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Miller JS, Oladele F, McAfee D, Adereti CO, Theodore WH, Akinsoji EO. Disparities in Epilepsy Diagnosis and Management in High-Income Countries: A Review of the Literature. Neurol Clin Pract 2024; 14:e200259. [PMID: 38585438 PMCID: PMC10996906 DOI: 10.1212/cpj.0000000000200259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/20/2023] [Indexed: 04/09/2024]
Abstract
Purpose of Review Currently, an estimated 3.4 million people in the United States live with epilepsy. Previous studies have identified health disparities associated with race/ethnicity, socioeconomic status (SES), sex, insurance status, and age in this population. However, there has been a dearth of research addressing these disparities. We performed a literature review of articles published between 2010 and 2020 pertaining to health disparities in people with epilepsy (PWE), identified key factors that contribute to gaps in their care, and discussed possible solutions. Recent Findings Health disparities in prevalence, treatment access, time to diagnosis, health care delivery and engagement, and clinical outcomes were identified among individuals who were either of low SES, rural-based, uninsured/underinsured, older patients, patients of color, or female sex. Summary Disparities in care for PWE continue to persist. Greater priority should be placed on addressing these gaps intricately tied to sociodemographic factors. Reforms to mitigate health disparities in PWE are necessary for timely diagnosis, effective treatment, and positive long-term outcomes.
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Affiliation(s)
- Joseph S Miller
- Ohio University Heritage College of Osteopathic Medicine (JSM), Dublin, OH; Memorial Sloan Kettering Cancer Center (FO), New York; University of Maryland School of Medicine (DM), Baltimore, MD; Ross University School of Medicine (COA); National Institute of Neurological Disorders and Stroke (WHT), National Institutes of Health, Bethesda, MD; and Department of Neurology (EOA), Emory University School of Medicine, Atlanta, GA
| | - Folake Oladele
- Ohio University Heritage College of Osteopathic Medicine (JSM), Dublin, OH; Memorial Sloan Kettering Cancer Center (FO), New York; University of Maryland School of Medicine (DM), Baltimore, MD; Ross University School of Medicine (COA); National Institute of Neurological Disorders and Stroke (WHT), National Institutes of Health, Bethesda, MD; and Department of Neurology (EOA), Emory University School of Medicine, Atlanta, GA
| | - Darrian McAfee
- Ohio University Heritage College of Osteopathic Medicine (JSM), Dublin, OH; Memorial Sloan Kettering Cancer Center (FO), New York; University of Maryland School of Medicine (DM), Baltimore, MD; Ross University School of Medicine (COA); National Institute of Neurological Disorders and Stroke (WHT), National Institutes of Health, Bethesda, MD; and Department of Neurology (EOA), Emory University School of Medicine, Atlanta, GA
| | - Christopher O Adereti
- Ohio University Heritage College of Osteopathic Medicine (JSM), Dublin, OH; Memorial Sloan Kettering Cancer Center (FO), New York; University of Maryland School of Medicine (DM), Baltimore, MD; Ross University School of Medicine (COA); National Institute of Neurological Disorders and Stroke (WHT), National Institutes of Health, Bethesda, MD; and Department of Neurology (EOA), Emory University School of Medicine, Atlanta, GA
| | - William H Theodore
- Ohio University Heritage College of Osteopathic Medicine (JSM), Dublin, OH; Memorial Sloan Kettering Cancer Center (FO), New York; University of Maryland School of Medicine (DM), Baltimore, MD; Ross University School of Medicine (COA); National Institute of Neurological Disorders and Stroke (WHT), National Institutes of Health, Bethesda, MD; and Department of Neurology (EOA), Emory University School of Medicine, Atlanta, GA
| | - Elizabeth O Akinsoji
- Ohio University Heritage College of Osteopathic Medicine (JSM), Dublin, OH; Memorial Sloan Kettering Cancer Center (FO), New York; University of Maryland School of Medicine (DM), Baltimore, MD; Ross University School of Medicine (COA); National Institute of Neurological Disorders and Stroke (WHT), National Institutes of Health, Bethesda, MD; and Department of Neurology (EOA), Emory University School of Medicine, Atlanta, GA
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Bensken WP, Vaca GFB, Williams SM, Khan OI, Jobst BC, Stange KC, Sajatovic M, Koroukian SM. Disparities in adherence and emergency department utilization among people with epilepsy: A machine learning approach. Seizure 2023; 110:169-176. [PMID: 37393863 PMCID: PMC10528555 DOI: 10.1016/j.seizure.2023.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/22/2023] [Accepted: 06/25/2023] [Indexed: 07/04/2023] Open
Abstract
PURPOSE We used a machine learning approach to identify the combinations of factors that contribute to lower adherence and high emergency department (ED) utilization. METHODS Using Medicaid claims, we identified adherence to anti-seizure medications and the number of ED visits for people with epilepsy in a 2-year follow up period. We used three years of baseline data to identify demographics, disease severity and management, comorbidities, and county-level social factors. Using Classification and Regression Tree (CART) and random forest analyses we identified combinations of baseline factors that predicted lower adherence and ED visits. We further stratified these models by race and ethnicity. RESULTS From 52,175 people with epilepsy, the CART model identified developmental disabilities, age, race and ethnicity, and utilization as top predictors of adherence. When stratified by race and ethnicity, there was variation in the combinations of comorbidities including developmental disabilities, hypertension, and psychiatric comorbidities. Our CART model for ED utilization included a primary split among those with previous injuries, followed by anxiety and mood disorders, headache, back problems, and urinary tract infections. When stratified by race and ethnicity we saw that for Black individuals headache was a top predictor of future ED utilization although this did not appear in other racial and ethnic groups. CONCLUSIONS ASM adherence differed by race and ethnicity, with different combinations of comorbidities predicting lower adherence across racial and ethnic groups. While there were not differences in ED use across races and ethnicity, we observed different combinations of comorbidities that predicted high ED utilization.
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Affiliation(s)
- Wyatt P Bensken
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Guadalupe Fernandez-Baca Vaca
- Department of Neurology, University Hospitals Cleveland Medical Center, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Scott M Williams
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Omar I Khan
- Epilepsy Center of Excellence, Baltimore VA Medical Center, US Department of Veterans Affairs, Baltimore, MD, USA
| | - Barbara C Jobst
- Department of Neurology, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, NH, Lebanon, USA
| | - Kurt C Stange
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA; Center for Community Health Integration, Departments of Family Medicine & Community Health, and Sociology, Case Western Reserve University, Cleveland, OH, USA
| | - Martha Sajatovic
- Departments of Neurology and Psychiatry, University Hospitals Cleveland Medical Center, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Siran M Koroukian
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Bensken WP, Alberti PM, Khan OI, Williams SM, Stange KC, Vaca GFB, Jobst BC, Sajatovic M, Koroukian SM. A framework for health equity in people living with epilepsy. Epilepsy Res 2022; 188:107038. [PMID: 36332544 PMCID: PMC9797034 DOI: 10.1016/j.eplepsyres.2022.107038] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 08/22/2022] [Accepted: 10/17/2022] [Indexed: 12/31/2022]
Abstract
Epilepsy is a disease where disparities and inequities in risk and outcomes are complex and multifactorial. While most epilepsy research to date has identified several key areas of disparities, we set out to provide a multilevel life course model of epilepsy development, diagnosis, treatment, and outcomes to highlight how these disparities represent true inequities. Our piece also presents three hypothetical cases that highlight how the solutions to address inequities may vary across the lifespan. We then identify four key domains (structural, socio-cultural, health care, and physiological) that contribute to the persistence of inequities in epilepsy risk and outcomes in the United States. Each of these domains, and their core components in the context of epilepsy, are reviewed and discussed. Further, we highlight the connection between domains and key areas of intervention to strive towards health equity. The goal of this work is to highlight these domains while also providing epilepsy researchers and clinicians with broader context of how their work fits into health equity.
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Affiliation(s)
- Wyatt P Bensken
- Department of Population and Quantitative Health Sciences, School of Medicine Case Western Reserve University, Cleveland, OH, USA.
| | - Philip M Alberti
- AAMC Center for Health Justice, Association of American Medical Colleges, Washington, DC, USA
| | - Omar I Khan
- Epilepsy Center of Excellence, Baltimore VA Medical Center US Department of Veterans Affairs, Baltimore, MD, USA
| | - Scott M Williams
- Department of Population and Quantitative Health Sciences, School of Medicine Case Western Reserve University, Cleveland, OH, USA; Department of Genetics and Genome Sciences, School of Medicine Case Western Reserve University, Cleveland, OH, USA
| | - Kurt C Stange
- Department of Population and Quantitative Health Sciences, School of Medicine Case Western Reserve University, Cleveland, OH, USA; Center for Community Health Integration, Departments of Family Medicine & Community Health, and Sociology Case Western Reserve University, Cleveland, OH, USA
| | - Guadalupe Fernandez-Baca Vaca
- Department of Neurology, University Hospitals Cleveland Medical Center, School of Medicine Case Western Reserve University, Cleveland, OH, USA
| | - Barbara C Jobst
- Department of Neurology, Geisel School of Medicine Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Martha Sajatovic
- Department of Neurology, University Hospitals Cleveland Medical Center, School of Medicine Case Western Reserve University, Cleveland, OH, USA; Department Psychiatry, University Hospitals Cleveland Medical Center, School of Medicine Case Western Reserve University, Cleveland, OH, USA
| | - Siran M Koroukian
- Department of Population and Quantitative Health Sciences, School of Medicine Case Western Reserve University, Cleveland, OH, USA
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Kamitaki BK, Zhang P, Master A, Adler S, Jain S, Thomas-Hawkins C, Lin H, Cantor JC, Choi H. Differences in elective epilepsy monitoring unit admission rates by race/ethnicity and primary payer in New Jersey. Epilepsy Behav 2022; 136:108923. [PMID: 36166877 DOI: 10.1016/j.yebeh.2022.108923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/21/2022] [Accepted: 09/13/2022] [Indexed: 12/14/2022]
Abstract
Elective admission to the epilepsy monitoring unit (EMU) is an essential service provided by epilepsy centers, particularly for those with drug-resistant epilepsy. Given previously characterized racial and socioeconomic healthcare disparities in the management of epilepsy, we sought to understand access and utilization of this service in New Jersey (NJ). We examined epilepsy hospitalizations in NJ between 2014 and 2016 using state inpatient and emergency department (ED) databases. We stratified admissions by race/ethnicity and primary payer and used these to estimate and compare (1) admission rates per capita in NJ, as well as (2) admission rates per number of ED visits for each group. Patients without insurance underwent elective EMU admission at the lowest rates across all racial/ethnic groups and payer types studied. Black patients with Medicaid and private insurance were admitted at disproportionately low rates relative to their number of ED visits. Hispanic/Latino and Asian/Pacific Islanders with private insurance, Hispanic/Latinos with Medicaid, and Asian/Pacific Islanders with Medicare were also admitted at low rates per capita within each respective payer category. Future studies should focus on addressing causal factors driving healthcare disparities in epilepsy, particularly for patients without adequate health insurance coverage and those who have been historically underserved by the healthcare system.
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Affiliation(s)
- Brad K Kamitaki
- Rutgers-Robert Wood Johnson Medical School, Department of Neurology, 125 Paterson Street, Suite 6200, New Brunswick, NJ 08901, USA.
| | - Pengfei Zhang
- Rutgers-Robert Wood Johnson Medical School, Department of Neurology, 125 Paterson Street, Suite 6200, New Brunswick, NJ 08901, USA
| | - Aditi Master
- Rutgers-Robert Wood Johnson Medical School, 675 Hoes Lane West, Piscataway, NJ 08854, USA
| | - Shoshana Adler
- Rutgers-Robert Wood Johnson Medical School, 675 Hoes Lane West, Piscataway, NJ 08854, USA
| | - Saloni Jain
- Rutgers-Robert Wood Johnson Medical School, 675 Hoes Lane West, Piscataway, NJ 08854, USA
| | - Charlotte Thomas-Hawkins
- Rutgers University School of Nursing, Division of Nursing Science, 180 University Ave, Newark, NJ 07102, USA
| | - Haiqun Lin
- Rutgers University School of Nursing, Division of Nursing Science, 180 University Ave, Newark, NJ 07102, USA
| | - Joel C Cantor
- Rutgers University, Center for State Health Policy, 112 Paterson Street, 5th Floor, New Brunswick, NJ 08901, USA
| | - Hyunmi Choi
- Columbia University, Department of Neurology, 710 West 168(th) Street, 7(th) Floor, New York, NY 10032, USA
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Szaflarski M. Racialized Inequities in Epilepsy Burden and Treatment. Neurol Clin 2022; 40:821-830. [DOI: 10.1016/j.ncl.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Health Disparities in Pediatric Epilepsy: Methods and Lessons Learned. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09898-1. [PMID: 35930105 PMCID: PMC9362655 DOI: 10.1007/s10880-022-09898-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2022] [Indexed: 11/09/2022]
Abstract
Epilepsy affects 1% of youth and is associated with neurocognitive and psychosocial comorbidities, increased risk of mortality, and poor health-related outcomes. Health disparities in children and youth with epilepsy (CYE) have been understudied. A Special Interest Group (SIG) within the Pediatric Epilepsy Research Consortium is conducting a scoping review to systematically assess the literature and highlight the gaps in access to clinical care and management of pediatric epilepsy. The methodology for this review is presented. In conducting a peer-reviewed assessment of the scope of health disparities in pediatric epilepsy, we learned that developing the methodology for and conducting a comprehensive scoping review with multiple contributors resulted in a time-intensive process. While there is an evidence to suggest that health disparities do exist in CYE, very few studies have focused on these disparities. Disparity results are often not included in key elements of articles, lending them to be underemphasized and underrecognized. Preliminary conclusions inform several important research considerations.
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What are the Risk Factor for Epilepsy Among Patients With Craniosynostosis? J Oral Maxillofac Surg 2022; 80:1191-1197. [DOI: 10.1016/j.joms.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/06/2022] [Accepted: 02/11/2022] [Indexed: 01/22/2023]
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Lanjewar SN, Sloan SA. Growing Glia: Cultivating Human Stem Cell Models of Gliogenesis in Health and Disease. Front Cell Dev Biol 2021; 9:649538. [PMID: 33842475 PMCID: PMC8027322 DOI: 10.3389/fcell.2021.649538] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/25/2021] [Indexed: 12/31/2022] Open
Abstract
Glia are present in all organisms with a central nervous system but considerably differ in their diversity, functions, and numbers. Coordinated efforts across many model systems have contributed to our understanding of glial-glial and neuron-glial interactions during nervous system development and disease, but human glia exhibit prominent species-specific attributes. Limited access to primary samples at critical developmental timepoints constrains our ability to assess glial contributions in human tissues. This challenge has been addressed throughout the past decade via advancements in human stem cell differentiation protocols that now offer the ability to model human astrocytes, oligodendrocytes, and microglia. Here, we review the use of novel 2D cell culture protocols, 3D organoid models, and bioengineered systems derived from human stem cells to study human glial development and the role of glia in neurodevelopmental disorders.
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Affiliation(s)
| | - Steven A. Sloan
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, United States
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9
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Kong WY, Saber H, Marawar R, Basha MM. Racial and ethnic trends in antiseizure medications trial enrolment: A systematic review using ClinicalTrials.gov. Epilepsy Res 2021; 173:106613. [PMID: 33743520 DOI: 10.1016/j.eplepsyres.2021.106613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/06/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe the racial and gender distribution in antiseizure medications (ASM) clinical trials using a systemic review of clinical trial registry database. METHODS We searched ClinicalTrials.gov database for ASM trials registered from September 1988 to January 2019. All randomized and non-randomized trials investigating ASM for epilepsy were included. Trials with intervention other than ASM or condition other than epilepsy were excluded. Data on age, race, ethnicity, and gender were extracted directly from database and from published data where available. Study location, trial identifier, year of completion, and funding sources were also collected. Meta-analysis of proportions was conducted using R software. RESULT Two hundred and thirty studies conducted globally with 39,576 participants were included. Overall, there are 53 % male on all registered ASM studies globally. For trials conducted in the United States (61 studies/5126 participants), 52 % of the participants were male with the following weighted racial distribution (80 % White 13 % Black 3% Asian 7% Hispanic). Subgroup analysis revealed that non-pharma-sponsored studies (50 studies, 4296 participants) have a higher representation of minorities as compared to pharma-sponsored studies (180 studies, 35,280 participants), including Hispanic (9% vs 3% respectively) and Black (18 % vs 11 % respectively). Temporal trends in racial distribution were noted when the duration of 2007-2019 was split into two groups: 2007-2013 (0% Asian, 5% Hispanic, 20 % Black); 2014-2019 (4% Asian, 7% Hispanic, 8% Black). CONCLUSION In this systematic review, participation of racial and ethnic minorities of Asian and Hispanic background was under-represented. Disparities of all minorities including Black participants was more notable over time and in studies sponsored by industry. Generalizability of ASM clinical trials to certain subgroups should be further examined.
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Affiliation(s)
- Wan Yee Kong
- Department of Neurology, Wayne State University, Detroit Medical Centre, Michigan University Health Center, 4201 St Antoine A, Detroit, MI, 48201, United States.
| | - Hamidreza Saber
- Department of Neurology, University of California, Los Angeles 710 Westwood Plaza, Los Angeles, CA, 90095-1769, United States.
| | - Rohit Marawar
- Department of Neurology, Wayne State University, Detroit Medical Centre, Michigan University Health Center, 4201 St Antoine A, Detroit, MI, 48201, United States.
| | - Maysaa Merhi Basha
- Department of Neurology, Wayne State University, Detroit Medical Centre, Michigan University Health Center, 4201 St Antoine A, Detroit, MI, 48201, United States.
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Record EJ, Bumbut A, Shih S, Merwin S, Kroner B, Gaillard WD. Risk factors, etiologies, and comorbidities in urban pediatric epilepsy. Epilepsy Behav 2021; 115:107716. [PMID: 33444988 DOI: 10.1016/j.yebeh.2020.107716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
The Seizures and Outcomes Study in Children (SOS-KIDS) identifies risk factors, etiologies, and comorbidities in a pediatric epilepsy population in a major city with diversity in socioeconomic levels. A thorough understanding of the range of issues impacting children with epilepsy is critical to establishing treatment that will produce better health outcomes. SOS-KIDS is a cross-sectional cohort study of pediatric epilepsy patients who live in Washington D.C. and are evaluated at Children's National Hospital. Families were recruited at the time of the child's routine clinic appointment or inpatient visit. Information was extracted from participants' electronic medical records (EMR) and parent reports; participants were screened for comorbidities using standardized screening measures. Data were collected from 289 participants (47% female, 53% male), and mean age was 7.9 years (2 months to 17 years). Twenty-nine percent of participants had primary generalized epilepsy, 63% focal epilepsy, 0.3% combined generalized and focal epilepsy, and 8% could not be distinguished. There were a variety of epilepsy risk factors including prematurity (10%), intraventricular hemorrhage (7%), neonatal seizures (8%), and febrile seizures (17%). The most common etiologies were cerebral malformations (13%) and genetic disorders (25%). Numerous participants had documented comorbidities including developmental delay (56%), intellectual disability (20%), headaches (16%), attention-deficit hyperactivity disorder (23%), and autism (7%). Of participants aged six years and older, depression, and anxiety were reported in 5% and 6% within the EMR, 14% and 19% in parent surveys, and 22% and 33% with standardized screening measures. We identified a wide variety of risk factors and etiologies among urban pediatric epilepsy patients, with genetic and structural being the most common. Neurologic and psychiatric comorbidities were common, but the prevalence of several psychiatric disorders reported within the EMR was substantially lower compared to that found when using parent surveys and standardized screening measures.
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Affiliation(s)
- E Justine Record
- Children's National Hospital, Center for Neuroscience, 111 Michigan Avenue NW, Washington, DC 20010, USA.
| | - Adrian Bumbut
- Children's National Hospital, Center for Neuroscience, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Sharon Shih
- Children's National Hospital, Center for Neuroscience, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Stephanie Merwin
- Children's National Hospital, Center for Neuroscience, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Barbara Kroner
- RTI International, 701 13th St NW #750, Washington, DC 20005, USA
| | - William D Gaillard
- Children's National Hospital, Center for Neuroscience, 111 Michigan Avenue NW, Washington, DC 20010, USA
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Bonkowsky JL, deVeber G, Kosofsky BE. Pediatric Neurology Research in the Twenty-First Century: Status, Challenges, and Future Directions Post-COVID-19. Pediatr Neurol 2020; 113:2-12. [PMID: 32979654 DOI: 10.1016/j.pediatrneurol.2020.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND The year 2020 marked a fundamental shift in the pediatric neurology field. An impressive positive trajectory of advances in patient care and research faced sudden global disruptions by the coronavirus disease 2019 pandemic and by an international movement protesting racial, socioeconomic, and health disparities. The disruptions revealed obstacles and fragility within the pediatric neurology research mission. However, renewed commitment offers unique opportunities for the pediatric neurology research community to enhance and prioritize research directions for the coming decades. METHODS The Research Committee of the Child Neurology Society evaluated the challenges and opportunities facing the pediatric neurology research field, including reviewing published literature, synthesizing publically available data, and conducting a survey of pediatric neurologists. RESULTS We identified three priority domains for the research mission: funding levels, active guidance, and reducing disparities. Funding levels: to increase funding to match the burden of pediatric neurological disease; to tailor funding mechanisms and strategies to support clinical trial efforts unique to pediatric neurology; and to support investigators across their career trajectory. Active guidance: to optimize infrastructure and strategies, to leverage novel therapeutics, enhance data collection, and improve inclusion of children in clinical trials. Reducing disparities: to reduce health disparities in children with neurological disease, to develop proactive measures to enhance workforce diversity and inclusion, and increase avenues to balance work-life obligations for investigators. CONCLUSIONS In this uniquely challenging epoch, the pediatric neurology research community has a timely and important mission to re-engage the public and government, advancing the health of children with neurological conditions.
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Affiliation(s)
- Joshua L Bonkowsky
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah; Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, Utah.
| | - Gabrielle deVeber
- Hospital for Sick Children Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Barry E Kosofsky
- Department of Pediatrics, New York-Presbyterian/Weill Cornell Medicine, New York, New York
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12
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Bensken WP, Navale SM, Andrew AS, Jobst BC, Sajatovic M, Koroukian SM. Delays and disparities in diagnosis for adults with epilepsy: Findings from U.S. Medicaid data. Epilepsy Res 2020; 166:106406. [PMID: 32745887 PMCID: PMC7998893 DOI: 10.1016/j.eplepsyres.2020.106406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/11/2020] [Accepted: 06/23/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To identify disparities in care pathways and time from first seizure to epilepsy diagnosis, we examined 2010-2014 Medicaid claims (including pharmacy) data from 16 States for individuals with incident epilepsy. METHODS We identified adults (18-64) with an incident epilepsy diagnosis from 1/2012 through 6/2014. These individuals were enrolled in Medicaid for the entire study period and had no history of anti-epileptic drug (AED) use before their first seizure claim. We identified care pathways and calculated the duration from initial seizure to epilepsy diagnosis. We tested associations between these pathways and race/ethnicity, as well as time differences between care pathways using a Chi-squared and Kruskal-Wallis tests. RESULTS The 14,337 adults followed five different care pathways. Their overall median duration from first seizure code to epilepsy diagnosis code was 19.0 months (interquartile range: 4.6, 30.4), and 56.0% filled an AED prescription. Some minorities were more likely to follow pathways with increased durations and delay to diagnosis, and the duration to diagnosis varied significantly across the care pathways. SIGNIFICANCE The many different care pathways seen in people with epilepsy show substantial and significant time delays between first seizure diagnosis and epilepsy diagnosis, including significant racial/ethnic disparities that warrant attention.
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Affiliation(s)
- Wyatt P Bensken
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, United States.
| | - Suparna M Navale
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Angeline S Andrew
- Department of Neurology: Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Barbara C Jobst
- Department of Neurology: Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Martha Sajatovic
- Departments of Neurology and Psychiatry: University Hospitals Cleveland Medical Center, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Siran M Koroukian
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
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Brown SC, King ZA, Kuohn L, Kamel H, Gilmore EJ, Frontera JA, Murthy S, Kim JA, Omay SB, Falcone GJ, Sheth KN. Association of race and ethnicity to incident epilepsy, or epileptogenesis, after subdural hematoma. Neurology 2020; 95:e2890-e2899. [PMID: 32907969 DOI: 10.1212/wnl.0000000000010742] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 06/25/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether race is associated with the development of epilepsy after subdural hematoma (SDH), we identified adult survivors of SDH in a statewide administrative dataset and followed them up for at least 1 year for revisits associated with epilepsy. METHODS We performed a retrospective cohort study using claims data on all discharges from emergency departments (EDs) and hospitals in California. We identified adults (age ≥18 years) admitted from 2005 to 2011 with first-time traumatic and nontraumatic SDH. We used validated diagnosis codes to identify a primary outcome of ED or inpatient revisit for epilepsy. We used multivariable Cox regression for survival analysis to identify demographic and medical risk factors for epilepsy. RESULTS We identified 29,342 survivors of SDH (mean age 71.2 [SD 16.4] years, female sex 11,954 [41.1%]). Three thousand two hundred thirty (11.0%) patients had revisits to EDs or hospitals with a diagnosis of epilepsy during the study period. Black patients (n = 1,684 [5.7%]) had significantly increased risk compared to White patients (n = 16,945 [57.7%]; hazard ratio [HR] 1.45, 95% confidence interval [CI] 1.28-1.64, p < 0.001). Status epilepticus during the index SDH admission, although infrequent (n = 94 [0.3%]), was associated with a nearly 4-fold risk of epilepsy (HR 3.75, 95% CI 2.80-5.03, p < 0.001). Alcohol use, drug use, smoking, renal disease, and markers of injury severity (i.e., intubation, surgical intervention, length of stay, disposition other than home) were also associated with epilepsy (all p < 0.05). CONCLUSIONS We found an association between Black race and ED and hospital revisits for epilepsy after SDH, establishing the presence of a racial subgroup that is particularly vulnerable to post-SDH epileptogenesis.
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Affiliation(s)
- Stacy C Brown
- From the Division of Neurocritical Care and Emergency Neurology (S.C.B., L.K., E.J.G., J.A.K., G.J.F., K.N.S.), Department of Neurology, and Department of Neurosurgery (S.B.O.), Yale School of Medicine, New Haven, CT; David Geffen School of Medicine at UCLA (Z.A.K.), Los Angeles, CA; Department of Neurology (H.K., S.M.), Weill Cornell Medicine; and Department of Neurology (J.A.F.), New York University School of Medicine, New York
| | - Zachary A King
- From the Division of Neurocritical Care and Emergency Neurology (S.C.B., L.K., E.J.G., J.A.K., G.J.F., K.N.S.), Department of Neurology, and Department of Neurosurgery (S.B.O.), Yale School of Medicine, New Haven, CT; David Geffen School of Medicine at UCLA (Z.A.K.), Los Angeles, CA; Department of Neurology (H.K., S.M.), Weill Cornell Medicine; and Department of Neurology (J.A.F.), New York University School of Medicine, New York
| | - Lindsey Kuohn
- From the Division of Neurocritical Care and Emergency Neurology (S.C.B., L.K., E.J.G., J.A.K., G.J.F., K.N.S.), Department of Neurology, and Department of Neurosurgery (S.B.O.), Yale School of Medicine, New Haven, CT; David Geffen School of Medicine at UCLA (Z.A.K.), Los Angeles, CA; Department of Neurology (H.K., S.M.), Weill Cornell Medicine; and Department of Neurology (J.A.F.), New York University School of Medicine, New York
| | - Hooman Kamel
- From the Division of Neurocritical Care and Emergency Neurology (S.C.B., L.K., E.J.G., J.A.K., G.J.F., K.N.S.), Department of Neurology, and Department of Neurosurgery (S.B.O.), Yale School of Medicine, New Haven, CT; David Geffen School of Medicine at UCLA (Z.A.K.), Los Angeles, CA; Department of Neurology (H.K., S.M.), Weill Cornell Medicine; and Department of Neurology (J.A.F.), New York University School of Medicine, New York
| | - Emily J Gilmore
- From the Division of Neurocritical Care and Emergency Neurology (S.C.B., L.K., E.J.G., J.A.K., G.J.F., K.N.S.), Department of Neurology, and Department of Neurosurgery (S.B.O.), Yale School of Medicine, New Haven, CT; David Geffen School of Medicine at UCLA (Z.A.K.), Los Angeles, CA; Department of Neurology (H.K., S.M.), Weill Cornell Medicine; and Department of Neurology (J.A.F.), New York University School of Medicine, New York
| | - Jennifer A Frontera
- From the Division of Neurocritical Care and Emergency Neurology (S.C.B., L.K., E.J.G., J.A.K., G.J.F., K.N.S.), Department of Neurology, and Department of Neurosurgery (S.B.O.), Yale School of Medicine, New Haven, CT; David Geffen School of Medicine at UCLA (Z.A.K.), Los Angeles, CA; Department of Neurology (H.K., S.M.), Weill Cornell Medicine; and Department of Neurology (J.A.F.), New York University School of Medicine, New York
| | - Santosh Murthy
- From the Division of Neurocritical Care and Emergency Neurology (S.C.B., L.K., E.J.G., J.A.K., G.J.F., K.N.S.), Department of Neurology, and Department of Neurosurgery (S.B.O.), Yale School of Medicine, New Haven, CT; David Geffen School of Medicine at UCLA (Z.A.K.), Los Angeles, CA; Department of Neurology (H.K., S.M.), Weill Cornell Medicine; and Department of Neurology (J.A.F.), New York University School of Medicine, New York
| | - Jennifer A Kim
- From the Division of Neurocritical Care and Emergency Neurology (S.C.B., L.K., E.J.G., J.A.K., G.J.F., K.N.S.), Department of Neurology, and Department of Neurosurgery (S.B.O.), Yale School of Medicine, New Haven, CT; David Geffen School of Medicine at UCLA (Z.A.K.), Los Angeles, CA; Department of Neurology (H.K., S.M.), Weill Cornell Medicine; and Department of Neurology (J.A.F.), New York University School of Medicine, New York
| | - Sacit Bulent Omay
- From the Division of Neurocritical Care and Emergency Neurology (S.C.B., L.K., E.J.G., J.A.K., G.J.F., K.N.S.), Department of Neurology, and Department of Neurosurgery (S.B.O.), Yale School of Medicine, New Haven, CT; David Geffen School of Medicine at UCLA (Z.A.K.), Los Angeles, CA; Department of Neurology (H.K., S.M.), Weill Cornell Medicine; and Department of Neurology (J.A.F.), New York University School of Medicine, New York
| | - Guido J Falcone
- From the Division of Neurocritical Care and Emergency Neurology (S.C.B., L.K., E.J.G., J.A.K., G.J.F., K.N.S.), Department of Neurology, and Department of Neurosurgery (S.B.O.), Yale School of Medicine, New Haven, CT; David Geffen School of Medicine at UCLA (Z.A.K.), Los Angeles, CA; Department of Neurology (H.K., S.M.), Weill Cornell Medicine; and Department of Neurology (J.A.F.), New York University School of Medicine, New York
| | - Kevin N Sheth
- From the Division of Neurocritical Care and Emergency Neurology (S.C.B., L.K., E.J.G., J.A.K., G.J.F., K.N.S.), Department of Neurology, and Department of Neurosurgery (S.B.O.), Yale School of Medicine, New Haven, CT; David Geffen School of Medicine at UCLA (Z.A.K.), Los Angeles, CA; Department of Neurology (H.K., S.M.), Weill Cornell Medicine; and Department of Neurology (J.A.F.), New York University School of Medicine, New York.
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14
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Teagarden DL, Morton ML, Janocko NJ, Groover O, Villarreal HK, Evans L, Drane DL, Karakis I. Socioeconomic disparities in patients with psychogenic nonepileptic seizures and their caregivers. Epilepsy Behav 2020; 110:107160. [PMID: 32493610 DOI: 10.1016/j.yebeh.2020.107160] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE There is no information on disparities of patients with psychogenic nonepileptic seizures (PNES) and their caregivers. The objective of this exploratory study is to compare patients with PNES and caregivers with low socioeconomic status (SES) with those of high SES for disparities in healthcare use, seizures, medication adverse effects, psychosocial impact, and knowledge about epilepsy. METHODS Patients with PNES and caregivers completed surveys about the aforementioned outcomes during their Epilepsy Monitoring Unit (EMU) admission. Associations were evaluated using SES as a binary independent variable and the patient- and caregiver-related outcomes as dependent variables. RESULTS Forty-three patients and 28 caregivers were recruited. The majority of patients were on average 36 years old, single women, unemployed, with some college education. The majority had PNES for 8 years averaging 20 seizures per month and were maintained on ≥2 antiepileptic drugs (AEDs) prior to their EMU admission. Most caregivers were first-degree relatives with a mean age of 43 years, married employed women of higher educational attainment, typically cohabitating with the patients. Low SES patients showed poorer knowledge about epilepsy (p < 0.0001) and higher anxiety levels (p = 0.03). Conversely, high SES patients demonstrated poorer social functioning (p = 0.04). High SES caregivers showed higher caregiving burden (p = 0.01). CONCLUSION There are noteworthy disparities in patients with PNES of different SES and their caregivers. Identification of those disparities is a critical step in the creation of appropriate interventions to address them.
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Affiliation(s)
- Diane L Teagarden
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew L Morton
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Nicholas J Janocko
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Olivia Groover
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Hannah K Villarreal
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Latasha Evans
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, University of Washington, Seattle, WA, USA
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
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15
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Tian N, Croft JB, Kobau R, Zack MM, Greenlund KJ. CDC-supported epilepsy surveillance and epidemiologic studies: A review of progress since 1994. Epilepsy Behav 2020; 109:107123. [PMID: 32451250 DOI: 10.1016/j.yebeh.2020.107123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 11/18/2022]
Abstract
To report progress, to identify gaps, and to plan epilepsy surveillance and research activities more effectively, the Centers for Disease Control and Prevention (CDC) Epilepsy Program has summarized findings from selected CDC-supported surveillance and epidemiologic studies about epilepsy from 1994 through 2019. We identified publications supported by CDC funding and publications conducted by the CDC Epilepsy Program alone or with partners. We included only epilepsy surveillance and epidemiologic studies focusing on epilepsy burden, epilepsy-related outcomes, and healthcare utilization. We describe the findings of these studies in the following order: 1)prevalence; 2)incidence; 3)epilepsy-related outcomes by selected demographic characteristics; 4)cysticercosis or neurocysticercosis (NCC); 5)traumatic brain injury (TBI); 6)comorbidity; 7)mortality; 8)access to care; 9)quality of care; and 10) cost. We have characterized these findings in relation to the scope of the first three domains of the 2012 Institute of Medicine report on epilepsy and its relevant first four recommendations. From 1994 through 2019, 76 publications on epilepsy-related epidemiologic and surveillance studies were identified. Over the past 25 years, CDC has expanded community, state, and national surveillance on epilepsy and supported epidemiologic studies by using multiple assessment methods and validated case-ascertainment criteria to identify epilepsy burden, epilepsy-related outcomes, and healthcare utilization in the general population or in population subgroups. Among identified research opportunities, studies on epilepsy incidence and risk factors, mortality, and cost are considered as important surveillance gaps. Other remaining gaps and suggested surveillance strategies are also proposed. Findings from this review may help epilepsy researchers and other stakeholders reference and prioritize future activities for epidemiologic and surveillance studies in epilepsy.
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Affiliation(s)
- Niu Tian
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, Epilepsy Program, 4770 Buford Highway, NE, Mailstop S107-6, Atlanta, GA 30341, USA.
| | - Janet B Croft
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, Epilepsy Program, 4770 Buford Highway, NE, Mailstop S107-6, Atlanta, GA 30341, USA
| | - Rosemarie Kobau
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, Epilepsy Program, 4770 Buford Highway, NE, Mailstop S107-6, Atlanta, GA 30341, USA
| | - Matthew M Zack
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, Epilepsy Program, 4770 Buford Highway, NE, Mailstop S107-6, Atlanta, GA 30341, USA
| | - Kurt J Greenlund
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, Epilepsy Program, 4770 Buford Highway, NE, Mailstop S107-6, Atlanta, GA 30341, USA
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16
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Poverty, insurance, and region as predictors of epilepsy treatment among US adults. Epilepsy Behav 2020; 107:107050. [PMID: 32294594 PMCID: PMC7242147 DOI: 10.1016/j.yebeh.2020.107050] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/17/2020] [Indexed: 11/20/2022]
Abstract
Disparities in epilepsy treatment have previously been reported. In the current study, we examine the role of socioeconomic status, health insurance, place of residence, and sociodemographic characteristics in past-year visit to a neurology or epilepsy provider and current use of antiseizure medications. Multiple years of data were compiled from the National Health Interview Surveys, Sample Adult Epilepsy Modules. The sample (n = 1655) included individuals 18 years and older who have been told by a doctor to have epilepsy or seizures. Independent variables included number of seizures in the past year, health insurance, poverty status, education, region, race/ethnicity, foreign-born status, age, and sex/gender. Two sets of weighted hierarchical logistic regression models were estimated predicting past-year epilepsy visit and current medication use. Accounting for recent seizure activity and other factors, uninsured and people residing outside of the Northeast were less likely to see an epilepsy provider, and people living in poverty were less likely to use medications, relative to their comparison groups. However, no racial/ethnic and nativity-based differences in specialty service or medication use were observed. Further research, including longitudinal studies of care trajectories and outcomes, are warranted to better understand healthcare needs of people with epilepsy, in particular treatment-resistant seizures, and to develop appropriate interventions at the policy, public health, and health system levels.
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17
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Quarells RC, Spruill TM, Escoffery C, Shallcross A, Montesdeoca J, Diaz L, Payano L, Thompson NJ. Depression self-management in people with epilepsy: Adapting project UPLIFT for underserved populations. Epilepsy Behav 2019; 99:106422. [PMID: 31371202 PMCID: PMC7432961 DOI: 10.1016/j.yebeh.2019.07.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/05/2019] [Indexed: 01/27/2023]
Abstract
Data from the 2015 National Health Interview Survey found that the prevalence of active epilepsy has increased to three million adults. Although findings have been mixed, some research indicates that Blacks and Hispanics share a higher burden of epilepsy prevalence compared with non-Hispanic whites. Moreover, depression is a common comorbid condition among people with epilepsy (PWE), affecting up to 55% of the epilepsy population. Widespread use and increased public health impact of evidence-based self-management interventions is critical to reducing disease burden and may require adapting original interventions into more culturally relevant versions for racial and ethnic minority groups. Project UPLIFT provides access to mental health self-management skills training that is distance-delivered, does not interfere with medication management, and has been shown to be effective in reducing depressive symptoms. This paper presents the process of exploring the adaptation of Project UPLIFT for Black and Hispanic PWE and herein suggests that evidence-based interventions can be successfully adapted for new populations or cultural settings through a careful and systematic process. Additional key lessons learned include the importance of community engagement and that language matters. Ultimately, if the adapted Project UPLIFT intervention produces positive outcomes for diverse populations of PWE, it will extend the strategies available to reduce the burden of depression. Implementing evidence-based interventions such as Project UPLIFT is critical to reducing disease burden; however, their delivery may need to be tailored to the needs and culture of the populations of interest.
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Affiliation(s)
- Rakale C Quarells
- Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA 30310, United States.
| | - Tanya M Spruill
- NYU School of Medicine, Department of Population Health, 180 Madison Ave, 7th Floor, New York, NY 10016, United States
| | - Cam Escoffery
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, United States
| | - Amanda Shallcross
- NYU School of Medicine, Department of Population Health, 180 Madison Ave, 7th Floor, New York, NY 10016, United States
| | - Jacqueline Montesdeoca
- NYU School of Medicine, Department of Population Health, 180 Madison Ave, 7th Floor, New York, NY 10016, United States
| | - Laura Diaz
- NYU School of Medicine, Department of Population Health, 180 Madison Ave, 7th Floor, New York, NY 10016, United States
| | - Leydi Payano
- NYU School of Medicine, Department of Population Health, 180 Madison Ave, 7th Floor, New York, NY 10016, United States
| | - Nancy J Thompson
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, United States
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18
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McGee RE, Sajatovic M, Quarells RC, Johnson EK, Liu H, Spruill TM, Fraser RT, Janevic M, Escoffery C, Thompson NJ. Depression and quality of life among African Americans with epilepsy: Findings from the Managing Epilepsy Well (MEW) Network integrated database. Epilepsy Behav 2019; 94:301-306. [PMID: 30975571 PMCID: PMC7430521 DOI: 10.1016/j.yebeh.2019.02.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/27/2019] [Accepted: 02/27/2019] [Indexed: 11/18/2022]
Abstract
Depression and worse quality of life (QOL) are significantly associated with epilepsy. However, limited descriptive data on depression and quality of life among African Americans with epilepsy are available. This study sought to describe the prevalence of depression among African Americans with epilepsy participating in self-management studies and to examine the relationship between depression and QOL. Using data from the Managing Epilepsy Well (MEW) research network, a subgroup of African Americans with epilepsy were selected for the analytic sample. Descriptive statistics indicated the prevalence of depression (Patient Health Questionnaire-9 [PHQ-9]) and reports of epilepsy-specific QOL (Quality of Life in Epilepsy-10 [QOLIE-10]) in the sample. Multiple linear regression examined the relationship between depression and QOL while controlling for sociodemographic characteristics and seizure frequency. The prevalence of depression (PHQ-9 ≥; 10) was 47.7%. Quality of life was the only variable significantly associated with depressive symptoms in multivariable analyses, suggesting that depressive symptoms have a stronger relationship with QOL than seizure frequency. With the high levels of depression and the significant relationship with QOL, regular screening of depression is needed among African Americans with epilepsy. Self-management programs that improve mood may also play an important role in improving the lives of African Americans with epilepsy.
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Affiliation(s)
- Robin E McGee
- Emory University, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA, 30322, United States of America.
| | - Martha Sajatovic
- Case Western Reserve University, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH 44106, United States of America.
| | - Rakale C Quarells
- Morehouse School of Medicine, 720 Westview Dr. SW, Atlanta, GA 30310, United States of America.
| | - Erika K Johnson
- University of Washington, Harborview Medical Center, 325 Ninth Ave, Seattle, WA 98104, United States of America.
| | - Hongyan Liu
- Case Western Reserve University, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH 44106, United States of America
| | - Tanya M Spruill
- New York University School of Medicine, 550 First Avenue, New York, NY 10016, United States of America.
| | - Robert T Fraser
- University of Washington, Harborview Medical Center, 325 Ninth Ave, Seattle, WA 98104, United States of America.
| | - Mary Janevic
- University of Michigan, 1415 Washington Heights, Ann Arbor, MI, United States of America.
| | - Cam Escoffery
- Emory University, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA, 30322, United States of America.
| | - Nancy J Thompson
- Emory University, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA, 30322, United States of America.
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Tian N, Boring M, Kobau R, Zack MM, Croft JB. Active Epilepsy and Seizure Control in Adults - United States, 2013 and 2015. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2018; 67:437-442. [PMID: 29672474 PMCID: PMC6191103 DOI: 10.15585/mmwr.mm6715a1] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Approximately 3 million American adults reported active epilepsy* in 2015 (1). Active epilepsy, especially when seizures are uncontrolled, poses substantial burdens because of somatic, neurologic, and mental health comorbidity; cognitive and physical dysfunction; side effects of antiseizure medications; higher injury and mortality rates; poorer quality of life; and increased financial cost (2). Thus, prompt diagnosis and seizure control (i.e., seizure-free in the 12 months preceding the survey) confers numerous clinical and social advantages to persons with active epilepsy. To obtain recent and reliable estimates of active epilepsy and seizure control status in the U.S. population, CDC analyzed aggregated data from the 2013 and the 2015 National Health Interview Surveys (NHISs). Overall, an annual estimated 2.6 million (1.1%) U.S. adults self-reported having active epilepsy, 67% of whom had seen a neurologist or an epilepsy specialist in the past year, and 90% of whom reported taking epilepsy medication. Among those taking epilepsy medication, only 44% reported having their seizures controlled. A higher prevalence of active epilepsy and poorer seizure control were associated with low family income, unemployment, and being divorced, separated, or widowed. Use of epilepsy medication was higher among adults who saw an epilepsy specialist in the past year than among those who did not. Health care and public health should ensure that adults with uncontrolled seizures have appropriate care and self-management support in order to promote seizure control, improve health and social outcomes, and reduce health care costs.
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20
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Perceived epilepsy stigma mediates relationships between personality and social well-being in a diverse epilepsy population. Epilepsy Behav 2018; 78:7-13. [PMID: 29161631 DOI: 10.1016/j.yebeh.2017.10.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/20/2017] [Accepted: 10/20/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Perceived epilepsy stigma and reduced social well-being are prevalent sources of distress in people with epilepsy (PWE). Yet, research on patient-level correlates of these difficulties is lacking, especially among underserved groups. MATERIALS AND METHODS Racially/ethnically diverse adults with intractable seizures (N=60, 62% female; 79% Black, 20% Hispanic/Latino, 8% White) completed validated measures of personality (NEO Five Factor Inventory, NEO-FFI-3), perceived epilepsy stigma (Epilepsy Stigma Scale, ESS), and quality of life (Quality of Life Inventory in Epilepsy, QOLIE-89). Controlling for covariates, ordinary least-squares (OLS) regression evaluated the total, direct, and indirect effects of NEO-FFI-3 neuroticism and extraversion scores on epilepsy-related social well-being (i.e., combination of QOLIE-89 social isolation and work/driving/social function subscales, α=0.87), mediated through perceived stigma. RESULTS In separate models, higher levels of neuroticism (N) and lower levels of extraversion (E) were significantly and independently associated with greater perceived stigma (N path a=0.71, p=0.005; E path a=-1.10, p<0.005). Stigma, in turn, was significantly and independently associated with poorer social well-being (N path b=0.23, p<0.001; E path b=-0.23, p<0.001). Bias-corrected bootstrap confidence intervals (CIs) showed that neuroticism and extraversion were indirectly associated with social well-being through their respective associations with perceived stigma (N path ab=-0.16, 95% CIs [-0.347, -0.044]; E path ab=0.25, 95% CIs [0.076, 0.493]). CONCLUSION Higher neuroticism and lower extraversion covaried with stigma beliefs, and these may be markers of poor social outcomes in PWE. Mediation models suggest that targeting epilepsy stigma beliefs may be a particularly useful component to incorporate when developing interventions aimed at promoting social well-being in diverse PWE.
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Kroner BL, Fahimi M, Gaillard WD, Kenyon A, Thurman DJ. Epilepsy or seizure disorder? The effect of cultural and socioeconomic factors on self-reported prevalence. Epilepsy Behav 2016; 62:214-7. [PMID: 27494358 DOI: 10.1016/j.yebeh.2016.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 11/17/2022]
Abstract
Self-reported epilepsy may be influenced by culture, knowledge, and beliefs. We screened 6420 residents of the District of Columbia (DC) for epilepsy to investigate whether socio-demographics were associated with whether they reported their diagnosis as epilepsy or as seizure disorder. Lifetime and active prevalence rates were 0.54% and 0.21%, respectively for 'epilepsy' and 1.30% and 0.70%, respectively for 'seizure disorder'. Seizure disorder was reported significantly more often than epilepsy among blacks, females, respondents≥50years, those with lower level education, respondents who lived alone and in low income neighborhoods, and those who resided in DC for at least five years. Clinicians should assure that patients and caregivers understand that epilepsy is synonymous with seizure disorder and other culturally appropriate terms, in order to optimize compliance with treatment, disease management instructions, and utilization of other resources targeted at persons with epilepsy. Furthermore, education and awareness campaigns aimed at improving access-to-care, reducing stigma, and increasing awareness of adverse events, such as SUDEP, should include a more diverse definition of epilepsy in their messages.
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Affiliation(s)
- Barbara L Kroner
- RTI International, Biostatistics and Epidemiology Division, 6110 Executive Boulevard, Rockville, MD 20852, USA.
| | - Mansour Fahimi
- GfK Custom Research, LLC Marketing & Data Sciences, Wayne, PA, USA.
| | - William D Gaillard
- Children's National Health Systems, Division of Epilepsy and Neurophysiology, 111 Michigan Avenue NW, Washington, DC 20010, USA.
| | - Anne Kenyon
- RTI International, Survey Research Division, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA.
| | - David J Thurman
- Center for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1600 Clifton Road, Atlanta, GA 30329, USA.
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22
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Kim H, Thurman DJ, Durgin T, Faught E, Helmers S. Estimating Epilepsy Incidence and Prevalence in the US Pediatric Population Using Nationwide Health Insurance Claims Data. J Child Neurol 2016; 31:743-9. [PMID: 26719495 DOI: 10.1177/0883073815620676] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 10/28/2015] [Indexed: 11/17/2022]
Abstract
This study aims to determine prevalence and incidence of epilepsy in the US pediatric population. We analyzed commercial claims and Medicaid insurance claims data between 2008 and 2012. Over 8 million continuously enrolled lives aged 0 to 19 years were included. Our definition of a prevalent case of epilepsy was based on International Classification of Diseases-coded diagnoses of epilepsy or seizures and evidence of prescribed antiepileptic drugs. Incident cases were identified in subjects continuously enrolled for ≥2 years of which the first 2 years had no indication of epilepsy or seizures. The overall prevalence estimate for 2012 was 6.8 per 1,000 children. The overall incidence estimate for 2012 was 104 per 100,000 pediatric population. This study provides estimates of the prevalence and incidence of epilepsy in the US pediatric population, using large claims datasets from multiple US population sectors. The findings appear reasonably representative of the US-insured pediatric population.
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Affiliation(s)
- Hyunmi Kim
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Edward Faught
- Emory University School of Medicine, Atlanta, GA, USA
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Wilson DA, Malek AM, Wagner JL, Wannamaker BB, Selassie AW. Mortality in people with epilepsy: A statewide retrospective cohort study. Epilepsy Res 2016; 122:7-14. [DOI: 10.1016/j.eplepsyres.2016.01.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 01/18/2016] [Accepted: 01/28/2016] [Indexed: 10/22/2022]
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Psychosocial factors associated with medication adherence in ethnically and socioeconomically diverse patients with epilepsy. Epilepsy Behav 2015; 46:242-5. [PMID: 25847430 PMCID: PMC4701194 DOI: 10.1016/j.yebeh.2015.01.034] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/21/2015] [Accepted: 01/22/2015] [Indexed: 11/23/2022]
Abstract
The current study examined psychosocial correlates of medication adherence in a socioeconomically and racially diverse sample of patients with epilepsy. Fifty-five patients with epilepsy completed standardized self-report questionnaires measuring depression, stress, social support, and medication and illness beliefs. Antiepileptic drug (AED) adherence was measured using the 8-item Morisky Medication Adherence Scale 36% reported poor adherence. We tested which psychosocial factors were independently and most strongly associated with AED adherence. Stress and depression were negatively correlated with adherence, while perceived social support was positively correlated with adherence (Ps<.05). When all three of these variables and relevant covariates in a multiple regression model were included, only perceived social support remained a significant predictor of adherence (P=.015). This study is one of the first to suggest the importance of targeting social support in screening and intervention approaches in order to improve AED adherence among low-income, racially/ethnically diverse patients with epilepsy.
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Pestana Knight EM, Schiltz NK, Bakaki PM, Koroukian SM, Lhatoo SD, Kaiboriboon K. Increasing utilization of pediatric epilepsy surgery in the United States between 1997 and 2009. Epilepsia 2015; 56:375-81. [PMID: 25630252 DOI: 10.1111/epi.12912] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine national trends of pediatric epilepsy surgery usage in the United States between 1997 and 2009. METHODS We performed a serial cross-sectional study of pediatric epilepsy surgery using triennial data from the Kids' Inpatient Database from 1997 to 2009. The rates of epilepsy surgery for lobectomies, partial lobectomies, and hemispherectomies in each study year were calculated based on the number of prevalent epilepsy cases in the corresponding year. The age-race-sex adjusted rates of surgeries were also estimated. Mann-Kendall trend test was used to test for changes in the rates of surgeries over time. Multivariable regression analysis was also performed to estimate the effect of time, age, race, and sex on the annual incidence of epilepsy surgery. RESULTS The rates of pediatric epilepsy surgery increased significantly from 0.85 epilepsy surgeries per 1,000 children with epilepsy in 1997 to 1.44 epilepsy surgeries per 1,000 children with epilepsy in 2009. An increment in the rates of epilepsy surgeries was noted across all age groups, in boys and girls, all races, and all payer types. The rate of increase was lowest in blacks and in children with public insurance. The overall number of surgical cases for each study year was lower than 35% of children who were expected to have surgery, based on the estimates from the Connecticut Study of Epilepsy. SIGNIFICANCE In contrast to adults, pediatric epilepsy surgery numbers have increased significantly in the past decade. However, epilepsy surgery remains an underutilized treatment for children with epilepsy. In addition, black children and those with public insurance continue to face disparities in the receipt of epilepsy surgery.
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Affiliation(s)
- Elia M Pestana Knight
- Pediatric Epilepsy Section, Epilepsy Center, Cleveland Clinic Neurological Institute, Cleveland, Ohio, U.S.A
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Bakaki PM, Koroukian SM, Jackson LW, Albert JM, Kaiboriboon K. Defining incident cases of epilepsy in administrative data. Epilepsy Res 2013; 106:273-9. [PMID: 23791310 PMCID: PMC3759552 DOI: 10.1016/j.eplepsyres.2013.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 04/07/2013] [Accepted: 05/13/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine the minimum enrollment duration for identifying incident cases of epilepsy in administrative data. METHODS We performed a retrospective dynamic cohort study using Ohio Medicaid data from 1992 to 2006 to identify a total of 5037 incident epilepsy cases who had at least 1 year of follow-up prior to epilepsy diagnosis (epilepsy-free interval). The incidence for epilepsy-free intervals from 1 to 8 years, overall and stratified by pre-existing disability status, was examined. The graphical approach between the slopes of incidence estimates and the epilepsy-free intervals was used to identify the minimum epilepsy-free interval that minimized misclassification of prevalent as incident epilepsy cases. RESULTS As the length of epilepsy-free interval increased, the incidence rates decreased. A graphical plot showed that the decline in incidence of epilepsy became nearly flat beyond the third epilepsy-free interval. CONCLUSION The minimum of 3-year epilepsy-free interval is needed to differentiate incident from prevalent cases in administrative data. Shorter or longer epilepsy-free intervals could result in over- or under-estimation of epilepsy incidence.
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Affiliation(s)
- Paul M. Bakaki
- Department of Epidemiology & Biostatistics, Case Western Reserve University
| | - Siran M. Koroukian
- Department of Epidemiology & Biostatistics, Case Western Reserve University
| | - Leila W. Jackson
- Department of Epidemiology & Biostatistics, Case Western Reserve University
| | - Jeffrey M. Albert
- Department of Epidemiology & Biostatistics, Case Western Reserve University
| | - Kitti Kaiboriboon
- Epilepsy Center, Department of Neurology, University Hospitals Case Medical Center Cleveland, Ohio
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Kaiboriboon K, Bakaki PM, Lhatoo SD, Koroukian S. Incidence and prevalence of treated epilepsy among poor health and low-income Americans. Neurology 2013; 80:1942-9. [PMID: 23616158 PMCID: PMC3716344 DOI: 10.1212/wnl.0b013e318293e1b4] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 02/06/2013] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To determine the incidence and prevalence of treated epilepsy in an adult Medicaid population. METHODS We performed a retrospective, dynamic cohort analysis using Ohio Medicaid claims data between 1992 and 2006. Individuals aged 18-64 years were identified as prevalent cases if they had ≥2 claims of epilepsy (ICD-9-CM: 345.xx) or ≥3 claims of convulsion (ICD-9-CM: 780.3 or 780.39) and ≥2 claims of antiepileptic drugs. Incident cases were required to have no epilepsy or convulsion claims for ≥5 years before epilepsy diagnosis. Subjects were determined as having preexisting disability and/or comorbid conditions, including brain tumor, depression, developmental disorders, migraine, schizophrenia, stroke, and traumatic brain injury, when at least one of these conditions occurred before epilepsy onset. RESULTS There were 9,056 prevalent cases of treated epilepsy in 1992-2006 and 1,608 incident cases in 1997-2006. The prevalence was 13.2/1,000 (95% confidence interval, 13.0-13.5/1,000). The incidence was 362/100,000 person-years (95% confidence interval, 344-379/100,000 person-years). The incidence and prevalence were significantly higher in men, in older people, in blacks, and in people with preexisting disability and/or comorbid conditions. The most common preexisting conditions in epilepsy subjects were depression, developmental disorders, and stroke, whereas people with brain tumor, traumatic brain injury, and stroke had the higher risk of developing epilepsy. CONCLUSIONS The Medicaid population has a high incidence and prevalence of epilepsy, in an order of magnitude greater than that reported in the US general population. This indigent population carries a disproportionate amount of the epilepsy burden and deserves more attention for its health care needs and support services.
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Affiliation(s)
- Kitti Kaiboriboon
- Epilepsy Center, Department of Neurology, University Hospitals Case Medical Center, OH, USA.
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