occurred in 56 (37%) patients, followed by tonic seizures in 31 (21%), infantile spasm in 19 (13%), myoclonic seizures in 4 (2.7%), atonic seizures in 6 (4%), and focal seizures in 33 (22%) patients. Global developmental delay and abnormalities in both neurologic exam and neuroimaging were more common in the structural and genetic groups. Electroencephalography was abnormal in 82 (55%) patients, including the majority of the structural group (26, 63.4%). CONCLUSION The etiology of epilepsy in this cohort remains undetermined (unknown) in a large proportion of cases, followed by genetic and structural causes. This result added to the published international data about epilepsy in the first 2-years of life.
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Affiliation(s)
- Amal Y. Kentab
- From the Division of Pediatric Neurology (Kentab, Al Bulayhi, Hamad, Al Wadei, Bashiri), Department of Pediatrics, King Khalid University Hospital, King Saud University Medical City, and from the Department of Pediatrics (Kentab, Bashiri), College of Medicine, King Saud University, and from the Department of Pediatric Neurology (Al Wadei), National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia,Address correspondence and reprint request to: Dr. Amal Y. Kentab Division of Pediatric Neurology, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0002-3627-4973
| | - Shumukh Al Bulayhi
- From the Division of Pediatric Neurology (Kentab, Al Bulayhi, Hamad, Al Wadei, Bashiri), Department of Pediatrics, King Khalid University Hospital, King Saud University Medical City, and from the Department of Pediatrics (Kentab, Bashiri), College of Medicine, King Saud University, and from the Department of Pediatric Neurology (Al Wadei), National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Muddathir H. Hamad
- From the Division of Pediatric Neurology (Kentab, Al Bulayhi, Hamad, Al Wadei, Bashiri), Department of Pediatrics, King Khalid University Hospital, King Saud University Medical City, and from the Department of Pediatrics (Kentab, Bashiri), College of Medicine, King Saud University, and from the Department of Pediatric Neurology (Al Wadei), National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ali Al Wadei
- From the Division of Pediatric Neurology (Kentab, Al Bulayhi, Hamad, Al Wadei, Bashiri), Department of Pediatrics, King Khalid University Hospital, King Saud University Medical City, and from the Department of Pediatrics (Kentab, Bashiri), College of Medicine, King Saud University, and from the Department of Pediatric Neurology (Al Wadei), National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Fahad A. Bashiri
- From the Division of Pediatric Neurology (Kentab, Al Bulayhi, Hamad, Al Wadei, Bashiri), Department of Pediatrics, King Khalid University Hospital, King Saud University Medical City, and from the Department of Pediatrics (Kentab, Bashiri), College of Medicine, King Saud University, and from the Department of Pediatric Neurology (Al Wadei), National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
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Wanigasinghe J, Sahu JK, Madaan P, Fatema K, Linn K, Chand P, Poudel P, Hamed E, Mynak ML, Hassan S. Classifying etiology of infantile spasms syndrome in resource-limited settings: A study from the South Asian region. Epilepsia Open 2021; 6:736-747. [PMID: 34653320 PMCID: PMC8633471 DOI: 10.1002/epi4.12548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/25/2021] [Accepted: 09/30/2021] [Indexed: 01/08/2023] Open
Abstract
Objective Etiological classification of infantile spasms syndrome (ISS) is important, considering the influence on prognosis based on the presence or absence of a known etiology. This study was performed to describe the limitations and difficulties experienced within the South Asian region when classifying the etiology of ISS according to the current recommendation. Method Data on healthcare indices and facilities related to management of ISS for the nine countries in the South Asian region were gathered by the South Asian West Syndrome Research Group. A Google survey was performed among three hundred and thirty pediatric neurologists in the region. The capacity within each country for investigating etiology of ISS according to current described benchmarks was evaluated. The difficulties experienced in this regard and the potential solutions were investigated. Results One hundred and sixty pediatric neurologists (response rate 48%) from Bangladesh (19/25), India (94/255), Myanmar (11/11), Nepal (6/8), Pakistan (19/25), and from Sri Lanka (7/8) responded. Three countries had no pediatric neurology services. Fifty‐six percent attempted to classify ISS etiology according to classification outlined by International League Against Epilepsy in 2017. The facilities to perform metabolic, genetic, and immunological investigations were very limited. Lack of funding for investigations and poor laboratory support were the two most frequent barriers encountered. Sixty percent indicated that a separate classification is suitable for low‐income setting; 78% suggested inclusion of separate category as “incompletely investigated” as an alternative solution to mitigate the barrier of achieving a better understanding of the etiological subtypes seen more frequently in this region. Significance The resources in South Asian region are limited to meet the recommendations for investigating etiology of ISS. Including the etiological subcategory “incompletely investigated” is proposed as an alternative to understand the true proportions of children in this region, with a definite known etiology and those with an unknown etiology.
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Affiliation(s)
| | - Jitendra Kumar Sahu
- Post graduate Institute of Medical Education and Research, Chandigarh, India
| | - Priyanka Madaan
- Post graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanij Fatema
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Kyaw Linn
- Yangon Children Hospital, Yangon, Myanmar
| | | | | | - Esmatullah Hamed
- French Medical Institute for Mothers and Children, Kabul, Afghanistan
| | - Mimi L Mynak
- Jigme Dorji Wangchuck National Referral Hospital, Thimpu, Nepal
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