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Ferrer-Mallol E, Matthews C, Aziza R, Mendoza A, Sahota N, Komarzynski S, Lakshminarayana R, Davies EH. Video-based assessments of activities of daily living: generating real-world evidence in pediatric rare diseases. Expert Rev Pharmacoecon Outcomes Res 2024; 24:713-721. [PMID: 38789406 DOI: 10.1080/14737167.2024.2360201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 05/22/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Preserving function and independence to perform activities of daily living (ADL) is critical for patients and carers to manage the burden of care and improve quality of life. In children living with rare diseases, video recording ADLs offer the opportunity to collect the patients' experience in a real-life setting and accurately reflect treatment effectiveness on outcomes that matter to patients and families. AREAS COVERED We reviewed the measurement of ADL in pediatric rare diseases and the use of video to develop at-home electronic clinical outcome assessments (eCOA) by leveraging smartphone apps and artificial intelligence-based analysis. We broadly searched PubMed using Boolean combinations of the following MeSH terms 'Rare Diseases,' 'Quality of Life,' 'Activities of Daily Living,' 'Child,' 'Video Recording,' 'Outcome Assessment, Healthcare,' 'Intellectual disability,' and 'Genetic Diseases, Inborn.' Non-controlled vocabulary was used to include human pose estimation in movement analysis. EXPERT OPINION Broad uptake of video eCOA in drug development is linked to the generation of technical and clinical validation evidence to confidently assess a patient's functional abilities. Software platforms handling video data must align with quality regulations to ensure data integrity, security, and privacy. Regulatory flexibility and optimized validation processes should facilitate video eCOA to support benefit/risk drug assessment.
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Soto Jansson J, Bjurulf B, Dellenmark Blom M, Hallböök T, Reilly C. Caregiver perceptions of the impact of Dravet syndrome on the family, current supports and hopes and fears for the future: A qualitative study. Epilepsy Behav 2024; 156:109790. [PMID: 38692022 DOI: 10.1016/j.yebeh.2024.109790] [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: 02/26/2024] [Revised: 04/06/2024] [Accepted: 04/10/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Dravet syndrome (DS) is a Developmental and Epileptic Encephalopathy (DEE) with onset typically in infancy. Seizures are pharmaco-resistant, and neurodevelopment is compromised in almost all children. There is limited data on the impact of the condition on the family, support needs and hopes and fears in Sweden. METHODS Interviews were undertaken with the caregivers of 36 of 48 (75%) living children with DS in Sweden focusing on the perceived impact on the family, current supports and hopes and fears for the future. Data from the interviews were analyzed by two raters using reflexive thematic analysis. RESULTS The analysis revealed seven main themes focusing on the perceived negative impact the disease has on caregivers and family functioning. These negative impacts concerned: caregiver sleep (e.g., frequent night waking), siblings (e.g., gets less attention/time), social life (e.g., limited vacations), family finances (e.g., limited career progression), parental health (both mental and physical) and need for constant supervision (e.g., child's need for constant supervision for fear of seizures). Another theme concerned the impact on family relationships. Whilst some caregivers perceived the impact to be negative (e.g., limited time for each other) others felt that having a child with DS lead to stronger relationships and more 'teamwork'. With respect to supports, the caregivers identified a number of areas where they felt the family could access appropriate supports. Themes regarding supports included: support from the wider family and friends, support from DS support groups (online or in-person), support from the child's hospital or disability service and respite care (e.g., child was looked after on weekends or had paid carers in the home). Regarding hopes and fears for the future, responses focused mainly on fears, including concerns about premature death of the child, transition to adult healthcare services and care arrangements for child when parents are dead. Hopes for the future included better treatment for epilepsy and associated neurodevelopmental problems and finding a cure for DS. CONCLUSIONS Caregivers of children with DS report that the disease can have a very comprehensive negative impact on caregiver and family functioning. Identifying and providing the supports to ameliorate these negative impacts is vital to optimize caregiver and family wellbeing and quality of life.
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Affiliation(s)
- Josefin Soto Jansson
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Member of the ERN EpiCARE, 413 45, Gothenburg, Sweden
| | - Björn Bjurulf
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Member of the ERN EpiCARE, 413 45, Gothenburg, Sweden; Dept. of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michaela Dellenmark Blom
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Member of the ERN EpiCARE, 413 45, Gothenburg, Sweden; Dept. of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tove Hallböök
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Member of the ERN EpiCARE, 413 45, Gothenburg, Sweden; Dept. of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Colin Reilly
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Member of the ERN EpiCARE, 413 45, Gothenburg, Sweden; Dept. of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Nabbout R, Hilgers RD. Innovative methodologies for rare diseases clinical trials. Orphanet J Rare Dis 2024; 19:190. [PMID: 38715067 PMCID: PMC11077753 DOI: 10.1186/s13023-024-03189-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Affiliation(s)
- Rima Nabbout
- Reference centre for rare epilepsies Université Paris cité, Paris, France.
- Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France.
- Institut Imagine, INSERM U1163, Paris, France.
| | - Ralf-Dieter Hilgers
- RWTH Aachen University, Institute of Medical Statistics, 52074, Aachen, Germany.
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Guerrini R, Chiron C, Vandame D, Linley W, Toward T. Comparative efficacy and safety of stiripentol, cannabidiol and fenfluramine as first-line add-on therapies for seizures in Dravet syndrome: A network meta-analysis. Epilepsia Open 2024; 9:689-703. [PMID: 38427284 PMCID: PMC10984299 DOI: 10.1002/epi4.12923] [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: 07/27/2023] [Revised: 01/15/2024] [Accepted: 01/21/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVES Stiripentol, fenfluramine, and cannabidiol are licensed add-on therapies to treat seizures in Dravet Syndrome (DS). There are no direct or indirect comparisons assessing their full licensed dose regimens, across different jurisdictions, as first-line add-on therapies in DS. METHODS We conducted a systematic review and frequentist network meta-analysis (NMA) of randomized controlled trial (RCT) data for licensed add-on DS therapies. We compared the proportions of patients experiencing: reductions from baseline in monthly convulsive seizure frequency (MCSF) of ≥50% (clinically meaningful), ≥75% (profound), and 100% (seizure-free); serious adverse events (SAEs); discontinuations due to AEs. RESULTS We identified relevant data from two placebo-controlled RCTs for each drug. Stiripentol 50 mg/kg/day and fenfluramine 0.7 mg/kg/day had similar efficacy in achieving ≥50% (clinically meaningful) and ≥75% (profound) reductions from baseline in MCSF (absolute risk difference [RD] for stiripentol versus fenfluramine 1% [95% confidence interval: -20% to 22%; p = 0.93] and 6% [-15% to 27%; p = 0.59], respectively), and both were statistically superior (p < 0.05) to licensed dose regimens of cannabidiol (10 or 20 mg/kg/day, with/irrespective of clobazam) for these outcomes. Stiripentol was statistically superior in achieving seizure-free intervals compared to fenfluramine (RD = 26% [CI: 8% to 44%; p < 0.01]) and licensed dose regimens of cannabidiol. There were no significant differences in the proportions of patients experiencing SAEs. The risk of discontinuations due to AEs was lower for stiripentol, although the stiripentol trials were shorter. SIGNIFICANCE This NMA of RCT data indicates stiripentol, as a first-line add-on therapy in DS, is at least as effective as fenfluramine and both are more effective than cannabidiol in reducing convulsive seizures. No significant difference in the incidence of SAEs between the three add-on agents was observed, but stiripentol may have a lower risk of discontinuations due to AEs. These results may inform clinical decision-making and the continued development of guidelines for the treatment of people with DS. PLAIN LANGUAGE SUMMARY This study compared three drugs (stiripentol, fenfluramine, and cannabidiol) used alongside other medications for managing seizures in a severe type of epilepsy called DS. The study found that stiripentol and fenfluramine were similarly effective in reducing seizures and both were more effective than cannabidiol. Stiripentol was the best drug for stopping seizures completely based on the available clinical trial data. All three drugs had similar rates of serious side effects, but stiripentol had a lower chance of being stopped due to side effects. This information can help guide treatment choices for people with DS.
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Affiliation(s)
- Renzo Guerrini
- Neuroscience DepartmentChildren's Hospital Meyer IRCCSFlorenceItaly
- University of FlorenceFlorenceItaly
| | - Catherine Chiron
- INSERM U1141, NeuroDiderotUniversité Paris CitéParisFrance
- Pediatric Neurology and Reference Center for Rare EpilepsiesAPHP, Necker‐Enfants Malades HospitalParisFrance
| | | | | | - Toby Toward
- Henley Health Economics LtdHenley‐on‐ThamesOxfordshireUK
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Schoenen S, Verbeeck J, Koletzko L, Brambilla I, Kuchenbuch M, Dirani M, Zimmermann G, Dette H, Hilgers RD, Molenberghs G, Nabbout R. Istore: a project on innovative statistical methodologies to improve rare diseases clinical trials in limited populations. Orphanet J Rare Dis 2024; 19:96. [PMID: 38431612 PMCID: PMC10909280 DOI: 10.1186/s13023-024-03103-2] [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: 04/28/2023] [Accepted: 02/23/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The conduct of rare disease clinical trials is still hampered by methodological problems. The number of patients suffering from a rare condition is variable, but may be very small and unfortunately statistical problems for small and finite populations have received less consideration. This paper describes the outline of the iSTORE project, its ambitions, and its methodological approaches. METHODS In very small populations, methodological challenges exacerbate. iSTORE's ambition is to develop a comprehensive perspective on natural history course modelling through multiple endpoint methodologies, subgroup similarity identification, and improving level of evidence. RESULTS The methodological approaches cover methods for sound scientific modeling of natural history course data, showing similarity between subgroups, defining, and analyzing multiple endpoints and quantifying the level of evidence in multiple endpoint trials that are often hampered by bias. CONCLUSION Through its expected results, iSTORE will contribute to the rare diseases research field by providing an approach to better inform about and thus being able to plan a clinical trial. The methodological derivations can be synchronized and transferability will be outlined.
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Affiliation(s)
- Stefanie Schoenen
- Institute of Medical Statistics, RWTH Aachen University, Pauwelsstrasse 19, 52074, Aachen, Germany
| | - Johan Verbeeck
- I-BioStat, Data Science Institute, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Lukas Koletzko
- Institute of Statistics, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
| | - Isabella Brambilla
- Dravet Italia Onlus - European Patient Advocacy Group (ePAG) EpiCARE, 37100, Verona, Italy
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Research Center for Pediatric Epilepsies, University of Verona, Via S. Francesco, 22, 37129, Verona, Italy
| | - Mathieu Kuchenbuch
- Institut des Maladies Gènètiques Imagine-Necker Enfants malades Hospital, 24 Boulevard du Montparnasse, 75015, Paris, France
- Necker Enfants malades Hospital, 149 Rue de Sèvre, 75015, Paris, France
| | - Maya Dirani
- Institut des Maladies Gènètiques Imagine-Necker Enfants malades Hospital, 24 Boulevard du Montparnasse, 75015, Paris, France
- Necker Enfants malades Hospital, 149 Rue de Sèvre, 75015, Paris, France
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Holger Dette
- Institute of Statistics, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
| | - Ralf-Dieter Hilgers
- Institute of Medical Statistics, RWTH Aachen University, Pauwelsstrasse 19, 52074, Aachen, Germany.
| | - Geert Molenberghs
- I-BioStat, Data Science Institute, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
- I-BioStat, KU Leuven, Kapucijnenvoer 35, 3000, Leuven, Belgium
| | - Rima Nabbout
- Institut des Maladies Gènètiques Imagine-Necker Enfants malades Hospital, 24 Boulevard du Montparnasse, 75015, Paris, France
- Necker Enfants malades Hospital, 149 Rue de Sèvre, 75015, Paris, France
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Soto Jansson J, Bjurulf B, Dellenmark Blom M, Hallböök T, Reilly C. Diagnosis, epilepsy treatment and supports for neurodevelopment in children with Dravet Syndrome: Caregiver reported experiences and needs. Epilepsy Behav 2024; 151:109603. [PMID: 38168600 DOI: 10.1016/j.yebeh.2023.109603] [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: 11/08/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Dravet syndrome is a rare infantile onset epilepsy syndrome encompassing treatment resistant epilepsy and neurodevelopmental difficulties. There is limited data regarding caregiver experiences of diagnosis, treatment and supports for the associated neurodevelopmental problems. METHOD Semi-structured interviews were conducted with caregivers of 36/48 children (75% of total population in Sweden) with Dravet syndrome. Data was analysed using thematic analysis. RESULTS Regarding the diagnostic experience, themes were: Delays in diagnostic process, genetic testing not optimal, communication of Dravet syndrome diagnosis and support and information soon after diagnosis. Caregivers felt that delays in diagnosis and testing could have been avoided whilst experiences of communication of diagnosis and support after diagnosis varied. In terms of treatment for seizures, the themes were: Satisfied with treatment, emergency treatment, treatment with antiseizure medications, strategies to control seizures via temperature regulation/avoidance of infections and use of equipment and aids. Caregivers were in the main accepting that seizures in Dravet syndrome are very difficult to treat and that seizure freedom is often an unachievable goal. Many felt frustrated that they were expected to take responsibility with respect to choice of medication. They often employed strategies (e.g., avoidance of physical activity) to reduce seizures or their impact. In terms of supports for neurodevelopmental problems, the themes were: Struggled to access support, lack of integrated healthcare and satisfaction with school. Many caregivers felt that accessing necessary supports for their children and developmental and behavioural needs was a struggle and that the provision of support often lacked integration e.g., lack of collaboration between child's disability service and school. Caregivers also expressed a desire that there would be better knowledge of Dravet syndrome in emergency departments and schools, that care would be better integrated and that there would be more supports for assessment and interventions regarding the associated neurodevelopmental problems. CONCLUSION The responses of caregivers of children with Dravet syndrome highlight the need for supports from diagnosis for both epilepsy and neurodevelopmental problems. Good examples of provision were identified but parents often felt they lacked support and support often came from providers who lacked knowledge of the syndrome. Collaboration between medical, disability and school services was often lacking.
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Affiliation(s)
- Josefin Soto Jansson
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden; Member of the ERN EpiCARE, 413 45 Gothenburg, Sweden
| | - Björn Bjurulf
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden; Member of the ERN EpiCARE, 413 45 Gothenburg, Sweden; Dept. of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michaela Dellenmark Blom
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden; Member of the ERN EpiCARE, 413 45 Gothenburg, Sweden; Dept. of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tove Hallböök
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden; Member of the ERN EpiCARE, 413 45 Gothenburg, Sweden; Dept. of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Colin Reilly
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden; Member of the ERN EpiCARE, 413 45 Gothenburg, Sweden; Dept. of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Chemaly N, Kuchenbuch M, Teng T, Marie E, D'Onofrio G, Lo Barco T, Brambilla I, Flege S, Hallet A, Nabbout R. A European pilot study in Dravet Syndrome to delineate what really matters for the patients and families. Epilepsia Open 2024; 9:388-396. [PMID: 34747137 PMCID: PMC10839355 DOI: 10.1002/epi4.12557] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/26/2021] [Accepted: 10/31/2021] [Indexed: 11/09/2022] Open
Abstract
We aimed to identify caregivers' opinions on the outcome measures that matter in clinical trials in individuals with Dravet syndrome (DS). We conducted a prospective European multicenter study based on an 11 closed questions survey developed by the French reference center for rare epilepsies and DS patients' advocacy groups. Items included questions on seizures and daily life outcomes that a clinical trial on a therapy for individuals with DS should target. Statistical analyses were performed to evaluate the impact of the country of residence and of the patients' age. The survey was answered by 153 caregivers (68%: France, 28%: Germany, and 24%: Italy) off individuals with DS. Individuals with DS included 86 males (mean age of 11.4 [interquartile: 7-20.4] years). Families ranked as important almost all the items proposed. However, items related to daily life had the highest rank in all three countries compared to items about seizures (P = 0.02). Increase in individuals' age was associated with a higher age at diagnosis (ρ = 0.26, P = 0.02), and a lower impact of seizure duration (ρ = -0.25, P = 0.005) and on the need of hospital referral (ρ = -0.26, P = 0.005). These data can help tailor patient-centered outcome measures in future clinical and real-life trials for DS.
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Affiliation(s)
- Nicole Chemaly
- Department of Pediatric NeurologyReference Centre for Rare EpilepsiesHôpital Necker‐Enfants MaladesAPHPMember of ERN EpiCAREParisFrance
- Laboratory of Translational Research for Neurological DisordersINSERM MR1163Imagine InstituteParisFrance
- Université de ParisParisFrance
| | - Mathieu Kuchenbuch
- Department of Pediatric NeurologyReference Centre for Rare EpilepsiesHôpital Necker‐Enfants MaladesAPHPMember of ERN EpiCAREParisFrance
- Laboratory of Translational Research for Neurological DisordersINSERM MR1163Imagine InstituteParisFrance
| | - Théo Teng
- Department of Pediatric NeurologyReference Centre for Rare EpilepsiesHôpital Necker‐Enfants MaladesAPHPMember of ERN EpiCAREParisFrance
| | | | - Gianluca D'Onofrio
- Department of Pediatric NeurologyReference Centre for Rare EpilepsiesHôpital Necker‐Enfants MaladesAPHPMember of ERN EpiCAREParisFrance
- Department of Women and Child HealthUniversity of PaduaPaduaItaly
| | - Tommaso Lo Barco
- Department of Pediatric NeurologyReference Centre for Rare EpilepsiesHôpital Necker‐Enfants MaladesAPHPMember of ERN EpiCAREParisFrance
- Child NeuropsychiatryDepartment of Surgical SciencesDentistry, Gynecology and PediatricsUniversity of VeronaVeronaItaly
| | | | | | | | - Rima Nabbout
- Department of Pediatric NeurologyReference Centre for Rare EpilepsiesHôpital Necker‐Enfants MaladesAPHPMember of ERN EpiCAREParisFrance
- Laboratory of Translational Research for Neurological DisordersINSERM MR1163Imagine InstituteParisFrance
- Université de ParisParisFrance
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Strzelczyk A, Lagae L, Wilmshurst JM, Brunklaus A, Striano P, Rosenow F, Schubert‐Bast S. Dravet syndrome: A systematic literature review of the illness burden. Epilepsia Open 2023; 8:1256-1270. [PMID: 37750463 PMCID: PMC10690674 DOI: 10.1002/epi4.12832] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023] Open
Abstract
We performed a systematic literature review and narrative synthesis according to a pre-registered protocol (Prospero: CRD42022376561) to identify the evidence associated with the burden of illness in Dravet syndrome (DS), a developmental and epileptic encephalopathy characterized by drug-resistant epilepsy with neurocognitive and neurobehavioral impairment. We searched MEDLINE, Embase, and APA PsychInfo, Cochrane's database of systematic reviews, and Epistemonikos from inception to June 2022. Non-interventional studies reporting on epidemiology (incidence, prevalence, and mortality), patient and caregiver health-related quality of life (HRQoL), direct and indirect costs and healthcare resource utilization were eligible. Two reviewers independently carried out the screening. Pre-specified data were extracted and a narrative synthesis was conducted. Overall, 49 studies met the inclusion criteria. The incidence varied from 1:15 400-1:40 900, and the prevalence varied from 1.5 per 100 000 to 6.5 per 100 000. Mortality was reported in 3.7%-20.8% of DS patients, most commonly due to sudden unexpected death in epilepsy and status epilepticus. Patient HRQoL, assessed by caregivers, was lower than in non-DS epilepsy patients; mean scores (0 [worst] to 100/1 [best]) were 62.1 for the Kiddy KINDL/Kid-KINDL, 46.5-54.7 for the PedsQL and 0.42 for the EQ-5D-5L. Caregivers, especially mothers, were severely affected, with impacts on their time, energy, sleep, career, and finances, while siblings were also affected. Symptoms of depression were reported in 47%-70% of caregivers. Mean total direct costs were high across all studies, ranging from $11 048 to $77 914 per patient per year (PPPY), with inpatient admissions being a key cost driver across most studies. Mean costs related to lost productivity were only reported in three publications, ranging from approximately $19 000 to $20 000 PPPY ($17 596 for mothers vs $1564 for fathers). High seizure burden was associated with higher resource utilization, costs and poorer HRQoL. The burden of DS on patients, caregivers, the healthcare system, and society is profound, reflecting the severe nature of the syndrome. Future studies will be able to assess the impact that newly approved therapies have on reducing the burden of DS.
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Affiliation(s)
- Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine‐Main, Center of Neurology and NeurosurgeryGoethe‐University and University Hospital FrankfurtFrankfurt am MainGermany
- LOEWE Center for Personalized and Translational Epilepsy Research (CePTER)Goethe‐University FrankfurtFrankfurt am MainGermany
| | - Lieven Lagae
- Department of Development and RegenerationUniversity Hospitals KU LeuvenLeuvenBelgium
| | - Jo M Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - Andreas Brunklaus
- Paediatric Neurosciences Research GroupRoyal Hospital for ChildrenGlasgowUK
- School of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Pasquale Striano
- IRCCS ‘G. Gaslini’ InstituteGenovaItaly
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child HealthUniversity of GenoaGenovaItaly
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine‐Main, Center of Neurology and NeurosurgeryGoethe‐University and University Hospital FrankfurtFrankfurt am MainGermany
- LOEWE Center for Personalized and Translational Epilepsy Research (CePTER)Goethe‐University FrankfurtFrankfurt am MainGermany
| | - Susanne Schubert‐Bast
- Epilepsy Center Frankfurt Rhine‐Main, Center of Neurology and NeurosurgeryGoethe‐University and University Hospital FrankfurtFrankfurt am MainGermany
- LOEWE Center for Personalized and Translational Epilepsy Research (CePTER)Goethe‐University FrankfurtFrankfurt am MainGermany
- Department of NeuropediatricsGoethe‐University and University Hospital FrankfurtFrankfurt am MainGermany
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Pinsent A, Weston G, Adams EJ, Linley W, Hawkins N, Schwenkglenks M, Hamlyn-Williams C, Toward T. Determining the Relationship Between Seizure-Free Days and Other Predictors of Quality of Life in Patients with Dravet Syndrome and Their Carers from FFA Registration Studies. Neurol Ther 2023; 12:1593-1606. [PMID: 37328668 PMCID: PMC10444918 DOI: 10.1007/s40120-023-00510-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/30/2023] [Indexed: 06/18/2023] Open
Abstract
INTRODUCTION Dravet syndrome (DS) is a rare, lifelong epileptic encephalopathy characterised by frequent and severe seizures associated with premature mortality. Typically diagnosed in infancy, patients also experience progressive behavioural, motor-function and cognitive decline. Twenty percent of patients do not reach adulthood. Quality of life (QoL) is impaired for both patients and their carers. Reducing convulsive seizure frequency, increasing convulsive seizure-free days (SFDs) and improving patient/carer QoL are primary treatment goals in DS. This study explored the relationship between SFDs and patients' and carers' QoL to inform a cost-utility analysis of fenfluramine (FFA). METHODS In FFA registration studies, patients (or their carer proxies) completed the Paediatric QoL inventory (PedsQL). These data were mapped to EuroQol-5 Dimensions Youth version (EQ-5D-Y) to provide patient utilities. Carer utilities were collected using EQ-5D-5L and mapped to EQ-5D-3L to align patient and carer QoL on the same scale. Linear mixed-effects and panel regression models were tested and Hausman tests identified the most appropriate approach for each group. On this basis, a linear mixed-effects regression model was used to examine the relationships between patient EQ-5D-Y and clinically relevant variables (age, frequency of SFDs per 28 days, motor impairments and treatment dose). A linear panel regression model examined the relationship between SFDs and carer QoL. RESULTS After adjustment for age and underlying comorbidities, the patient regression model showed that SFDs per 28 days was a significant predictor of QoL. Each additional patient-SFD increased utility by 0.005 (p < 0.001). The carer linear panel model also showed that increasing SFDs per 28 days was a significant predictor of improved QoL. Each additional SFD increased carer utility by 0.014 (p < 0.001). CONCLUSION This regression framework highlights that SFDs are significantly correlated with both patients' and carers' QoL. Treatment with effective antiseizure medications that increase SFDs directly improves QoL for patients and their carers.
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Affiliation(s)
- Amy Pinsent
- Aquarius Population Health, Unit 29 Tileyard Studios, London, N7 9AH, UK
| | - Georgie Weston
- Aquarius Population Health, Unit 29 Tileyard Studios, London, N7 9AH, UK
| | - Elisabeth J Adams
- Aquarius Population Health, Unit 29 Tileyard Studios, London, N7 9AH, UK.
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Ciucă A, Banka S, Newman WG, Moldovan R, Kirkham JJ. Assessment highlights need for improvement in standards of development of core outcome sets for rare genetic diseases. J Clin Epidemiol 2023; 161:84-93. [PMID: 37423316 DOI: 10.1016/j.jclinepi.2023.07.002] [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: 04/11/2023] [Revised: 06/15/2023] [Accepted: 07/02/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVES A rare disease is classified as such if it affects less than one person in 2,000. The Core Outcome Set STandards for Development (COS-STAD) is a set of standards that represent the minimum recommendations to be considered in the process of core outcome set (COS) development. The aim of this study was to provide a baseline assessment of COS development standards for rare genetic diseases. STUDY DESIGN AND SETTING Core Outcome Measures in Effectiveness Trials (COMET) database contains nearly 400 published COS studies according to the latest systematic review. Studies focusing on COS development for rare genetic diseases were eligible for inclusion and were assessed by two independent evaluators. RESULTS Nine COS studies were included in the analysis. Eight different rare genetic diseases were investigated. None of the studies met all the standards for development. The number of standards met ranged from 6 to 10, and the median was 7. CONCLUSION This study is the first study to assess COS-STAD for rare genetic diseases, and it highlights a great need for improvement. First in terms of numbers of rare diseases considered for COS developments, second in methodology, particularly regarding the consensus process, and third in reporting of the COS development studies.
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Affiliation(s)
- Andrada Ciucă
- Department of Psychology, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Siddharth Banka
- Manchester Centre for Genomic Medicine, St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Evolution, Infection and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester, UK
| | - William G Newman
- Manchester Centre for Genomic Medicine, St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Evolution, Infection and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Ramona Moldovan
- Department of Psychology, Babeș-Bolyai University, Cluj-Napoca, Romania; Manchester Centre for Genomic Medicine, St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Evolution, Infection and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Jamie J Kirkham
- Centre for Biostatistics, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
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Domaradzki J, Walkowiak D. Caring for Children with Dravet Syndrome: Exploring the Daily Challenges of Family Caregivers. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1410. [PMID: 37628409 PMCID: PMC10453293 DOI: 10.3390/children10081410] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023]
Abstract
While Polish studies focus on the symptoms, causes and treatment of people suffering from Dravet syndrome (DS), much less is known about the situation of the family caregivers of DS children. This study was designed to explore the experiences, daily challenges and needs related to caring for DS children. An anonymous self-administered online questionnaire was developed. The survey was completed by 75 family caregivers affiliated with the Association for People with Severe Refractory Epilepsy DRAVET.PL on Facebook. Most caregivers felt burdened by their children's reduced mobility (57.3%), mood swings (57.3%), lack of access to rehabilitation and medicine (56%) and healthcare expenses (50.7%). Caregivers also complained of a lack of time to themselves (76%) and work restrictions resulting from caregiving (72%). They consequently reported experiencing fatigue (84%), a deterioration of mental health (60%) and intimacy problems with their spouse/partner (53.4%). An important source of strain was a prolonged diagnostic odyssey and the constant struggle over the healthcare services for DS children. Since DS caregivers' problems and needs are often overlooked, they may be described as the forgotten people in DS. Healthcare professionals should be educated about the challenges related to caring for DS child, psycho-social status and coping resources of DS caregivers, and should focus on identification, monitoring and supporting caregivers' physical and mental well-being and needs.
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Affiliation(s)
- Jan Domaradzki
- Department of Social Sciences and Humanities, Poznan University of Medical Sciences, 60-806 Poznań, Poland
| | - Dariusz Walkowiak
- Department of Organization and Management in Health Care, Poznan University of Medical Sciences, 60-356 Poznań, Poland;
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Sullivan KR, Ruggiero SM, Xian J, Thalwitzer KM, Ali R, Stewart S, Cosico M, Steinberg J, Goss J, Pfalzer AC, Horning KJ, Weitzel N, Corey S, Conway L, Rigby CS, Bichell TJ, Helbig I. A disease concept model for STXBP1-related disorders. Epilepsia Open 2023; 8:320-333. [PMID: 36625631 PMCID: PMC10235567 DOI: 10.1002/epi4.12688] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/31/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE STXBP1-related disorders are rare genetic epilepsies and neurodevelopmental disorders, but the impact of symptoms across clinical domains is poorly understood. Disease concept models are formal frameworks to assess the lived experience of individuals and their families and provide a basis for generating outcome measures. METHODS We conducted semistructured, qualitative interviews with 19 caregivers of 16 individuals with STXBP1-related disorders and 7 healthcare professionals. We systematically coded themes using NVivo software and grouped concepts into the domains of symptoms, symptom impact, and caregiver impact. We quantified the frequency of concepts throughout the lifespan and across clinical subgroups stratified by seizure history and developmental trajectories. RESULTS Over 25 hours of interviews, we coded a total of 3626 references to 38 distinct concepts. In addition to well-recognized clinical features such as developmental delay (n = 240 references), behavior (n = 201), and seizures (n = 147), we identified previously underrepresented symptoms including gastrointestinal (n = 68) and respiratory symptoms (n = 24) and pain (n = 30). The most frequently referenced symptom impacts were autonomy (n = 96), socialization (n = 64), and schooling (n = 61). Emotional impact (n = 354), support (n = 200), and daily life & activities (n = 108) were highly cited caregiver impacts. We found that seizures were more commonly referenced in infancy than in other age groups, while behavior and socialization were more likely to be referred to in childhood. We found that caregivers of individuals with ongoing seizures were less likely to reference developmental delay, possibly due to the relatively high impact of seizures. SIGNIFICANCE STXBP1-related disorders are complex conditions affecting a wide range of clinical and social domains. We comprehensively mapped symptoms and their impact on families to generate a comprehensive disease model as a foundation for clinical endpoints in future trials.
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Affiliation(s)
- Katie R. Sullivan
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- The Epilepsy NeuroGenetics Initiative (ENGIN)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Sarah M. Ruggiero
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- The Epilepsy NeuroGenetics Initiative (ENGIN)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Julie Xian
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- The Epilepsy NeuroGenetics Initiative (ENGIN)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of Biomedical and Health Informatics (DBHi)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Kim M. Thalwitzer
- The Epilepsy NeuroGenetics Initiative (ENGIN)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of Biomedical and Health Informatics (DBHi)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Rahma Ali
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- The Epilepsy NeuroGenetics Initiative (ENGIN)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Sydni Stewart
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- The Epilepsy NeuroGenetics Initiative (ENGIN)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Mahgenn Cosico
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- The Epilepsy NeuroGenetics Initiative (ENGIN)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of Biomedical and Health Informatics (DBHi)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | | | - James Goss
- STXBP1 Foundation, ApexHolly SpringsNorth CarolinaUSA
| | | | - Kyle J. Horning
- Vanderbilt UniversityNashvilleTennesseeUSA
- COMBINEDBrainBrentwoodTennesseeUSA
| | | | | | - Laura Conway
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Terry Jo Bichell
- Vanderbilt UniversityNashvilleTennesseeUSA
- COMBINEDBrainBrentwoodTennesseeUSA
| | - Ingo Helbig
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- The Epilepsy NeuroGenetics Initiative (ENGIN)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of Biomedical and Health Informatics (DBHi)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of NeurologyUniversity of Pennsylvania, Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
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Domaradzki J, Walkowiak D. Emotional experiences of family caregivers of children with Dravet syndrome. Epilepsy Behav 2023; 142:109193. [DOI: https:/doi.org/10.1016/j.yebeh.2023.109193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
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Marshall J, Skrobanski H, Moore-Ramdin L, Kornalska K, Swinburn P, Bowditch S. Caregivers' Perspectives on the Impact of Cannabidiol (CBD) Treatment for Dravet and Lennox-Gastaut Syndromes: A Multinational Qualitative Study. J Child Neurol 2023; 38:394-406. [PMID: 37455396 PMCID: PMC10467005 DOI: 10.1177/08830738231185241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 05/03/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To increase understanding of the impact of cannabidiol (CBD) on outcomes beyond seizure control among individuals with Dravet syndrome or Lennox-Gastaut syndrome. METHODS Qualitative interviews were conducted with caregivers of individuals with Dravet syndrome or Lennox-Gastaut syndrome treated with plant-derived, highly purified CBD medicine (Epidiolex in the USA; Epidyolex in Europe; 100 mg/mL oral solution). Symptoms and impacts of Dravet syndrome and Lennox-Gastaut syndrome on individuals were explored, as were the effects of CBD. Data were analyzed using thematic analysis. RESULTS Twenty-one caregivers of individuals with Dravet syndrome (n = 14) and Lennox-Gastaut syndrome (n = 7) aged 4-22 years participated. Health-related quality of life improvements associated with CBD included cognitive function, communication, behavior, mobility, and participation in daily activities. Seizure frequency reduction was commonly reported (n = 12), resulting in caregivers having greater freedom and family life being less disrupted. Adverse events were reported by 10 caregivers. CONCLUSION In addition to reduced seizure frequency, CBD may have a wide range of beneficial effects beyond seizure control that warrant further investigation.
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Domaradzki J, Walkowiak D. Emotional experiences of family caregivers of children with Dravet syndrome. Epilepsy Behav 2023; 142:109193. [PMID: 37028149 DOI: 10.1016/j.yebeh.2023.109193] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Since the psychosocial implications of Dravet syndrome (DS) are much more serious and far-reaching than in other types of epilepsy, caring for a DS child seriously affects the entire family. This study describes the emotional experiences of family caregivers of DS children and evaluates the way caregiving affects their perceived quality of life. METHODS An anonymous, self-administered online questionnaire was sent to family caregivers of DS children through the online patient advocacy organization the Association for People with Severe Refractory Epilepsy DRAVET.PL. It focussed on the psychosocial impact of caregiving for DS children, the perceived burden of caregiving, caregivers' emotional experiences and feelings related to caregiving, and the impact of DS on the perceived quality of life. RESULTS Caregivers stressed that caring for a DS child is associated with a significant psychosocial and emotional burden that affects the entire family. Although most caregivers reported that it was the child's health problems and behavioral and psychological disorders that were the most challenging aspects of caregiving, they were also burdened by the lack of emotional support. As caregivers were profoundly engaged in caregiving, they experienced a variety of distressing emotions, including feelings of helplessness, anxiety and fear, anticipated grief, depression, and impulsivity. Many caregivers also reported that their children's disease disrupted their relationships with their spouses, family, and healthy children. As caregivers reported experiencing role overload, physical fatigue, and mental exhaustion, they stressed the extent to which caregiving for DS children impaired their quality of life, their social and professional life, and was a source of financial burden. CONCLUSIONS As this study identified specific burden domains affecting DS caregivers' well-being family carers often need special attention, support, and help. To alleviate the humanistic burden of DS carers a bio-psychosocial approach focusing on physical, mental, and psychosocial interventions should include both DS children and their caregivers.
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Affiliation(s)
- Jan Domaradzki
- Department of Social Sciences and Humanities, Poznan University of Medical Sciences, Poznań, Poland.
| | - Dariusz Walkowiak
- Department of Organization and Management in Health Care, Poznan University of Medical Sciences, Poznań, Poland
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Ruggiero SM, Xian J, Helbig I. The current landscape of epilepsy genetics: where are we, and where are we going? Curr Opin Neurol 2023; 36:86-94. [PMID: 36762645 PMCID: PMC10088099 DOI: 10.1097/wco.0000000000001141] [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] [Indexed: 02/11/2023]
Abstract
PURPOSE OF REVIEW In this review, we aim to analyse the progress in understanding the genetic basis of the epilepsies, as well as ongoing efforts to define the increasingly diverse and novel presentations, phenotypes and divergences from the expected that have continually characterized the field. RECENT FINDINGS A genetic workup is now considered to be standard of care for individuals with an unexplained epilepsy, due to mounting evidence that genetic diagnoses significantly influence treatment choices, prognostication, community support, and increasingly, access to clinical trials. As more individuals with epilepsy are tested, novel presentations of known epilepsy genes are being discovered, and more individuals with self-limited epilepsy are able to attain genetic diagnoses. In addition, new genes causative of epilepsy are being uncovered through both traditional and novel methods, including large international data-sharing collaborations and massive sequencing efforts as well as computational methods and analyses driven by the Human Phenotype Ontology (HPO). SUMMARY New approaches to gene discovery and characterization are advancing rapidly our understanding of the genetic and phenotypic architecture of the epilepsies. This review highlights relevant and groundbreaking studies published recently that have pushed forward the field of epilepsy genetics.
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Affiliation(s)
- Sarah M Ruggiero
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA, 19146, USA
| | - Julie Xian
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA, 19146, USA
| | - Ingo Helbig
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA, 19146, USA
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
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Patient profile, management, and quality of life associated with Dravet syndrome: a cross-sectional, multicentre study of 80 patients in Spain. Sci Rep 2023; 13:3355. [PMID: 36849632 PMCID: PMC9971205 DOI: 10.1038/s41598-023-30273-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 02/20/2023] [Indexed: 03/01/2023] Open
Abstract
The aim of this study was to describe the profile of patients diagnosed with Dravet syndrome (DS), their clinical management, and the impact of DS on their quality of life (QoL) and family. Data of 80 patients from 11 centres in Spain was collected. Patients (47.5% female) were 12.7 (9.6) years on average (SD, standard deviation). Despite the first episode occurred when patients were a mean (SD) of 0.4 (0.2) years, DS was not diagnosed until they were 6.9 (10.1) years old. The majority (86.7%) had SCN1A gene mutations and 73.4% had seizures during the last year (mostly generalized motor seizures [47.8%]). The mean (SD) number of status epilepticus episodes was 3.6 (8.0) since diagnosis and 0.1 (0.5) in the last year. On the Health Utilities Index Mark (HUI) multi-attribute scale, the mean global score (SD) was 0.56 (0.24) in HUI2 and 0.32 (0.37) in HUI3. The impact of the disease was severe in most patients (HUI2, 81%; HUI3, 83.5%). In the Care-related QoL (CarerQol) the mean (SD) well-being score was 7.2 (2.1). Most caregivers (90%) were satisfied with their caregiving tasks, although 75% had difficulties combining these tasks with daily activities, 68.8% reported mental health problems and 61.2% physical problems.
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Lei R, Shen Q, Yang B, Hou T, Liu H, Luo X, Li Y, Zhang J, Norris SL, Chen Y. Core Outcome Sets in Child Health: A Systematic Review. JAMA Pediatr 2022; 176:1131-1141. [PMID: 36094597 DOI: 10.1001/jamapediatrics.2022.3181] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Developing core outcome sets is essential to ensure that results of clinical trials are comparable and useful. A number of core outcome sets in pediatrics have been published, but a comprehensive in-depth understanding of core outcome sets in this field is lacking. OBJECTIVE To systematically identify core outcome sets in child health, collate the diseases to which core outcome sets have been applied, describe the methods used for development and stakeholder participation, and evaluate the methodological quality of existing core outcome sets. EVIDENCE REVIEW MEDLINE, SCOPUS, Cochrane Library, and CINAHL were searched using relevant search terms, such as clinical trials, core outcome, and children, along with relevant websites, such as Core Outcome Measures in Effectiveness Trials (COMET). Four researchers worked in teams of 2, performed literature screening and data extraction, and evaluated the methodological quality of core outcome sets using the Core Outcome Set-Standards for Development (COS-STAD). FINDINGS A total of 77 pediatric core outcome sets were identified, mainly developed by organizations or researchers in Europe, North America, and Australia and mostly from the UK (22 [29%]) and the US (22 [29%]). A total of 77 conditions were addressed; the most frequent International Classification of Diseases, 11th Revision category was diseases of the digestive system (14 [18%]). Most of the outcomes in pediatric core outcome sets were unordered (34 [44%]) or presented in custom classifications (29 [38%]). Core outcome sets used 1 or more of 8 development methods; the most frequent combination of methods was systematic review/literature review/scoping review, together with the Delphi approach and consensus for decision-making (10 [14%]). Among the 6 main types of stakeholders, clinical experts were the most frequently involved (74 [100%]), while industry representatives were rarely involved (4 [5%]). Only 6 core outcome sets (8%) met the 12 criteria of COS-STAD. CONCLUSIONS AND RELEVANCE Future quality of pediatric core outcome sets should be improved based on the standards proposed by the COMET initiative, while core outcome sets methodology and reporting standards should be extended to pediatric populations to help improve the quality of core outcome sets in child health. In addition, the COMET outcome taxonomy should also add items applicable to children.
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Affiliation(s)
- Ruobing Lei
- Chevidence Lab of Child and Adolescent Health, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Quan Shen
- Chevidence Lab of Child and Adolescent Health, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Bo Yang
- Shapingba District Center for Disease Control and Prevention of Chongqing, Chongqing, China
| | - Tianchun Hou
- Chevidence Lab of Child and Adolescent Health, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hui Liu
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Xufei Luo
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Yuehuan Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Junhua Zhang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | | | - Yaolong Chen
- Chevidence Lab of Child and Adolescent Health, Children's Hospital of Chongqing Medical University, Chongqing, China.,Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China
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Harbottle V, Arnott B, Gale C, Rowen E, Kolehmainen N. Identifying common health indicators from paediatric core outcome sets: a systematic review with narrative synthesis using the WHO International Classification of Functioning, Health and Disability. BMJ Paediatr Open 2022; 6:e001537. [PMID: 36645779 PMCID: PMC9621176 DOI: 10.1136/bmjpo-2022-001537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/19/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Indicators of child health have the potential to inform societal conversations, decision-making and prioritisation. Paediatric core outcome sets are an increasingly common way of identifying a minimum set of outcomes for trials within clinical groups. Exploring commonality across existing sets may give insight into universally important and inclusive child health indicators. METHODS A search of the Core Outcome Measures in Effectiveness Trial register from 2008 to 2022 was carried out. Eligible articles were those reporting on core outcome sets focused on children and young people aged 0-18 years old. The International Classification of Functioning, Disability and Health (ICF) was used as a framework to categorise extracted outcomes. Information about the involvement of children, young people and their families in the development of sets was also extracted. RESULTS 206 articles were identified, of which 36 were included. 441 unique outcomes were extracted, mapping to 22 outcome clusters present across multiple sets. Medical diagnostic outcomes were the biggest cluster, followed by pain, communication and social interaction, mobility, self-care and school. Children and young people's views were under-represented across core outcome sets, with only 36% of reviewed studies including them at any stage of development. CONCLUSIONS Existing paediatric core outcome sets show overlap in key outcomes, suggesting the potential for generic child health measurement frameworks. It is unclear whether existing sets best reflect health dimensions important to children and young people, and there is a need for better child and young person involvement in health indicator development to address this.
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Affiliation(s)
- Victoria Harbottle
- Rehabilitation Department, Great North Children's Hospital, Newcastle Upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Bronia Arnott
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Chris Gale
- Academic Neonatal Medicine, Imperial College London, London, UK
| | - Elizabeth Rowen
- Rehabilitation Department, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Niina Kolehmainen
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Aledo-Serrano Á, Mingorance A, Villanueva V, García-Peñas JJ, Gil-Nagel A, Boronat S, Aibar J, Cámara S, Yániz MJ, Aras LM, Blanco B, Sánchez-Carpintero R. The Charlotte Project: Recommendations for patient-reported outcomes and clinical parameters in Dravet syndrome through a qualitative and Delphi consensus study. Front Neurol 2022; 13:975034. [PMID: 36119672 PMCID: PMC9481303 DOI: 10.3389/fneur.2022.975034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/15/2022] [Indexed: 11/17/2022] Open
Abstract
Objective The appropriate management of patients with Dravet Syndrome (DS) is challenging, given the severity of symptoms and the burden of the disease for patients and caregivers. This study aimed to identify, through a qualitative methodology and a Delphi consensus-driven process, a set of recommendations for the management of DS to guide clinicians in the assessment of the clinical condition and quality of life (QoL) of DS patients, with a special focus on patient- and caregiver-reported outcomes (PROs). Methods This study was conducted in five phases, led by a multidisciplinary scientific committee (SC) including pediatric neurologists, epileptologists, a neuropsychologist, an epilepsy nurse, and members of DS patient advocates. In phases 1 and 2, a questionnaire related to patients' QoL was prepared and answered by caregivers and the SC. In phase 3, the SC generated, based on these answers and on a focus group discussion, a 70-item Delphi questionnaire, covering six topic categories on a nine-point Likert scale. In phase 4, 32 panelists, from different Spanish institutions and with a multidisciplinary background, answered the questionnaire. Consensus was obtained and defined as strong or moderate if ≥80% and 67–79% of panelists, respectively, rated the statement with ≥7. Phase 5 consisted of the preparation of the manuscript. Results The panelists agreed on a total of 69 items (98.6%), 54 (77.14%), and 15 (21.43%) with strong and moderate consensus, respectively. The experts' recommendations included the need for frequent assessment of patient and caregivers QoL parameters. The experts agreed that QoL should be assessed through specific questionnaires covering different domains. Likewise, the results showed consensus regarding the regular evaluation of several clinical parameters related to neurodevelopment, attention, behavior, other comorbidities, and sudden unexpected death in epilepsy (SUDEP). A consensus was also reached on the instruments, specific parameters, and caregivers' education in the routine clinical management of patients with DS. Conclusions This consensus resulted in a set of recommendations for the assessment of clinical and QoL parameters, including PROs, related to the general evaluation of QoL, neurodevelopment, attention, behavior, other comorbidities affecting QoL, SUDEP, and QoL of caregivers/relatives and patients with DS.
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Affiliation(s)
- Ángel Aledo-Serrano
- Epilepsy Program, Neurology Department, Ruber Internacional Hospital, Madrid, Spain
- *Correspondence: Ángel Aledo-Serrano
| | - Ana Mingorance
- Dracaena Consulting SL, Loulou Foundation, London, United Kingdom
| | | | | | - Antonio Gil-Nagel
- Epilepsy Program, Neurology Department, Ruber Internacional Hospital, Madrid, Spain
| | | | | | - Silvia Cámara
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Bjurulf B, Reilly C, Hallböök T. Caregiver reported seizure precipitants and measures to prevent seizures in children with Dravet syndrome. Seizure 2022; 103:3-10. [DOI: 10.1016/j.seizure.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/19/2022] [Accepted: 09/25/2022] [Indexed: 11/26/2022] Open
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22
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Quirke F, Ariff S, Battin M, Bernard C, Bloomfield FH, Daly M, Devane D, Haas DM, Healy P, Hurley T, Kibet V, Kirkham JJ, Koskei S, Meher S, Molloy E, Niaz M, Ní Bhraonáin E, Okaronon CO, Tabassum F, Walker K, Biesty L. Core outcomes in neonatal encephalopathy: a qualitative study with parents. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001550. [PMID: 36053648 PMCID: PMC9328095 DOI: 10.1136/bmjpo-2022-001550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/07/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify the outcomes considered important to parents or caregivers of infants diagnosed with neonatal encephalopathy, hypoxic ischaemic encephalopathy or birth asphyxia in high-income and low- to middle-income countries (LMiCs), as part of the outcome-identification process in developing a core outcome set (COS) for the treatment of neonatal encephalopathy. DESIGN A qualitative study involving 25 semistructured interviews with parents or other family members (caregivers) of infants who were diagnosed with, and treated for, neonatal encephalopathy, hypoxic ischaemic encephalopathy or birth asphyxia. SETTING Interviews were conducted in high-income countries (HiCs) (n=11) by Zoom video conferencing software and in LMiCs (n=14) by phone or face to face. FINDINGS Parents identified 54 outcomes overall, which mapped to 16 outcome domains. The domains identified were neurological outcomes, respiratory outcomes, gastrointestinal outcomes, cardiovascular outcomes, motor development, cognitive development, development (psychosocial), development (special senses), cognitive development, development (speech and social), other organ outcomes, survival/living outcomes, long-term disability, hospitalisation, parent-reported outcomes and adverse events. CONCLUSIONS This study provides insight into the outcomes that parents of infants diagnosed with neonatal encephalopathy have identified as the most important, to be considered in the process of developing a COS for the treatment of neonatal encephalopathy. We also provide description of the processes employed to ensure the inclusion of participants from LMiCs as well as HiCs.
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Affiliation(s)
- Fiona Quirke
- Health Research Board - Neonatal Encephalopathy PhD Training Network (NEPTuNE), Trinity College Dublin, Dublin, Ireland .,Health Research Board-Trials Methodology Research Network (HRB-TMRN), Galway, Ireland.,School of Nursing & Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Shabina Ariff
- Department of Pediatrics & Child Health, The Aga Khan University, Karachi, Pakistan
| | | | - Caitlin Bernard
- Department of Obstetrics and Gynecology, Indiana University, Bloomington, Indiana, USA
| | | | - Mandy Daly
- Advocacy and Policymaking Irish Neonatal Health Alliance, Wicklow, Ireland
| | - Declan Devane
- Health Research Board - Neonatal Encephalopathy PhD Training Network (NEPTuNE), Trinity College Dublin, Dublin, Ireland.,Health Research Board-Trials Methodology Research Network (HRB-TMRN), Galway, Ireland.,School of Nursing & Midwifery, National University of Ireland Galway, Galway, Ireland.,Evidence Synthesis Ireland, National University of Ireland Galway, Galway, Ireland.,Cochrane Ireland, National Univeristy of Ireland Galway, Galway, Ireland
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University, Bloomington, Indiana, USA
| | - Patricia Healy
- School of Nursing & Midwifery, National University of Ireland Galway, Galway, Ireland.,Evidence Synthesis Ireland, National University of Ireland Galway, Galway, Ireland
| | - Tim Hurley
- Health Research Board - Neonatal Encephalopathy PhD Training Network (NEPTuNE), Trinity College Dublin, Dublin, Ireland.,Department of Paediatric and Child Health, Tallaght University Hospital (TUH), Dublin, Ireland
| | | | - Jamie J Kirkham
- Centre for Biostatistics, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | | | - Eleanor Molloy
- Health Research Board - Neonatal Encephalopathy PhD Training Network (NEPTuNE), Trinity College Dublin, Dublin, Ireland.,Paediatrics, Trinity College Dublin, Dublin, Ireland.,Paediatrics, Tallaght Hospital, Dublin, Ireland
| | - Maira Niaz
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | | | - Karen Walker
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Linda Biesty
- School of Nursing & Midwifery, National University of Ireland Galway, Galway, Ireland.,Evidence Synthesis Ireland, National University of Ireland Galway, Galway, Ireland.,Qualitative Research in Trials Centre (QUESTS), National University of Ireland Galway, Galway, Ireland
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23
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Strzelczyk A, Kurlemann G, Bast T, Bettendorf U, Kluger G, Mayer T, Neubauer BA, Polster T, von Spiczak S, Trollmann R, Wolff M, Toward T, Gruenert J, Gibson E, Pritchard C, Carroll J, Rosenow F, Schubert-Bast S. Exploring the relationships between composite scores of disease severity, seizure-freedom and quality of life in Dravet syndrome. Neurol Res Pract 2022; 4:22. [PMID: 35659154 PMCID: PMC9169336 DOI: 10.1186/s42466-022-00186-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/02/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In Dravet syndrome (DS), a rare epileptic and developmental encephalopathy, the effectiveness of a new treatment is predominantly measured in terms of seizure frequency. However, this may not fully capture the impact of a treatment on the broader aspects of the syndrome and patients' health-related quality of life (HRQoL). Using a previously published survey which collected data from DS patients and their carers on the broader manifestations of their syndrome, their HRQoL, and their experience of seizures, this study created composite measures of symptom severity to offer new perspectives on the multifaceted aspects of this rare condition. METHODS Survey responses on the severity of physical and psychosocial symptoms were combined with independent assessments of disability and care need, to generate three composite symptom scores assessing the manifestations of DS (physical, psychosocial and care requirements). Variation in HRQoL was investigated in multiple regression analyses to assess the strength of association between each of these composite measures and three forms of seizure measures (seizure frequency, days with no seizures and longest interval without seizures), as experienced over a 4- and 12-week period. RESULTS Composite scores were calculated for a cohort of 75 primarily paediatric patients who were enrolled in the study. Strong associations were found between each of the three composite symptom scores and each of the three seizure measures, with the regression coefficient on symptom score highly significant (p ≤ 0.001) in all nine comparisons. Separate regressions using predictors of HRQoL (Kiddy KINDL and Kid KINDL) as the dependent variable were inconclusive, identifying only behavioural/attention problems and status epilepticus as significant predictors of HRQoL. CONCLUSIONS These results allow the development of a composite score that may be useful in developing a clinical understanding of the severity of DS for an individual patient and establishing their treatment goals. Where measurement of long-term sequalae of disease is not feasible, such as clinical trials, correlation of the composite score with experience of seizures and seizure-free periods may allow a better contextualisation of the results of short-term assessments. TRIAL REGISTRATION German Clinical Trials Register (DRKS), DRKS00011894. Registered 16 March 2017, http://www.drks.de/ DRKS00011894.
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Affiliation(s)
- Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University Frankfurt, Schleusenweg 2-16 (Haus 95), 60528, Frankfurt am Main, Germany.
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany.
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany.
| | - Gerhard Kurlemann
- Department of Neuropediatrics, University of Münster, Münster, Germany
| | - Thomas Bast
- Epilepsy Center Kork, Kehl-Kork, Germany
- Faculty of Medicine, University of Freiburg, Freiburg i. Br., Germany
| | | | - Gerhard Kluger
- Epilepsy Center for Children and Adolescents, Clinic for Neuropediatrics and Neurorehabilitation, Schön Klinik Vogtareuth, Vogtareuth, Germany
- Research Institute "Rehabilitation, Transition, and Palliation", PMU Salzburg, Salzburg, Austria
| | - Thomas Mayer
- Epilepsy Center Kleinwachau, Radeberg, Dresden, Germany
| | - Bernd A Neubauer
- Department of Neuropediatrics, Justus-Liebig-University Giessen, Giessen, Germany
| | | | - Sarah von Spiczak
- Northern German Epilepsy Center for Children and Adolescents, Raisdorf, Kiel, Germany
| | - Regina Trollmann
- Department of Neuropediatrics, Friedrich-Alexander University, Erlangen, Germany
| | - Markus Wolff
- Department of Pediatric Neurology, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Toby Toward
- Zogenix International Limited, Maidenhead, United Kingdom
| | - Jens Gruenert
- Zogenix International Limited, Maidenhead, United Kingdom
| | | | | | | | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University Frankfurt, Schleusenweg 2-16 (Haus 95), 60528, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University Frankfurt, Schleusenweg 2-16 (Haus 95), 60528, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
- Department of Neuropediatrics, Goethe-University Frankfurt, Frankfurt am Main, Germany
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24
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The clinical, economic, and humanistic burden of Dravet syndrome - A systematic literature review. Epilepsy Behav 2022; 130:108661. [PMID: 35334258 DOI: 10.1016/j.yebeh.2022.108661] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/22/2022] [Accepted: 03/03/2022] [Indexed: 11/22/2022]
Abstract
Dravet syndrome (DS) is a developmental and epileptic encephalopathy with evolving disease course as individuals age. In recent years, the treatment landscape of DS has changed considerably, and a comprehensive systematic review of the contemporary literature is lacking. Here we synthesized published evidence on the occurrence of clinical impacts by age, the economic and humanistic (health-related quality-of-life [HRQoL]) burden, and health state utility. We provide an evidence-based, contemporary visualization of the clinical manifestations, highlighting that DS is not limited to seizures; non-seizure manifestations appear early in life and increase over time, contributing significantly to the economic and humanistic burden of disease. The primary drivers of HRQoL in DS include seizure severity, cognition, and motor and behavioral problems; in turn, these directly affect caregivers through the extent of assistance required and consequent impact on activities of daily living. Unsurprisingly, costs are driven by seizure-related events, hospitalizations, and in-home medical care visits. This systematic review highlights a paucity of longitudinal data; most studies meeting inclusion criteria were cross-sectional or had short follow-up. Nonetheless, available data illustrate the substantial impact on individuals, their families, and healthcare systems and establish the need for novel therapies to address the complex spectrum of DS manifestations.
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25
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Schoonjans AS, Roosens L, Dewals W, Paelinck BP, Ceulemans B. Therapeutic drug monitoring of fenfluramine in clinical practice: Pharmacokinetic variability and impact of concomitant antiseizure medications. Epilepsia 2022; 63:686-696. [PMID: 35032026 DOI: 10.1111/epi.17162] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/23/2021] [Accepted: 12/23/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study was undertaken to determine the plasma concentration and pharmacokinetic variability of fenfluramine (FFA) and its main active metabolite norfenfluramine (norFFA) in relation to the prevalence of adverse effects in patients with refractory epilepsy treated with FFA. In addition, the interaction with concomitant antiseizure medications including stiripentol (STP) is studied. METHODS Patients were recruited at our center from two open-label sources, an investigator-initiated observational study and an international multicenter extension study. Venous blood samples were collected between June 2015 and December 2020. Plasma FFA and norFFA concentrations were determined by liquid chromatography tandem spectrometric analysis. Clinical data were collected retrospectively. Intrapatient coefficient of variation was calculated for all patients with at least three samples. Interpatient variability was calculated based on the concentration to weight-adjusted dose ratio (C/D) of all patients. RESULTS We collected 321 samples from 61 patients (49 with Dravet syndrome, seven with Lennox-Gastaut syndrome, and five with a developmental and epileptic encephalopathy). With a mean daily dose of .33 mg/kg/day (SD = ±.16), the median FFA plasma concentration was 41.4 µg/L (range = 5.1-712.5) and median norFFA concentration 28.1 µg/L (range = 2.6-149.6). The FFA plasma concentration was linearly related to the daily dose (p < .001) and norFFA levels (p < .001). The C/D of FFA increased with age (p < .001). Median FFA C/D was 428% higher (p < .001), norFFA C/D 83% lower (p < .001), and norFFA/FFA 23% lower (p < .001) in patients treated with STP comedication. Higher FFA concentration was associated with fatigue (p = .001) and somnolence (p < .001), but not anorexia (p = .0619) or reduction in seizure frequency (p = .772). Gender and other ASMs were not associated with significant variations in (nor)FFA C/D ratio. SIGNIFICANCE Most FFA levels are in the lower range (<50 µg/L), although a high interpatient and intrapatient variability is present. In combination with STP, the dose of FFA should be reduced.
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Affiliation(s)
- An-Sofie Schoonjans
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium.,University of Antwerp, Antwerp, Belgium
| | - Laurence Roosens
- University of Antwerp, Antwerp, Belgium.,Laboratory for TDM and Toxicology, Antwerp University Hospital, Edegem, Belgium
| | - Wendy Dewals
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | | | - Berten Ceulemans
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium.,University of Antwerp, Antwerp, Belgium
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26
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Kersting C, Hülsmann J, Weckbecker K, Mortsiefer A. Patients' perspective on supposedly patient-relevant process and outcome parameters: a cross-sectional survey within the 'PRO patients study'. BMC Health Serv Res 2022; 22:72. [PMID: 35031052 PMCID: PMC8759763 DOI: 10.1186/s12913-021-07437-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To be able to make informed choices based on their individual preferences, patients need to be adequately informed about treatment options and their potential outcomes. This implies that studies measure the effects of care based on parameters that are relevant to patients. In a previous scoping review, we found a wide variety of supposedly patient-relevant parameters that equally addressed processes and outcomes of care. We were unable to identify a consistent understanding of patient relevance and therefore aimed to develop an empirically based concept including a generic set of patient-relevant parameters. As a first step we evaluated the process and outcome parameters identified in the scoping review from the patients' perspective. METHODS We conducted a cross-sectional survey among German general practice patients. Ten research practices of Witten/Herdecke University supported the study. During a two-week period in the fall of 2020, patients willing to participate self-administered a short questionnaire. It evaluated the relevance of the 32 parameters identified in the scoping review on a 5-point Likert scale and offered a free-text field for additional parameters. These free-text answers were inductively categorized by two researchers. Quantitative data were analyzed using descriptive statistics. Bivariate analyses were performed to determine whether there are any correlations between rating a parameter as highly relevant and patients' characteristics. RESULTS Data from 299 patients were eligible for analysis. All outcomes except 'sexuality' and 'frequency of healthcare service utilization' were rated important. 'Confidence in therapy' was rated most important, followed by 'prevention of comorbidity' and 'mobility'. Relevance ratings of five parameters were associated with patients' age and gender, but not with their chronic status. The free-text analysis revealed 15 additional parameters, 12 of which addressed processes of care, i.e., 'enough time in physician consultation'. CONCLUSION Patients attach great value to parameters addressing processes of care. It appears as though the way in which patients experience the care process is not less relevant than what comes of it. Relevance ratings were not associated with chronic status, but few parameters were gender- and age-related. TRIAL REGISTRATION Core Outcome Measures in Effectiveness Trials Initiative, registration number: 1685.
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Affiliation(s)
- Christine Kersting
- Chair of General Practice II and Patient-Centeredness in Primary Care, Institute of General Practice and Primary Care, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany.
| | - Julia Hülsmann
- Chair of General Practice I and Interprofessional Care, Institute of General Practice and Primary Care, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany
| | - Klaus Weckbecker
- Chair of General Practice I and Interprofessional Care, Institute of General Practice and Primary Care, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany
| | - Achim Mortsiefer
- Chair of General Practice II and Patient-Centeredness in Primary Care, Institute of General Practice and Primary Care, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany
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27
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Bar C, Breuillard D, Kuchenbuch M, Jennesson M, Le Guyader G, Isnard H, Rolland A, Doummar D, Fluss J, Afenjar A, Berquin P, De Saint Martin A, Dupont S, Goldenberg A, Lederer D, Lesca G, Maurey H, Meyer P, Mignot C, Nica A, Odent S, Poisson A, Scalais E, Sekhara T, Vrielynck P, Barcia G, Nabbout R. Adaptive behavior and psychiatric comorbidities in KCNB1 encephalopathy. Epilepsy Behav 2022; 126:108471. [PMID: 34915430 DOI: 10.1016/j.yebeh.2021.108471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 12/13/2022]
Abstract
AIM KCNB1 encephalopathy encompasses a broad phenotypic spectrum associating intellectual disability, behavioral disturbances, and epilepsies of various severity. Using standardized parental questionnaires, we aimed to capture the heterogeneity of the adaptive and behavioral features in a series of patients with KCNB1 pathogenic variants. METHODS We included 25 patients with a KCNB1 encephalopathy, aged from 3.2 to 34.1 years (median = 10 years). Adaptive functioning was assessed in all patients using the French version of the Vineland Adaptive Behavior Scales, Second Edition (VABS-II) questionnaire. We screened global behavior with the Childhood Behavioral Check-List (CBCL, Achenbach) and autism spectrum disorder (ASD) with the Social Communication Questionnaire (SCQ). We used a cluster analysis to identify subgroups of adaptive profiles. RESULTS VABS-II questionnaire showed pathological adaptive behavior in all participants with a severity of adaptive deficiency ranging from mild in 8/20 to severe in 7/20. Eight out of 16 were at risk of Attention Problems at the CBCL and 13/18 were at risk of autism spectrum disorder (ASD). The adaptive behavior composite score significantly decreased with age (Spearman's Rho=-0.72, p<0.001) but not the equivalent ages, suggesting stagnation and slowing but no regression over time. The clustering analysis identified two subgroups of patients, one showing more severe adaptive behavior. The severity of the epilepsy phenotype predicted the severity of the behavioral profile with a sensitivity of 70% and a specificity of 90.9%. CONCLUSION This study confirms the deleterious consequences of early-onset epilepsy in addition to the impact of the gene dysfunction in patients with KCNB1 encephalopathy. ASD and attention disorders are frequent. Parental questionnaires should be considered as useful tools for early screening and care adaptation.
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Affiliation(s)
- Claire Bar
- APHP, Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, member of ERN EPICARE, Université de Paris, Paris, France; Laboratory of Translational Research for Neurological Disorders, INSERM UMR 1163, Imagine Institute, Université de Paris, Paris, France
| | - Delphine Breuillard
- APHP, Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, member of ERN EPICARE, Université de Paris, Paris, France; Laboratory of Translational Research for Neurological Disorders, INSERM UMR 1163, Imagine Institute, Université de Paris, Paris, France
| | - Mathieu Kuchenbuch
- APHP, Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, member of ERN EPICARE, Université de Paris, Paris, France; Laboratory of Translational Research for Neurological Disorders, INSERM UMR 1163, Imagine Institute, Université de Paris, Paris, France
| | | | - Gwenaël Le Guyader
- Department of Genetics, CHU de Poitiers, BP 577, 86021 Poitiers Cedex, France; EA3808 - NEUVACOD Unité neurovasculaire et troubles cognitifs, Université de Poitiers, Pôle Biologie Santé, France
| | - Hervé Isnard
- Pediatric Neurologist, Medical Office 28 rue de la république, Lyon 69002, France
| | - Anne Rolland
- Department of Pediatrics, CHU de NANTES, Nantes, France
| | - Diane Doummar
- Department of Pediatric Neurology, AP-HP, Hôpital Armand Trousseau, Sorbonne Université, Paris, France
| | - Joel Fluss
- Pediatric Neurology Unit, Geneva Children's Hospital, 6 rue Willy-Donzé, 1211 Genève 4, Switzerland
| | - Alexandra Afenjar
- Sorbonne Universités, Centre de Référence Malformations et maladies congénitales du cervelet et déficiences intellectuelles de causes rares, département de génétique et embryologie médicale, Hôpital Trousseau, AP-HP, Paris, France
| | - Patrick Berquin
- Department of Pediatric Neurology, CHU Amiens-Picardie, Université de Picardie Jules Verne, Amiens France Pediatric Neurology Unit, France
| | - Anne De Saint Martin
- Department of Pediatric Neurology, Strasbourg University Hospital, Strasbourg, Hôpital de Hautepierre, Strasbourg, France
| | - Sophie Dupont
- Epileptology Unit and Rehabilitation Unit AP-HP, GH Pitie-Salpêtrière-Charles Foix, F-75013 Paris, France; Sorbonne University, UPMC Univ. Paris 06, F-75005 Paris, France
| | - Alice Goldenberg
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs, CHU Rouen, Rouen, France
| | | | - Gaétan Lesca
- Department of Genetics, Hospices Civils de Lyon, 69002 Lyon, France; Institut NeuroMyoGène, CNRS UMR 5310 - INSERM U1217, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Hélène Maurey
- Department of Pediatric Neurology, AP-HP, Hôpital Universitaire Bicêtre, Kremlin Bicêtre, France
| | - Pierre Meyer
- Department of Pediatric Neurology, CHU Montpellier, Montpellier, France; PhyMedExp, U1046 INSERM, UMR9214 CNRS, Université de Montpellier, Montpellier, France
| | - Cyril Mignot
- INSERM, U 1127, CNRS UMR 7225, Sorbonne Université, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France; APHP, Sorbonne Université, Groupe Hospitalier Pitié-Salpêtrière, Department of Genetics, Centre de Reference Déficience Intellectuelle de Causes Rares
| | - Anca Nica
- Neurology Department, Center for Clinical Research (CIC 1414), Rennes University Hospital, France; Laboratory Of Signal Processing (LTSI), UMR 1099 INSERM, Rennes F-35000, France
| | - Sylvie Odent
- Service de Génétique clinique, Reference Ccentre for Rare Developmental Abnormalities CLAD-Ouest, member of ERN ITHACA, CHU Rennes, France; CNRS UMR 6290 Institut de Génétique et Développement de Rennes IGDR, Univ Rennes, Rennes, France
| | - Alice Poisson
- GénoPsy, Reference Center for Diagnosis and Management of Genetic Psychiatric Disorders, Centre Hospitalier le Vinatier and EDR-Psy Team (Centre National de la Recherche Scientifique & Lyon 1 Claude Bernard University), France
| | - Emmanuel Scalais
- Pediatric Neurology Unit, Centre Hospitalier de Luxembourg, Luxembourg
| | - Tayeb Sekhara
- Department of Pediatric Neurology, C.H.I.R.E.C, Brussels, Belgium
| | - Pascal Vrielynck
- William Lennox Neurological Hospital, Reference Center for Refractory Epilepsy UCLouvain, Ottignies, Belgium
| | - Giulia Barcia
- Laboratory of Translational Research for Neurological Disorders, INSERM UMR 1163, Imagine Institute, Université de Paris, Paris, France; APHP, Department of Clinical Genetics, Necker-Enfants Malades Hospital, Paris, France
| | - Rima Nabbout
- APHP, Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, member of ERN EPICARE, Université de Paris, Paris, France; Laboratory of Translational Research for Neurological Disorders, INSERM UMR 1163, Imagine Institute, Université de Paris, Paris, France.
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28
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Rheims S. Autonomic dysfunction in developmental and epileptic encephalopathies: a daily-life issue. Dev Med Child Neurol 2021; 63:1367. [PMID: 34379809 DOI: 10.1111/dmcn.15014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and University of Lyon, Lyon, France
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29
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Lo SH, Lloyd A, Marshall J, Vyas K. Patient and Caregiver Health State Utilities in Lennox-Gastaut Syndrome and Dravet Syndrome. Clin Ther 2021; 43:1861-1876.e16. [PMID: 34774333 DOI: 10.1016/j.clinthera.2021.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 09/02/2021] [Accepted: 09/24/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Lennox-Gastaut syndrome (LGS) and Dravet syndrome (DS) are rare, treatment-resistant forms of epilepsy characterized by childhood onset of seizures. Cost-effectiveness analysis for new antiseizure medications typically requires health state utilities (HSUs) that reflect the patient and caregiver burden of the relevant conditions. This study aimed to estimate HSUs for LGS and DS. Focus was placed on valuing the impact of seizure frequency and seizure-free days on health-related quality of life (HRQL) for patients and caregivers. METHODS Health state vignettes that described the experience of living with and caring for a child with LGS or DS were developed based on a targeted literature review and feedback from interviews with LGS and DS clinical experts and DS caregivers. Vignettes varied by the number of seizures and seizure-free days per month. Twenty-four vignettes were developed that described patient HRQL (6 per condition) and caregiver HRQL (6 per condition) for LGS or DS. Vignettes were evaluated via interviews from the general population in the United Kingdom and Sweden using a visual analog scale and time trade-off (TTO) method. Participants were recruited by interviewers based in different regions of the United Kingdom and Sweden using convenience sampling. FINDINGS Two hundred interviews were conducted by video call from March to April 2020. One hundred participants evaluated each of the 6 patient and 6 caregiver vignettes for LGS; a different 100 participants evaluated each of the DS vignettes. The estimated utility values vary consistently according to seizure frequency and number of seizure-free days. Patient TTO utility values range from -0.186 (highest seizure frequency and fewest seizure-free days) to 0.754 (seizure-free state) for LGS and from 0.171 to 0.778 for DS. The caregiver TTO utility values range from 0.032 to 0.810 and 0.510 to 0.881 for LGS and DS, respectively. Fewer seizures and additional seizure-free days are associated with better patient and caregiver HRQL. IMPLICATIONS This study estimated utility values for patients with LGS or DS and their caregivers using visual analog scale and TTO valuation among a general public sample. These utility values can be used in cost-effectiveness assessments of new antiseizure medications. The findings indicate the importance of seizure-free days as well as seizure frequency in patient and caregiver HRQL, which may inform the design of future clinical trials.
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Affiliation(s)
- Siu Hing Lo
- Acaster Lloyd Consulting Ltd, London, United Kingdom.
| | - Andrew Lloyd
- Acaster Lloyd Consulting Ltd, London, United Kingdom
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Gallop K, Lloyd AJ, Olt J, Marshall J. Impact of developmental and epileptic encephalopathies on caregivers: A literature review. Epilepsy Behav 2021; 124:108324. [PMID: 34607217 DOI: 10.1016/j.yebeh.2021.108324] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Developmental and epileptic encephalopathies (DEEs) are rare neurodevelopmental disorders characterized by early-onset seizures and numerous comorbidities. Due to the complex requirements for the care of a child with a DEE, these disorders would be expected to impact health-related quality of life (HRQL) for caregivers as well as for patients. The objective of this literature review was to describe the impact of DEEs on the HRQL, emotional wellbeing, and usual activities (social, work, relationships, etc.) of caregivers, including the wider impact on other family members such as siblings. METHODS A literature search was conducted in May 2020 using MEDLINE® and Embase® databases. Quantitative and qualitative studies were identified using search terms related to family, disease type (including >20 specific DEEs), and quality of life/methodology. Each study was assessed for relevance and was graded using customized critical appraisal criteria. Findings from studies that were given the highest quality ratings were summarized and used to develop a conceptual model to illustrate the complex impact of DEEs on caregiver HRQL. RESULTS Sixty-seven relevant studies were identified, of which 39 (27 quantitative, 12 qualitative) met the highest appraisal criteria. The studies recruited caregivers of patients with one of eight individual DEEs, or pediatric intractable or refractory epilepsy. Most studies reported negative impacts on HRQL and emotional wellbeing in caregivers. The wide-ranging impact of a DEE was highlighted by reports of negative effects on caregivers' physical health, daily activities, relationships, social activities, leisure time, work, and productivity. Factors that influenced the perceived impact included demographic characteristics (e.g., child's age, living arrangements, family income) and clinical factors (e.g., feeding or sleep difficulties, disease severity). Few studies evaluated the impact on siblings. CONCLUSIONS There is evidence that DEEs can impact HRQL and emotional wellbeing and can limit usual activities for the primary caregiver and their wider family. However, no research was identified regarding many individual DEEs, and only limited research assessed the impact on different family members with most studies focusing on mothers. Further research is required to understand the influence of certain factors such as the age of the patient, disease severity, and seizures on caregiver burden. Furthermore, the review highlighted the lack of appropriate measurement tools to assess caregiver HRQL in this population.
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Affiliation(s)
- Katy Gallop
- Acaster Lloyd Consulting Ltd, Lacon House, 84 Theobald's Road, London WC1X 8NL, United Kingdom.
| | - Andrew J Lloyd
- Acaster Lloyd Consulting Ltd, Lacon House, 84 Theobald's Road, London WC1X 8NL, United Kingdom
| | - Jennifer Olt
- Acaster Lloyd Consulting Ltd, Lacon House, 84 Theobald's Road, London WC1X 8NL, United Kingdom
| | - Jade Marshall
- GW Pharma Ltd, 1 Cavendish Place, London W1G 0QF, United Kingdom
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Juandó-Prats C, James E, Bilder DA, McNair L, Kenneally N, Helfer J, Huang N, Vila MC, Sullivan J, Wirrell E, Rico S. DRAVET ENGAGE. Parent caregivers of children with Dravet syndrome: Perspectives, needs, and opportunities for clinical research. Epilepsy Behav 2021; 122:108198. [PMID: 34284219 DOI: 10.1016/j.yebeh.2021.108198] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 11/15/2022]
Abstract
Dravet syndrome (DS) is an intractable developmental and epileptic encephalopathy significantly impacting affected children and their families. A novel, one-time, adeno-associated virus (AAV)-mediated gene regulation therapy was designed to treat the underlying cause of DS, potentially improving the full spectrum of DS manifestations. To ensure the first-in-human clinical trial addresses meaningful outcomes for patients and families, we examined their perspectives, priorities, goals, and desired outcomes in the design phase through a mixed methods approach (quantitative and qualitative). We conducted a non-identifiable parent caregiver survey, shared through a patient advocacy organization (n = 36 parents; children age ≤6 years). Parents were also engaged via three group discussions (n = 10; children age 2-20 years) and optional follow-up in-depth individual interviews (n = 6). Qualitative data analysis followed an inductive interpretive process, and qualitative researchers conducted a thematic analysis with a narrative approach. Survey results revealed most children (94%) were diagnosed by age 1, with onset of seizures at mean age 6.2 months and other DS manifestations before 2 years. The most desired disease aspects to address with potential new disease-modifying therapies were severe seizures (ranked by 92% of caregivers) and communication issues (development, expressive, receptive; 72-83%). Qualitative results showed the need for trial outcomes that recognize the impact of DS on the whole family. Parents eventually hope for trials including children of all ages and were both excited about the potential positive impact of a one-time disease-modifying therapy and mindful of potential long-term implications. Participants reflected on the details and risks of a clinical trial design (e.g., sham procedures) and described the different factors that relate to their decision to participate in a trial. Their main aspirations were to stop neurodevelopmental stagnation, to reduce seizures, and to reduce the impact on their families' wellbeing. To our knowledge, this is the first study within a patient-oriented research framework that specifically explored parents' needs and perceptions regarding clinical trials of a potential disease-modifying therapy for children with a severe, developmental disease, such as DS.
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Affiliation(s)
- Clara Juandó-Prats
- Dalla Lana School of Public Health, University of Toronto, ON, Canada; Applied Health Research Center, St. Michael's Hospital, Unity Health Toronto, ON, Canada.
| | - Emma James
- Encoded Therapeutics, Inc., South San Francisco, CA, USA
| | | | | | - Noah Kenneally
- Humane Services and Early Learning, MacEwan University, Edmonton, AB, Canada
| | | | - Norman Huang
- Encoded Therapeutics, Inc., South San Francisco, CA, USA
| | | | - Joseph Sullivan
- University of California, San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | - Elaine Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Salvador Rico
- Encoded Therapeutics, Inc., South San Francisco, CA, USA
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Dravet syndrome: Effects on informal caregivers' mental health and quality of life - A systematic review. Epilepsy Behav 2021; 122:108206. [PMID: 34280725 DOI: 10.1016/j.yebeh.2021.108206] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/27/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Dravet syndrome (DS) is a severe developmental and epileptic encephalopathy, with predictable negative consequences for informal caregivers' mental health. This systematic review aimed to evaluate the representativeness of depression, anxiety, and burden in these caregivers and assess their quality of life. METHODS The PRISMA recommendations were followed, and a comprehensive search was conducted on PubMed/MEDLINE, WoS and Scopus databases, without date or language limits. Only observational quantitative studies on adult informal caregivers of patients with DS were considered. RESULTS Of 876 records found, 21 full-text articles were assessed and only 6 met the inclusion criteria. The latter have mostly a cross-sectional design and include samples composed by 19 to 742 caregivers, mainly mothers/females. Most of the study participants had a Bachelor's degree/higher educational level and were married. An important incidence of depression and anxiety on DS caregivers was reported, with significantly higher levels compared with population norms and with carers of other patients with epilepsy. Depression/anxiety were shown to be significantly associated with caregivers' fatigue and compromised sleep quality. Other important aspects of burden have been identified; however, comparisons between studies were not possible as different scales were used. Caregivers' health-related quality of life is also affected, with mothers reporting a worse perception on this domain. CONCLUSIONS Mental health and quality of life of DS caregivers are compromised, with mothers bearing an apparently greater burden. Studies using validated instruments for this population to assess the previously considered outcomes are needed, in order to inform the development of preventive strategies and problem-oriented interventions.
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Raising the bar: Fenfluramine sets new treatment standards for Dravet syndrome. Epilepsy Behav 2021; 121:108061. [PMID: 34058492 DOI: 10.1016/j.yebeh.2021.108061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/10/2021] [Accepted: 05/10/2021] [Indexed: 12/19/2022]
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Brock DC, Demarest S, Benke TA. Clinical Trial Design for Disease-Modifying Therapies for Genetic Epilepsies. Neurotherapeutics 2021; 18:1445-1457. [PMID: 34595733 PMCID: PMC8609073 DOI: 10.1007/s13311-021-01123-5] [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] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 02/04/2023] Open
Abstract
Although trials with anti-seizure medications (ASMs) have not shown clear anti-epileptogenic or disease-modifying activity in humans to date, rapid advancements in genomic technology and emerging gene-mediated and gene replacement options offer hope for the successful development of disease-modifying therapies (DMTs) for genetic epilepsies. In fact, more than 26 potential DMTs are in various stages of preclinical and/or clinical development for genetic syndromes associated with epilepsy. The scope of disease-modification includes but is not limited to effects on the underlying pathophysiology, the condition's natural history, epilepsy severity, developmental achievement, function, behavior, sleep, and quality of life. While conventional regulatory clinical trials for epilepsy therapeutics have historically focused on seizure reduction, similarly designed trials may prove ill-equipped to identify these broader disease-modifying benefits. As we look forward to this pipeline of DMTs, focused consideration should be given to the challenges they pose to conventional clinical trial designs for epilepsy therapeutics. Just as DMTs promise to fundamentally alter how we approach the care of patients with genetic epilepsy syndromes, DMTs likewise challenge how we traditionally construct and measure the success of clinical trials. In the following, we briefly review the historical and preclinical frameworks for DMT development for genetic epilepsies and explore the many novel challenges posed for such trials, including the choice of suitable outcome measures, trial structure, timing and duration of treatment, feasible follow-up period, varying safety profile, and ethical concerns.
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Affiliation(s)
- Dylan C Brock
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045, USA.
- Children's Hospital Colorado, Aurora, CO, 80045, USA.
| | - Scott Demarest
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045, USA
- Children's Hospital Colorado, Aurora, CO, 80045, USA
| | - Tim A Benke
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045, USA
- Departments of Neurology, Pharmacology, and Otolaryngology, University of Colorado School of Medicine, CO, 80045, Aurora, USA
- Children's Hospital Colorado, Aurora, CO, 80045, USA
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Nabbout R, Chemaly N, Chiron C, Kuchenbuch M. Safety considerations selecting antiseizure medications for the treatment of individuals with Dravet syndrome. Expert Opin Drug Saf 2021; 20:561-576. [PMID: 33645379 DOI: 10.1080/14740338.2021.1890025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Management of individuals with Dravet Syndrome has evolved significantly over the past 10 years. Progress has been made in understanding the pathophysiology, the long-term outcome and possible consequences of inappropriate therapies, new drugs have been approved by the regulatory authorities and patients and families expressed their needs beyond seizures' control.Areas covered: The authors aimed at providing an overview of the main antiseizure medications used in Dravet syndrome with a particular focus on safety considerations. As the highly active phase of seizures takes place before the age of 5 years, the characteristics of antiseizure medications in infancy and childhood have also been considered due to their impact on antiseizure medication safety.Expert opinion: Recent treatments, evaluated via randomized clinical trials, are promising in terms of efficacy and safety in individuals with DS. However, the balance between expected benefits and risks taken must be accurately assessed on an individual basis. There is a lack of data to understand the needs of patients and families, a major point particularly in this population, where the evaluation of efficacy and safety beyond seizures is difficult due to cognitive delay and behavioral disorders and where this evaluation is coming almost exclusively from caregivers.
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Affiliation(s)
- Rima Nabbout
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker Enfants Malades University Hospital, Université De Paris, Paris, France.,Institut National De La Santé Et De La Recherche Médicale (INSERM), UMR 1163, Institut Imagine, Université De Paris, Paris, France
| | - N Chemaly
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker Enfants Malades University Hospital, Université De Paris, Paris, France.,Institut National De La Santé Et De La Recherche Médicale (INSERM), UMR 1163, Institut Imagine, Université De Paris, Paris, France
| | - C Chiron
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker Enfants Malades University Hospital, Université De Paris, Paris, France.,INSERM U1141, Paris, France & Neurospin, CEA, Gif/Yvette, France
| | - M Kuchenbuch
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker Enfants Malades University Hospital, Université De Paris, Paris, France.,Institut National De La Santé Et De La Recherche Médicale (INSERM), UMR 1163, Institut Imagine, Université De Paris, Paris, France
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Schoonjans AS, Ceulemans B. A critical evaluation of fenfluramine hydrochloride for the treatment of Dravet syndrome. Expert Rev Neurother 2021; 22:351-364. [PMID: 33455486 DOI: 10.1080/14737175.2021.1877540] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Dravet Syndrome (DS) is a severe developmental and epileptic encephalopathy. Fenfluramine recently demonstrated to be a highly efficacious and safe treatment option for DS patients. Fenfluramine has been recently approved by the FDA and EMA and is marketed as Fintepla®.Areas covered: DS and the need for additional anticonvulsive treatment options is discussed. The results of three placebo-controlled phase III studies (1 with and 2 without stiripentol) and 2 open label (extension) studies are reviewed. All studies demonstrate a consistent and impressive seizure reduction, confirming the results of two smaller investigator-initiated trials. The mechanism of action of fenfluramine is discussed. Finally, the place of fenfluramine in the future treatment of DS is outlined.Expert opinion: Fenfluramine has a potent anticonvulsive effect in DS. Although not yet fully elucidated, the anticonvulsive mechanism of fenfluramine seems to be mainly serotonergic. Fenfluramine is generally well tolerated. A dose reduction is necessary in combination with stiripentol. Considering new competitors, efficacy seems lower for cannabidiol and is comparable with stiripentol. Preclinical studies indicate a disease specific action and possible disease modification in DS. The latter would support the use of fenfluramine above its anticonvulsive effect and needs to be further elaborated.
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Affiliation(s)
- An-Sofie Schoonjans
- Department of Pediatrics and Pediatric Neurology, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Berten Ceulemans
- Department of Pediatrics and Pediatric Neurology, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Lee A, Davies A, Young AE. Systematic review of international Delphi surveys for core outcome set development: representation of international patients. BMJ Open 2020; 10:e040223. [PMID: 33234639 PMCID: PMC7684826 DOI: 10.1136/bmjopen-2020-040223] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/20/2020] [Accepted: 10/06/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES A core outcome set (COS) describes a minimum set of outcomes to be reported by all clinical trials of one healthcare condition. Delphi surveys are frequently used to achieve consensus on core outcomes. International input is important to achieve global COS uptake. We aimed to investigate participant representation in international Delphi surveys, with reference to the inclusion of patients and participants from low and middle income countries as stakeholders (LMICs). DESIGN Systematic review. DATA SOURCES EMBASE, Medline, Web of Science, COMET database and hand-searching. ELIGIBILITY CRITERIA Protocols and studies describing Delphi surveys used to develop an international COS for trial reporting, published between 1 January 2017 and 6 June 2019. DATA EXTRACTION AND SYNTHESIS Delphi participants were grouped as patients or healthcare professionals (HCPs). Participants were considered international if their country of origin was different to that of the first or senior author. Data extraction included participant numbers, country of origin, country income group and whether Delphi surveys were translated. We analysed the impact these factors had on outcome prioritisation. RESULTS Of 90 included studies, 69% (n=62) were completed and 31% (n=28) were protocols. Studies recruited more HCPs than patients (median 60 (IQR 30-113) vs 30 (IQR 14-66) participants, respectively). A higher percentage of HCPs was international compared with patients (57% (IQR 37-78) vs 20% (IQR 0-68)). Only 31% (n=28) studies recruited participants from LMICs. Regarding recruitment from LMICs, patients were under-represented (16% studies; n=8) compared with HCPs (22%; n=28). Few (7%; n=6) studies translated Delphi surveys. Only 3% studies (n=3) analysed Delphi responses by geographical location; all found differences in outcome prioritisation. CONCLUSIONS There is a disproportionately lower inclusion of international patients, compared with HCPs, in COS-development Delphi surveys, particularly within LMICs. Future international Delphi surveys should consider exploring for geographical and income-based differences in outcome prioritisation. PROSPERO REGISTRATION NUMBER CRD42019138519.
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Affiliation(s)
- Alice Lee
- Academic Foundation Doctor, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Anna Davies
- Senior Research Fellow, Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Amber E Young
- Consultant Paediatric Anaesthetist and Lead Children's Burns Research Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Senior Research Fellow, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Boada CM, French JA, Dumanis SB. Proceedings of the 15th Antiepileptic Drug and Device Trials Meeting: State of the Science. Epilepsy Behav 2020; 111:107189. [PMID: 32563052 DOI: 10.1016/j.yebeh.2020.107189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 05/23/2020] [Indexed: 12/11/2022]
Abstract
On May 22-24, 2019, the 15th Antiepileptic Drug and Device (AEDD) Trials Conference was held, which focused on current issues related to AEDD development from preclinical models to clinical prognostication. The conference featured regulatory agencies, academic laboratories, and healthcare companies involved in emerging epilepsy therapies and research. The program included discussions around funding and support for investigations in epilepsy and neurologic research, clinical trial design and integrated outcome measures for people with epilepsy, and drug development and upcoming disease-modifying therapies. Finally, the conference included updates from the preclinical, clinical, and device pipeline. Summaries of the talks are provided in this paper, with the various pipeline therapeutics in the listed tables to be outlined in a subsequent publication.
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Affiliation(s)
- Christina M Boada
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | - Jacqueline A French
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
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Carrizosa-Moog J, Isaza-Jaramillo S. Perceptions of adult and child neurologists of transition programs in epilepsy in Latin America: A cross-sectional study. Epilepsy Behav 2020; 110:107159. [PMID: 32516745 DOI: 10.1016/j.yebeh.2020.107159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/24/2020] [Accepted: 05/04/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE The objective of this study was to review the existence and opinion Latin American adult and child neurologists have about the development and function of transition programs in epilepsy. METHODS This was a cross-sectional study. A questionnaire was constructed with sociodemographic variables, knowledge about transition programs, barriers for building up transition programs, and 21 topics regarding the degree of involvement of healthcare providers and carers should have during the transition process. The online questionnaire was sent to 136 Latin American chapter officers registered in the International League Against Epilepsy (ILAE) webpage and to 36 clinicians assisting to the 13th Latin American Summer School on Epilepsy. RESULTS The answer rate was 68% (117/172), and all 19 Latin American countries were represented. Adult neurologists represented 60.7%. Only 16.2% knew of transition programs in epilepsy. The main limitations for transition programs were poor education about transition (76.9%), inflexible healthcare systems (75.2%), absence of financial support (61.5%), need of multidisciplinary teams (59%), and scarce communication between child and adult neurologists (53%). Providers and carers are expected to get involved at a high degree in all 21 presented topics for a transition process. The topics with highest percentage of commitment were violence and carrying weapons (93.2%), mental health (92.3%), alcohol and drugs (91.4%), suicide (90.6%), care of own's disease (90.5%), mortality risk (89.7%), and integral healthcare (92.2%). CONCLUSION Only a few transition programs exist in Latin America. Knowing the benefits of and barriers for transition programs opens the opportunity to move further this strategy in the region considering local specificities. Education, communication skills, team working, and advocacy for adolescents with epilepsy could be initial starting points.
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Affiliation(s)
- Jaime Carrizosa-Moog
- Child and Adolescent Neurology Service, Department of Pediatrics, Faculty of Medicine, University of Antioquia, Calle 18 B Sur No. 38 - 51, Medellín, Colombia.
| | - Sandra Isaza-Jaramillo
- Adult Neurology Service, Department of Internal Medicine, Faculty of Medicine, University of Antioquia, Cra. 51d # 62-29, Medellín, Colombia.
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Kersting C, Kneer M, Barzel A. Patient-relevant outcomes: what are we talking about? A scoping review to improve conceptual clarity. BMC Health Serv Res 2020; 20:596. [PMID: 32600321 PMCID: PMC7325243 DOI: 10.1186/s12913-020-05442-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/18/2020] [Indexed: 12/21/2022] Open
Abstract
Background With respect to patient-centered care, measuring care effects based on patient-relevant outcomes is becoming increasingly important. There is some uncertainty about what outcomes are particularly relevant to patients and who determines their relevance. To determine this, we conducted a scoping review of the international literature with the aim to improve the conceptual clarity regarding (1) the terminology used for supposedly patient-relevant outcomes, (2) the variety of outcomes considered patient-relevant, and (3) justifications for the choice of these specific outcomes. Methods We conducted a systematic search in Embase, PubMed (including Medline), Cochrane Central, Scopus, and Google Scholar with a special focus on article titles. Search terms included patient-relevant, patient-important, patient-preferred, and outcome(s), endpoint(s), parameter(s), indicator(s). We limited the search period from January 2000 to July 2019. Full-text articles reporting outcomes that were described as patient-relevant met the inclusion criteria. Two researchers independently analyzed all eligible articles applying quantitative and structuring content analysis. Results We identified 155 articles, 44 of which met the inclusion criteria. A content analysis revealed 35 different terms used with regard to patient-relevant outcomes. However, authors predominantly referred to patient-important outcomes (23 articles, 52.3%) and patient-relevant outcomes (17 articles, 38.6%). A structuring content analysis of all extracted outcomes revealed a total of 281 codes, pooled in 32 inductive categories. Among these, the following categories dominated: symptoms, adverse events/complications, survival/mortality, pain. In just 16 of the articles (36.4%), authors provided justifications for the choice of the outcome being based either on patient and/or expert opinions. In another 13 articles (29.5%), no justification was provided. Conclusion This scoping review on patient-relevant outcomes was driven by the questions (1) what outcomes are particularly relevant to patients, and (2) who determines their relevance. We found a wide range of supposedly patient-relevant outcomes, with only one third of articles involving patients in the justification of the outcome selection. In view of this conceptual uncertainty it appears difficult to determine or even to compare a particular patient benefit of interventions. A set of generic outcomes relevant to patients would be helpful to contribute to a consistent understanding of patient relevance.
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Affiliation(s)
- Christine Kersting
- Institute of General Practice and Interprofessional Care, Faculty of Health/School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany.
| | - Malte Kneer
- Institute of General Practice and Interprofessional Care, Faculty of Health/School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany
| | - Anne Barzel
- Institute of General Practice and Interprofessional Care, Faculty of Health/School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany.,Institute of General Medicine, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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41
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Auvin S, Avbersek A, Bast T, Chiron C, Guerrini R, Kaminski RM, Lagae L, Muglia P, Cross JH. Drug Development for Rare Paediatric Epilepsies: Current State and Future Directions. Drugs 2020; 79:1917-1935. [PMID: 31734883 DOI: 10.1007/s40265-019-01223-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Rare diseases provide a challenge in the evaluation of new therapies. However, orphan drug development is of increasing interest because of the legislation enabling facilitated support by regulatory agencies through scientific advice, and the protection of the molecules with orphan designation. In the landscape of the rare epilepsies, very few syndromes, namely Dravet syndrome, Lennox-Gastaut syndrome and West syndrome, have been subject to orphan drug development. Despite orphan designations for rare epilepsies having dramatically increased in the past 10 years, the number of approved drugs remains limited and restricted to a handful of epilepsy syndromes. In this paper, we describe the current state of orphan drug development for rare epilepsies. We identified a large number of compounds currently under investigation, but mostly in the same rare epilepsy syndromes as in the past. A rationale for further development in rare epilepsies could be based on the match between the drug mechanisms of action and the knowledge of the causative gene mutation or by evidence from animal models. In case of the absence of strong pathophysiological hypotheses, exploratory/basket clinical studies could be helpful to identify a subpopulation that may benefit from the new drug. We provide some suggestions for future improvements in orphan drug development such as promoting paediatric drug investigations, better evaluation of the incidence and the prevalence, together with the natural history data, and the development of new primary outcomes.
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Affiliation(s)
- Stéphane Auvin
- PROTECT, INSERM U1141, Université de Paris, Paris, France. .,Service de Neurologie Pédiatrique, AP-HP, Hôpital Universitaire Robert-Debré, 48, Boulevard Sérurier, 75935, Paris Cedex 19, France.
| | | | - Thomas Bast
- The Kork Epilepsy Center, Kehl-Kork, Germany.,Medical Faculty of the University of Freiburg, Freiburg, Germany
| | - Catherine Chiron
- PROTECT, INSERM U1141, Université de Paris, Paris, France.,Service de Neurologie Pédiatrique, AP-HP, Hôpital Necker-Enfanst Malades, Paris, France
| | - Renzo Guerrini
- Neuroscience Department, Children's Hospital Anna Meyer-University of Florence, Florence, Italy
| | - Rafal M Kaminski
- UCB Pharma, Braine-l'Alleud, Belgium.,Roche Pharma Research and Early Development (pRED), Roche Innovation Center, Basel, Switzerland
| | - Lieven Lagae
- Department Development and Regeneration, Section Paediatric Neurology, University Hospitals, University of Leuven, Leuven, Belgium
| | | | - J Helen Cross
- UCL NIHR BRC Great Ormond Street Institute of Child Health, London, UK
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Krick T, Huter K, Seibert K, Domhoff D, Wolf-Ostermann K. Measuring the effectiveness of digital nursing technologies: development of a comprehensive digital nursing technology outcome framework based on a scoping review. BMC Health Serv Res 2020; 20:243. [PMID: 32209099 PMCID: PMC7092516 DOI: 10.1186/s12913-020-05106-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 03/12/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Digital nursing technologies (DNT) comprise an expanding, highly diverse field of research, explored using a wide variety of methods and tools. Study results are therefore difficult to compare, which raises the question how effectiveness of DNT can be adequately measured. Methods currently used might not be sufficient for certain specific nursing contexts. A comprehensive outcome framework that shows the multitude of possible outcome areas could be useful to generate more comparable results. The aim of the present study is to develop an outcome framework for DNT and to indicate which outcome areas have been most frequently evaluated in previous studies and how this has been done. METHODS We combined an inductive and deductive approach to develop the framework. The numerical analysis is based on a scoping review focussing on the effectiveness of DNT for persons in need of care, formal or informal caregivers or care institutions. Nine databases were included in the screening: Medline, Scopus, CINAHL, Cochrane Library, ACM Digital Library, IEEE Xplore, the Collection of Computer Science Bibliographies, GeroLit and CareLit. Additional literature searches and expert interviews were included. RESULTS The developed framework comprises four outcome target groups and 47 outcome areas. There are considerable differences in the researched outcome areas for the individual outcome target groups. Persons in need of care were by far the most frequently surveyed, particularly with respect to their psychological health. There are much fewer studies on formal and informal caregivers, and it is particularly noticeable that the quality of life of both groups has rarely been investigated. Care process quality was most frequently researched for organisations. CONCLUSION We were able to provide a comprehensive DNT outcome framework, thereby identifying the outcome tools used and the less researched outcome areas. We recommend a detailed investigation of all areas and tools in future research projects with a view to initiating a discussion on the differing importance of existing outcome areas and on a standardisation of outcome tools. We also recommend the development of outcome areas for the macro level of effectiveness assessment.
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Affiliation(s)
- Tobias Krick
- SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 3, 28359, Bremen, Germany.
- High-profile Area of Health Sciences, University of Bremen, 28359, Bremen, Germany.
| | - Kai Huter
- SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 3, 28359, Bremen, Germany
- High-profile Area of Health Sciences, University of Bremen, 28359, Bremen, Germany
| | - Kathrin Seibert
- High-profile Area of Health Sciences, University of Bremen, 28359, Bremen, Germany
- Institute for Public Health and Nursing Research, University of Bremen, Grazer Straße 4, 28359, Bremen, Germany
| | - Dominik Domhoff
- High-profile Area of Health Sciences, University of Bremen, 28359, Bremen, Germany
- Institute for Public Health and Nursing Research, University of Bremen, Grazer Straße 4, 28359, Bremen, Germany
| | - Karin Wolf-Ostermann
- High-profile Area of Health Sciences, University of Bremen, 28359, Bremen, Germany
- Institute for Public Health and Nursing Research, University of Bremen, Grazer Straße 4, 28359, Bremen, Germany
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Scheffer IE, Nabbout R. SCN1A‐related phenotypes: Epilepsy and beyond. Epilepsia 2019; 60 Suppl 3:S17-S24. [DOI: 10.1111/epi.16386] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Ingrid E. Scheffer
- Departments of Medicine and Paediatrics Austin Health and Royal Children’s Hospital Florey and Murdoch Children’s Research Institute The University of Melbourne Melbourne VIC Australia
| | - Rima Nabbout
- Reference Centre for Rare Epilepsies Department of Paediatric Neurology Necker Enfants Malades Hospital Imagine Institute U1163 Paris Descartes University Paris France
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Ricobaraza A, Mora-Jimenez L, Puerta E, Sanchez-Carpintero R, Mingorance A, Artieda J, Nicolas MJ, Besne G, Bunuales M, Gonzalez-Aparicio M, Sola-Sevilla N, Valencia M, Hernandez-Alcoceba R. Epilepsy and neuropsychiatric comorbidities in mice carrying a recurrent Dravet syndrome SCN1A missense mutation. Sci Rep 2019; 9:14172. [PMID: 31578435 PMCID: PMC6775062 DOI: 10.1038/s41598-019-50627-w] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 09/11/2019] [Indexed: 11/30/2022] Open
Abstract
Dravet Syndrome (DS) is an encephalopathy with epilepsy associated with multiple neuropsychiatric comorbidities. In up to 90% of cases, it is caused by functional happloinsufficiency of the SCN1A gene, which encodes the alpha subunit of a voltage-dependent sodium channel (Nav1.1). Preclinical development of new targeted therapies requires accessible animal models which recapitulate the disease at the genetic and clinical levels. Here we describe that a C57BL/6 J knock-in mouse strain carrying a heterozygous, clinically relevant SCN1A mutation (A1783V) presents a full spectrum of DS manifestations. This includes 70% mortality rate during the first 8 weeks of age, reduced threshold for heat-induced seizures (4.7 °C lower compared with control littermates), cognitive impairment, motor disturbances, anxiety, hyperactive behavior and defects in the interaction with the environment. In contrast, sociability was relatively preserved. Electrophysiological studies showed spontaneous interictal epileptiform discharges, which increased in a temperature-dependent manner. Seizures were multifocal, with different origins within and across individuals. They showed intra/inter-hemispheric propagation and often resulted in generalized tonic-clonic seizures. 18F-labelled flourodeoxyglucose positron emission tomography (FDG-PET) revealed a global increase in glucose uptake in the brain of Scn1aWT/A1783V mice. We conclude that the Scn1aWT/A1783V model is a robust research platform for the evaluation of new therapies against DS.
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Affiliation(s)
- Ana Ricobaraza
- University of Navarra, Gene Therapy Program CIMA, IdiSNA, Navarra institute for health research, Pamplona, Spain.
| | - Lucia Mora-Jimenez
- University of Navarra, Gene Therapy Program CIMA, IdiSNA, Navarra institute for health research, Pamplona, Spain
| | - Elena Puerta
- University of Navarra, Department of Pharmacology and Toxicology, IdiSNA, Navarra institute for health research, Pamplona, Spain
| | - Rocio Sanchez-Carpintero
- University Clinic of Navarra, Dravet Syndrome Unit, Pediatric Neurology Unit, IdiSNA, Navarra institute for health research, Pamplona, Spain
| | | | - Julio Artieda
- University of Navarra, Neuroscience Program CIMA, IdiSNA, Navarra institute for health research, Neurophysiology Service, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Maria Jesus Nicolas
- University of Navarra, Neuroscience Program CIMA, IdiSNA, Navarra institute for health research, Pamplona, Spain
| | - Guillermo Besne
- University of Navarra, Neuroscience Program CIMA, IdiSNA, Navarra institute for health research, Pamplona, Spain
| | - Maria Bunuales
- University of Navarra, Gene Therapy Program CIMA, IdiSNA, Navarra institute for health research, Pamplona, Spain
| | - Manuela Gonzalez-Aparicio
- University of Navarra, Gene Therapy Program CIMA, IdiSNA, Navarra institute for health research, Pamplona, Spain
| | - Noemi Sola-Sevilla
- University Clinic of Navarra, Dravet Syndrome Unit, Pediatric Neurology Unit, IdiSNA, Navarra institute for health research, Pamplona, Spain
| | - Miguel Valencia
- University of Navarra, Neuroscience Program CIMA, IdiSNA, Navarra institute for health research, Pamplona, Spain
| | - Ruben Hernandez-Alcoceba
- University of Navarra, Gene Therapy Program CIMA, IdiSNA, Navarra institute for health research, Pamplona, Spain
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Nabbout R, Auvin S, Chiron C, Thiele E, Cross H, Scheffer IE, Schneider AL, Guerrini R, Williamson N, Mistry A, Grimes R, Bennett B. Perception of impact of Dravet syndrome on children and caregivers in multiple countries: looking beyond seizures. Dev Med Child Neurol 2019; 61:1229-1236. [PMID: 30828793 DOI: 10.1111/dmcn.14186] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/26/2018] [Indexed: 11/26/2022]
Abstract
AIM To assess the relevance and generalizability across countries of concepts of the impact of Dravet syndrome beyond seizures, as recognized by families. METHOD Caregivers of children with Dravet syndrome in four countries (Australia [n=8]; USA, UK, and Italy [all n=4]) participated in 1-hour qualitative telephone interviews, identifying key Dravet syndrome concepts. Interviews were recorded, transcribed, and, where necessary, translated into English for thematic analysis. Conceptual saturation was assessed and findings compared to the previously developed French conceptual disease model. RESULTS The most common seizure types reported by caregivers were tonic-clonic, absence, or focal-impaired awareness (localized/partial). Fever and physical activity were the most commonly reported triggers. Patient-relevant impacts included impairment in cognition, motor skills, communication, social skills, and behavioural functioning. Caregivers consistently reported negative social, physical, and family impacts. Concepts identified in the interviews showed similarity with the French conceptual model. Minor differences between countries are likely to reflect variations in health care systems. INTERPRETATION Findings in Italy, Australia, UK, and USA confirm that the key impacts of Dravet syndrome on children and caregivers identified in France are generalizable across countries. Key symptom and impact concepts relevant to children and parents should be targeted as critical outcomes in new therapy evaluations. WHAT THIS PAPER ADDS Relevance of the impact of Dravet syndrome on children and caregivers was confirmed across countries. Patient and caregiver-relevant Dravet syndrome impacts contribute to poorer health-related quality of life. Indirect seizure impacts were reported to be as important as direct impacts. Country-specific differences in concepts probably reflect differences in health care systems.
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Affiliation(s)
- Rima Nabbout
- Reference Centre for Rare Epilepsies, Necker-Enfants Malades, Inserm U1163, Paris, France
| | | | - Catherine Chiron
- Reference Centre for Rare Epilepsies, Necker-Enfants Malades, Inserm U1163, Paris, France
| | - Elizabeth Thiele
- Herscot Center for Tuberous Sclerosis Complex, Massachusetts General Hospital, Boston, MA, USA
| | - Helen Cross
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Ingrid E Scheffer
- Departments of Medicine and Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Florey and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Amy L Schneider
- Departments of Medicine and Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Renzo Guerrini
- The Meyer Children's Hospital, University of Florence, Florence, Italy
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Seizure management and prescription patterns of anticonvulsants in Dravet syndrome: A multicenter cohort study from Germany and review of literature. Epilepsy Behav 2019; 98:88-95. [PMID: 31301455 DOI: 10.1016/j.yebeh.2019.06.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/11/2019] [Accepted: 06/11/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was to describe the treatment pattern of patients with Dravet syndrome (DS) in Germany with routine antiepileptic drugs (AEDs) and emergency medication, and to review the literature of real-world evidence on medicine utilization of patients with DS in Europe. METHODS Patient use of routine AEDs and emergency medications over 3-6 months was analyzed from a 2018 multicenter survey of 93 caregivers of patients with DS throughout Germany. Results were contextualized in a review of real-world evidence on medicine utilization of patients with DS in Europe. RESULTS The variety of medications and the most frequent combinations routinely used by patients with DS (AEDs and others) are described. Patients use a large number of pharmaceutical treatments to manage seizures. The five most commonly used AEDs were sodium valproate (66% of the patients; mean daily dose: 660 mg; 24.5 mg per kg bodyweight), bromide (44%; 1462 mg; 51.2 mg per kg), clobazam (41%; 10.4 mg; 0.32 mg per kg), stiripentol (35%; 797 mg; 27.6 mg per kg), and topiramate (24%; 107 mg; 3.5 mg per kg). Ninety percent had reported using emergency medications in the last 3 months;, with the most common medications being Buccolam (40%, an oromucosal form of midazolam) and diazepam (20%, mostly rectal application). No discernable relationships between current medication and age or seizure frequency were observed. SIGNIFICANCE This is the first comprehensive report of routine AEDs and emergency medication use in a large sample of patients with DS in Germany over a period of 3-6 months and shows that despite the most common AED combinations being in line with clinical guidelines/best practice, there is no discernable impact of best treatment on seizure frequency. We find a higher use of bromide in Germany compared with other real-world evidence in Europe.
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Abstract
Dravet syndrome is a rare but severe epilepsy syndrome that begins in the first year of life with recurrent seizures triggered by fever that are typically prolonged and hemiclonic. The epilepsy is highly drug resistant. Although development is normal at onset, over time, most patients develop moderate-to-severe intellectual disability, behavior disorders, and a characteristic crouch gait. There is a significant mortality, predominantly owing to sudden unexpected death in epilepsy. Complete seizure control is rarely attainable. Initial therapy includes valproic acid and clobazam, but response is typically inadequate. The results of new drugs for Dravet syndrome, including stiripentol, cannabidiol, and fenfluramine, are very promising. Stiripentol was associated with a greater than 50% reduction in convulsive seizure frequency in 71% of cases, when added to valproic acid and clobazam, and also markedly reduced status epilepticus. Pharmaceutical-grade cannabidiol resulted in a median change in monthly motor seizures from baseline of - 36.5%. Fenfluramine was associated with a greater than 50% reduction in seizures of 70%, with one quarter of cases achieving near seizure freedom over the duration of the trial. These agents are generally well tolerated, with few patients discontinuing for adverse effects. There is limited evidence to date regarding improvement in cognition with these newer agents; however, a meaningful change is challenging to assess over short trial periods and requires longer follow-up studies. While current treatments focus predominantly on seizure control, newer therapies including genetic treatments and antisense oligonucleotides can target the SCN1A channelopathy, and thus, may also significantly impact the important co-morbidities associated with this syndrome.
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Affiliation(s)
- Elaine C Wirrell
- Child and Adolescent Neurology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
| | - Rima Nabbout
- Hôpital Necker Enfants Malades, Université Paris Descartes, Paris, France
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48
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Polster T. Individualized treatment approaches: Fenfluramine, a novel antiepileptic medication for the treatment of seizures in Dravet syndrome. Epilepsy Behav 2019; 91:99-102. [PMID: 30269941 DOI: 10.1016/j.yebeh.2018.08.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 08/16/2018] [Accepted: 08/16/2018] [Indexed: 01/02/2023]
Abstract
Dravet syndrome is a rare and severe encephalopathy that first presents in infancy with seizures refractory to conventional antiepileptic drugs. Forty-five percent of patients report four or more tonic-clonic seizures per month despite multidrug regimens. Fenfluramine, an amphetamine derivative, was initially developed as an appetite suppressant with a serotonergic mechanism of action. Clinical observation of a potential antiepileptic activity in a small homogeneous cohort of patients combined with a genetic workup of these patients led to the hypothesis of fenfluramine as a treatment for seizures in Dravet syndrome. This concept was successfully evaluated in a zebrafish model and led to a Phase 3 trial of fenfluramine to treat seizures in children with Dravet syndrome. Preliminary results of the trial suggest that fenfluramine may be a highly effective, well-tolerated treatment for patients with Dravet syndrome. This short review summarizes the history of use of fenfluramine from the initial clinical observations followed by preclinical studies and subsequent successful clinical trial. This article is part of the Special Issue "Individualized Epilepsy Management: Medicines, Surgery and Beyond."
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Affiliation(s)
- Tilman Polster
- Paediatric Epileptology, Mara Hospital, Bethel Epilepsy Centre, Bielefeld, Germany.
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49
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Schoonjans AS, De Keersmaecker S, Van Bouwel M, Ceulemans B. More daytime sleepiness and worse quality of sleep in patients with Dravet Syndrome compared to other epilepsy patients. Eur J Paediatr Neurol 2019; 23:61-69. [PMID: 30340858 DOI: 10.1016/j.ejpn.2018.09.012] [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: 01/08/2018] [Revised: 09/13/2018] [Accepted: 09/23/2018] [Indexed: 01/15/2023]
Abstract
AIM Sleep problems are often reported in patients with a Dravet Syndrome (DS). In this study we explored the sleep behavior in DS and compared the prevalence of sleep problems with other epilepsy patients. METHODS An online questionnaire based on the 'Sleep Behavior Questionnaire by Simonds & Parraga (SQ-SP)' was distributed amongst DS parents and a control group (parents from children with epilepsy). Completed questionnaires were evaluated by factor scores and Composite Sleep Index (CSI). RESULTS Fifty-six responses were recorded in the DS group (42 were ≤18 year). Caregivers reported an overall frequency of sleep problems in 42.3% (22/52). Severe sleep problems, measured by CSI, were found in 28.3% (13/46) mainly related to night waking or daytime sleepiness. In the control group (n = 66, 62 were ≤18 year), sleep problems were reported by 21.2% (14/52) of the parents. Comparison analysis between pediatric DS and epilepsy patients revealed no significant differences between the prevalence of different types of sleep disorders, except for daytime sleepiness (p = 0.042). However, the parent (or caregiver)-reported quality of sleep was significantly lower in the DS group (p = 0.011). INTERPRETATION Sleep problems are frequent in DS patients and are mainly related to daytime sleepiness and night waking. Compared with other epilepsy patients, severe sleep problems are not more common in patients with a DS. However DS patients tend to have more mild night waking problems, which may explain the worse parental-reported sleep quality in DS patients.
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Affiliation(s)
- An-Sofie Schoonjans
- Department of Pediatric Neurology, Antwerp University Hospital, University of Antwerp, Belgium.
| | | | - Maxime Van Bouwel
- Faculty of Medicine and Health Sciences, Antwerp University Hospital, Antwerp, Belgium
| | - Berten Ceulemans
- Department of Pediatric Neurology, Antwerp University Hospital, University of Antwerp, Belgium
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Brigo F, Striano P, Balagura G, Belcastro V. Emerging drugs for the treatment of Dravet syndrome. Expert Opin Emerg Drugs 2018; 23:261-269. [DOI: 10.1080/14728214.2018.1552937] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Francesco Brigo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Division of Neurology, “Franz Tappeiner” Hospital, Merano, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, “G. Gaslini” Institute, Genova, Italy
| | - Ganna Balagura
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, “G. Gaslini” Institute, Genova, Italy
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