Supporting and empowering people with epilepsy: Contribution of the Epilepsy Specialist Nurses (SENsE study)

Seizure control via pH manipulation: a phase II double-blind randomised controlled trial of inhaled carbogen as adjunctive treatment of paediatric convulsive status epilepticus (Carbogen for Status Epilepticus in Children Trial (CRESCENT))

BACKGROUND

Paediatric convulsive status epilepticus is the most common neurological emergency presenting to emergency departments. Risks of resultant neurological morbidity and mortality increase with seizure duration. If the seizure fails to stop within defined time-windows, standard care follows an algorithm of stepwise escalation to more intensive treatments, ultimately resorting to induction of general anaesthesia and ventilation. Additionally, ventilatory support may also be required to treat respiratory depression, a common unwanted effect of treatment. There is strong pre-clinical evidence that pH (acid-base balance) is an important determinant of seizure commencement and cessation, with seizures tending to start under alkaline conditions and terminate under acidic conditions. These mechanisms may be particularly important in febrile status epilepticus: prolonged fever-related seizures which predominantly affect very young children. This trial will assess whether imposition of mild respiratory acidosis by manipulation of inhaled medical gas improves response rates to first-line medical treatment.

METHODS

A double-blind, placebo-controlled trial of pH manipulation as an adjunct to standard medical treatment of convulsive status epilepticus in children. The control arm receives standard medical management whilst inhaling 100% oxygen; the active arm receives standard medical management whilst inhaling a commercially available mixture of 95% oxygen, 5% carbon dioxide known as 'carbogen'. Due to the urgent need to treat the seizure, deferred consent is used. The primary outcome is success of first-line treatment in seizure cessation. Planned subgroup analyses will be undertaken for febrile and non-febrile seizures. Secondary outcomes include rates of induction of general anaesthesia, admission to intensive care, adverse events, and 30-day mortality.

DISCUSSION

If safe and effective 95% oxygen, 5% carbon dioxide may be an important adjunct in the management of convulsive status epilepticus with potential for pre-hospital use by paramedics, families, and school staff.

TRIAL REGISTRATION

EudraCT: 2021-005367-49. CTA: 17136/0300/001.

ISRCTN

52731862. Registered on July 2022.

Integrated Care in Epilepsy Management: A Scoping Review of the Models and Components of Health and Social Care Delivery

Introduction

Epilepsy is the most common neurological condition globally. Integrating health and social care is fundamental in epilepsy management, but the scope of progress in this area is unclear. This scoping review aimed to capture the range and type of integrated care components and models in epilepsy management.

Methods

Four databases were searched for articles published since 2010 that reported on integrated care in epilepsy. Data were extracted and synthesised into components of integrated care that had been implemented or recommended only. Models of integrated care were identified, and their components tabulated.

Results

Fifteen common and interrelated components of integrated care emerged that were aligned with four broad areas: healthcare staff and pathways (e.g., epilepsy nurses); tasks and services (e.g., care coordination); education and engagement (e.g., shared decision making); and technology for diagnosis and communication (e.g., telehealth). Twelve models of integrated care were identified; seven were implemented and five were recommended.

Discussion

There is a growing evidence-base supporting integrated, person-centred epilepsy care, but implementation is challenged by entrenched silos, underdeveloped pathways for care, and deficits in epilepsy education.

Conclusion

Integrating epilepsy care relies on changes to workforce development and policy frameworks to support whole-of-system vision for improving care.

Further advances in epilepsy

In 2017, one of us reviewed advances in epilepsy (Manford in J Neurol 264:1811-1824, 2017). The current paper brings that review up to date and gives a slight change in emphasis. Once again, the story is of evolution rather than revolution. In recognition that most of our current medications act on neurotransmitters or ion channels, and not on the underlying changes in connectivity and pathways, they have been renamed as antiseizure (ASM) medications rather than antiepileptic drugs. Cenobamate is the one newly licensed medication for broader use in focal epilepsy but there have been a number of developments for specific disorders. We review new players and look forward to new developments in the light of evolving underlying science. We look at teratogenicity; old villains and new concerns in which clinicians play a vital role in explaining and balancing the risks. Medical treatment of status epilepticus, long without evidence, has benefitted from high-quality trials to inform practice; like buses, several arriving at once. Surgical treatment continues to be refined with improvements in the pre-surgical evaluation of patients, especially with new imaging techniques. Alternatives including stereotactic radiotherapy have received further focus and targets for palliative stimulation techniques have grown in number. Individuals' autonomy and quality of life continue to be the subject of research with refinement of what clinicians can do to help persons with epilepsy (PWE) achieve control. This includes seizure management but extends to broader considerations of human empowerment, needs and desires, which may be aided by emerging technologies such as seizure detection devices. The role of specialist nurses in improving that quality has been reinforced by specific endorsement from the International League against Epilepsy (ILAE).

Effect of educational interventions on level of epilepsy knowledge in children with epilepsy and parents: Systematic review and meta-analysis

AIM AND OBJECTIVES

The aim of the study was to synthesise the effect of educational interventions on the level of epilepsy knowledge in children with epilepsy and parents.

BACKGROUND

Educational interventions are commonly used to provide knowledge about epilepsy management. One of the most important responsibilities of nurses is to inform children with epilepsy and parents in a skilful way.

DESIGN

Systematic review and meta-analysis based on PRISMA 2020.

METHODS

We searched CINAHL, Cochrane Library, Science Direct, Web of Science, Ovid, PubMed, Scopus, Springer Link, ProQuest, TR Index ending March 2021. The review followed the PRISMA guidelines. This meta-analysis was analysed in Comprehensive Meta-Analysis version 3 software. The risk of bias of included studies was assessed with the Cochrane handbook. The results were the level of epilepsy knowledge of children and parents.

RESULTS

Ten studies meeting the inclusion criteria were included in this meta-analysis, including four randomised studies and six non-randomised studies. Educational interventions had large effect on improving the level of epilepsy knowledge in children with epilepsy (p < .001, Hedge's g = 1.19) and parents (p < .001, Hedge's g = 1.41). As a result of the subgroup analyses, significant differences were found only in the type of educational intervention. It was found that traditional education is more effective than technology-based education in improving the level of epilepsy knowledge in parents (p = .005, Hedge's g = 1.77).

CONCLUSION

Educational interventions have high and beneficial effect on the level of epilepsy knowledge in the children with epilepsy and parents; can be used as effective interventions in the epilepsy management. However, due to low number of randomised controlled studies, further high-quality randomised controlled studies are needed about this topic.

RELEVANCE TO CLINICAL PRACTICE

The findings will contribute to the use of educational interventions in the epilepsy management for health professionals, especially nurses. Thus these interventions will contribute to improving epilepsy management of children with epilepsy and parents.

Screening for anxiety, depression and suicidality by epilepsy specialists in adult services in Scotland

OBJECTIVE

Clinical guidelines recommend screening people with epilepsy (PWE) regularly for mental distress, but it is unclear how guidelines are implemented. We surveyed epilepsy specialists in adult Scottish services to determine approaches used to screen for anxiety, depression, and suicidality; the perceived difficulty of screening; factors associated with intention to screen; and treatment decisions made following positive screens.

METHODS

An anonymous email-based questionnaire survey of epilepsy nurses and epilepsy neurology specialists (n = 38) was conducted.

RESULTS

Two in every three specialists used a systematic screening approach; a third did not. Clinical interview was employed more often than standardized questionnaire. Clinicians reported positive attitudes towards screening but found screening difficult to implement. Intention to screen was associated with favorable attitude, perceived control, and social norm. Pharmacological and non-pharmacological interventions were proposed equally often for those screening positive for anxiety or depression.

CONCLUSION

Routine screening for mental distress is carried out in Scottish epilepsy treatment settings but is not universal. Attention should be paid to clinician factors associated with screening, such as intention to screen and resulting treatment decisions. These factors are potentially modifiable, offering a means of closing the gap between guideline recommendations and clinical practice.

Incorporation of Epilepsy into Life Skills Education: Perceptions of Primary School Learners in Mpumalanga and Limpopo Province—A Qualitative Exploratory Study

Providing education on epilepsy is crucial, as this helps individuals to acquire the necessary knowledge and skills to effectively manage seizures while also reducing the stigma and misconceptions surrounding the condition. The aim of this research was to examine how learners perceive the integration of epilepsy education into life skills training. A descriptive-exploratory design was utilized for the study. The research took place in the provinces of Limpopo and Mpumalanga, located in South Africa, where primary schools in chosen rural communities were selected for the research. Six focus group discussions were conducted with learners aged 9 to 14 years in grades 4 to 7. Each group was comprised of six learners, resulting in a total of 36 individuals who satisfied the inclusion criteria. Data were collected from August to November 2022. Semi-structured interviews were utilized to collect data until saturation was reached. The collected data were analyzed with the assistance of ATLAS.ti. The study’s results underscore the significance of incorporating epilepsy education into life skills curricula at the primary school level, as revealed by two prominent themes that emerged: first, the reasons provided by students for the integration of epilepsy education into life skills training, and second, the preferred teaching methodologies for epilepsy education within the life skills curriculum as identified by learners. Trustworthiness and ethical consideration were ensured. It is recommended that guidelines for epilepsy life skills should be developed to enhance the wellbeing and academic performance of learners with epilepsy in primary schools in Mpumalanga and Limpopo provinces.

Determining the role and responsibilities of the community epilepsy nurse in the management of epilepsy

AIMS AND OBJECTIVES

The aim of this study is to enhance the understanding of the core elements and influencing factors on the community-based epilepsy nurse's role and responsibilities.

BACKGROUND

Internationally, epilepsy nurse specialists play a key role in providing person-centred care and management of epilepsy but there is a gap in understanding of their role in the community.

DESIGN

A national three-stage, mixed-method study was conducted.

METHODS

One-on-one, in-depth semi-structured qualitative interviews were conducted online with 12 community-based epilepsy nurses (Stage 1); retrospective analysis of data collected from the National Epilepsy Line, a nurse-led community helpline (Stage 2); and focus group conducted with four epilepsy nurses, to delve further into emerging findings (Stage 3). A thematic analysis was conducted in Stages 1 and 3, and a descriptive statistical analysis of Stage 2 data. Consolidated Criteria for Reporting Qualitative studies checklist was followed for reporting.

RESULTS

Three key themes emerged: (1) The epilepsy nurse career trajectory highlighted a lack of standardised qualifications, competencies, and career opportunities. (2) The key components of the epilepsy nurse role explored role diversity, responsibilities, and models of practice in the management of living with epilepsy, and experiences navigating complex fragmented systems and practices. (3) Shifting work practices detailed the adapting work practices, impacted by changing service demands, including COVID-19 pandemic experiences, role boundaries, funding, and resource availability.

CONCLUSION

Community epilepsy nurses play a pivotal role in providing holistic, person-centred epilepsy management They contribute to identifying and addressing service gaps through innovating and implementing change in service design and delivery.

RELEVANCE TO CLINICAL PRACTICE

Epilepsy nurses' person-centred approach to epilepsy management is influenced by the limited investment in epilepsy-specific integrated care initiatives, and their perceived value is impacted by the lack of national standardisation of their role and scope of practice.

NO PATIENT OR PUBLIC CONTRIBUTION

Only epilepsy nurses' perspectives were sought.

Enhancing patients' experiences of living with epilepsy

Epilepsy is a multifaceted neurological condition that has many causes. Living with epilepsy can have significant physical, psychological and social effects on an individual and their family. A patient's experience of living with epilepsy can be influenced by multiple factors, such as pre-existing comorbidities or underlying risk factors for developing comorbidities. This article explores the experiences of patients with epilepsy at the point of diagnosis, in hospital and when taking anti-epileptic drugs. It also details various evidence-based interventions that can improve these patients' experiences and the quality of care that they receive.

Using a mixed method to develop consensus-based aims, contents, intended learning outcomes, teaching, and evaluation methods for a course on epilepsy for postgraduate or continuing education in community health nursing programs

BACKGROUND

Knowledge deficits with regard to epilepsy have been reported among healthcare professionals. This study was conducted to develop consensus-based aims, contents, intended learning outcomes, teaching, and evaluation methods for a course on epilepsy for postgraduate or continuing education in community health nursing programs.

METHODS

A mixed method which combined a thorough search of literature, the nominal group technique, the Delphi technique, and survey of students' agreement was used. The databases MEDLINE/PUBMED, EMBASE, COCHRANE, CInAHL/EBESCO, SCOPUS, Google Scholar, Google Books, and Amazon were searched to identify potential aims, topics/contents, intended learning outcomes, teaching, and evaluation methods. Discussions and deliberations in serial meetings based on the nominal group technique were attended by educators/academicians (n = 12), neurologists (n = 2), practicing nurses (n = 5), pharmacists (n = 2), patients with epilepsy (n = 2), and students in postgraduate and continuing education programs (n = 7) to supplement and refine the data collected from the literature. The qualitative data were analyzed using RQDA tool for R. The Delphi technique was used among educators/academicians (n = 15), neurologists (n = 2), practicing nurses (n = 5), pharmacists (n = 2), patients with epilepsy (n = 3), and students in postgraduate and continuing education programs (n = 8) to achieve formal consensus.

RESULTS

Consensus was achieved on 6 aims, 16 intended learning outcomes, and 27 topics in the course. Of the topics, 13 were relevant to nature of epilepsy and seizures, 2 were relevant to the impact of epilepsy and seizures on different life aspects of patients with epilepsy, 4 were relevant to advocating for the patients and supporting their choices, 5 were relevant to educating patients and their caregivers, and 3 were relevant to assessments and services.

CONCLUSION

Consensus-based aims, topics/contents, intended learning outcomes, teaching, and evaluation methods of a course on epilepsy for postgraduate or continuing education in community health nursing programs were developed. Consensus-based courses could bridge knowledge gaps and improve educating community health nursing programs on epilepsy. Further studies are needed to determine if such consensus-based courses could promote care of patients with epilepsy.

Patient-reported experiences of consultation with an advanced nurse practitioner: Factor structure and reliability analysis of the patient enablement and satisfaction survey

AIM

The aim was to analyse the psychometric properties of a patient-reported-experience measure, the Patient Enablement and Satisfaction Survey (PESS), when used to evaluate the care provided by Advanced Nurse Practitioners (ANPs) in terms of factor structure and internal consistency. The PESS is a 20-item, patient-completed data collection tool that was originally developed to measure patient experience and enablement following consultation with nurses in general practice.

DESIGN

Cross-sectional survey; validity and reliability analysis.

METHODS

The sample in this study consisted of 178 patients who consulted with 26 ANPs working in four different specialities. Data were collected between June and December 2019. An exploratory factor analysis of the PESS was conducted to determine convergent validity which was supported by parallel analysis and the traditional Kaiser criterion. The internal consistency of individual PESS items was determined via Cronbach's alpha, McDonald's omega, the Average Variance Extracted tests and item-subscale/total score correlations.

RESULTS

A three-factor structure (PESS-ANP) was found through exploratory factor analysis and this was supported by parallel analysis, the traditional Kaiser criterion and the percentage of variance explained criterion. A high degree of internal consistency was reported across all factors. One question was omitted from the analysis ('Overall Satisfaction') following the identification of problematic cross-loadings. The three factor solution was identified as: patient satisfaction, quality of care provision and patient enablement.

CONCLUSION

The findings of this study propose a three-factor model that is sufficiently reliable for analysing the experience and enablement of patients following consultation with an ANP.

IMPACT

Increasingly, patient-reported experience measures are being used to evaluate patients' experience of receiving care from a healthcare professional. The PESS was identified to be reliable in evaluating the experience of patients who receive care from an ANP while a three-factor structure was proposed that can capture specific attributes of this care.

Classifying epilepsy pragmatically: Past, present, and future

The classification of epilepsy is essential for people with epilepsy and their families, healthcare providers, physicians and researchers. The International League Against Epilepsy proposed updated seizure and epilepsy classifications in 2017, while another four-dimensional epilepsy classification was updated in 2019. An Integrated Epilepsy Classification system was proposed in 2020. Existing classifications, however, lack consideration of important pragmatic factors relevant to the day-to-day life of people with epilepsy and stakeholders. Despite promising developments, consideration of comorbidities in brain development, genetic causes, and environmental triggers of epilepsy remains largely user-dependent in existing classifications. Demographics of epilepsy have changed over time, while existing classification schemes exhibit caveats. A pragmatic classification scheme should incorporate these factors to provide a nuanced classification. Validation across disparate contexts will ensure widespread applicability and ease of use. A team-based approach may simplify communication between healthcare personnel, while an individual-centred perspective may empower people with epilepsy. Together, incorporating these elements into a modern but pragmatic classification scheme may ensure optimal care for people with epilepsy by emphasising cohesiveness among its myriad users. Technological advancements such as 7T MRI, next-generation sequencing, and artificial intelligence may affect future classification efforts.

The emerging role of the advanced practice epilepsy nurse: A comparative study between two countries

AIMS AND OBJECTIVES

The aim of the study was to compare advanced practice in epilepsy nurses in Spain and United Kingdom, identifying differences in the domains of standard advanced practice.

BACKGROUND

Europe has recently faced the challenge of providing high-quality care for patients with epilepsy, a disease that generates many health demands. In some countries, such as the United Kingdom, advanced practice nursing is well established and could serve as a guide for implantation in countries where it is still in development, as is the case of Spain.

DESIGN

A multicentre cross-sectional descriptive cohort study compared differences in the roles of advanced practice nurses in Spain and the United Kingdom.

METHODS

The Advanced Practice Role Delineation Tool and its validated Spanish version were administered using an online questionnaire in a cohort of advanced practice epilepsy nurses in both countries. A convenience sample was recruited between January to December 2019. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.

RESULTS

Most United Kingdom nurses in our sample came from community environments, in contrast to Spanish nurses who worked in hospital. All domains analysed in the survey had significantly higher scores in the United Kingdom than in the Spanish cohort, especially in the research and leadership domains.

CONCLUSIONS

The advanced practice role in Spain is underdeveloped compared with the United Kingdom. Differences in the settings of advanced roles in epilepsy nurses may be explained by greater community practice in the United Kingdom and differences in organisational and health systems.

RELEVANCE TO CLINICAL PRACTICE

Our study showed the need to implement specific policies to develop advance practice nurse roles in Spain to improve the quality of care of patients with epilepsy.

Feasibility of telephone-delivered therapy for common mental health difficulties embedded in pediatric epilepsy clinics

BACKGROUND

Mental and physical health treatment should be delivered together for children and young people with epilepsy. Training healthcare professionals (HCPs) in epilepsy services to deliver mental health interventions is an important way to facilitate integrated care.

OBJECTIVE

To determine the feasibility of remotely delivered assessment and psychological treatment for mental health difficulties delivered by HCPs in pediatric epilepsy clinics with limited formal training in psychological interventions. We hypothesized that it would be (i) feasible to train HCPs to deliver the psychological intervention and (ii) that participants receiving the psychological therapy would report reductions in symptoms of mental health difficulties including anxiety, depression, and behavior difficulties and improve quality of life.

METHODS

Thirty-four children and young people with epilepsy who had impairing symptoms of a common mental health difficulty (anxiety, depression, disruptive behavior, and/or trauma) were allocated to receive 6 months of a modular cognitive behavioral intervention delivered by a HCP with limited formal psychological therapy experience. Thirteen HCPs were trained in delivery of the intervention. Healthcare professional competence was assessed in a two-stage process. Parent-reported measures of mental health symptoms and quality of life were completed at baseline and following the intervention. Paired t-tests were used to analyze changes in symptoms over time.

RESULTS

All thirteen HCPs who participated in the training were considered competent in therapeutic delivery by the end of the training period. Twenty-three patients completed pre- and post-intervention measures and were included in the analysis. There were statistically significant improvements in: symptoms of mental health problems (p = 0.01; Cohen's d = 0.62), total impact of mental health problems (p = 0.03; Cohen's d = 0.52), anxiety and depression symptoms (p = 0.02; Cohen's d = 0.57) and quality of life (p = 0.01; Cohen's d = 0.57).

CONCLUSION

A modular cognitive behavioral treatment delivered over the telephone by HCPs with limited experience of psychological therapy was feasible and effective in treating mental health problems in children and young people with epilepsy. Health-related Quality of Life also improved over the duration of treatment. A randomized controlled trial (RCT) is needed to demonstrate efficacy of the intervention.

Safety and feasibility of an intensive epilepsy nurse-based treatment course

PURPOSE

To determine safety, feasibility and patient satisfaction of an epilepsy nurse-based treatment course with frequent contacts and changes of anti-epileptic treatment provided by supervised anti-epileptic drug (AED) prescribing epilepsy nurses.

METHODS

Regular prescheduled clinical contacts with a neurologist to adjust AED treatment were largely substituted by on-demand contacts with epilepsy nurses with the delegated right to adapt AED within predefined limits. To secure safety, electronic medical files of patients with 6 or more contacts with epilepsy nurses were retrospectively analysed for clinical characteristics, safety measures and seizure frequency before/after the intensive treatment course and patients were asked to complete a questionnaire about treatment satisfaction.

RESULTS

Between January 1^st 2016 and 31^st December 2018, 2721 patients were treated by epilepsy nurses (2561 ambulatory controls, 8690 phone contacts). 617 patients received an intensive treatment course (six or more contacts in the observation period, range: 6-65) with an average length of 24.3 months. The average number of AED tried was 3.4. In patients with ongoing seizures (n = 310), 165 (53.2 %) reported an improvement of seizure frequency by 50 % or more. Seizure frequency fell from 4.4 to 2.4 days with seizures/months (p < 0.001). The epilepsy-related hospitalization rate was 0.86/patient; 27 episodes with status epilepticus occurred in 21 patients, three hospitalizations were due to severe side effects. There were no fatal complications. No hospitalization was related to the intensive treatment course by prescribing epilepsy nurses. The overall patients' satisfaction was high.

CONCLUSION

Intensive epilepsy treatment facilitated by epilepsy nurses was safe and associated with high patient accept and improvement of seizure frequency.

Coproducing health and well-being in partnership with patients, families, and healthcare providers: A qualitative study exploring the role of an epilepsy patient portal

BACKGROUND

Coproduced epilepsy care sees people with epilepsy (PwE), their care-proxies, and healthcare providers (HCPs), working together as partners to build strong relationships, improve communication, trust, and share decision-making. Coproduction underpins good quality patient- and family-centered care (PFCC) that is responsive to individual patient needs, preferences, and values. By facilitating information sharing and exchange between partners, electronic patient portals (ePortal) can enable coproduction. This paper explores what HCPs, PwE, and their care-proxies value from their user experience of PiSCES, the Irish epilepsy ePortal.

METHODS

A purposeful sample of actors involved in the receipt and delivery of epilepsy care and services were recruited via adult epilepsy centers at St James's and Beaumont Hospitals in Dublin. Interactive codesign sessions, surveys, and focus groups were used to elicit perspectives from PwE, care-proxies, and HCPs to understand their perception of how PiSCES could enhance or inhibit the epilepsy care process.

RESULTS

Results illustrate that participants welcome the role PiSCES can play in: empowering PwE/care-proxies, strengthening confidence in the healthcare system; aiding memory; advancing health literacy, motivating PwE to understand their condition better; acting as a passport of care between different clinical settings; and creating a foundation for stronger coproduction partnerships. PiSCES was generally embraced; however, some HCPs expressed plausible concerns about how clinical implementation might impact their work practices.

CONCLUSION

"Nothing about me without me" is a core value of the PiSCES initiative, recognizing that people need to be included in the planning of their own treatment and care. Our data show that PwE, their care-proxies, and HCPs value PiSCES potential, particularly in bolstering healthcare partnerships that foster inclusion, confidence, and trust.

LoVE in a time of CoVID: Clinician and patient experience using telemedicine for chronic epilepsy management

As part of our ongoing interest in patient- and family-centered care in epilepsy, we began, before the onset of the CoVID-19 pandemic, to evaluate the concerns and preferences of those delivering and receiving care via telemedicine. CoVID-19 arrived and acted as an unexpected experiment in nature, catalyzing telemedicine's widespread implementation across many disciplines of medicine. The arrival of CoVID-19 in Ireland gave us the opportunity to record these perceptions pre- and post-CoVID. Data were extracted from the National Epilepsy Electronic Patient Record (EEPR). Power BI Analytics collated data from two epilepsy centers in Dublin. Analysis of data on reasons for using the telephone support line was conducted. A subset of patients and clinicians who attended virtual encounters over both periods were asked for their perception of telemedicine care through a mixed methods survey. Between 23rd December 2019 and 23rd March 2020 (pre-CoVID era), a total of 1180 patients were seen in 1653 clinical encounters. As part of a telemedicine pilot study, 50 of these encounters were scheduled virtual telephone appointments. Twenty eight surveys were completed by clinicians and 18 by patients during that period. From 24th March 2020 to 24th June 2020, 1164 patients were seen in 1693 encounters of which 729 (63%) patients were seen in 748 scheduled virtual encounters. 118 clinician impressions were captured through an online survey and 75 patients or carers completed a telephone survey during the post-CoVID era. There was no backlog of appointments or loss of care continuity forced by the pandemic. Clinicians expressed strong levels of satisfaction, but some doubted the suitability of new patients to the service or candidates for surgery receiving care via telemedicine. Patients reported positive experiences surrounding telephone appointments comparing them favorably to face-to-face encounters. The availability of a shared EEPR demonstrated no loss of care contact for patients with epilepsy. The survey showed that telemedicine is seen as an effective and satisfactory method of delivering chronic outpatient care.

The epilepsy specialist nurse: A mixed-methods case study on the role and activities

PURPOSE

To describe the role and activities of epilepsy specialist nurses (ESNs) operating as a team in the setting of a hospital specialising in the diagnosis and management of seizure disorders.

METHODS

We conducted a descriptive mixed-methods embedded single case study. We recruited 9 ESNs, 14 of their professional colleagues and 9 'key informants' to analyse their perceptions of the role and activities of ESNs. We collected data through interviews, questionnaires, observations, and documentation. The study was conducted at the Filadelfia Epilepsy Hospital, Denmark.

RESULTS

The team of ESNs offers holistic care to patients and their caregivers regarding the clinical, social, and emotional aspects of epilepsy. The ESNs are integrated in a multidisciplinary team and promote collaboration among the team members. ESNs also contribute to organisational aspects and perform research activities.

CONCLUSION

A structured group of ESNs can operate effectively and extensively in a specialised hospital setting. Our findings contribute to clarifying the description of the ESN's role, and provide an example of how ESNs can be incorporated into a hospital's organisational structure.

Patient satisfaction with information provided by epilepsy specialist nurses: Results of an online survey

The aim of this study was to investigate the perspective of Norwegian patients with epilepsy regarding the information that they have received about epilepsy-related issues and to determine whether there was a difference in information received between those who had been followed up by an epilepsy specialist nurse (ESN) and those who had not. Further, were there differences regarding satisfaction with the information between the two groups? We conducted an online survey in close collaboration with the Norwegian Epilepsy Association. A total of 1859 respondents (1182 patients with epilepsy and 677 carers for patients with epilepsy) completed a web-based questionnaire. They were asked about epilepsy-related issues on which they had received information, the extent to which they were satisfied with this information, and whether they were being followed up by an ESN or not. Significantly more patients followed up by an ESN had received information about the epilepsy diagnosis, antiseizure drugs (ASDs), routine use of ASD, and risk of seizure-related injuries as compared to those not followed up by an ESN. In addition, patients followed by an ESN were more likely to be satisfied with the information they received. Just above or under half of the respondents had received or were satisfied with information about depression, anxiety, premature death, and sexual wellbeing. Our results indicate that follow-up by ESNs results in improvements in the information provided to patients with epilepsy; ESNs should be an integral part of comprehensive epilepsy service.

Telephone-based follow-up of children with epilepsy: Comparison of accuracy between a specialty nurse and a pediatric neurology fellow

•

Childhood epilepsy forms a significant burden on the health-care delivery system.

•

Telemedicine is a proposed effective alternative in overcoming this burden.

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Even simple mobile phones can be used by paramedical professionals.

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Tele-consultation in childhood epilepsy by pediatric neurology fellow has excellent sensitivity and specificity.

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A specialty nurse has also acceptable sensitivity and specificity in comparison with face-to-face consultation.

Background

Childhood epilepsy forms a significant burden on the health-care delivery system. Only a few pediatric neurologists available in most of the developing countries and caregivers face a lot of financial and logistic hardships, apart from a long waiting period for initial and follow up visits. Telemedicine is a proposed effective alternative in overcoming this burden.

Methods

Telephonic consultation by a pediatric neurology fellow was compared with that of a specialty nurse; both against face-to-face consultation (gold standard). Care-givers of children 4 months-18 years with epilepsy were telephonically consulted 24−48 hours before their scheduled hospital appointment by one specialty nurse and one pediatric neurology fellow at least 24 h apart in a random sequence. During the hospital visit, another pediatric neurology fellow blinded to the telephonic consultation, documented the same after Face-to-Face interview.

Results

In 141 children with epilepsy, 504 critical clinical events were identified. Telephonic consultation by pediatric neurology fellow had a sensitivity of 99 %, 97 %, and 100 % and specificity of 100 % each in detecting whether the child had any breakthrough seizure, any adverse event and whether the drug compliance was adequate or poor respectively, as compared to face-to-face consultation. Telephonic consultation by specialty nurse had a sensitivity of 91 %, 84 %, and 98 % and specificity of 97 %, 99 %, and 81 % in detecting whether the child had any breakthrough seizure, adverse event and whether the drug compliance was adequate or poor respectively. But the specialty nurses fared poorly in identifying atypical seizure semiologies like atonic and myoclonic seizures and documenting an exact number of breakthrough seizures, as well as few subjective adverse effects like behavioral abnormality and scholastic worsening, which was performed excellently by the pediatric neurology fellow.

Conclusions

Telephonic consultation in childhood epilepsy by pediatric neurology fellow has excellent sensitivity and specificity. A specialty nurse has also acceptable sensitivity and specificity in comparison with a face-to-face consultation.

Towards a pragmatic epilepsy classification: Future considerations

The Integrated Epilepsy Classification was recently proposed to merge the 2017 International League Against Epilepsy classification and the four-dimensional epilepsy classification updated in 2019. The efforts in developing the concept of an Integrated Epilepsy Classification scheme are encouraging. However, consideration of brain age, validation in contexts that differ in socioeconomic status and with poor healthcare infrastructure, and incorporation of a team-based approach are necessary. These advancements allow for better clinical management of people with epilepsy and empower people with epilepsy globally.

Painting epilepsy - The essence of disease by participants of the Latin American Summer School on Epilepsy (LASSE XIII)

PURPOSE

The purpose of this study was to present and analyze the way epilepsy researchers and specialists present epilepsy through visual art forms.

METHODS

Students and epilepsy specialists, including clinicians and scientists, participating in the Latin American Summer School on Epilepsy (LASSE XIII) 2019 were asked to voluntarily portray epilepsy artistically by painting or drawing what they perceive that represents the feeling or challenges of persons with epilepsy. Resulting artwork was categorized according to several themes. The latter was analyzed in the clinical and social context of the disease.

RESULTS

Twenty-six paintings available for analysis have been reviewed. The three main interpretations of epilepsy were outlined as follows: epilepsy as an identity schism, epilepsy as a loss of control, and epilepsy as a complex condition. Five artworks best suited the first category as they presented people with faces split into healthy and diseased sides, representing the emotional and social burden of seizures. Three drawings defined epilepsy as a loss of control, visualizing that all the phases of seizure activity (ictal, postictal, and interictal) are able to imprison the patient by disrupting mental processes. The last theme included four artworks that defined epilepsy as being a multicomponent enigma: the intertwining of unresolved pathophysiologic processes and psychosocial burden accompanying the disease was emphasized. In addition, the challenges to care for the patients in order to improve not only seizures but also their quality of life were noticed as an idea complementing the visual definition of epilepsy.

CONCLUSION

Participants of LASSE XIII demonstrated an ability to empathize with their patients in retrospect by portraying the inner feelings of division and imprisonment of those having seizures. Epilepsy specialists visualize the disease as a composite phenomenon both in terms of its neural origin and of multidisciplinary requirements to implement its care.

Factors influencing the implementation of Epilepsy Specialist Nurse role: Using the Consolidation Framework for Implementation Research

BACKGROUND

Research to support the added value of including Epilepsy Specialist Nurses as members of the multidisciplinary team is developing, yet little information exists on factors influencing the translation of these roles into practice.

AIM

To describe the enabling and inhibiting factors to the implementation of the Epilepsy Specialist Nurse role in the Republic of Ireland.

METHODS

A qualitative design involving semi-structure interviews, observation and analysis of documents, such as portfolios was used. The sample included 12 Epilepsy Specialist Nurses, 24 multidisciplinary team members, and 35 individuals with epilepsy and family members. Data were analysed using the Consolidation Framework for Implementation Research. Reporting rigour is demonstrated using the COREQ checklist (See Appendix S1).

RESULTS

While there was overwhelming support for the role, barriers and enablers were identified across all domains of the Consolidation Framework for Implementation Research. Enablers included national policies and guidelines, leadership from senior nursing and medical colleagues, climate of learning and mentorship, networking opportunities, infrastructural supports and competence of Epilepsy Specialist Nurses. Barriers included the limited consideration of service expansion and the increasingly complex nature of clinical cases on workload capacity. Deficits in infrastructural supports, challenges in relation to role preparation, role implementation and role responsibility, including concerns around lone practitioner models and concerns that the role was a cost-saving measure, also emerged as potential barriers to future sustainability.

CONCLUSION

The Consolidation Framework for Implementation Research offers researchers a pragmatic typology for analysing interrelationships between enabling and inhibiting factors that impact implementation of advanced practice roles, across different evidence sources, disciplines and boundaries.

RELEVANCE TO CLINICAL PRACTICE

In order to secure role sustainability, managers need to address the rate of service expansion, models of role development, deficits in supports and perceived motivations for role development on the quality, acceptability and sustainability of services provided.

Education and epilepsy: Examples of good practice and cooperation. Report of the IBE Commission on Education

Education for patients, for families, for professionals, and for officials is one of the most important tools for improving knowledge about epilepsy and fighting discrimination. There are many educational initiatives worldwide, but they are often known only at a local level. Studies on epilepsy educational programs are rare and therefore published to a limited extent. The newly established International Bureau for Epilepsy (IBE) Education Commission enforces the exchange of educational activities and best practices, discussing education content and topics, target groups, and their educational needs, timing, tutors, and funding. A brief review of examples of all continents will be given. The needs for studies and for more exchange and closer cooperation will be addressed with proposals for further actions.