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Puras Z, Richardson S, Vincent Watkins L, Shankar R. Status Epilepticus a risk factor for Sudden Unexpected Death in Epilepsy (SUDEP): A scoping review and narrative synthesis. Epilepsy Behav 2024; 160:110085. [PMID: 39388974 DOI: 10.1016/j.yebeh.2024.110085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 09/07/2024] [Accepted: 10/03/2024] [Indexed: 10/12/2024]
Abstract
BACKGROUND Sudden Unexpected Death in Epilepsy (SUDEP) is a leading cause of mortality among people with epilepsy (PWE). Risk factors such as increased seizure frequency, drug-resistant epilepsy, and early epilepsy onset are well recognised. However, little evidence of the role of seizure severity, specifically Status Epilepticus (SE) on SUDEP risk exists. OBJECTIVE To identify mechanisms, risk factors and clinical characteristics overlap between SE and SUDEP. METHODS A scoping review using the PRISMA-ScR model was performed by two reviewers using suitable search terms. The PubMed Advanced Search tool along with the ancestry method was utilised to identify suitable articles published between 06/1992 and 05/2023. Quantitative, qualitative and mixed method studies were included. A narrative synthesis was undertaken and is presented as themes and subthemes. RESULTS Of 5453 papers identified in the preliminary search, 50 studies were suitable for final analysis. Key themes include overlap between SE complications and SUDEP risk factors (pharmaco-resistant generalised tonic-clonic epilepsy, intellectual disability), overlap of shared risk factors (alcohol abuse, developmental epileptic encephalopathies) and clinical characteristics (cardiac and respiratory). SE's role in development of drug-resistant epilepsy was the strongest potential mechanism for SE's contribution to SUDEP risk. SE's contribution to recurrent ictal hypoxaemia episodes and lowered heart rate variability suggests a relationship with SUDEP needing further study. CONCLUSIONS This review identifies research areas of influence of SE on SUDEP risk. Such research could inform counselling for patients concerned about seizure severity in relation to their SUDEP risk and optimise surveillance and subsequent management of post-SE epileptogenic outcomes.
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Affiliation(s)
- Zygimantas Puras
- University of Plymouth, Peninsula Schools of Medicine and Dentistry, Plymouth, Devon, United Kingdom
| | - Saffron Richardson
- University of Plymouth, Peninsula Schools of Medicine and Dentistry, Plymouth, Devon, United Kingdom
| | - Lance Vincent Watkins
- University of Plymouth, Peninsula Schools of Medicine and Dentistry, Plymouth, Devon, United Kingdom; Swansea University, Swansea Bay University Health Board, Swansea, Wales, United Kingdom; University of South Wales, United Kingdom
| | - Rohit Shankar
- University of Plymouth, Peninsula Schools of Medicine and Dentistry, Plymouth, Devon, United Kingdom.
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Milne-Ives M, Duun-Henriksen J, Blaabjerg L, Mclean B, Shankar R, Meinert E. At home EEG monitoring technologies for people with epilepsy and intellectual disabilities: A scoping review. Seizure 2023; 110:11-20. [PMID: 37295277 DOI: 10.1016/j.seizure.2023.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/06/2023] [Accepted: 05/07/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Conducting electroencephalography in people with intellectual disabilities (PwID) can be challenging, but the high proportion of PwID who experience seizures make it an essential part of their care. To reduce hospital-based monitoring, interventions are being developed to enable high-quality EEG data to be collected at home. This scoping review aims to summarise the current state of remote EEG monitoring research, potential benefits and limitations of the interventions, and inclusion of PwID in this research. METHODS The review was structured using the PRISMA extension for Scoping Reviews and the PICOS framework. Studies that evaluated a remote EEG monitoring intervention in adults with epilepsy were retrieved from the PubMed, MEDLINE, Embase, CINAHL, Web of Science, and ClinicalTrials.gov databases. A descriptive analysis provided an overview of the study and intervention characteristics, key results, strengths, and limitations. RESULTS 34,127 studies were retrieved and 23 were included. Five types of remote EEG monitoring were identified. Common benefits included producing useful results of comparable quality to inpatient monitoring and patient experience. A common limitation was the challenge of capturing all seizures with a small number of localised electrodes. No randomised controlled trials were included, few studies reported sensitivity and specificity, and only three considered PwID. CONCLUSIONS Overall, the studies demonstrated the feasibility of remote EEG interventions for out-of-hospital monitoring and their potential to improve data collection and quality of care for patients. Further research is needed on the effectiveness, benefits, and limitations of remote EEG monitoring compared to in-patient monitoring, especially for PwID.
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Affiliation(s)
- Madison Milne-Ives
- Centre for Health Technology, University of Plymouth, Plymouth, PL4 6DT, UK
| | | | | | - Brendan Mclean
- Royal Cornwall Hospitals NHS Trust, Treliske, Truro, Cornwall, TR1 3LJ, UK; Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, PL4 8AA, UK; Cornwall Partnership NHS Foundation Trust, Carew House, Beacon Technology Park, Dunmere Rd, Bodmin, PL31 2QN, UK
| | - Rohit Shankar
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, PL4 8AA, UK; Cornwall Partnership NHS Foundation Trust, Carew House, Beacon Technology Park, Dunmere Rd, Bodmin, PL31 2QN, UK
| | - Edward Meinert
- Centre for Health Technology, University of Plymouth, Plymouth, PL4 6DT, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK; Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, W6 8RP, UK.
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Newman H, Rudra S, Burrows L, Tromans S, Watkins L, Triantafyllopoulou P, Hassiotis A, Gabrielsson A, Shankar R. Who cares? A scoping review on intellectual disability, epilepsy and social care. Seizure 2023; 107:35-42. [PMID: 36958062 DOI: 10.1016/j.seizure.2023.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/25/2023] [Accepted: 03/01/2023] [Indexed: 03/25/2023] Open
Abstract
PURPOSE Nearly a quarter of people with Intellectual disability (PwID) have epilepsy. Many have seizures across their lifetime. In the UK supporting their epilepsy linked risks and needs, particularly in professional care settings and in the community, requires significant social care input. Therefore, the interface between social and health care services is important. This study aim is to identify key intersectional areas of social provision for PWID and epilepsy. METHODS A scoping review of the literature was performed in accordance with PRISMA guidance with suitable search terms. The search was completed in CINAHL, Embase, Psych INFO, SCIE, and Cochrane electronic databases by an information specialist. A quality assessment was completed for the included studies where appropriate. The included studies were analysed qualitatively to identify key themes and provide a narrative description of the evidence by two reviewers. RESULTS Of 748 papers screened, 94 were retrieved. Thirteen articles met the inclusion criteria with a range of methodologies. A thematic analysis generated four key categories for significant social care involvement i.e., staff training and education; emergency seizure management; holistic approach to care; and nocturnal monitoring and supervision. CONCLUSIONS PwID with epilepsy have support needs that require fulfilling by various aspects of special care provision, many within the social ambit. Inspite of evidence of these needs and recurrent calls to work jointly with social care providers this has not happened. There is limited research into social care role in epilepsy management in PwID which needs addressing.
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Affiliation(s)
- Hannah Newman
- University of Plymouth Peninsula School of Medicine, Plymouth, UK; Livewell southwest, Plymouth,UK
| | - Sonya Rudra
- Central and North London NHS Foundation Trust, London, UK
| | - Lisa Burrows
- University of Plymouth Peninsula School of Medicine, Plymouth, UK; Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Samuel Tromans
- University of Leicester, Leicester, UK; Leicestershire Partnership NHS Trust, Leicester, UK
| | - Lance Watkins
- Swansea Bay University Health Board, Port Talbot, UK; University of South Wales, Pontypridd, UK
| | | | | | | | - Rohit Shankar
- University of Plymouth Peninsula School of Medicine, Plymouth, UK; Cornwall Partnership NHS Foundation Trust, Truro, UK.
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Branford D, Sun JJ, Shankar R. Antiseizure medications prescribing for behavioural and psychiatric concerns in adults with an intellectual disability living in England. Br J Psychiatry 2023; 222:191-195. [PMID: 36786124 DOI: 10.1192/bjp.2022.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Antiseizure medications (ASMs) are the second most widely prescribed psychotropic for people with intellectual disabilities in England. Multiple psychotropic prescribing is prevalent in almost half of people with intellectual disabilities on ASMs. This analysis identifies limited evidence of ASM benefit in challenging behaviour management and suggests improvements needed to inform clinical practice.
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Affiliation(s)
- David Branford
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, UK
| | - James J Sun
- Royal Free London NHS Foundation Trust, London, UK
| | - Rohit Shankar
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, UK; and Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust, Bodmin, UK
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Kløvgaard M, Sabers A, Ryvlin P. Update on Sudden Unexpected Death in Epilepsy. Neurol Clin 2022; 40:741-754. [DOI: 10.1016/j.ncl.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Watkins LV, Henley W, Sun JJ, Perera B, Angus-Leppan H, Sawhney I, Purandare K, Eyeoyibo M, Scheepers M, Lines G, Winterhalder R, Shankar R. Tackling increased risks in older adults with intellectual disability and epilepsy: data from a national multicentre cohort study. Seizure 2022; 101:15-21. [DOI: 10.1016/j.seizure.2022.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 10/18/2022] Open
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Epilepsy related multimorbidity, polypharmacy and risks in adults with intellectual disabilities: a national study. J Neurol 2022; 269:2750-2760. [DOI: 10.1007/s00415-021-10938-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022]
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Morley K. Enhancing patients' experiences of living with epilepsy. Nurs Stand 2022; 37:29-34. [PMID: 34719902 DOI: 10.7748/ns.2021.e11686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 06/13/2023]
Abstract
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.
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Affiliation(s)
- Kim Morley
- Hampshire Hospitals NHS Foundation Trust, Winchester, England
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Snoeijen-Schouwenaars FM, Young C, Rowe C, van Ool JS, Schelhaas HJ, Shankar R. People with epilepsy and intellectual disability: More than a sum of two conditions. Epilepsy Behav 2021; 124:108355. [PMID: 34624802 DOI: 10.1016/j.yebeh.2021.108355] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Around 25% of people with Intellectual Disability (PwID) have comorbid epilepsy with seizures in up to two-thirds being drug-resistant. Little is known of the general characteristics and prescribing practices to this population. AIM Describe and compare characteristics of two cohorts of PwID and epilepsy in two different countries to inform clinical practice better. METHOD An explorative, retrospective, case-note review in a specialist ID community service in England and in an expert center for PwID and epilepsy in the Netherlands was conducted. Information on ID severity, medical/behavioral/psychiatric/neurodevelopmental/genetic comorbidities, psychotropic, and antiepileptic drugs (AEDs) for each cohort was collected. FINDINGS The English cohort consisted of 167 people (98 males; age range 18-73 years; mild/moderate ID- 35%) and the Dutch cohort of 189 people (111 males; age range 18-85 years; mild/moderate ID - 51%). The two cohorts were comparable in their baseline characteristics. The Dutch had higher rates of physical comorbidity, but less mental or behavioral disorders and were more likely to be on anti-psychotic medication. The mean dosages between three most common AEDs prescribed were similar. The most frequently prescribed drug in both centers is valproate. Three-quarters of the Dutch were on three or more AEDs compared to a third in the English cohort. CONCLUSIONS Structured description of the characteristics, differences, and commonalities of PwID, treatment, and services of both countries is presented. This is the first real-world study to reveal unique characteristics of managing epilepsy for a complex ID population. In particular, it highlights the considerable comorbid psychiatric burden and psychotropic prescribing.
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Affiliation(s)
- Francesca M Snoeijen-Schouwenaars
- Academic Centre for Epileptology Kempenhaeghe, Department of Residential Care, etherlands; Academic Centre for Epileptology Kempenhaeghe, Department of Neurology, Netherlands
| | - Charlotte Young
- Cornwall Partnership NHS Foundation Trust, Bodmin, United Kingdom
| | - Charles Rowe
- Cornwall Partnership NHS Foundation Trust, Bodmin, United Kingdom
| | - Jans S van Ool
- Academic Centre for Epileptology Kempenhaeghe, Department of Residential Care, etherlands; Academic Centre for Epileptology Kempenhaeghe, Department of Neurology, Netherlands
| | - Helenius J Schelhaas
- Academic Centre for Epileptology Kempenhaeghe, Department of Residential Care, etherlands; Academic Centre for Epileptology Kempenhaeghe, Department of Neurology, Netherlands
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Bodmin, United Kingdom; Cornwall Intellectual Disability Equitable Research (CIDER) University of Plymouth Peninsula Medical School, Truro, United Kingdom.
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Tromans S, Kinney M, Chester V, Alexander R, Roy A, Sander JW, Dudson H, Shankar R. Priority concerns for people with intellectual and developmental disabilities during the COVID-19 pandemic. BJPsych Open 2020; 6:e128. [PMID: 33118913 PMCID: PMC7609203 DOI: 10.1192/bjo.2020.122] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The approach taken to support individuals during the coronavirus disease 2019 (COVID-19) pandemic needs to take into account the requirements of people with intellectual disabilities and/or autism, who represent a major vulnerable group, with higher rates of co-occurring health conditions and a greater risk of dying prematurely. To date, little evidence on COVID-related concerns have been produced and no report has provided structured feedback from the point of view of people with intellectual disabilities and/or autism or of their family/carers. AIMS To provide systemised evidence-based information of the priority concerns for people with intellectual disabilities and/or autism regarding the COVID-19 pandemic. METHOD Senior representatives of major UK-based professional and service-user representative organisations with a stake in the care of people with intellectual disabilities and/or autism were contacted to provide a list of concerns across three domains: 'mental health and challenging behaviour', 'physical health and epilepsy' and 'social circumstances and support'. The feedback was developed into statements on frequently reported priorities. These statements were then rated independently by expert clinicians. A video-conference meeting to reconcile outliers and to generate a consensus statement list was held. RESULTS Thirty-two organisations were contacted, of which 26 (81%) replied. From the respondent's data, 30 draft consensus statements were generated. Following expert clinician review, there was initially strong consensus for seven statements (23%), increasing to 27 statements (90%) following video conferencing. CONCLUSIONS These recommendations highlight the expectations of people with intellectual disabilities and/or autism in the current pandemic. This could support policymakers and professionals' deliver and evidence person-centred care.
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Affiliation(s)
- Sam Tromans
- Leicestershire Partnership NHS Trust, UK; and Department of Health Sciences, University of Leicester, UK
| | | | - Verity Chester
- Hertfordshire Partnership University NHS Foundation Trust, UK; and Norwich Medical School, University of East Anglia, UK
| | - Regi Alexander
- Hertfordshire Partnership University NHS Foundation Trust, UK; and University of Hertfordshire, UK
| | - Ashok Roy
- Coventry and Warwickshire Partnership NHS Trust, UK; and University of Warwick, UK
| | - Josemir W Sander
- UCL Queen Square Institute of Neurology, UK; Chalfont Centre for Epilepsy, UK; and Stichting Epilepsie Instellingen Nederland (SEIN), the Netherlands
| | - Harry Dudson
- Department of Health Sciences, University of Leicester, UK
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, UK; and University of Exeter Medical School, Truro, UK
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Abstract
Sudden unexpected death in epilepsy (SUDEP) remains an important cause of epilepsy-related mortality, especially in patients with refractory epilepsy. The exact cause is not known, but postictal cardiac, respiratory, and brainstem dysfunctions are implicated. SUDEP prevention remains a big challenge. Except for low-quality evidence of preventive effect of nocturnal supervision for SUDEP, no other evidence-based preventive modality is available. Other potential preventive strategies for SUDEP include reducing the occurrence of generalized tonic-clonic seizures using seizure detection devices, detecting cardiorespiratory distress through respiratory and heart rate monitoring devices, preventing airway obstruction (safety pillows), and reducing central hypoventilation using selective serotonin reuptake inhibitors and adenosine and opiate antagonists. However, none of the above-mentioned modalities has been proven to prevent SUDEP. The present review intends to provide insight into the available SUDEP prevention modalities.
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