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Vargas ME, Gershon AS, Pugliese M, Gotfrit RJ, Manuel D, Sadatsafavi M, Stukel TA, To T, Kendall CE, Thavorn K, Robillard R, Kendzerska T. Pandemic Effect on Healthcare Use and Death in Adults with Epilepsy: A Population Study. Can J Neurol Sci 2023:1-11. [PMID: 38115804 DOI: 10.1017/cjn.2023.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVES We conducted a population-based study using Ontario health administrative data to describe trends in healthcare utilization and mortality in adults with epilepsy during the first pandemic year (March 2020-March 2021) compared to historical data (2016-2019). We also investigated if changes in outpatient visits and diagnostic testing during the first pandemic year were associated with increased risk for hospitalizations, emergency department (ED) visits, or death. METHODS Projected monthly visit rates (per 100,000 people) for outpatient visits, electroencephalography, magnetic resonance, computed tomography, all-cause ED visits, hospitalizations, and mortality were calculated based on historical data by fitting monthly time series autoregressive integrated moving-average models. Two-way interactions were calculated using Quasi-Poisson models. RESULTS In adults with epilepsy during the first quarter of the pandemic, we demonstrated a reduction in all-cause outpatient visits, diagnostic testing, ED visits and hospitalizations, and a temporary increase in mortality (observed rates of 355.8 vs projected 308.8, 95% CI: 276.3-345.1). By the end of the year, outpatient visits increased (85,535.4 vs 76,620.6, 95% CI: 71,546.9-82,059.4), and most of the diagnostic test rates returned to the projected. The increase in the rate of all-cause mortality during the pandemic, compared to pre-pandemic, was greater during months with the lower frequency of diagnostic tests than months with higher frequency (interaction p-values <.0001). CONCLUSION We described the impact of the pandemic on healthcare utilization and mortality in adults with epilepsy during the first year. We demonstrated that access to relevant diagnostic testing is likely important for this population while planning restrictions on non-urgent health services.
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Affiliation(s)
| | - Andrea S Gershon
- ICES, Ottawa, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Research Institute, The Hospital of Sick Children, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael Pugliese
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
| | - Ryan Jason Gotfrit
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Douglas Manuel
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, Respiratory Evaluation Sciences Program, The University of British Columbia, Vancouver, BC, Canada
| | - Therese A Stukel
- ICES, Ottawa, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Teresa To
- ICES, Ottawa, Toronto, ON, Canada
- Research Institute, The Hospital of Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Claire E Kendall
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Kednapa Thavorn
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Tetyana Kendzerska
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Ahrens SM, Ostendorf AP, Lado FA, Arnold ST, Bai S, Bensalem-Owen MK, Chapman KE, Clarke DF, Eisner M, Fountain NB, Gray JM, Gunduz MT, Hopp JL, Riker E, Schuele SU, Small B, Herman ST. Impact of the COVID-19 Pandemic on Epilepsy Center Practice in the United States. Neurology 2022; 98:e1893-e1901. [PMID: 35292559 PMCID: PMC9141627 DOI: 10.1212/wnl.0000000000200285] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/09/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Persons with epilepsy, especially those with drug resistant epilepsy (DRE), may benefit from inpatient services such as admission to the epilepsy monitoring unit (EMU) and epilepsy surgery. The COVID-19 pandemic caused reductions in these services within the US during 2020. This article highlights changes in resources, admissions, and procedures among epilepsy centers accredited by the National Association of Epilepsy Centers (NAEC). METHODS We compared data reported in 2019, prior to the COVID-19 pandemic, and 2020 from all 260 level 3 and level 4 NAEC accredited epilepsy centers. Data were described using frequency for categorical variables and median for continuous variables and were analyzed by center level, center population category, and geographical location. Qualitative responses from center directors to questions regarding the impact from COVID-19 were summarized utilizing thematic analysis. Responses from the NAEC center annual reports as well as a supplemental COVID-19 survey were included. RESULTS EMU admissions declined 23% (-21,515) in 2020, with largest median reductions in level 3 centers [-55 admissions (-44%)] and adult centers [-57 admissions (-39%)]. The drop in admissions was more substantial in the East North Central, East South Central, Mid Atlantic, and New England US Census divisions. Survey respondents attributed reduced admissions to re-assigning EMU beds, restrictions on elective admissions, reduced staffing, and patient reluctance for elective admission. Treatment surgeries declined by 371 cases (5.7%), with the largest reduction occurring in VNS implantations [-486 cases (-19%)] and temporal lobectomies [-227 cases (-16%)]. All other procedure volumes increased, including a 35% (54 cases) increase in corpus callosotomies. DISCUSSION In the US, access to care for persons with epilepsy declined during the COVID-19 pandemic in 2020. Adult patients, those relying on level 3 centers for care, and many persons in the eastern half of the US were most affected.
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Affiliation(s)
- Stephanie M Ahrens
- From the Department of Pediatrics (S.M.A., A.P.O., M.T.G.), Nationwide Children's Hospital and Ohio State University, Columbus; Department of Neurology (F.A.L.), Hofstra Northwell Comprehensive Epilepsy Center, Great Neck, NY; Department of Pediatrics (S.T.A.), Children's Medical Center, Dallas, TX; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (M.K.B.O.), University of Kentucky, Lexington; Department of Child Health (K.E.C.), University of Arizona College of Medicine and Barrow Neurological Institute at Phoenix Children's Hospital; Division of Pediatric Neurology, Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; National Association of Epilepsy Centers (J.M.G., E.R., B.S.), Washington, DC; University of Maryland Medical Center (J.L.H.), Baltimore; Ken and Ruth Davee Department of Neurology (S.U.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Neurology (S.T.H.), Barrow Neurological Institute, Phoenix, AZ
| | - Adam P Ostendorf
- From the Department of Pediatrics (S.M.A., A.P.O., M.T.G.), Nationwide Children's Hospital and Ohio State University, Columbus; Department of Neurology (F.A.L.), Hofstra Northwell Comprehensive Epilepsy Center, Great Neck, NY; Department of Pediatrics (S.T.A.), Children's Medical Center, Dallas, TX; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (M.K.B.O.), University of Kentucky, Lexington; Department of Child Health (K.E.C.), University of Arizona College of Medicine and Barrow Neurological Institute at Phoenix Children's Hospital; Division of Pediatric Neurology, Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; National Association of Epilepsy Centers (J.M.G., E.R., B.S.), Washington, DC; University of Maryland Medical Center (J.L.H.), Baltimore; Ken and Ruth Davee Department of Neurology (S.U.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Neurology (S.T.H.), Barrow Neurological Institute, Phoenix, AZ
| | - Fred Alexander Lado
- From the Department of Pediatrics (S.M.A., A.P.O., M.T.G.), Nationwide Children's Hospital and Ohio State University, Columbus; Department of Neurology (F.A.L.), Hofstra Northwell Comprehensive Epilepsy Center, Great Neck, NY; Department of Pediatrics (S.T.A.), Children's Medical Center, Dallas, TX; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (M.K.B.O.), University of Kentucky, Lexington; Department of Child Health (K.E.C.), University of Arizona College of Medicine and Barrow Neurological Institute at Phoenix Children's Hospital; Division of Pediatric Neurology, Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; National Association of Epilepsy Centers (J.M.G., E.R., B.S.), Washington, DC; University of Maryland Medical Center (J.L.H.), Baltimore; Ken and Ruth Davee Department of Neurology (S.U.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Neurology (S.T.H.), Barrow Neurological Institute, Phoenix, AZ
| | - Susan T Arnold
- From the Department of Pediatrics (S.M.A., A.P.O., M.T.G.), Nationwide Children's Hospital and Ohio State University, Columbus; Department of Neurology (F.A.L.), Hofstra Northwell Comprehensive Epilepsy Center, Great Neck, NY; Department of Pediatrics (S.T.A.), Children's Medical Center, Dallas, TX; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (M.K.B.O.), University of Kentucky, Lexington; Department of Child Health (K.E.C.), University of Arizona College of Medicine and Barrow Neurological Institute at Phoenix Children's Hospital; Division of Pediatric Neurology, Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; National Association of Epilepsy Centers (J.M.G., E.R., B.S.), Washington, DC; University of Maryland Medical Center (J.L.H.), Baltimore; Ken and Ruth Davee Department of Neurology (S.U.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Neurology (S.T.H.), Barrow Neurological Institute, Phoenix, AZ
| | - Shasha Bai
- From the Department of Pediatrics (S.M.A., A.P.O., M.T.G.), Nationwide Children's Hospital and Ohio State University, Columbus; Department of Neurology (F.A.L.), Hofstra Northwell Comprehensive Epilepsy Center, Great Neck, NY; Department of Pediatrics (S.T.A.), Children's Medical Center, Dallas, TX; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (M.K.B.O.), University of Kentucky, Lexington; Department of Child Health (K.E.C.), University of Arizona College of Medicine and Barrow Neurological Institute at Phoenix Children's Hospital; Division of Pediatric Neurology, Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; National Association of Epilepsy Centers (J.M.G., E.R., B.S.), Washington, DC; University of Maryland Medical Center (J.L.H.), Baltimore; Ken and Ruth Davee Department of Neurology (S.U.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Neurology (S.T.H.), Barrow Neurological Institute, Phoenix, AZ
| | - Meriem K Bensalem-Owen
- From the Department of Pediatrics (S.M.A., A.P.O., M.T.G.), Nationwide Children's Hospital and Ohio State University, Columbus; Department of Neurology (F.A.L.), Hofstra Northwell Comprehensive Epilepsy Center, Great Neck, NY; Department of Pediatrics (S.T.A.), Children's Medical Center, Dallas, TX; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (M.K.B.O.), University of Kentucky, Lexington; Department of Child Health (K.E.C.), University of Arizona College of Medicine and Barrow Neurological Institute at Phoenix Children's Hospital; Division of Pediatric Neurology, Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; National Association of Epilepsy Centers (J.M.G., E.R., B.S.), Washington, DC; University of Maryland Medical Center (J.L.H.), Baltimore; Ken and Ruth Davee Department of Neurology (S.U.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Neurology (S.T.H.), Barrow Neurological Institute, Phoenix, AZ
| | - Kevin E Chapman
- From the Department of Pediatrics (S.M.A., A.P.O., M.T.G.), Nationwide Children's Hospital and Ohio State University, Columbus; Department of Neurology (F.A.L.), Hofstra Northwell Comprehensive Epilepsy Center, Great Neck, NY; Department of Pediatrics (S.T.A.), Children's Medical Center, Dallas, TX; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (M.K.B.O.), University of Kentucky, Lexington; Department of Child Health (K.E.C.), University of Arizona College of Medicine and Barrow Neurological Institute at Phoenix Children's Hospital; Division of Pediatric Neurology, Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; National Association of Epilepsy Centers (J.M.G., E.R., B.S.), Washington, DC; University of Maryland Medical Center (J.L.H.), Baltimore; Ken and Ruth Davee Department of Neurology (S.U.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Neurology (S.T.H.), Barrow Neurological Institute, Phoenix, AZ
| | - Dave F Clarke
- From the Department of Pediatrics (S.M.A., A.P.O., M.T.G.), Nationwide Children's Hospital and Ohio State University, Columbus; Department of Neurology (F.A.L.), Hofstra Northwell Comprehensive Epilepsy Center, Great Neck, NY; Department of Pediatrics (S.T.A.), Children's Medical Center, Dallas, TX; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (M.K.B.O.), University of Kentucky, Lexington; Department of Child Health (K.E.C.), University of Arizona College of Medicine and Barrow Neurological Institute at Phoenix Children's Hospital; Division of Pediatric Neurology, Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; National Association of Epilepsy Centers (J.M.G., E.R., B.S.), Washington, DC; University of Maryland Medical Center (J.L.H.), Baltimore; Ken and Ruth Davee Department of Neurology (S.U.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Neurology (S.T.H.), Barrow Neurological Institute, Phoenix, AZ
| | - Mariah Eisner
- From the Department of Pediatrics (S.M.A., A.P.O., M.T.G.), Nationwide Children's Hospital and Ohio State University, Columbus; Department of Neurology (F.A.L.), Hofstra Northwell Comprehensive Epilepsy Center, Great Neck, NY; Department of Pediatrics (S.T.A.), Children's Medical Center, Dallas, TX; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (M.K.B.O.), University of Kentucky, Lexington; Department of Child Health (K.E.C.), University of Arizona College of Medicine and Barrow Neurological Institute at Phoenix Children's Hospital; Division of Pediatric Neurology, Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; National Association of Epilepsy Centers (J.M.G., E.R., B.S.), Washington, DC; University of Maryland Medical Center (J.L.H.), Baltimore; Ken and Ruth Davee Department of Neurology (S.U.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Neurology (S.T.H.), Barrow Neurological Institute, Phoenix, AZ
| | - Nathan B Fountain
- From the Department of Pediatrics (S.M.A., A.P.O., M.T.G.), Nationwide Children's Hospital and Ohio State University, Columbus; Department of Neurology (F.A.L.), Hofstra Northwell Comprehensive Epilepsy Center, Great Neck, NY; Department of Pediatrics (S.T.A.), Children's Medical Center, Dallas, TX; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (M.K.B.O.), University of Kentucky, Lexington; Department of Child Health (K.E.C.), University of Arizona College of Medicine and Barrow Neurological Institute at Phoenix Children's Hospital; Division of Pediatric Neurology, Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; National Association of Epilepsy Centers (J.M.G., E.R., B.S.), Washington, DC; University of Maryland Medical Center (J.L.H.), Baltimore; Ken and Ruth Davee Department of Neurology (S.U.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Neurology (S.T.H.), Barrow Neurological Institute, Phoenix, AZ
| | - Johanna M Gray
- From the Department of Pediatrics (S.M.A., A.P.O., M.T.G.), Nationwide Children's Hospital and Ohio State University, Columbus; Department of Neurology (F.A.L.), Hofstra Northwell Comprehensive Epilepsy Center, Great Neck, NY; Department of Pediatrics (S.T.A.), Children's Medical Center, Dallas, TX; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (M.K.B.O.), University of Kentucky, Lexington; Department of Child Health (K.E.C.), University of Arizona College of Medicine and Barrow Neurological Institute at Phoenix Children's Hospital; Division of Pediatric Neurology, Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; National Association of Epilepsy Centers (J.M.G., E.R., B.S.), Washington, DC; University of Maryland Medical Center (J.L.H.), Baltimore; Ken and Ruth Davee Department of Neurology (S.U.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Neurology (S.T.H.), Barrow Neurological Institute, Phoenix, AZ
| | - Muhammed Talha Gunduz
- From the Department of Pediatrics (S.M.A., A.P.O., M.T.G.), Nationwide Children's Hospital and Ohio State University, Columbus; Department of Neurology (F.A.L.), Hofstra Northwell Comprehensive Epilepsy Center, Great Neck, NY; Department of Pediatrics (S.T.A.), Children's Medical Center, Dallas, TX; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (M.K.B.O.), University of Kentucky, Lexington; Department of Child Health (K.E.C.), University of Arizona College of Medicine and Barrow Neurological Institute at Phoenix Children's Hospital; Division of Pediatric Neurology, Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; National Association of Epilepsy Centers (J.M.G., E.R., B.S.), Washington, DC; University of Maryland Medical Center (J.L.H.), Baltimore; Ken and Ruth Davee Department of Neurology (S.U.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Neurology (S.T.H.), Barrow Neurological Institute, Phoenix, AZ
| | - Jennifer L Hopp
- From the Department of Pediatrics (S.M.A., A.P.O., M.T.G.), Nationwide Children's Hospital and Ohio State University, Columbus; Department of Neurology (F.A.L.), Hofstra Northwell Comprehensive Epilepsy Center, Great Neck, NY; Department of Pediatrics (S.T.A.), Children's Medical Center, Dallas, TX; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (M.K.B.O.), University of Kentucky, Lexington; Department of Child Health (K.E.C.), University of Arizona College of Medicine and Barrow Neurological Institute at Phoenix Children's Hospital; Division of Pediatric Neurology, Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; National Association of Epilepsy Centers (J.M.G., E.R., B.S.), Washington, DC; University of Maryland Medical Center (J.L.H.), Baltimore; Ken and Ruth Davee Department of Neurology (S.U.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Neurology (S.T.H.), Barrow Neurological Institute, Phoenix, AZ
| | - Ellen Riker
- From the Department of Pediatrics (S.M.A., A.P.O., M.T.G.), Nationwide Children's Hospital and Ohio State University, Columbus; Department of Neurology (F.A.L.), Hofstra Northwell Comprehensive Epilepsy Center, Great Neck, NY; Department of Pediatrics (S.T.A.), Children's Medical Center, Dallas, TX; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (M.K.B.O.), University of Kentucky, Lexington; Department of Child Health (K.E.C.), University of Arizona College of Medicine and Barrow Neurological Institute at Phoenix Children's Hospital; Division of Pediatric Neurology, Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; National Association of Epilepsy Centers (J.M.G., E.R., B.S.), Washington, DC; University of Maryland Medical Center (J.L.H.), Baltimore; Ken and Ruth Davee Department of Neurology (S.U.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Neurology (S.T.H.), Barrow Neurological Institute, Phoenix, AZ
| | - Stephan U Schuele
- From the Department of Pediatrics (S.M.A., A.P.O., M.T.G.), Nationwide Children's Hospital and Ohio State University, Columbus; Department of Neurology (F.A.L.), Hofstra Northwell Comprehensive Epilepsy Center, Great Neck, NY; Department of Pediatrics (S.T.A.), Children's Medical Center, Dallas, TX; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (M.K.B.O.), University of Kentucky, Lexington; Department of Child Health (K.E.C.), University of Arizona College of Medicine and Barrow Neurological Institute at Phoenix Children's Hospital; Division of Pediatric Neurology, Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; National Association of Epilepsy Centers (J.M.G., E.R., B.S.), Washington, DC; University of Maryland Medical Center (J.L.H.), Baltimore; Ken and Ruth Davee Department of Neurology (S.U.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Neurology (S.T.H.), Barrow Neurological Institute, Phoenix, AZ
| | - Barbara Small
- From the Department of Pediatrics (S.M.A., A.P.O., M.T.G.), Nationwide Children's Hospital and Ohio State University, Columbus; Department of Neurology (F.A.L.), Hofstra Northwell Comprehensive Epilepsy Center, Great Neck, NY; Department of Pediatrics (S.T.A.), Children's Medical Center, Dallas, TX; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (M.K.B.O.), University of Kentucky, Lexington; Department of Child Health (K.E.C.), University of Arizona College of Medicine and Barrow Neurological Institute at Phoenix Children's Hospital; Division of Pediatric Neurology, Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; National Association of Epilepsy Centers (J.M.G., E.R., B.S.), Washington, DC; University of Maryland Medical Center (J.L.H.), Baltimore; Ken and Ruth Davee Department of Neurology (S.U.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Neurology (S.T.H.), Barrow Neurological Institute, Phoenix, AZ
| | - Susan T Herman
- From the Department of Pediatrics (S.M.A., A.P.O., M.T.G.), Nationwide Children's Hospital and Ohio State University, Columbus; Department of Neurology (F.A.L.), Hofstra Northwell Comprehensive Epilepsy Center, Great Neck, NY; Department of Pediatrics (S.T.A.), Children's Medical Center, Dallas, TX; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (M.K.B.O.), University of Kentucky, Lexington; Department of Child Health (K.E.C.), University of Arizona College of Medicine and Barrow Neurological Institute at Phoenix Children's Hospital; Division of Pediatric Neurology, Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; National Association of Epilepsy Centers (J.M.G., E.R., B.S.), Washington, DC; University of Maryland Medical Center (J.L.H.), Baltimore; Ken and Ruth Davee Department of Neurology (S.U.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Neurology (S.T.H.), Barrow Neurological Institute, Phoenix, AZ
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