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Mitchell JW, Sossi F, Miller I, Jaber PB, Das-Gupta Z, Fialho LS, Amos A, Austin JK, Badzik S, Baker G, Zeev BB, Bolton J, Chaplin JE, Cross JH, Chan D, Gericke CA, Husain AM, Lally L, Mbugua S, Megan C, Mesa T, Nuñez L, von Oertzen TJ, Perucca E, Pullen A, Ronen GM, Sajatovic M, Singh MB, Wilmshurst JM, Wollscheid L, Berg AT. Development of an International Standard Set of Outcomes and Measurement Methods for Routine Practice for Adults with Epilepsy: The International Consortium for Health Outcomes Measurement Consensus Recommendations. Epilepsia 2024; 65:1916-1937. [PMID: 38738754 DOI: 10.1111/epi.17971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 05/14/2024]
Abstract
At present, there is no internationally accepted set of core outcomes or measurement methods for epilepsy clinical practice. Therefore, the International Consortium for Health Outcomes Measurement (ICHOM) convened an international working group of experts in epilepsy, people with epilepsy and their representatives to develop minimum sets of standardized outcomes and outcomes measurement methods for clinical practice that support patient-clinician decision-making and quality improvement. Consensus methods identified 20 core outcomes. Measurement tools were recommended based on their evidence of strong clinical measurement properties, feasibility, and cross-cultural applicability. The essential outcomes included many non-seizure outcomes: anxiety, depression, suicidality, memory and attention, sleep quality, functional status, and the social impact of epilepsy. The proposed set will facilitate the implementation of the use of patient-centered outcomes in daily practice, ensuring holistic care. They also encourage harmonization of outcome measurement, and if widely implemented should reduce the heterogeneity of outcome measurement, accelerate comparative research, and facilitate quality improvement efforts.
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Affiliation(s)
- James W Mitchell
- Institute of Systems, Molecular and Integrative Biology (ISMIB), University of Liverpool, Liverpool, UK
| | - Frieda Sossi
- International Consortium for Health Outcomes Measurement, London, UK
| | - Isabel Miller
- International Consortium for Health Outcomes Measurement, London, UK
| | | | - Zofia Das-Gupta
- International Consortium for Health Outcomes Measurement, London, UK
| | - Luz Sousa Fialho
- International Consortium for Health Outcomes Measurement, London, UK
| | - Action Amos
- International Bureau for Epilepsy, Africa Region, University of Edinburgh, Edinburgh, UK
| | - Joan K Austin
- Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Scott Badzik
- Lived Experience Representative, Cincinnati, Ohio, USA
| | - Gus Baker
- University of Liverpool, Liverpool, UK
| | - Bruria Ben Zeev
- The Edmond and Lilly Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | | | | | - J Helen Cross
- Developmental Neurosciences Dept, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Derrick Chan
- KK Women's and Children's Hospital, Duke-NUS, Singapore
| | - Christian A Gericke
- The University of Queensland Medical School, Brisbane, Queensland, Australia
| | - Aatif M Husain
- Duke University Medical Center and Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Lorraine Lally
- LLM (International Human Rights Law), LLM (Financial Services Law), Galway, Ireland
| | | | | | - Tomás Mesa
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Lilia Nuñez
- Centro Medico Nacional 20 de Noviembre, Médica Sur, Mexico City, Mexico
| | - Tim J von Oertzen
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Emilio Perucca
- Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Gabriel M Ronen
- Department of Pediatrics, CanChild Centre for Childhood Disability Research, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Martha Sajatovic
- Departments of Psychiatry and of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Mamta B Singh
- All Indian Institute of Medicine Sciences, New Delhi, India
| | - Jo M Wilmshurst
- Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | | | - Anne T Berg
- Department of Neurology, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
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Chan CCH, Leung HW. WRAPPER study: Real-world effectiveness and tolerability of adjunctive perampanel for people with drug-resistant epilepsy in Hong Kong. Epilepsia Open 2024; 9:345-354. [PMID: 38101856 PMCID: PMC10839329 DOI: 10.1002/epi4.12882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/01/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE The Prince of Wales Hospital (PWH) Real-world Analysis of People with Drug-Resistant Epilepsy (DRE) on PERampanel (WRAPPER) study assessed effectiveness and tolerability of adjunctive perampanel in people with DRE attending PWH. METHODS This was a prospective single-center real-world observational study involving 70 people with DRE between July 2016 and June 2021. A post hoc analysis after the initial study period of 16 weeks assessed outcomes for an extended period up to 52 weeks. RESULTS After 16 weeks, median dose of perampanel was 2 mg (IQR 24 mg). 50% responder rates were 40.0%, 41.5%, and 48.7% at 16, 26, and 52 weeks. Seizure freedom was 12.9%, 20.7%, and 25.6% at 16, 26, and 52 weeks. Monthly seizure frequency reduced from 3.0 (IQR 3.0-6.6) at baseline to 2.0 (IQR 2.0-6.0, p = 0.005) at 16 weeks; 2.0 (IQR 2.0-5.0, p = 0.01) at 26 weeks; and 2.0 (IQR 0.0-4.0, p = 0.018) at 52 weeks. Older age predicted 50% responders (OR 1.08, 95% CI 1.01-1.14, p = 0.048). At 16 weeks, 51.4% (36/70) had treatment-emergent adverse effects (TEAEs). Most common was seizure exacerbation at 35.7% (25/70) followed by fatigue at 15.7% (11/70). NPI-12 and ZBI scores indicated no increase in neuropsychiatric symptoms on perampanel. SIGNIFICANCE Low-dose 2-4 mg adjunctive perampanel for people with DRE conferred appreciable improvements in seizure reduction without significant neuropsychiatric adverse effects in the real-world setting at a tertiary center in Hong Kong and had better antiseizure effect with advancing age. PLAIN LANGUAGE SUMMARY This real-world study from Hong Kong found low-dose perampanel was effective and tolerable for people with drug-resistant epilepsy. Furthermore, perampanel was also potentially more effective with advancing age.
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Affiliation(s)
- Charlie C. H. Chan
- Division of Neurology, Department of Medicine and TherapeuticsPrince of Wales HospitalHong KongSpecial Administrative RegionsChina
- Present address:
Department of Medicine and TherapeuticsPrince of Wales HospitalHong KongSpecial Administrative RegionsChina
| | - Ho Wan Leung
- Division of Neurology, Department of Medicine and TherapeuticsPrince of Wales HospitalHong KongSpecial Administrative RegionsChina
- Present address:
Department of Medicine and TherapeuticsPrince of Wales HospitalHong KongSpecial Administrative RegionsChina
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Bahcecioglu Turan G, Özer Z, Yıldız E. Examination of health literacy and personal impact of epilepsy in patients with epilepsy. Epilepsy Behav 2023; 147:109406. [PMID: 37672822 DOI: 10.1016/j.yebeh.2023.109406] [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: 05/07/2023] [Revised: 07/28/2023] [Accepted: 08/19/2023] [Indexed: 09/08/2023]
Abstract
AIM We conducted this study to examine the impact of health literacy on the personal impact of epilepsy in patients with epilepsy. METHOD We conducted this cross-sectional and correlational study with 125 individuals who were admitted to the neurology outpatient clinic of a university hospital in eastern Turkey, who met the research criteria, and who accepted to participate in the study. We collected the data by using the "Descriptive Information Form (DIF)", "The Personal Impact of Epilepsy Scale (PIES)", and "Health Literacy Scale (HLS)". RESULTS We found that the mean HLS total score of the participants was 104.84 ± 22.88. We also found the mean PIES total score to be 27.08 ± 18.56. Regression results using PIES as a dependent variable reported that the model created was statistically significant (F (21,83) = 11.398, p < 0.05). Among the variables included in the model, income status and HLS were negative (β = -0.209; β = -0.194; β = -0.364, respectively) predictors of the PIES total score. However, seizure status in the last year, number of drugs used, and seizure type were positive predictors of the PIES total score. We found that the variables included in the analysis explained 74% of the total PIES score. CONCLUSION In conclusion, the health literacy level (HLL) of the participants was sufficient or very good, and the effect of the disease on individuals with epilepsy was low. The effect of the disease on individuals with epilepsy decreased as the level of health literacy increased.
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Affiliation(s)
| | - Zülfünaz Özer
- Department of Nursing, Faculty of Health Sciences, Istanbul Sabahattin Zaim University, Istanbul, Turkey.
| | - Esra Yıldız
- Faculty of Nursing, Atatürk University, Erzurum, Turkey.
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Rusli RA, Makmor Bakry M, Mohamed Shah N, Hui Jan T. Seizure severity assessment tools for adult epilepsy patients: A systematic review. Epilepsy Behav 2023; 142:109154. [PMID: 37001468 DOI: 10.1016/j.yebeh.2023.109154] [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: 11/21/2022] [Revised: 02/07/2023] [Accepted: 02/19/2023] [Indexed: 05/08/2023]
Abstract
INTRODUCTION Seizure outcomes from antiseizure medication (ASM) therapy can be measured across various domains using assessment tools. The available tools may contain an array of different components or items. Seizure severity assessment, as opposed to seizure frequency count may have been a more accurate measurement in determining the effectiveness of ASM therapy. This study aimed to review studies developing seizure severity assessment tools for adults with epilepsy, describe the development methods and validation, and compare the list of items in these tools. METHODS The systematic search utilized established databases such as Scopus, Ovid, Web of Science, Medline, Wiley Online, and Cochrane Library. Studies published from inception to December 15, 2022, were selected. Publications describing the development of tools to measure seizure severity among adult epilepsy patients were included. Outcome measures including the tool's content, development methods, validity, and reliability assessments were compared. RESULTS The search produced eight publications describing the development of eight seizure severity assessment tools. One of these tools is part of a multidimensional assessment of the overall impact of epilepsy. The frequently used method in the initial development was the qualitative method (n = 6) where two publications reanalyzed the items from previous studies. Face validity was the most common validation test conducted (n = 4). At least one reliability assessment was conducted for each of the tools, most commonly by the test-retest method (n = 6) and inter-rater reliability (n = 5). All of these tools cover the components of pre-ictal (warning/aura), ictal, and postictal (recovery) events. CONCLUSION The identified tools described the assessment of seizure severity using various subscales. The emergence of new methods in quantifying seizure severity unfolds opportunities in discovering more comprehensive assessments of seizure severity in both clinical trials and daily clinical practice.
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Affiliation(s)
- Rose Aniza Rusli
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia; Hospital Shah Alam, Persiaran Kayangan, 40000 Shah Alam, Selangor, Malaysia
| | - Mohd Makmor Bakry
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia.
| | - Noraida Mohamed Shah
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Tan Hui Jan
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, 56000 Kuala Lumpur, Malaysia
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Roghani A, Bouldin E, Mobasher H, Kalvesmaki A, Panahi S, Henion A, VanCott A, Raquel Lopez M, Jo Pugh M. COVID-19 pandemic experiences among people with epilepsy: Effect on symptoms of co-occurring health conditions and fear of seizure. Epilepsy Behav 2023; 144:109206. [PMID: 37236022 DOI: 10.1016/j.yebeh.2023.109206] [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: 01/13/2023] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The Coronavirus disease 2019 (COVID-19) pandemic profoundly affected people worldwide, but little is known about how it impacted people with epilepsy (PWE). We examined the associations between COVID-19 stressors and health outcomes including increases in other health symptoms and fear of seizure among PWE. METHODS This cross-sectional study used data from an online survey that asked about demographic characteristics, health conditions, and potential life stressors during COVID-19. Data were collected from October 30 to December 8, 2020. COVID-19 stressors were anger, anxiety, stress, healthcare access, fear of seeking healthcare, social isolation, sense of control over their lives, and alcohol consumption. A binary variable was created for each of these measures to indicate whether PWEs experienced a negative change versus a neutral or positive change. We used multivariable logistic regression to assess the associations of COVID-19 stressors with primary outcomes: exacerbated co-occurring health conditions and increasing fear of seizure during the pandemic. RESULTS Of the 260 PWE included in the study, 165 (63.5%) were women; the average age was 38.7 years. During the survey administration period, 79 (30.3%) of the respondents reported exacerbated co-occurring health conditions, and 94 (36.2%) reported an increased fear of seizures. Regression results indicated that the fear of seeking healthcare during COVID-19 was associated with both exacerbated co-occurring health conditions (aOR 1.12; 95%CI 1.01-1.26) and increasing fear of seizure (aOR 2.31; 95%CI 1.14-4.68). Social isolation was associated with exacerbated co-occurring health conditions during COVID-19 (aOR 1.14; 95%CI 1.01-1.29). Reduced access to physical healthcare was associated with increasing fear of seizure (aOR 2.58; 95%CI 1.15-5.78). CONCLUSION A considerable number of PWE experienced more symptoms of existing health conditions and fear of seizure during the initial year of the pandemic (2020). Fear of seeking healthcare services was associated with both negative outcomes. Assuring access to health care and reducing social isolation could potentially reduce negative outcomes for PWE. It is necessary to provide adequate support for PWE to reduce risks as COVID-19 continues to be a health concern.
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Affiliation(s)
- Ali Roghani
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Erin Bouldin
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Helal Mobasher
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Andrea Kalvesmaki
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA; VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Samin Panahi
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA; VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Amy Henion
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Anne VanCott
- VA Pittsburgh Health Care System, Pittsburgh, PA, USA; Department of Neurology, Epilepsy Division University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria Raquel Lopez
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mary Jo Pugh
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA; VA Salt Lake City Health Care System, Salt Lake City, UT, USA
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Chiang S, Moss R, Stern JM, Hughes I, Josephson SA, Pearce JR, Kopald BE, Patel AD, Rao VR. Development of a core outcome set for quality of life for adults with drug-resistant epilepsy: A multistakeholder Delphi consensus study. Epilepsia 2023; 64:170-183. [PMID: 36347817 PMCID: PMC11161193 DOI: 10.1111/epi.17461] [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: 07/30/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE In 2017, the American Academy of Neurology (AAN) convened the AAN Quality Measurement Set working group to define the improvement and maintenance of quality of life (QOL) as a key outcome measure in epilepsy clinical practice. A core outcome set (COS), defined as an accepted, standardized set of outcomes that should be minimally measured and reported in an area of health care research and practice, has not previously been defined for QOL in adult epilepsy. METHODS A cross-sectional Delphi consensus study was employed to attain consensus from patients and caregivers on the QOL outcomes that should be minimally measured and reported in epilepsy clinical practice. Candidate items were compiled from QOL scales recommended by the AAN 2017 Quality Measurement Set. Inclusion criteria to participate in the Delphi study were adults with drug-resistant epilepsy diagnosed by a physician, no prior diagnosis of psychogenic nonepileptic seizures or a cognitive and/or developmental disability, or caregivers of patients meeting these criteria. RESULTS A total of 109 people satisfied inclusion/exclusion criteria and took part in Delphi Round 1 (patients, n = 95, 87.2%; caregivers, n = 14, 12.8%), and 55 people from Round 1 completed Round 2 (patients, n = 43, 78.2%; caregivers, n = 12, 21.8%). One hundred three people took part in the final consensus round. Consensus was attained by patients/caregivers on a set of 36 outcomes that should minimally be included in the QOL COS. Of these, 32 of the 36 outcomes (88.8%) pertained to areas outside of seizure frequency and severity. SIGNIFICANCE Using patient-centered Delphi methodology, this study defines the first COS for QOL measurement in clinical practice for adults with drug-resistant epilepsy. This set highlights the diversity of factors beyond seizure frequency and severity that impact QOL in epilepsy.
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Affiliation(s)
- Sharon Chiang
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | | | - John M. Stern
- Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA
| | - Inna Hughes
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - S. Andrew Josephson
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | | | - Brandon E. Kopald
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Anup D. Patel
- Department of Pediatrics and Division of Neurology, Center for Clinical Excellence, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Vikram R. Rao
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
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Kang W, Ju C, Joo J, Lee J, Shon YM, Park SM. Closed-loop direct control of seizure focus in a rodent model of temporal lobe epilepsy via localized electric fields applied sequentially. Nat Commun 2022; 13:7805. [PMID: 36528681 PMCID: PMC9759546 DOI: 10.1038/s41467-022-35540-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Direct electrical stimulation of the seizure focus can achieve the early termination of epileptic oscillations. However, direct intervention of the hippocampus, the most prevalent seizure focus in temporal lobe epilepsy is thought to be not practicable due to its large size and elongated shape. Here, in a rat model, we report a sequential narrow-field stimulation method for terminating seizures, while focusing stimulus energy at the spatially extensive hippocampal structure. The effects and regional specificity of this method were demonstrated via electrophysiological and biological responses. Our proposed modality demonstrates spatiotemporal preciseness and selectiveness for modulating the pathological target region which may have potential for further investigation as a therapeutic approach.
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Affiliation(s)
- Wonok Kang
- grid.49100.3c0000 0001 0742 4007School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology, Pohang, 37673 Republic of Korea ,grid.49100.3c0000 0001 0742 4007Medical Device Innovation Center, Pohang University of Science and Technology, Pohang, 37673 Republic of Korea
| | - Chanyang Ju
- grid.49100.3c0000 0001 0742 4007Medical Device Innovation Center, Pohang University of Science and Technology, Pohang, 37673 Republic of Korea ,grid.49100.3c0000 0001 0742 4007Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang, 37673 Republic of Korea
| | - Jaesoon Joo
- grid.264381.a0000 0001 2181 989XBiomedical Engineering Research Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, 06351 South Korea
| | - Jiho Lee
- grid.49100.3c0000 0001 0742 4007Medical Device Innovation Center, Pohang University of Science and Technology, Pohang, 37673 Republic of Korea ,grid.49100.3c0000 0001 0742 4007Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang, 37673 Republic of Korea
| | - Young-Min Shon
- grid.264381.a0000 0001 2181 989XBiomedical Engineering Research Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, 06351 South Korea ,grid.264381.a0000 0001 2181 989XDepartment of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, 06351 Republic of Korea
| | - Sung-Min Park
- grid.49100.3c0000 0001 0742 4007School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology, Pohang, 37673 Republic of Korea ,grid.49100.3c0000 0001 0742 4007Medical Device Innovation Center, Pohang University of Science and Technology, Pohang, 37673 Republic of Korea ,grid.49100.3c0000 0001 0742 4007Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang, 37673 Republic of Korea ,grid.49100.3c0000 0001 0742 4007Department of Electrical Engineering, Pohang University of Science and Technology, Pohang, 37673 Republic of Korea ,grid.49100.3c0000 0001 0742 4007Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, 37673 Republic of Korea ,grid.15444.300000 0004 0470 5454Institute of Convergence Science, Yonsei University, Seoul, 03722 Republic of Korea
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Singh G, Sharma S, Bansal N, Sharma M, Chowdhury A, Sharma S, Bansal RK, Goraya JS, Setia RK, Paul BS, Sander JW. A cluster-randomized trial comparing home-based primary health care and usual clinic care for epilepsy in a resource-limited country. Epilepsia Open 2022; 7:781-791. [PMID: 36213959 PMCID: PMC9712458 DOI: 10.1002/epi4.12659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/05/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To ascertain whether home-based care with community and primary healthcare workers' support improves adherence to antiseizure medications, seizure control, and quality of life over routine clinic-based care in community samples of people with epilepsy in a resource-poor country. METHODS Participants included consenting individuals with active epilepsy identified in a population survey in impoverished communities. The intervention included antiseizure medication provision, adherence reinforcement and epilepsy self- and stigma management guidance provided by a primary health care-equivalent worker. We compared the intervention group to a routine clinic-based care group in a cluster-randomized trial lasting 24 months. The primary outcome was antiseizure medication adherence, appraised from monthly pill counts. Seizure outcomes were assessed by monthly seizure aggregates and time to first seizure and impact by the Personal Impact of Epilepsy scale. RESULTS Enrolment began on September 25, 2017 and was complete by July 24, 2018. Twenty-four clusters, each comprising ten people with epilepsy, were randomized to either home- or clinic-care. Home-care recipients were more likely to have used up their monthly-dispensed epilepsy medicine stock (regression coefficient: 0.585; 95% confidence intervals, 0.289-0.881; P = 0.001) and had fewer seizures (regression coefficient: -2.060; 95%CI, -3.335 to -0.785; P = 0.002). More people from clinic-care (n = 44; 37%) than home-care (n = 23; 19%) exited the trial (P = 0.003). The time to first seizure, adverse effects and the personal impact of epilepsy were similar in the two arms. SIGNIFICANCE Home care for epilepsy compared to clinic care in resource-limited communities improves medication adherence and seizure outcomes and reduces the secondary epilepsy treatment gap.
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Affiliation(s)
- Gagandeep Singh
- Research & Development UnitDayanand Medical CollegeLudhianaIndia,Department of NeurologyDayanand Medical CollegeLudhianaIndia,UCL Queen Square Institute of NeurologyLondon WC1N 3BGLondonUK
| | - Suman Sharma
- Research & Development UnitDayanand Medical CollegeLudhianaIndia
| | - Namita Bansal
- Research & Development UnitDayanand Medical CollegeLudhianaIndia
| | - Meenakshi Sharma
- Non‐communicable Diseases DivisionIndian Council of Medical ResearchNew DelhiIndia
| | - Anurag Chowdhury
- Department of Social & Preventive MedicineDayanand Medical CollegeLudhianaIndia
| | - Sarit Sharma
- Department of Social & Preventive MedicineDayanand Medical CollegeLudhianaIndia
| | | | | | | | | | - Josemir W. Sander
- UCL Queen Square Institute of NeurologyLondon WC1N 3BGLondonUK,Chalfont Centre for EpilepsyChalfont St Peter SL9 0RJLondonUK,Stichting Epilepsie Instellingen Nederland (SEIN)HeemstedeThe Netherlands,Neurology DepartmentWest of China Hospital, Sichuan UniversityChengduChina
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9
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Minimum clinically important difference (MCID) of the personal impact of epilepsy scale (PIES). Epilepsy Behav 2022; 130:108691. [PMID: 35453042 DOI: 10.1016/j.yebeh.2022.108691] [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: 01/17/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The Personal Impact of Epilepsy Scale (PIES) assesses patient functional status in subscales of (1) seizure impact, (2) medication effects, (3) mood & social status, and (4) overall quality of life. This study was designed to determine the Minimal Clinically Important Change (MCID) in PIES subscale and total scores that demonstrate improvement. METHODS To ascertain the correspondence of PIES score change and clinical status change (improved, same, worse) in each PIES subscale and total score, we used two distinct retrospective anchor-based assessments of clinical status (patient self-assessment and trained rater assessment) across two clinic visits. Mean PIES scores were compared between clinical status groups, controlling for days between visits and initial clinical status. Personal Impact of Epilepsy Scale score change was quantified for each group to determine MCID. A small prospective proof-of-concept study was conducted in a separate subject group. RESULTS Patient self-report anchor analysis demonstrated lower (better) PIES scores in the "improved" group vs the "worse" group on the mood & social subscale (p < .001) and total score (p = .002), with a similar trend on the seizure subscale (p = 0.056). Clinical rater anchor analysis demonstrated lower PIES scores in the "improved" vs "worse" group in the mood & social subscale (p = .029) and a trend in total score (p = .082). For the "improved" group, the reduction in PIES scores between visits averaged across both anchor analyses was 8.14% for subscales and 8.67% for total score. DISCUSSION/CONCLUSION Reduction of 8% on a PIES subscale or total score indicates meaningful improvement in patient clinical status, and is designated the MCID for this instrument. Personal Impact of Epilepsy Scale can be useful in day-to-day clinical care and as an outcome metric in clinical research.
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Oberdhan D, Bacci E, Hill JN, Palsgrove A, Hareendran A. Developing a Conceptual Disease Model of Patient Experiences and Identifying Patient-Reported Clinical Outcome Assessments for Use in Trials of Treatments for Focal Onset Seizures. Neuropsychiatr Dis Treat 2022; 18:611-631. [PMID: 35345602 PMCID: PMC8957350 DOI: 10.2147/ndt.s354031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/09/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To identify concepts important to understanding the experiences of adults with focal onset seizures (FOS) and evaluate clinical outcome assessments (COAs) for measuring these concepts in clinical trials of treatments for FOS. METHODS A search of published qualitative research, clinical trials, and approved product labels for FOS treatments was performed to develop a conceptual disease model (CDM) of patients' experience of living with FOS. Concepts of interest (COI) were selected, and a second literature search was conducted to identify COAs measuring these concepts. Ten COAs were selected and reviewed to document their development process, evidence of measurement properties, and methods for interpreting change scores using criteria proposed in regulatory guidelines for patient-reported outcomes to support label claims. RESULTS Concepts identified from the published literature (13 articles, 1 conference abstract), 24 clinical trials, and 8 product labels were included in a novel CDM. Impacts on physical, cognitive, and social and emotional function were chosen as COI for evaluating treatment outcomes for FOS; the additional concept of social support and coping strategies was chosen to understand patients' lived experiences. From 51 unique COAs identified, 10 were selected based on their potential coverage of the COI; some symptom severity and health-related quality of life (HRQoL) COAs covered multiple COI. Of these 10, 8 COAs evaluated impacts/limitations on physical function, 8 measured social and emotional impacts, and 5 assessed social support and coping strategies. While most assessments had gaps in evidence validating their measurement properties, 2 COAs measuring symptom severity and 1 COA measuring HRQoL had evidence confirming their potential utility in clinical trials to support label claims. CONCLUSION This research provides insights into the experience of patients with FOS and identifies COAs that measure concepts considered to support endpoints in clinical trials for FOS.
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Affiliation(s)
- Dorothee Oberdhan
- Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, MD, USA
| | | | | | - Andrew Palsgrove
- Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, MD, USA
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11
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Özer Z, Turan GB, Yıldız E. Turkish validity and reliability of the Personal Impact of Epilepsy Scale. Epilepsy Behav 2021; 125:108352. [PMID: 34775243 DOI: 10.1016/j.yebeh.2021.108352] [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: 06/18/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 10/19/2022]
Abstract
AIM This study evaluated the validity and reliability of the Turkish Personal Impact of Epilepsy Scale (PIES). MATERIALS AND METHOD This methodological study was carried out at a university hospital in Erzurum, eastern Turkey between January and April 2021. The data were collected from 126 patients who agreed to participate in the study within these dates via face-to-face interviews, a personal information form, and the Turkish PIES. The PIES consists of 25 items, scored between 0 and 4, and three subscales. The scale itself is a 5-point, Likert-type scale. Following the scale's translation process, its content and construct validity were evaluated. Exploratory and confirmatory factor analysis were conducted for construct validity and item analysis, and internal consistency analysis took place to confirm the scale's reliability. RESULTS As a result of the evaluations and analyses, the Turkish PIES's content validity index was 0.94. In the exploratory analysis, the scale's total variance rate was 70.82%. The Cronbach's alpha value of the Seizures subscale was 0.728, that of the Medication Side Effects subscale was 0.947, for the Comorbidities subscale it was 0.929, and the total scale's Cronbach's alpha value was 0.954. The results of the EFA (Exploratory Factor Analysis) and CFA (Confirmatory Factor Analysis) showed that the Turkish PIES, per its 25 items and three-factor structure, is a sufficient measurement instrument. Good fit index values were also obtained as a result of the CFA. CONCLUSION The Turkish version of the PIES is a valid and reliable instrument to evaluate the effects of seizures, medication side effects, mood/social state, and quality of life of patients with epilepsy.
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Affiliation(s)
- Zülfünaz Özer
- Department of Nursing, Faculty of Health Sciences, Istanbul Sabahattin Zaim University, Istanbul, Turkey
| | | | - Esra Yıldız
- Faculty of Nursing Atatürk Üniversitesi, University, Erzurum, Turkey
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12
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Chiang S, Moss R, Meskis MA, Vogel-Farley V, Sullivan JE, Patel AD, Rao VR. Impact of intellectual and developmental disability on quality-of-life priorities in adults with epilepsy. Epilepsy Behav 2021; 123:108282. [PMID: 34509036 PMCID: PMC11161194 DOI: 10.1016/j.yebeh.2021.108282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/29/2021] [Accepted: 08/14/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Adults living with intellectual and developmental disability (IDD) and epilepsy (IDD-E) face challenges in addition to those faced by the general population of adults with epilepsy, which may be associated with distinct priorities for improving health-related quality of life (HR-QOL). This study sought to (1) conduct a survey of HR-QOL priorities identified by adults with IDD-E and caregivers, and (2) perform an exploratory cross-sectional comparison to adults with epilepsy who do not have IDD. METHODS This cross-sectional study recruited 65 adults with IDD-E and 134 adults with epilepsy without IDD and caregivers. Using a three-step development process, 256 items from existing quality-of-life scales recommended by the American Academy of Neurology (AAN) were rated by patients/caregivers for their importance as HR-QOL priorities. HR-QOL items identified as critical to the majority of the sample of adults with IDD-E were reported. Health-related quality of life priorities were compared between adults with IDD-E and adults with epilepsy without IDD. RESULTS Health-related quality of life was significantly lower in adults with IDD-E. Health-related quality of life domains identified as critical priorities by adults with IDD-E included seizure burden, anti-seizure medication side effects, seizure unpredictability, and family impact. Priorities for improving HR-QOL differed between adults with and without IDD-E, with concerns about family impact, difficulty finding appropriate living conditions, inadequate assistance, and difficulty transitioning from pediatric-to-adult care valued significantly more among those with IDD-E. SIGNIFICANCE Intellectual and developmental disability is an important determinant of HR-QOL among adults with epilepsy. We report HR-QOL priorities identified by adults with IDD-E and their caregivers. These results may help epilepsy clinicians and researchers develop tailored strategies to address priorities of the patient with IDD-E/caregiver community.
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Affiliation(s)
- Sharon Chiang
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.
| | - Robert Moss
- Seizure Tracker, LLC, Springfield, VA, United States
| | | | | | - Joseph E Sullivan
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Anup D Patel
- Department of Pediatrics and Division of Neurology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Vikram R Rao
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
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13
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Severity and disability related to epilepsy from the perspective of patients and physicians: A cross-cultural adaptation of the GASE and GAD scales. Seizure 2021; 90:93-98. [DOI: 10.1016/j.seizure.2021.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 12/22/2022] Open
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Venkatesh P, Sneider D, Danish M, Sisterson ND, Zaher N, Urban A, Grover P, Richardson RM, Kokkinos V. Quantifying a frequency modulation response biomarker in responsive neurostimulation. J Neural Eng 2021; 18. [PMID: 33691289 DOI: 10.1088/1741-2552/abed82] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/10/2021] [Indexed: 11/11/2022]
Abstract
Objective.Responsive neurostimulation (RNS) is an effective treatment for controlling seizures in patients with drug-resistant focal epilepsy who are not suitable candidates for resection surgery. A lack of tools for detecting and characterizing potential response biomarkers, however, contributes to a limited understanding of mechanisms by which RNS improves seizure control. We developed a method to quantify ictal frequency modulation, previously identified as a biomarker of clinical responsiveness to RNS.Approach.Frequency modulation is characterized by shifts in power across spectral bands during ictal events, over several months of neurostimulation. This effect was quantified by partitioning each seizure pattern into segments with distinct spectral content and measuring the extent of change from the baseline distribution of spectral content using the squared earth mover's distance.Main results.We analyzed intracranial electroencephalography data from 13 patients who received RNS therapy, six of whom exhibited frequency modulation on expert evaluation. Patients in the frequency modulation group had, on average, significantly larger and more sustained changes in their squared earth mover's distances (mean = 13.97 × 10-3± 1.197 × 10-3). In contrast, those patients without expert-identified frequency modulation exhibited statistically insignificant or negligible distances (mean = 4.994 × 10-3± 0.732 × 10-3).Significance.This method is the first step towards a quantitative, feedback-driven system for systematically optimizing RNS stimulation parameters, with an ultimate goal of truly personalized closed-loop therapy for epilepsy.
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Affiliation(s)
- Praveen Venkatesh
- Department of Electrical and Computer Engineering, Carnegie Mellon University, Pittsburgh, PA, United States of America
| | - Daniel Sneider
- Department of Electrical and Computer Engineering, Carnegie Mellon University, Pittsburgh, PA, United States of America
| | - Mohammed Danish
- Department of Electrical and Computer Engineering, Carnegie Mellon University, Pittsburgh, PA, United States of America
| | - Nathaniel D Sisterson
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States of America
| | - Naoir Zaher
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Alexandra Urban
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Pulkit Grover
- Department of Electrical and Computer Engineering, Carnegie Mellon University, Pittsburgh, PA, United States of America
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States of America.,Harvard Medical School, Boston, MA, United States of America
| | - Vasileios Kokkinos
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States of America.,Harvard Medical School, Boston, MA, United States of America
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Fuller AT, Almojuela A, Kaddumukasa MN, Chakraborty P, Smith PJ, Kolls BJ, Van Belleghem F, Muhumuza C, Nshemerirwe S, Kaddumukasa M, Nakasujja N, Nakku J, Kakooza-Mwesige A, Haglund MM, Koltai DC. Hospital-based epilepsy care in Uganda: A prospective study of three major public referral hospitals. Epilepsy Behav 2021; 114:107301. [PMID: 32861671 DOI: 10.1016/j.yebeh.2020.107301] [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: 02/13/2020] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study sets out to describe the current demographics of people with epilepsy (PWE) attending hospital-based care in Uganda and the epilepsy treatment practices within three of the largest Ugandan public referral hospitals. METHODS In a six-month prospective cohort study, 626 children and adults attending epilepsy clinics at Mulago National Referral Hospital, Butabika National Referral Mental Hospital and Mbarara Regional Referral Hospital were enrolled. Using a study questionnaire, data were collected at baseline and at 3 weeks, 3 months, and 6 months following enrollment. Specific data surrounding individual patient demographics, clinical characteristics and severity of epilepsy, and treatment of epilepsy with antiepileptic drugs (AEDs) were collected. RESULTS Female patients totaled to 50.8%, with a nearly equal gender distribution at each hospital. There was no statistical difference in gender or age between sites. The majority of PWE had completed primary school, with less than 15% of patients completing more than a secondary education. Seizure severity was high, with most patients having multiple seizures per week at the initial onset of epilepsy, and greater than 90% of patients reporting a loss of consciousness with seizures. The majority of patients (54.95%) also reported a developmental or learning delay. Most patients were on 1 AED (46.01%) or 2 AEDs (36.90%), with carbamazepine being the most frequently prescribed AED. There was a trend towards improved seizure severity over the follow-up period, as assessed by the corresponding Personal Impact of Epilepsy Scale (PIES) subscale. CONCLUSIONS People with epilepsy attending hospital-based care in Uganda tend to have severe forms of epilepsy requiring management with AEDs. Current hospital-based practices show a positive trend for seizure burden and quality of life of PWE in Uganda. Further interventions to improve overall access to biomedical care are required to continue to advance the management of PWE across all communities. This article is part of the Special Issue "The Intersection of Culture, Resources, and Disease: Epilepsy Care in Uganda".
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Affiliation(s)
- Anthony T Fuller
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University, School of Medicine, Durham, NC, USA
| | - Alysa Almojuela
- Section of Neurosurgery, Rady Faculty of Health Sciences, University of Manitoba, GB1-820 Sherbrook Street, Health Sciences Centre, Winnipeg, MB R3A 1R9, Canada
| | - Martin N Kaddumukasa
- Department of Medicine, Mulago National Referral Hospital, Neurology Unit, Kampala, Uganda; School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Payal Chakraborty
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA
| | - Patrick J Smith
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, DUMC Box 3119, Trent Drive, Durham, NC, USA
| | - Brad J Kolls
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke University School of Medicine, Department of Neurology, Durham, NC, USA; Duke Clinical Research Institute, Neuroscience Medicine, 300 W Morgan St, Durham, NC 27701, USA
| | - Florence Van Belleghem
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Department of Medicine, Group Biomedical Sciences, KU Leuven, Belgium
| | - Christine Muhumuza
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Makerere University School of Public Health, Department of Epidemiology and Biostatistics, Mulago Complex, P.O. Box 7072, Kampala, Uganda
| | - Sylvia Nshemerirwe
- Butabika National Referral Mental Hospital, P.O. Box 7017, Kampala, Uganda
| | - Mark Kaddumukasa
- School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Noeline Nakasujja
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Juliet Nakku
- Butabika National Referral Mental Hospital, P.O. Box 7017, Kampala, Uganda
| | - Angelina Kakooza-Mwesige
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Mulago Hill Road, P.O. Box 7072, Kampala, Uganda; Department of Paediatrics and Child Health, Mulago National Referral Hospital, Pediatric Neurology Unit, Kampala, Uganda
| | - Michael M Haglund
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University, School of Medicine, Durham, NC, USA
| | - Deborah C Koltai
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, DUMC Box 3119, Trent Drive, Durham, NC, USA; Duke University School of Medicine, Department of Neurology, Durham, NC, USA.
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Chakraborty P, Vissoci JRN, Muhumuza C, Fuller AT, Koltai DC, Nshemerirwe S, Haglund MM, Kaddumukasa MN. Validity of the Personal Impact of Epilepsy Scale (PIES) in patients with epilepsy in Uganda. Epilepsy Behav 2021; 114:107303. [PMID: 32718815 DOI: 10.1016/j.yebeh.2020.107303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE We sought to address the construct validity and reliability of the Personal Impact of Epilepsy Scale (PIES), an epilepsy-specific quality-of-life measure, in patients with epilepsy in Uganda. We also sought to assess the applicability of the scale across three languages: English, Luganda, and Runyankole. METHODS Patients with epilepsy (N = 626) were recruited at the time of care seeking from Mulago National Referral Hospital (MNRH), Butabika National Referral Mental Hospital (BNRMH), and Mbarara Regional Referral Hospital (MRRH), and were given the English, Runyankole, and Luganda versions of the PIES as a part of a larger interview. Reliability, internal consistency specifically, was assessed using three parameters: Cronbach's alpha, McDonald's Omega, and composite reliability. Construct validity (internal structure) was evaluated with principal component analysis (PCA) for three factors, as well as confirmatory factor analysis (CFA) for a three-factor structure of the scale. We also assessed correlations between the three PIES subscales and the seizure severity question in the Liverpool Seizure Severity Scale (LSSS) and reported seizure frequency. RESULTS The three-factor model of the PIES had adequate reliability, with Cronbach's Alpha, McDonald's Omega, and composite reliability values over 0.7, except for the Cronbach's Alpha and McDonald's Omega values for the second factor, which was slightly lower than 0.7 in the full sample as well as when stratified by study language. The PCA and CFA models for the scale demonstrated adequate fit with the Tucker-Lewis index (TLI), comparative fit index (CFI), and root mean square error of approximation (RMSEA), with TLI and CFI values above 0.9 and RMSEA values less than 0.08. However, the model demonstrated inadequate fit with the Chi-square indicator, which yielded a significant p-value. Individual factor loadings ranged from 0.50 to 0.95 in the full sample, 0.45 to 0.98 in the English sample, and 0.45 to 0.93 in the Luganda sample. Finally, the three PIES subscales aligned with reported seizure frequency and the seizure severity question from the LSSS. CONCLUSIONS This study presents the first Luganda and Runyankole versions of the PIES, and the first validation of this scale in English and Luganda with patients with epilepsy in Uganda. The PIES was found to have acceptable psychometric properties for reliability and validity parameters. Thus, the scale is recommended for use and for further investigation in patients with epilepsy in Uganda. This article is part of the Special Issue "The Intersection of Culture, Resources, and Disease: Epilepsy Care in Uganda".
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Affiliation(s)
- Payal Chakraborty
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA
| | - Joao Ricardo Nickenig Vissoci
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University School of Medicine, Department of Surgery, Emergency Medicine, Durham, NC, USA
| | - Christine Muhumuza
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Makerere University School of Public Health, Department of Epidemiology and Biostatistics, New Mulago complex, P.O.BOX 7072, Kampala, Uganda
| | - Anthony T Fuller
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University School of Medicine, Durham, NC, USA
| | - Deborah C Koltai
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA; Duke University School of Medicine, Department of Neurology, Durham, NC, USA.
| | - Sylvia Nshemerirwe
- Butabika National Referral Mental Hospital, P.O.BOX 7017, Kampala, Uganda
| | - Michael M Haglund
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University School of Medicine, Durham, NC, USA
| | - Martin N Kaddumukasa
- Department of Medicine, Mulago National Referral Hospital, Neurology Unit, Kampala, Uganda; School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
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Abstract
Closed-loop brain stimulation is increasingly used in level 4 epilepsy centers without an understanding of how the device behaves on a daily basis. This lack of insight is a barrier to improving closed-loop therapy and ultimately understanding why some patients never achieve seizure reduction. We aimed to quantify the accuracy of closed-loop seizure detection and stimulation on the RNS device through extrapolating information derived from manually reviewed ECoG recordings and comprehensive device logging information. RNS System event logging data were obtained, reviewed, and analyzed using a custom-built software package. A weighted-means methodology was developed to adjust for bias and incompleteness in event logs and evaluated using Bland–Altman plots and Wilcoxon signed-rank tests to compare adjusted and non-weighted (standard method) results. Twelve patients implanted for a mean of 21.5 (interquartile range 13.5–31) months were reviewed. The mean seizure frequency reduction post-RNS implantation was 40.1% (interquartile range 0–96.2%). Three primary levels of event logging granularity were identified (ECoG recordings: 3.0% complete (interquartile range 0.3–1.8%); Event Lists: 72.9% complete (interquartile range 44.7–99.8%); Activity Logs: 100% complete; completeness measured with respect to Activity Logs). Bland–Altman interpretation confirmed non-equivalence with unpredictable differences in both magnitude and direction. Wilcoxon signed rank tests demonstrated significant (p < 10−6) differences in accuracy, sensitivity, and specificity at >5% absolute mean difference for extrapolated versus standard results. Device behavior logged by the RNS System should be used in conjunction with careful review of stored ECoG data to extrapolate metrics for detector performance and stimulation.
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Pandey DK, Dasgupta R, Levy J, Wang H, Serafini A, Habibi M, Song W, Shafer PO, Loeb JA. Enhancing epilepsy self-management and quality of life for adults with epilepsy with varying social and educational backgrounds using PAUSE to Learn Your Epilepsy. Epilepsy Behav 2020; 111:107228. [PMID: 32599431 PMCID: PMC7319931 DOI: 10.1016/j.yebeh.2020.107228] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE People with epilepsy (PWE) come from a wide variety of social backgrounds and educational skillsets, making self-management (SM) education for improving their condition challenging. Here, we evaluated whether a mobile technology-based personalized epilepsy SM education intervention, PAUSE to Learn Your Epilepsy (PAUSE), improves SM measures such as self-efficacy, epilepsy SM behaviors, epilepsy outcome expectations, quality of life (QOL), and personal impact of epilepsy in adults with epilepsy. METHODS Recruitment for the PAUSE study occurred from October 2015 to March 2019. Ninety-one PWE were educated using an Internet-enabled computer tablet application that downloads custom, patient-specific educational programs from Epilepsy.com. Validated self-reported questionnaires were used for outcome measures. Participants were assessed at baseline (T0), the first follow-up at completion of the PWE-paced 8-12-week SM education intervention (T1), and the second follow-up at least 3 months after the first follow-up (T2). Multiple linear regression was used to assess within-subject significant changes in outcome measures between these time points. RESULTS The study population was diverse and included individuals with a wide variety of SM educational needs and abilities. The median time for the first follow-up assessment (T1) was approximately 4 months following the baseline (T0) and 8 months following baseline for the second follow-up assessment (T2). Participants showed significant improvement in all SM behaviors, self-efficacy, outcome expectancy, QOL, and personal impact of epilepsy measures from T0 to T1. Participants who scored lower at baseline tended to show greater improvement at T1. Similarly, results showed that participant improvement was sustained in the majority of SM measures from T1 to T2. CONCLUSION This study demonstrated that a mobile technology-based personalized SM intervention is feasible to implement. The results provide evidence that epilepsy SM behavior and practices, QOL, outcome expectation for epilepsy treatment and management, self-efficacy, and outcome expectation and impact of epilepsy significantly improve following a personalized SM education intervention. This underscores a greater need for a pragmatic trial to test the effectiveness of personalized SM education, such as PAUSE to Learn Your Epilepsy, in broader settings specifically for the unique needs of the hard-to-reach and hard-to-treat population of PWE.
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Affiliation(s)
- Dilip K. Pandey
- Neurology and Rehabilitation, University of Illinois College of Medicine, University of Illinois Chicago, 912 S. Wood St, Chicago, IL 60612, USA,Corresponding author at: 174N NPI (MC 796), 912 S Wood St, Chicago, IL 60612, USA
| | - Raktima Dasgupta
- Health Policy and Administration, School of Public Health, University of Illinois Chicago, 1603 W. Taylor St., Chicago, IL 60612, USA
| | - Jessica Levy
- Neurology and Rehabilitation, University of Illinois College of Medicine, University of Illinois Chicago, 912 S. Wood St, Chicago, IL 60612, USA
| | - Heng Wang
- Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, 1603 W. Taylor St., Chicago, IL 60612, USA
| | - Anna Serafini
- Neurology and Rehabilitation, University of Illinois College of Medicine, University of Illinois Chicago, 912 S. Wood St, Chicago, IL 60612, USA
| | - Mitra Habibi
- Pharmacy Practice, College of Pharmacy, University of Illinois Chicago, 833 S. Wood St., Chicago, IL 60612, USA
| | - Woojin Song
- Neurology and Rehabilitation, University of Illinois College of Medicine, University of Illinois Chicago, 912 S. Wood St, Chicago, IL 60612, USA
| | - Patricia O. Shafer
- Epilepsy Foundation, 8301 Professional Place West, Landover, MD 20785, USA
| | - Jeffrey A. Loeb
- Neurology and Rehabilitation, University of Illinois College of Medicine, University of Illinois Chicago, 912 S. Wood St, Chicago, IL 60612, USA
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Dewar SR, Heilemann MV, Engel J, Lee EE, Pieters HC. Perceptions of illness severity in adults with drug-resistant temporal lobe epilepsy. Epilepsy Behav 2020; 109:107091. [PMID: 32417384 DOI: 10.1016/j.yebeh.2020.107091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to explore how subjective perceptions of illness severity were described by a sample of participants with drug-resistant epilepsy (DRE) who were considering surgery. METHODS A qualitative methodology, constructivist grounded theory, guided all aspects of the study. Data were collected via 51 semi-structured interviews with 35 adults in our multiethnic sample. At interview, the 20 women (57%) and 15 men (43%) ranged in age from 18 to 68 years (mean = 35.6 years) and had lived with epilepsy for an average of 15.4 y (range = 2-44 years). RESULTS A grounded theory with four interrelated categories was developed to reflect the process by which participants arrived at an explanation of illness severity. Illness severity for participants evolved as participants reflected upon the burdensome impact of uncontrolled seizures on self and others. Epilepsy, when compared with other chronic conditions, was described as less serious, and participants imagined that other peoples' seizures were comparatively worse than their own. Illness severity was not uppermost in participants' minds but emerged as a concept that was both relative and linked to social burden. Perceptions of overall disease severity expanded upon determinants of seizure severity to offer a more complete explanation of what patients themselves did about longstanding, uncontrolled epilepsy. CONCLUSIONS Perceptions of illness severity played a vital role in treatment decision-making with the potential to impact the illness trajectory. How to measure components of illness severity represents a new challenge for outcomes research in DRE.
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Affiliation(s)
- Sandra R Dewar
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America.
| | - MarySue V Heilemann
- School of Nursing, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Jerome Engel
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, United States of America; Department of Neurobiology, University of California Los Angeles, Los Angeles, CA, United States of America; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States of America; The Brain Research Institute, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Eunice E Lee
- School of Nursing, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Huibrie C Pieters
- School of Nursing, University of California Los Angeles, Los Angeles, CA, United States of America
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Kokkinos V, Sisterson ND, Wozny TA, Richardson RM. Association of Closed-Loop Brain Stimulation Neurophysiological Features With Seizure Control Among Patients With Focal Epilepsy. JAMA Neurol 2020; 76:800-808. [PMID: 30985902 DOI: 10.1001/jamaneurol.2019.0658] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance A bidirectional brain-computer interface that performs neurostimulation has been shown to improve seizure control in patients with refractory epilepsy, but the therapeutic mechanism is unknown. Objective To investigate whether electrographic effects of responsive neurostimulation (RNS), identified in electrocorticographic (ECOG) recordings from the device, are associated with patient outcomes. Design, Setting, and Participants Retrospective review of ECOG recordings and accompanying clinical meta-data from 11 consecutive patients with focal epilepsy who were implanted with a neurostimulation system between January 28, 2015, and June 6, 2017, with 22 to 112 weeks of follow-up. Recorded ECOG data were obtained from the manufacturer; additional system-generated meta-data, including recording and detection settings, were collected directly from the manufacturer's management system using an in-house, custom-built platform. Electrographic seizure patterns were identified in RNS recordings and evaluated in the time-frequency domain, which was locked to the onset of the seizure pattern. Main Outcomes and Measures Patterns of electrophysiological modulation were identified and then classified according to their latency of onset in relation to triggered stimulation events. Seizure control after RNS implantation was assessed by 3 main variables: mean frequency of seizure occurrence, estimated mean severity of seizures, and mean duration of seizures. Overall seizure outcomes were evaluated by the extended Personal Impact of Epilepsy Scale questionnaires, a patient-reported outcome measure of 3 domains (seizure characteristics, medication adverse effects, and quality of life), with a range of possible scores from 0 to 300 in which lower scores indicate worse status, and the Engel scale, which comprises 4 classes (I-IV) in which lower numbers indicate greater improvement. Results Electrocorticographic data from 11 patients (8 female; mean [range] age, 35 [19-65] years; mean [range] duration of epilepsy, 19 [5-37] years) were analyzed. Two main categories of electrophysiological signatures of stimulation-induced modulation of the seizure network were discovered: direct and indirect effects. Direct effects included ictal inhibition and early frequency modulation but were not associated with improved clinical outcomes (odds ratio [OR], 0.67; 95% CI, 0.06-7.35; P > .99). Only indirect effects-those occurring remote from triggered stimulation-were associated with improved clinical outcomes (OR, infinity; 95% CI, -infinity to infinity; P = .02). These indirect effects included spontaneous ictal inhibition, frequency modulation, fragmentation, and ictal duration modulation. Conclusions and Relevance These findings suggest that RNS effectiveness may be explained by long-term, stimulation-induced modulation of seizure network activity rather than by direct effects on each detected seizure.
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Affiliation(s)
- Vasileios Kokkinos
- Brain Modulation Laboratory, Department of Neurological Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, Pennsylvania
| | - Nathaniel D Sisterson
- Medical student, Brain Modulation Laboratory, Department of Neurological Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Thomas A Wozny
- Brain Modulation Laboratory, Department of Neurological Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - R Mark Richardson
- Brain Modulation Laboratory, Department of Neurological Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, Pennsylvania.,University of Pittsburgh Brain Institute, Pittsburgh, Pennsylvania
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Pottkämper JCM, Hofmeijer J, van Waarde JA, van Putten MJAM. The postictal state - What do we know? Epilepsia 2020; 61:1045-1061. [PMID: 32396219 PMCID: PMC7317965 DOI: 10.1111/epi.16519] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 04/05/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023]
Abstract
This narrative review provides a broad and comprehensive overview of the most important discoveries on the postictal state over the past decades as well as recent developments. After a description and definition of the postictal state, we discuss postictal sypmtoms, their clinical manifestations, and related findings. Moreover, pathophysiological advances are reviewed, followed by current treatment options.
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Affiliation(s)
- Julia C M Pottkämper
- Clinical Neurophysiology, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.,Department of Psychiatry, Rijnstate Hospital, Arnhem, The Netherlands.,Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Jeannette Hofmeijer
- Clinical Neurophysiology, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.,Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Michel J A M van Putten
- Clinical Neurophysiology, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
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22
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Assessing the personal impact of epilepsy in a population-based cohort of Veterans. Epilepsy Behav 2020; 106:107047. [PMID: 32247175 DOI: 10.1016/j.yebeh.2020.107047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE Epilepsy impacts patient lives in multidimensional ways. Although previous work has investigated epilepsy impact on health status, little is known about the overall quantified impact of epilepsy in Veterans. Our goal was to describe the impact of epilepsy on Veterans' lives using the Personal Impact of Epilepsy Scale (PIES) and determine the patient and clinical characteristics most strongly correlated with epilepsy impact. We described cohort characteristics and developed regression models to determine which characteristics were most strongly associated with PIES subscale (seizure, medication, comorbidity) scores and quality of life (QOL). RESULTS Approximately 36% of those who were invited responded to the survey. Of the 438 respondents included in the analyses, roughly 50% were aged 45-64 years (35% >65; 14% 18-44); 19% were women. Almost 90% had previously received care by an epilepsy specialist, 37% of which was in Veterans Health Administration (VHA) and 38% in both VHA and community. The PIES scores were moderately low (mean: 88.68, [standard deviation (SD) = 63.24]; 300 total). The PIES overall and subscale scores were significantly lower for older Veterans with epilepsy (VWE) (>65) compared with younger (18-44 years) and middle-aged (45-64 years) VWE [p < 0.001], indicating that older Veterans had a lower epilepsy impact overall, and for seizures, medication, and comorbidity. The younger and middle-aged VWE had a significantly higher proportion with psychiatric diagnosis compared with older VWE [p < 0.001]. There was a trend for significance for the overall PIES scores by gender, with women having total higher (worse) scores (mean = 93.10, SD = 69.68) than men (mean = 74.39, SD = 59.97), which was driven by a statistically higher score on the seizure subscale for women (mean = 27.66, SD = 27.97) compared with men (mean = 19.29, SD 25.35; p = 0.04). Regression models revealed that frequent seizures (>1/month, >2/month) and diagnoses of dementia significantly predicted higher (more negative) Seizure Severity PIES score [all p < 0.05]. Frequent seizures (>1/month), number of antiepileptic drugs (AEDs), and diagnosis of dementia predicted negative impact, and older age predicted positive impact for medication subscale. Frequent seizures (>1/month) and diagnoses of depression and dementia predicted negative mood and social impact [all p < 0.05]. Seizure frequency (>2/month) was the only variable that significantly predicted lack of excellent QOL [p < 0.05]. Effects for gender were not significant after controlling for other variables. CONCLUSIONS Findings were similar to a prior study of generic health outcomes in younger and older VWE using the 36-Item Short Form Survey (SF-36). Seizure frequency was consistently associated with negative impact of epilepsy in all age groups. While dementia and other diagnosed health conditions also contributed to epilepsy impact, older VWE had significantly lower PIES scores even after controlling for physical conditions and dementia. Lower (better) scores for comorbidity and medication scales in older VWE may be due to fewer diagnosed psychiatric comorbidities and psychiatric medication that have similar cognitive impact as AEDs, and which may also interact with AEDs. Implementation of patient self-management programs to improve seizure control may reduce epilepsy impact for Veterans and reduce Veterans Affairs (VA) healthcare utilization. The PIES may also be useful to measure outcomes of self-management interventions.
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Pandey DK, Levy J, Serafini A, Habibi M, Song W, Shafer PO, Loeb JA. Self-management skills and behaviors, self-efficacy, and quality of life in people with epilepsy from underserved populations. Epilepsy Behav 2019; 98:258-265. [PMID: 31398690 DOI: 10.1016/j.yebeh.2019.07.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/10/2019] [Accepted: 07/14/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE People with epilepsy (PWE) from underserved populations face significant barriers to epilepsy management and therefore may lack knowledge about epilepsy and self-management (SM) of epilepsy. This paper evaluates SM practices, self-efficacy, outcome expectancy, quality of life, and personal impact of epilepsy in PWE from underserved populations as compared with all PWE. METHODS Recruitment for the Managing Epilepsy Well (MEW) Network PAUSE to Learn Your Epilepsy study occurred from October 2015 to March 2019. Participants were assessed at baseline; after SM education intervention; and 6-, 9-, and 15-month postbaseline assessment. Baseline data from 112 PWE were analyzed for this report. RESULTS Study population was diverse: 63% were women, 47.3% were non-Hispanic black, 24.1% were Hispanic, and 57.4% had public healthcare coverage. Participants on average had epilepsy for 14 years, and 49.1% reported at least one seizure within the past month, but only 27% reported having used a seizure diary or calendar for seizure tracking. Self-management practices & behaviors were significantly lower among PWE from underserved populations than all PWE, though self-efficacy among PWE from underserved populations was significantly higher. CONCLUSION This study identifies the unique epilepsy SM needs of PWE from underserved populations. We discuss the need for a personalized approach for developing SM skills and behaviors among these PWE.
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Affiliation(s)
- Dilip K Pandey
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine, University of Illinois at Chicago, 912 S. Wood St, Chicago, IL 60612, USA.
| | - Jessica Levy
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine, University of Illinois at Chicago, 912 S. Wood St, Chicago, IL 60612, USA
| | - Anna Serafini
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine, University of Illinois at Chicago, 912 S. Wood St, Chicago, IL 60612, USA
| | - Mitra Habibi
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, 833 S. Wood St, Chicago, IL 60612, USA
| | - Woojin Song
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine, University of Illinois at Chicago, 912 S. Wood St, Chicago, IL 60612, USA
| | - Patricia O Shafer
- Epilepsy Foundation, 8301 Professional Place West, Landover, MD, USA
| | - Jeffrey A Loeb
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine, University of Illinois at Chicago, 912 S. Wood St, Chicago, IL 60612, USA
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Singh G, Sharma S, Bansal RK, Setia RK, Sharma S, Bansal N, Chowdhury A, Goraya JS, Chatterjee S, Kaur S, Kaur M, Kalra S, Sander JW. A home-based, primary-care model for epilepsy care in India: Basis and design. Epilepsia Open 2019; 4:264-274. [PMID: 31168493 PMCID: PMC6546011 DOI: 10.1002/epi4.12311] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 01/24/2019] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES A cluster-randomized trial of home-based care using primary-care resources for people with epilepsy has been set up to optimize epilepsy care in resource-limited communities in low- and middle-income countries. The primary aim is to determine whether treatment adherence to antiepileptic drugs is better with home-based care or with routine clinic-based care. The secondary aims are to compare the effects of the two care pathways on seizure control and quality of life. METHODS The home-based intervention comprises epilepsy medication provision, adherence reinforcement, and epilepsy self-management and stigma management guidance provided by an auxiliary nurse-midwife equivalent. The experimental group will be compared to a routine clinic-based care group using a cluster-randomized design in which the unit of analysis is a cluster of 10 people with epilepsy residing in an area cared for by a single accredited government grass-roots health care worker. The primary outcome is treatment adherence as measured by monthly tablet counts supplemented by two self-completed questionnaires. The secondary outcomes include monthly seizure frequency, time to first seizure (in days) after enrollment, proportion of patients experiencing seizure freedom for the duration of the study, and quality of life measured by the "Personal Impact of Epilepsy Scale," all assessed by an independent study nurse. RESULTS The screening phase and neurologic evaluations and randomizations have been recently completed and follow-up is underway. SIGNIFICANCE The results of the trial are likely to have substantial bearing on the development of governmental policies and strategies to provide coverage and care for patients with epilepsy in resource-limited countries.
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Affiliation(s)
- Gagandeep Singh
- Department of NeurologyDayanand Medical CollegeLudhianaIndia
- The Research & Development UnitDayanand Medical CollegeLudhianaIndia
- NIHR University College London Hospitals Biomedical Research CentreUCL Queen Square Institute of NeurologyLondonUK
| | - Suman Sharma
- The Research & Development UnitDayanand Medical CollegeLudhianaIndia
| | | | | | - Sarit Sharma
- Department of Social & Preventive MedicineDayanand Medical CollegeLudhianaIndia
| | - Namita Bansal
- The Research & Development UnitDayanand Medical CollegeLudhianaIndia
| | - Anuraag Chowdhury
- Department of Social & Preventive MedicineDayanand Medical CollegeLudhianaIndia
| | | | | | - Sukhpreet Kaur
- The Research & Development UnitDayanand Medical CollegeLudhianaIndia
| | - Manpreet Kaur
- The Research & Development UnitDayanand Medical CollegeLudhianaIndia
| | - Shivani Kalra
- College of NursingDayanand Medical CollegeLudhianaIndia
| | - Josemir W. Sander
- NIHR University College London Hospitals Biomedical Research CentreUCL Queen Square Institute of NeurologyLondonUK
- Chalfont Centre for EpilepsyChalfont St PeterUK
- Stichting Epilepsie Instellingen Nederland (SEIN)HeemstedeThe Netherlands
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Hendrix N, Ollendorf DA, Chapman RH, Loos A, Liu S, Kumar V, Linder JA, Pearson SD, Veenstra DL. Cost-Effectiveness of Targeted Pharmacotherapy for Moderate to Severe Plaque Psoriasis. J Manag Care Spec Pharm 2018; 24:1210-1217. [PMID: 30479197 PMCID: PMC10398188 DOI: 10.18553/jmcp.2018.24.12.1210] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Newer classes of targeted drugs for moderate to severe plaque psoriasis are more effective and more expensive than older classes, posing a difficult and potentially costly decision about whether to use them as initial targeted treatments. OBJECTIVE To estimate the clinical and economic outcomes of initial targeted treatment for the following drugs: adalimumab, etanercept, and infliximab (TNFα inhibitors); apremilast (PDE4 inhibitor); ustekinumab (IL-12/23 inhibitor); and ixekizumab, secukinumab, and brodalumab (IL-17 inhibitors). METHODS We developed a Markov model to simulate patient outcomes as measured by quality-adjusted life-years (QALYs) and health care costs over a 10-year period. We assumed that patients who fail initial targeted treatment either proceed to subsequent therapy or discontinue targeted treatment. Effectiveness estimates for initial treatment were defined as improvement in Psoriasis Area and Severity Index (PASI) from baseline and derived from a 2018 network meta-analysis. Wholesale acquisition drug costs were discounted by a class-specific, empirically derived rebate percentage off of 2016 costs. We conducted one-way and probabilistic sensitivity analyses to assess uncertainty in results. RESULTS The incremental benefits compared with no targeted treatment were, in descending order: ixekizumab 1.68 QALYs (95% credible range [CR] = 1.11-2.02), brodalumab 1.64 QALYs (95% CR = 1.08-1.98), secukinumab 1.51 QALYs (95% CR = 1.00-1.83), ustekinumab 1.43 QALYs (95% CR=0.94-1.74), infliximab 1.27 QALYs (95% CR = 0.89-1.55), adalimumab 1.15 QALYs (95% CR = 0.76-1.44), etanercept 0.97 QALYs (95% CR = 0.61-1.25), and apremilast 0.87 QALYs (95% CR = 0.52-1.17). Costs of care without targeted treatment totaled $66,451, and costs of targeted treatment ranged from $137,080 (apremilast) to $255,422 (ustekinumab). Probabilistic sensitivity analysis results indicated that infliximab and apremilast are likely to be the most cost-effective initial treatments at willingness-to-pay thresholds around $100,000 per QALY, while IL-17 drugs are more likely to be cost-effective at thresholds approaching $150,000 per QALY. Acquisition cost of the initial targeted drug and utility of clinical response were the most influential parameters. CONCLUSIONS Our findings suggest that initial targeted treatment with IL-17 inhibitors is the most effective treatment strategy for plaque psoriasis patients who have failed methotrexate and phototherapy. Apremilast, brodalumab, infliximab, ixekizumab, and secukinumab are cost-effective at different willingness-to-pay thresholds. Additional research is needed on whether the effectiveness of targeted agents changes when used after previously targeted agents. DISCLOSURES Funding for this study was contributed by the Institute for Clinical and Economic Review (ICER). Ollendorf, Chapman, Pearson, and Kumar are current employees, and Loos and Liu are former employees, of ICER, an independent organization that evaluates the evidence on the value of health care interventions, which is funded by grants from the Laura and John Arnold Foundation, Blue Shield of California Foundation, and the California HealthCare Foundation. ICER's annual policy summit is supported by dues from Aetna, AHIP, Anthem, Alnylam, AstraZeneca, Blue Shield of California, Cambia Health Solutions and MedSavvy, CVS Caremark, Editas, Express Scripts, Genentech, GlaxoSmithKline, Harvard Pilgrim Health Care, Health Care Service Corporation, OmedaRx, United Healthcare, Johnson & Johnson, Kaiser Permanente, Premera Blue Cross, Merck, National Pharmaceutical Council, Takeda, Pfizer, Novartis, Lilly, Humana, Prime Therapeutics, Sanofi, and Spark Therapeutics. Linder owns stock in Amgen, Biogen, and Eli Lilly; has contingent value rights in Sanofi Genzyme (related to alemtuzumab for multiple sclerosis); has received grant support from Astellas Pharma not related to this study and Clintrex, which was supported by AstraZeneca on an unrelated topic; and has received an honorarium from the Society of Healthcare Epidemiology of America (SHEA) as part of the SHEA Antimicrobial Stewardship Research Workshop Planning Committee, an educational activity supported by Merck. No other authors have potential conflicts of interest.
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Affiliation(s)
- Nathaniel Hendrix
- Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle
| | | | | | - Anne Loos
- Institute for Clinical and Economic Review, Boston, Massachusetts
| | - Shanshan Liu
- Institute for Clinical and Economic Review, Boston, Massachusetts
| | - Varun Kumar
- Institute for Clinical and Economic Review, Boston, Massachusetts
| | - Jeffrey A. Linder
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - David L. Veenstra
- Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle
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Roberts MH, Takeda MY, Kindilien S, Barqawi YK, Borrego ME. Assessment of components included in published societal perspective or QALY outcome economic analyses for antiepileptic drug treatment in chronic epilepsy. Expert Rev Pharmacoecon Outcomes Res 2018; 18:487-503. [PMID: 29911955 PMCID: PMC6564682 DOI: 10.1080/14737167.2018.1489243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 06/12/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Antiepileptic drug (AED) treatments seek to control seizures with minimal or no adverse effects, effects which can substantially impact costs and outcomes for patients, caregivers, and third party payers. The First and Second Panel on Cost-Effectiveness in Health and Medicine recommend inclusion of a societal reference case, even in studies conducted from a healthcare sector perspective, for comparability of findings across studies. Cost and outcome evaluation components include direct medical, non-direct medical-related (e.g. patient-time and transportation costs for treatment) and non-healthcare sectors (e.g. lost productivity). AREAS COVERED Guided by Second Panel recommendations, this review developed an overall impact inventory and detailed adverse effect impact inventory to assess the scope and methods in published economic evaluations of AED treatments for adults with chronic epilepsy. Societal perspective evaluations or evaluations that utilized quality-adjusted life-years (QALYs) as an outcome were reviewed. The majority of reviewed articles were healthcare sector perspective studies, methods for estimating QALYs varied widely, and a minority considered specific AED treatment adverse effects. EXPERT COMMENTARY Only considering a healthcare sector perspective fails to provide full information for patients on AED treatments. Using an impact inventory to guide study scope and design will facilitate full reporting of costs and benefits.
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Affiliation(s)
- Melissa H Roberts
- a Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy , University of New Mexico , Albuquerque , USA
| | - Mikiko Y Takeda
- a Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy , University of New Mexico , Albuquerque , USA
| | - Shannon Kindilien
- a Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy , University of New Mexico , Albuquerque , USA
| | - Yazan K Barqawi
- a Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy , University of New Mexico , Albuquerque , USA
| | - Matthew E Borrego
- a Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy , University of New Mexico , Albuquerque , USA
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Sourbron J, Klinkenberg S, Kessels A, Schelhaas HJ, Lagae L, Majoie M. Vagus Nerve Stimulation in children: A focus on intellectual disability. Eur J Paediatr Neurol 2017; 21:427-440. [PMID: 28188025 DOI: 10.1016/j.ejpn.2017.01.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 10/26/2016] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Vagus Nerve Stimulation (VNS) can be an efficacious add-on treatment in patients with drug-resistant epilepsy, who are not eligible for surgery. Evidence of VNS efficacy in children with intellectual disability (ID) is scarce. OBJECTIVES The purpose of this study was to review all available VNS data in the pediatric population (≤18 years old) and focus on the subpopulation with ID since appropriate treatment of these children is often challenging and complex. METHODS Cochrane, EMBASE, PubMed and MEDLINE were used to collect all research associated to VNS and ID (or synonyms) leading to a total of 37 studies. Seven studies showed the results of patients with ID and those without separately; thereby only these studies were included in the VNS meta-analysis. RESULTS Our meta-analysis showed that VNS was less effective in pediatric epilepsy patients with ID compared to those without ID (Mantel-Haenszel meta-analysis; p = 0.028, OR 0.18 (CI 95% 0.039-0.84)). However, there were no prospective controlled studies. Numerous studies reported quality of life (QoL) improvements in this subpopulation. The most common adverse events were transient and well tolerated. Side effects on cognition and behavior were not reported. DISCUSSION These results might be a reason to consider VNS early on in the treatment of this subgroup. The significantly greater amount of retrospective studies, differences in follow-up (FU), lack of control data, heterogeneous series and limited number of patients could have biased the outcome measurements. Hence, current data do not exclude VNS for children with drug-resistant epilepsy and ID but should be interpreted with caution.
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Affiliation(s)
- Jo Sourbron
- Laboratory for Molecular Biodiscovery, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Sylvia Klinkenberg
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alfons Kessels
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht, The Netherlands
| | | | - Lieven Lagae
- Department of Development and Regeneration, Section Pediatric Neurology, University Hospitals KU Leuven, Leuven, Belgium
| | - Marian Majoie
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Neurology, Epilepsy Center Kempenhaeghe, The Netherlands.
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Affiliation(s)
- Robert S Fisher
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford Neuroscience Health Center, 213 Quarry Road, Room 4865, Palo Alto, CA 94304-5979, United States.
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Aghaei-Lasboo A, Fisher RS. Methods for Measuring Seizure Frequency and Severity. Neurol Clin 2016; 34:383-94, viii. [DOI: 10.1016/j.ncl.2015.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cramer JA. Reflections on a career in epilepsy: An unplanned journey. Epilepsy Behav 2016; 57:217-219. [PMID: 26926002 DOI: 10.1016/j.yebeh.2016.01.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 01/21/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Joyce A Cramer
- Yale University School of Medicine, 49 Briar Hollow Lane, Unit 1804, Houston, TX, USA.
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Borghs S, Tomaszewski EL, Halling K, de la Loge C. Understanding the Patient Perspective of Seizure Severity in Epilepsy: Development of a Conceptual Model. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 9:419-31. [PMID: 27002318 DOI: 10.1007/s40271-016-0165-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE For patients with uncontrolled epilepsy, the severity and postictal sequelae of seizures might be more impactful than their frequency. Seizure severity is often assessed using patient-reported outcome (PRO) instruments; however, evidence of content validity for existing instruments is lacking. Our aim was to understand the real-life experiences of patients with uncontrolled epilepsy. METHODS A preliminary conceptual model was developed. The model was refined through (1) a targeted literature review of qualitative research on seizure severity; (2) interviews with four clinical epilepsy experts to evaluate identified concepts; and (3) qualitative interviews with patients with uncontrolled epilepsy, gathering descriptions of symptoms and impacts of epilepsy, focusing on how patients experience and describe "seizure severity." Findings were summarized in a final conceptual model of seizure severity in epilepsy. RESULTS Twenty-five patients (12 who experienced primary generalized tonic-clonic seizures and 13 who experienced partial-onset seizures) expressed 42 different symptoms and 26 different impacts related to seizures. The final conceptual model contained a wide range of concepts related to seizure frequency, symptoms, and duration. CONCLUSION Our model identified several new concepts that characterize the patient experience of seizure severity. A seizure severity PRO instrument should cover a wide range of seizure symptoms alongside frequency and duration of seizures. This qualitative work reinforces the notion that measuring seizure frequency is insufficient and that seizure severity is important in defining the patient's experience of epilepsy. This model could be used to assess the content validity of existing PRO instruments, or could support the development of a new one.
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Blond BN, Detyniecki K, Hirsch LJ. Assessment of Treatment Side Effects and Quality of Life in People with Epilepsy. Neurol Clin 2016; 34:395-410, viii. [PMID: 27086986 DOI: 10.1016/j.ncl.2015.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Epilepsy impairs quality of life in physical, psychological, cognitive, social, and occupational domains. In people who are not seizure free, depression and adverse medication effects have a predominant role in determining quality of life. The assessment of these factors and other comorbidities is essential for maximizing quality of life in epilepsy. There are multiple tools available to assess medication effects and quality of life in a structured format. Such tools can provide superior assessments and allow clinicians to have a greater impact on their patients' quality of life.
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Affiliation(s)
- Benjamin N Blond
- Department of Neurology, Comprehensive Epilepsy Center, Yale University, New Haven, CT, USA
| | - Kamil Detyniecki
- Department of Neurology, Comprehensive Epilepsy Center, Yale University, New Haven, CT, USA
| | - Lawrence J Hirsch
- Department of Neurology, Comprehensive Epilepsy Center, Yale University, New Haven, CT, USA.
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Sirven JI. What is in a number? The Personal Impact of Epilepsy Scale (PIES). Epilepsy Behav 2015; 42:138-9. [PMID: 25496797 DOI: 10.1016/j.yebeh.2014.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/08/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Joseph I Sirven
- Division of Epilepsy, Department of Neurology, Mayo Clinic, Phoenix, AZ, USA.
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