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Siebenbrodt K, Willems LM, von Podewils F, Mross PM, Strüber M, Langenbruch L, Bierhansl L, Gorny I, Schulz J, Gaida B, Conradi N, Süß A, Rosenow F, Strzelczyk A. Determinants of quality of life in adults with epilepsy: a multicenter, cross-sectional study from Germany. Neurol Res Pract 2023; 5:41. [PMID: 37533112 PMCID: PMC10398956 DOI: 10.1186/s42466-023-00265-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/04/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Assessment of quality of life (QoL) has become an important indicator for chronic neurological diseases. While these conditions often limit personal independence and autonomy, they are also associated with treatment-related problems and reduced life expectancy. Epilepsy has a tremendous impact on the QoL of patients and their families, which is often underestimated by practitioners. The aim of this work was to identify relevant factors affecting QoL in adults with epilepsy. METHODS This cross-sectional, multicenter study was conducted at four specialized epilepsy centers in Germany. Patients diagnosed with epilepsy completed a standardized questionnaire focusing on QoL and aspects of healthcare in epilepsy. Univariate regression analyses and pairwise comparisons were performed to identify variables of decreased QoL represented by the overall Quality of Life in Epilepsy Inventory (QOLIE-31) score. The variables were then considered in a multivariate regression analysis after multicollinearity analysis. RESULTS Complete datasets for the QOLIE-31 were available for 476 patients (279 [58.6%] female, 197 [41.4%] male, mean age 40.3 years [range 18-83 years]). Multivariate regression analysis revealed significant associations between low QoL and a high score on the Liverpool Adverse Events Profile (LAEP; beta=-0.28, p < 0.001), Hospital Anxiety and Depression Scale - depression subscale (HADS-D; beta=-0.27, p < 0.001), Neurological Disorders Depression Inventory in Epilepsy (NDDI-E; beta=-0.19, p < 0.001), revised Epilepsy Stigma Scale (beta=-0.09, p = 0.027), or Seizure Worry Scale (beta=-0.18, p < 0.001) and high seizure frequency (beta = 0.14, p < 0.001). CONCLUSION Epilepsy patients had reduced QoL, with a variety of associated factors. In addition to disease severity, as measured by seizure frequency, the patient's tolerability of anti-seizure medications and the presence of depression, stigma, and worry about new seizures were strongly associated with poor QoL. Diagnosed comorbid depression was underrepresented in the cohort; therefore, therapeutic decisions should always consider individual psychobehavioral and disease-specific aspects. Signs of drug-related adverse events, depression, fear, or stigmatization should be actively sought to ensure that patients receive personalized and optimized treatment. TRIAL REGISTRATION German Clinical Trials Register (DRKS00022024; Universal Trial Number: U1111-1252-5331).
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Affiliation(s)
- Kai Siebenbrodt
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany.
- LOEWE Center for Personalized Translational Epilepsy Research (CEPTeR), Goethe-University Frankfurt, Frankfurt am Main, Germany.
| | - Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CEPTeR), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Felix von Podewils
- Department of Neurology, Epilepsy Center, University Hospital Greifswald, Greifswald, Germany
| | - Peter Michael Mross
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg, Germany
- Institute for Artificial Intelligence in Medicine, Philipps-University Marburg, Marburg, Germany
| | - Michael Strüber
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CEPTeR), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Lisa Langenbruch
- Institute for Artificial Intelligence in Medicine, Philipps-University Marburg, Marburg, Germany
| | - Laura Bierhansl
- Epilepsy Center Münster-Osnabrück, Department of Neurology with Institute of Translational Neurology, Westfälische Wilhelms-University, Münster, Germany
| | - Iris Gorny
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Juliane Schulz
- Department of Neurology, Epilepsy Center, University Hospital Greifswald, Greifswald, Germany
| | - Bernadette Gaida
- Department of Neurology, Epilepsy Center, University Hospital Greifswald, Greifswald, Germany
| | - Nadine Conradi
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CEPTeR), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Annika Süß
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CEPTeR), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CEPTeR), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany
- LOEWE 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, Germany
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Lu Y, Wang W, Ma Y, Fan Z, Xiong L, Zhao J, He Y, Li C, Wang A, Xiao N, Wang T. miR-10a induces inflammatory responses in epileptic hippocampal neurons of rats via PI3K/Akt/mTOR signaling pathway. Neuroreport 2023; 34:526-534. [PMID: 37270844 DOI: 10.1097/wnr.0000000000001920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Epilepsy is a common chronic neurological disorder worldwide. MicroRNAs (miRNAs) play an important role in the pathogenesis of epilepsy. However, the mechanism of the regulatory effect of miR-10a on epilepsy is unclear. In this study, we investigated the effect of miR-10a expression on the PI3K/Akt/mTOR signaling pathway and inflammatory cytokines in epileptic hippocampal neurons of rats. The miRNA differential expression profile of rat epileptic brain was analyzed using bioinformatic approaches. Neonatal Sprague-Dawley rat hippocampal neurons were prepared as epileptic neuron models in vitro by replacing culture medium with magnesium-free extracellular solution. The hippocampal neurons were transfected with miR-10a mimics, and transcript levels of miR-10a, PI3K, Akt and mTOR were detected by quantitative reverse transcription-PCR, and PI3K, mTOR, Akt, TNF-α, IL-1β, IL-6 protein expression levels were detected by Western blot. Cytokines secretory levels were detected by ELISA. Sixty up-regulated miRNAs were identified in the hippocampal tissue of epileptic rats and might affect the PI3K-Akt signaling pathway. In the epileptic hippocampal neurons model, the expression levels of miR-10a were significantly increased, with decreasing levels of PI3K, Akt and mTOR, and increasing levels of TNF-α, IL-1β and IL-6. The miR-10a mimics promoted the expression of TNF-α, IL-1β and IL-6. Meanwhile, miR-10a inhibitor activated PI3K/Akt/mTOR pathway and inhibited cytokines secretion. Finally, cytokine secretion was increased by treated with PI3K inhibitor and miR-10a inhibitor. The miR-10a may promote inflammatory responses in rat hippocampal neurons by inhibiting the PI3K/Akt/mTOR pathway, suggesting that miR-10a may be one of the target therapeutic molecules for epilepsy treatment.
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Affiliation(s)
- Yuanming Lu
- Department of Neurology, First People's Hospital of Guangyuan, Guangyuan, Sichuan
| | - Wanshi Wang
- Air Service Department, Central Theater Air Force Hospital of Chinese PLA, Datong, Shanxi
| | - Yanping Ma
- Department of Geriatrics, Chengyang District People's Hospital, Qingdao, Shandong
| | - Zilian Fan
- Department of Neurology, First People's Hospital of Guangyuan, Guangyuan, Sichuan
| | - Lan Xiong
- Department of Neurology, First People's Hospital of Guangyuan, Guangyuan, Sichuan
| | - Junhao Zhao
- Department of Neurology, First People's Hospital of Guangyuan, Guangyuan, Sichuan
| | - Yongwen He
- Department of Neurology, First People's Hospital of Guangyuan, Guangyuan, Sichuan
| | - Chao Li
- Department of Neurology, First People's Hospital of Guangyuan, Guangyuan, Sichuan
| | - Anjie Wang
- Department of Neurology, First People's Hospital of Guangyuan, Guangyuan, Sichuan
| | | | - Tianxun Wang
- Department of Cardiology, First People's Hospital of Guangyuan, Guangyuan, Sichuan, China
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Möller L, Krämer G, Habermehl L, Menzler K, Knake S. Driving regulations for epilepsy in Europe. Seizure 2023; 109:83-91. [PMID: 37276778 DOI: 10.1016/j.seizure.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/12/2023] [Accepted: 05/20/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Across Europe, there are differences regarding driving restrictions for patients with epilepsies and seizures. In the light of increasing mobility, knowledge about those different regulations is of high importance for counseling patients, and physicians. METHODS A structured online survey was sent to the official representatives of the different European ILAE chapters, asking for the local driving restrictions for patients with epilepsies, first seizures, syncopes, and psychogenic non-epileptic seizures. RESULTS The survey was sent to 38 chapters or representatives of 47 European Countries. 33 chapters answered. The majority of countries require 1 year of seizure-freedom for the ability to drive (Group 1, former categories A, B, B + E, F, G. H, K, L, and P; driving license which authorizes its holder to drive vehicle classes categories of the motor vehicle), usually with the need to continue antiseizure medication (ASM). Some countries have much stricter regulations before allowing for driving. Legal regulations after a first unprovoked seizure differ between 6 months for Group 1 license holders in most European countries, and one year in Luxembourg and Malta. In Serbia, there is no legal regulation for this special situation. The situation after a first seizure is even more complex for Group 2 license holders (former categories C1, C1+E, C, C + E, D1, D1+E, D, D + E). CONCLUSION Knowledge of the different recommendations of the individual European countries is of high relevance in the counseling of epilepsy patients. Europe-wide regulations, e.g. following the IBE-recommendations are needed to facilitate the patients' situation.
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Affiliation(s)
- Leona Möller
- Department of Neurology, Epilepsy Center Hessen, Philipps University Marburg, Marburg, Germany.
| | | | - Lena Habermehl
- Department of Neurology, Epilepsy Center Hessen, Philipps University Marburg, Marburg, Germany
| | - Katja Menzler
- Department of Neurology, Epilepsy Center Hessen, Philipps University Marburg, Marburg, Germany
| | - Susanne Knake
- Department of Neurology, Epilepsy Center Hessen, Philipps University Marburg, Marburg, Germany
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Willems LM, Zöllner JP, Hamann L, Knake S, Kovac S, von Podewils F, Rosenow F, Strzelczyk A. Unemployment and early retirement among patients with epilepsy - A study on predictors, resilience factors and occupational reintegration measures. Epilepsy Behav 2023; 144:109255. [PMID: 37209554 DOI: 10.1016/j.yebeh.2023.109255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/22/2023]
Abstract
The primary aim of this study was to identify predictors and resilience factors for unemployment and early retirement in patients with epilepsy of working age based on data from a multicenter German cohort study performed in 2020 (n = 456) by using multivariate binary logistic regression analysis. A second aim was to assess the assumed working ability of patients as well as the use of occupational reintegration measures. The unemployment rate was 8.3%, and 18% of patients had retired early due to epilepsy. Multivariate binary logistic regression analysis identified the presence of a relevant disability and frequent seizures as significant predictors of unemployment and early retirement, while seizures in remission were the only resilience factor associated with job retention. Regarding occupational incapacity, at the time of the survey, most of the patients in early retirement or unemployment were fit for work in their original or extended occupational setting. The proportion of patients with recent epilepsy-related occupational retraining (0.4%) or job changes (0.9%) was low, and only 2.4% reported an epilepsy-related reduction in work time. These findings underline the persistent disadvantage of patients with epilepsy in the professional field and the urgent need for effective, comprehensive work reintegration measures that must be made accessible for all patients.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany.
| | - Johann Philipp Zöllner
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Laura Hamann
- Department of Neurology, University Hospital Greifswald, Greifswald, Germany
| | - Susanne Knake
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Stjepana Kovac
- Epilepsy Center Münster-Osnabrück, Department of Neurology, Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Felix von Podewils
- Department of Neurology, University Hospital Greifswald, Greifswald, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
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Fang X, Qiao S, Zhang R, Yang T, Wang Z, Kong Q, Sun M, Geng J, Fang C, Chen Y, Sun Y, Zhang D, Qu L, Shang W, Wang J, Liu X. Effects of coronavirus disease 2019 vaccination on seizures in patients with epilepsy. Chin Med J (Engl) 2023; 136:571-577. [PMID: 36848187 PMCID: PMC10106124 DOI: 10.1097/cm9.0000000000002558] [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: 07/30/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Given that seizures may be triggered by vaccination, this study aimed to evaluate the risk and correlative factors of seizures in patients with epilepsy (PWE) after being vaccinated against coronavirus disease 2019 (COVID-19). METHODS This study retrospectively enrolled PWE who were vaccinated against COVID-19 in the epilepsy centers of 11 hospitals in China. We divided the PWE into two groups as follows: (1) patients who developed seizures within 14 days of vaccination were assigned to the SAV (with seizures after vaccination) group; (2) patients who were seizure-free within 14 days of vaccination were assigned to the SFAV (seizure-free after vaccination) group. To identify potential risk factors for seizure reccurence, the binary logistic regression analysis was performed. Besides, 67 PWE who had not been vaccinated were also included for elucidating the effects of vaccination on seizures recurrence, and binary logistic regression analysis was performed to determine whether vaccination would affect the recurrence rate of PWE who had drug reduction or withdrawal. RESULTS The study included a total of 407 patients; of which, 48 (11.8%) developed seizures within 14 days after vaccination (SAV group), whereas 359 (88.2%) remained seizure-free (SFAV group). The binary logistic regression analysis revealed that duration of seizure freedom ( P < 0.001) and withdrawal from anti-seizure medications (ASMs) or reduction in their dosage during the peri-vaccination period were significantly associated with the recurrence of seizures (odds ratio = 7.384, 95% confidence interval = 1.732-31.488, P = 0.007). In addition, 32 of 33 patients (97.0%) who were seizure-free for more than three months before vaccination and had a normal electroencephalogram before vaccination did not have any seizures within 14 days of vaccination. A total of 92 (22.6%) patients experienced non-epileptic adverse reactions after vaccination. Binary logistic regression analysis results showed that vaccine did not significantly affect the recurrence rate of PWE who had the behavior of ASMs dose reduction or withdrawal ( P = 0.143). CONCLUSIONS PWE need protection from the COVID-19 vaccine. PWE who are seizure-free for >3 months before vaccination should be vaccinated. Whether the remaining PWE should be vaccinated depends on the local prevalence of COVID-19. Finally, PWE should avoid discontinuing ASMs or reducing their dosage during the peri-vaccination period.
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Affiliation(s)
- Xiqin Fang
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, Shandong 250000, China
- Department of Neurology, Institute of Epilepsy, Shandong University, Jinan, Shandong 250000, China
| | - Shan Qiao
- Department of Neurology, Institute of Epilepsy, Shandong University, Jinan, Shandong 250000, China
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong 250000, China
| | - Ranran Zhang
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, Shandong 250000, China
- Department of Neurology, Institute of Epilepsy, Shandong University, Jinan, Shandong 250000, China
| | - Tingting Yang
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, Shandong 250000, China
- Department of Neurology, Institute of Epilepsy, Shandong University, Jinan, Shandong 250000, China
| | - Zhihao Wang
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, Shandong 250000, China
- Department of Neurology, Institute of Epilepsy, Shandong University, Jinan, Shandong 250000, China
| | - Qingxia Kong
- Department of Neurology, Affiliated Hospital of Jining Medical College, Jining, Shandong 272000, China
| | - Meihua Sun
- Department of Neurology, Tengzhou Central People's Hospital, Jining, Shandong 277599, China
| | - Jianhong Geng
- Department of Neurology, Affiliated Hospital of Weifang Medical College, Weifang, Shandong 261000, China
| | - Chunyan Fang
- Department of Neurology, Zhucheng People's Hospital, Weifang, Shandong 262200, China
| | - Yanxiu Chen
- Department of Neurology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, China
| | - Yanping Sun
- Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, China
| | - Dongmei Zhang
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong 276000, China
| | - Lixing Qu
- Department of Neurology, Dezhou People's Hospital, Dezhou, Shandong 253000, China
| | - Wei Shang
- Department of Neurology, Second Hospital of Shandong University, Jinan, Shandong 250000, China
| | - Jianguo Wang
- Department of Neurology, Jinan Central Hospital, Jinan, Shandong 250000, China
| | - Xuewu Liu
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, Shandong 250000, China
- Department of Neurology, Institute of Epilepsy, Shandong University, Jinan, Shandong 250000, China
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Mühlenfeld N, Störmann P, Marzi I, Rosenow F, Strzelczyk A, Verboket RD, Willems LM. Seizure related injuries - Frequent injury patterns, hospitalization and therapeutic aspects. Chin J Traumatol 2022; 25:272-276. [PMID: 34763994 PMCID: PMC9458997 DOI: 10.1016/j.cjtee.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 09/23/2021] [Accepted: 10/08/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Epileptic seizures frequently result in distinct physical injuries, fractures, traumatic brain injuries and minor trauma. The aim of this study was to retrospectively determine the frequent injury patterns due to seizure episode and to analyze consecutive acute medical care. METHODS This retrospective mono-center study was conducted at Frankfurt University Hospital, Frankfurt am Main, Germany between January 2007 and December 2017. Epilepsy patients with seizure-related fractures admitted to the emergency department were identified via a retrospective systematic query in the hospital information system using the ICD-10 German modification codes G40.0-G40.9. Patients with an unclear diagnosis of epilepsy were excluded. Sociodemographic as well as disease specific aspects were analyzed. Descriptive and Kruskal-Wallis one-way analysis of variance were used for statistical analysis. RESULTS A total number of 62 epilepsy patients were included. The mean age was 58.1 years. Fractures concerned the upper extremity most frequently (43.5%, n = 20), and 70.0% (14/20) were humerus fractures. Admission to intensive care unit for acute trauma care was necessary in 29.0% patients (n = 18), and surgery in 45.2% patients (n = 28). Twenty-five patients (26.6%) showed clinical or radiological signs of traumatic brain injury. Provoking factors were identified in 20 patients (32.3%), i.e., acute withdrawal or excess of alcohol (n = 15), relevant sleep deprivation (n = 2), and intoxication or withdrawal of other illegal drugs or trivial infect (n = 1 for each) and non-compliance with anti-seizure drugs (n = 1). A decreased T-score (-1.04 ± 1.15) and Z-score (-0.84 ± 0.75) compared to healthy subjects were found. CONCLUSION Fractures in upper extremities, trunk and craniocerebral trauma occur frequently as seizure-induced injuries. Alcohol excess and withdrawal are important provoking factors and should be targeted with preventive measurements to avoid seizure related injuries and accidents.
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Affiliation(s)
- Nils Mühlenfeld
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Frankfurt Am Main, Germany,Corresponding author.
| | - Philipp Störmann
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Frankfurt Am Main, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Frankfurt Am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University Frankfurt, Frankfurt Am Main, Germany,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-Universität Frankfurt, Frankfurt Am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University Frankfurt, Frankfurt Am Main, Germany,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-Universität Frankfurt, Frankfurt Am Main, Germany,Department of Neurology and Epilepsy Center Hessen, Philipps-University Marburg, Marburg (Lahn), Germany
| | - René D. Verboket
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Frankfurt Am Main, Germany
| | - Laurent M. Willems
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University Frankfurt, Frankfurt Am Main, Germany,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-Universität Frankfurt, Frankfurt Am Main, Germany
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Zöllner JP, Noda AH, McCoy J, Schulz J, Tsalouchidou PE, Langenbruch L, Kovac S, Knake S, von Podewils F, Hamacher M, Mann C, Leyer AC, van Alphen N, Schubert-Bast S, Rosenow F, Strzelczyk A. Use of Health-Related Apps and Telehealth in Adults with Epilepsy in Germany: A Multicenter Cohort Study. Telemed J E Health 2022; 29:540-550. [PMID: 35984859 DOI: 10.1089/tmj.2022.0238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Telehealth can improve the treatment of chronic disorders, such as epilepsy. Telehealth prevalence and use increased during the coronavirus disease 2019 (COVID-19) pandemic. However, familiarity with and use of telehealth and health-related mobile applications (apps) by persons with epilepsy remain unknown. Methods: We investigated telehealth use, demographics, and clinical variables within the multicenter Epi2020 cross-sectional study. Between October and December 2020, adults with epilepsy completed a validated questionnaire, including individual questions regarding knowledge and use of apps and telehealth. Results: Of 476 included individuals (58.2% women; mean age 40.2 ± 15.4 years), 41.6% reported using health-related apps. Health apps were used more frequently (pedometer 32.1%, exercise app 17.6%) than medical apps (health insurance 15.1%, menstrual apps 12.2%) or apps designed for epilepsy (medication reminders 10.3%, seizure calendars 4.6%). Few used seizure detectors (i.e., apps as medical devices 1.9%) or mobile health devices (fitness bracelet 11.3%). A majority (60.9%) had heard the term telehealth, 78.6% of whom had a positive view. However, only 28.6% had a concrete idea of telehealth, and only 16.6% reported personal experience with telehealth. A majority (55%) would attend a teleconsultation follow-up, and 41.2% would in a medical emergency. Data privacy and availability were considered equally important by 50.8%, 21.8% considered data privacy more important, and 20.2% considered data availability more important. Current health-related app use was independently associated with younger age (p = 0.003), higher education (p < 0.001), and subjective COVID-19-related challenges (p = 0.002). Persistent seizure occurrence (vs. seizure freedom ≥12 months) did not affect willingness to use teleconsultations on multivariable logistic regression analysis. Conclusions: Despite positive telehealth views, few persons with epilepsy in Germany are familiar with specific apps or services. Socioeconomic factors influence telehealth use more than baseline epilepsy characteristics. Telehealth education and services should target socioeconomically disadvantaged individuals to reduce the digital care gap. German Clinical Trials Register (DRKS00022024; Universal Trial Number: U1111-1252-5331).
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Affiliation(s)
- Johann Philipp Zöllner
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt-Goethe-University, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research, Goethe-University, Frankfurt am Main, Germany
| | - Anna H Noda
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt-Goethe-University, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research, Goethe-University, Frankfurt am Main, Germany
| | - Jeannie McCoy
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt-Goethe-University, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research, Goethe-University, Frankfurt am Main, Germany
| | - Juliane Schulz
- Department of Neurology, University Hospital Greifswald, Greifswald, Germany
| | - Panagiota-Eleni Tsalouchidou
- Epilepsy Center Hessen, Department of Neurology, University Hospital Marburg-Philipps-University, Marburg (Lahn), Germany
| | - Lisa Langenbruch
- Epilepsy Center Münster-Osnabrück, Department of Neurology with Institute of Translational Neurology, University Hospital Münster-Westfälische Wilhelms-University, Münster, Germany.,Department of Neurology, Osnabrück Hospital, Osnabrück, Germany
| | - Stjepana Kovac
- Epilepsy Center Münster-Osnabrück, Department of Neurology with Institute of Translational Neurology, University Hospital Münster-Westfälische Wilhelms-University, Münster, Germany
| | - Susanne Knake
- Epilepsy Center Hessen, Department of Neurology, University Hospital Marburg-Philipps-University, Marburg (Lahn), Germany
| | - Felix von Podewils
- Department of Neurology, University Hospital Greifswald, Greifswald, Germany
| | - Mario Hamacher
- Department of Neurology, University Hospital Greifswald, Greifswald, Germany
| | - Catrin Mann
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt-Goethe-University, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research, Goethe-University, Frankfurt am Main, Germany
| | - Anne-Christine Leyer
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt-Goethe-University, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research, Goethe-University, Frankfurt am Main, Germany.,Department of Pediatrics and Neuropediatrics, University Hospital Frankfurt-Goethe-University, Frankfurt am Main, Germany
| | - Natascha van Alphen
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt-Goethe-University, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research, Goethe-University, Frankfurt am Main, Germany
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt-Goethe-University, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research, Goethe-University, Frankfurt am Main, Germany.,Department of Pediatrics and Neuropediatrics, University Hospital Frankfurt-Goethe-University, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt-Goethe-University, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research, Goethe-University, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt-Goethe-University, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research, Goethe-University, Frankfurt am Main, Germany
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8
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Mollayeva T, Tran A, Chan V, Colantonio A, Sutton M, Escobar MD. Decoding health status transitions of over 200 000 patients with traumatic brain injury from preceding injury to the injury event. Sci Rep 2022; 12:5584. [PMID: 35379824 PMCID: PMC8980052 DOI: 10.1038/s41598-022-08782-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 02/28/2022] [Indexed: 11/17/2022] Open
Abstract
For centuries, the study of traumatic brain injury (TBI) has been centred on historical observation and analyses of personal, social, and environmental processes, which have been examined separately. Today, computation implementation and vast patient data repositories can enable a concurrent analysis of personal, social, and environmental processes, providing insight into changes in health status transitions over time. We applied computational and data visualization techniques to categorize decade-long health records of 235,003 patients with TBI in Canada, from preceding injury to the injury event itself. Our results highlighted that health status transition patterns in TBI emerged along with the projection of comorbidity where many disorders, social and environmental adversities preceding injury are reflected in external causes of injury and injury severity. The strongest associations between health status preceding TBI and health status at the injury event were between multiple body system pathology and advanced age-related brain pathology networks. The interwoven aspects of health status on a time continuum can influence post-injury trajectories and should be considered in TBI risk analysis to improve prevention, diagnosis, and care.
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Willems LM, Hochbaum M, Zöllner JP, Schulz J, Menzler K, Langenbruch L, Kovac S, Knake S, von Podewils F, Hamacher M, Hamer HM, Reese JP, Frey K, Rosenow F, Strzelczyk A. Trends in resource utilization and cost of illness in patients with active epilepsy in Germany from 2003 to 2020. Epilepsia 2022; 63:1591-1602. [PMID: 35305026 DOI: 10.1111/epi.17229] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/26/2022] [Accepted: 03/16/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To calculate epilepsy-related direct, indirect, and total costs in adult patients with active epilepsy (ongoing unprovoked seizures) in Germany and to analyze cost components and dynamics compared to previous studies from 2003, 2008 and 2013. This analysis was part of the Epi2020 study. METHODS Direct and indirect costs related to epilepsy were calculated with a multicenter survey using an established and validated questionnaire with a bottom-up design and human capital approach over a 3-month period in late 2020. Epilepsy-specific costs in the German health care sector from 2003, 2008 and 2013 were corrected for inflation to allow for a valid comparison. RESULTS Data on the disease-specific costs for 253 patients in 2020 were analyzed. The mean total costs were calculated at € 5,551 (± € 5,805; median: € 2,611; range: € 274 to € 21,667) per three months, comprising mean direct costs of € 1,861 (± € 1,905; median: € 1,276; range: € 327 to € 13,158) and mean indirect costs of € 3,690 (± € 5,298; median: € 0; range: € 0 to € 11,925). The main direct costs components were hospitalization (42.4%), anti-seizure medication (42.2%) and outpatient care (6.2%). Productivity losses due to early retirement (53.6%), part-time work or unemployment (30.8%) and seizure-related off-days (15.6%) were the main reasons for indirect costs. However, compared to 2013, there was no significant increase of direct costs (-10.0%), and indirect costs significantly increased (p<0.028, +35.1%), resulting in a significant increase in total epilepsy-related costs (p<0.047, +20.2%). Compared to the 2013 study population, a significant increase of cost of illness could be observed (p=0.047). SIGNIFICANCE The present study shows that disease-related costs in adult patients with active epilepsy increased from 2013 to 2020. As direct costs have remained constant, this increase is attributable to an increase in indirect costs. These findings highlight the impact of productivity loss caused by early retirement, unemployment, working time reduction and seizure-related days off.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CEPTeR), Goethe-University, Frankfurt, Frankfurt am Main, Germany
| | - Maja Hochbaum
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CEPTeR), Goethe-University, Frankfurt, Frankfurt am Main, Germany
| | - Johann Philipp Zöllner
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CEPTeR), Goethe-University, Frankfurt, Frankfurt am Main, Germany
| | - Juliane Schulz
- Department of Neurology, University Hospital Greifswald, Greifswald, Germany
| | - Katja Menzler
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Lisa Langenbruch
- Epilepsy Center Münster-Osnabrück, Department of Neurology with Institute of Translational Neurology, Westfälische Wilhelms-University, Münster, Germany.,Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany
| | - Stjepana Kovac
- Epilepsy Center Münster-Osnabrück, Department of Neurology with Institute of Translational Neurology, Westfälische Wilhelms-University, Münster, Germany
| | - Susanne Knake
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Felix von Podewils
- Department of Neurology, University Hospital Greifswald, Greifswald, Germany
| | - Mario Hamacher
- Department of Neurology, University Hospital Greifswald, Greifswald, Germany
| | - Hajo M Hamer
- Epilepsy Center and Department of Neurology, Friedrich-Alexander-University, Erlangen, Germany
| | - Jens-Peter Reese
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Katharina Frey
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CEPTeR), Goethe-University, Frankfurt, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CEPTeR), Goethe-University, Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CEPTeR), Goethe-University, Frankfurt, Frankfurt am Main, Germany
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10
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Willems LM, Knake S, Rosenow F, Reese JP, Conradi N, Strzelczyk A. EuroQOL-5D-3L does not adequately map quality-of-life deterioration in severely affected patients with epilepsy. Epilepsy Behav 2022; 127:108554. [PMID: 35063789 DOI: 10.1016/j.yebeh.2022.108554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/21/2021] [Accepted: 01/03/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The steadily increasing impact of health-related quality of life (HRQOL) on reasonable diagnostic and therapeutic decisions makes the correct mapping of HRQOL indispensable in modern epileptology. The aim of this study was to address the reliability of the often-used generic HRQOL screening questionnaire EuroQOL 5-dimension, 3-level (EQ-5D-3L) by comparing its normalized index value (calculated via the time trade-off method) and visual analog scale (VAS) to the gold standard of the extensive Quality of Life in Epilepsy Inventory (QOLIE-31). QOLIE-10 scores were compared with the extensive QOLIE-31 and EQ-5D-3L TTO. METHODS We conducted a retrospective analysis of a monocentric study of 184 patients with epilepsy. Bivariate Spearman correlation analysis and Fisher's r-to-z transformation were used to compare the strengths of correlations of EQ-5D-3L, QOLIE-10 and QOLIE-31 with different epilepsy-specific domains (disease severity, drug interactions, emotional well-being, stigmatization, seizure-related anxiety, cognitive impairment). RESULTS The different metrics of EQ-5D-3L, QOLIE-10 and QOLIE-31 showed moderate to very strong intra- and inter-metric correlations for overall HRQOL. Quality of Life in Epilepsy Inventory-31 VAS and EQ-5D-3L VAS did not show any significantly different strengths of correlations with respect to the domains studied. In contrast, the correlation strength of the normalized EQ-5D-3L index value differed significantly from the QOLIE-31 T-score for several domains, for example, for drug-related adverse events, neuropsychological deficits, symptoms of depression and seizure worry. In seizure-free patients, EQ-5D-3L VAS and EQ-5D-3L index values correlated significantly less with the domain of "cognitive impairment" than the QOLIE-31 T-score. In patients without relevant neuropsychological deficits, the strengths of correlations with the assessed domains did not differ significantly between EQ-5D-3L metrics and the QOLIE-31 T-score. The HRQOL mapping probability of QOLIE-10 was inferior to QOLIE-31 and comparable to EQ-5D-3L regarding the analyzed domains. CONCLUSION In contrast to the EQ-5D-3L VAS, EQ-5D-3L index values do not adequately map health-related quality of life in severely affected patients with epilepsy and therefore should not be used as screening tools. The QOLIE-31 T-score remains the gold standard for HRQOL assessment in patients with epilepsy.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Susanne Knake
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Jens-Peter Reese
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Würzburg, Germany
| | - Nadine Conradi
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany.
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11
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Schwab C, Wadle NE, Knake S, von Podewils F, Siebenbrodt K, Kohlhase K, Schulz J, Menzler K, Mann C, Rosenow F, Seifart C, Strzelczyk A. Patients' knowledge about epilepsy-related risks, morbidity, and mortality: A multicenter cohort study from Germany. Epilepsy Behav 2021; 124:108343. [PMID: 34619541 DOI: 10.1016/j.yebeh.2021.108343] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Patient education is a central component of quality care. Enhancing patient knowledge can improve patients' quality of life and facilitate successful self-management. We sought to identify patients' knowledge levels and knowledge gaps regarding epilepsy-related risks, morbidity, and mortality. METHODS Adult patients with epilepsy presenting to the university hospitals in Frankfurt, Greifswald, and Marburg between February 2018 and May 2020 were asked to participate in this questionnaire-based study. RESULTS A total of 238 patients (52% women), with a mean age of 39.2 years (range: 18-77 years), participated in this study. Spontaneously, the majority of patients (51.3%) named driving a car, and other traffic-related accidents as possible causes of morbidity and mortality, and 23.9% of patients reported various causes of premature death, such as suffocation, drowning, and respiratory or cardiac arrest due to seizures. Falls due to epilepsy (19.7%) and injuries in general (17.6%) were named as further causes of morbidity and mortality. The vast majority were aware that alcohol (87.4%), sleep deprivation (86.6%), and risky activities in daily life (80.3%) increased the risk of seizure occurrence or increased morbidity and mortality. Regarding overall mortality, 52.1% thought that people with epilepsy were at greater risk of premature death, whereas 46.2% denied this fact to be true. Only 29.4% were aware of status epilepticus, and 27.3% were aware of sudden unexpected death in epilepsy (SUDEP). Driving ability, working ability, and seizure risk were named as major or moderate concerns among patients, but the risk of premature mortality was not a major concern. One-quarter of all patients (26.9%) indicated that they were not counseled about any risk factors or causes of morbidity or mortality by their physicians. CONCLUSIONS A lack of knowledge concerning premature mortality, SUDEP, and status epilepticus exists among adult patients with epilepsy. A substantial number of patients indicated that these issues were not discussed adequately by their physicians.
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Affiliation(s)
- Christina Schwab
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Nora-Elena Wadle
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Susanne Knake
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Felix von Podewils
- Epilepsy Center and Department of Neurology, University of Greifswald, Greifswald, Germany
| | - Kai Siebenbrodt
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Konstantin Kohlhase
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Juliane Schulz
- Epilepsy Center and Department of Neurology, University of Greifswald, Greifswald, Germany
| | - Katja Menzler
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Catrin Mann
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Carola Seifart
- Institutional Review Board, Medical Faculty, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany; Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany.
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12
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Einstellungen und Hinderungsgründe bezüglich Telemedizin bei Epilepsien: Eine Umfrage in neurologischen Praxen. ZEITSCHRIFT FÜR EPILEPTOLOGIE 2021. [PMCID: PMC8243621 DOI: 10.1007/s10309-021-00417-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Zusammenfassung
Hintergrund
In Anbetracht ihres bedeutenden Potenzials zur Verbesserung der medizinischen Versorgung wird Telemedizin weiterhin zu wenig genutzt. Trotz einiger erfolgreicher Pilotprojekte in den vergangenen Jahren ist insbesondere über die Hindernisse der Etablierung und Verstetigung von Telemedizin wenig bekannt. Diese Studie hatte das Ziel, die Einstellung niedergelassener Neurologen hinsichtlich der Nutzung von Telemedizin in der Epileptologie und resultierende Hinderungsgründe zu verstehen. Gleichzeitig werden mögliche Lösungsansätze präsentiert.
Methoden
Mithilfe eines individuell erstellten 14-Item-Fragebogens befragten wir prospektiv alle Neurologen, die zuvor die Teilnahme an einem transregionalen Telemedizinpilotprojekt im Bereich der Epileptologie abgelehnt oder keine Rückmeldung gegeben hatten, zu Gründen für und gegen den generellen Einsatz von bzw. die Teilnahme an Telemedizin.
Ergebnisse
Von 58 kontaktierten Neurologen antworteten 33 (57 %). Die häufigsten Gründe für die fehlende Nutzung der Telemedizin waren ein vermuteter Zeitmangel oder ein vermuteter zu großer organisatorischer Aufwand (49 %). Zudem wurden Bedenken bezüglich der technischen Ausstattung (30 %) und eine Präferenz für alternative Wege der intersektoralen Kommunikation (30 %) angegeben. Befürchtete Probleme in Bezug auf die Kostenerstattung für telemedizinische Leistungen waren für 27 % ein Hindernis. Neurologen in ländlichen Gebieten waren signifikant häufiger bereit, zunächst eine telemedizinische Konsultation anzufordern, bevor sie eine Überweisung ausstellen (p = 0,006).
Schlussfolgerungen
Die flächendeckende Etablierung von Telemedizinstrukturen ist immer noch durch Hindernisse erschwert, die meist im organisatorischen Bereich liegen. Die bestehenden Herausforderungen im Gesundheitswesen in ländlichen Gebieten sind eine besondere Chance für die Implementierung von Telemedizin. Die meisten Probleme der Telemedizin können gelöst werden, sollten aber bereits bei der Konzeptionierung von Projekten mitbedacht werden, um ihre Verstetigung zu erleichtern.
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Verboket RD, Mühlenfeld N, Sterz J, Störmann P, Marzi I, Balcik Y, Rosenow F, Strzelczyk A, Willems LM. [Inpatient treatment costs, cost-driving factors and potential reimbursement problems due to epileptic seizure-related injuries and fractures]. Chirurg 2021; 92:361-368. [PMID: 32757045 PMCID: PMC8016784 DOI: 10.1007/s00104-020-01257-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The systematic analysis of disease-specific costs is becoming increasingly more relevant in an economically oriented healthcare system. Chronic diseases are of particular interest due to the long duration as well as frequent hospitalization and physician visits. Epilepsy is a frequent neurological disorder affecting all age groups with the clinical hallmark of paroxysmal epileptic seizures, which are often associated with injuries. OBJECTIVE The aim of this work was to process the inpatient treatment costs due to seizure-related injuries and fractures. Moreover, relevant cost-causing factors were addressed. Using an alternative calculation of the costs of care, the question of potential reimbursement problems in the current German diagnosis-related groups (G-DRG) system was additionally assessed. METHODS For this monocentric retrospective analysis the actual proceeds of 62 inpatients who were treated at the University Hospital Frankfurt between January 2010 and January 2018 for injuries and fractures due to epileptic seizures were used. The analysis of potential cost-causing factors was carried out with respect to relevant sociodemographic and clinical aspects. The alternative calculation of the costs of treatment was carried out using established health economic methods. RESULTS The average DRG revenue was 7408€ (±8993€, median 5086€, range 563-44,519€), the average calculated costs were 9423€ (±11,113€, 5626€, range 587-49,830€). A length of stay ≥7 days (p = 0.014) was identified as a significant cost-driving factor. Due to the significant difference (p < 0.001) between revenue and calculated costs, an analysis was made according to factors for potential reimbursement problems, which remained significant for a length of stay of ≥7 days (p = 0.014) and for treatment in the intensive care unit (p = 0.019). CONCLUSION The inpatient treatment costs for patients with injuries and fractures due to epileptic seizures are high and therefore relevant from a health economic perspective. In general, reimbursement according to the G‑DRG appears to cover the actual costs, but there may be reimbursement problems for patients with a long period of hospitalization or a stay in an intensive care ward.
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Affiliation(s)
- René D Verboket
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
| | - Nils Mühlenfeld
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Jasmina Sterz
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Philipp Störmann
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Ingo Marzi
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Yunus Balcik
- Epilepsiezentrum Frankfurt Rhein-Main und Klinik für Neurologie, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Felix Rosenow
- Epilepsiezentrum Frankfurt Rhein-Main und Klinik für Neurologie, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Adam Strzelczyk
- Epilepsiezentrum Frankfurt Rhein-Main und Klinik für Neurologie, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
- Epilepsiezentrum Hessen und Klinik für Neurologie, Philipps-Universität Marburg, Marburg (Lahn), Deutschland
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Laurent M Willems
- Epilepsiezentrum Frankfurt Rhein-Main und Klinik für Neurologie, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
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Everolimus als krankheitsspezifische Therapieoption bei mit tuberöser Sklerose assoziierter, therapierefraktärer Epilepsie – ein systematischer Überblick. ZEITSCHRIFT FUR EPILEPTOLOGIE 2021. [DOI: 10.1007/s10309-020-00393-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ZusammenfassungTuberöse Sklerose („tuberous sclerosis complex“ [TSC]) ist eine seltene genetische Erkrankung, die neben kutanen und viszeralen Organmanifestationen typischerweise bereits in einem sehr frühen Erkrankungsstadium mit einer schweren, meist therapierefraktären Epilepsie einhergeht. Aufgrund seiner direkten Wirkung am durch TSC dysregulierten mTOR-Signalweg sowie der synergistischen Effekte auf andere Organmanifestationen kommt das Rapamycin-Derivat Everolimus (EVE) zunehmend zur Anwendung. Ziel dieses systematischen Reviews ist, die Wirksamkeit, Sicherheit und Verträglichkeit von EVE bei Patienten mit TSC-assoziierter, therapierefraktärer Epilepsie aufzuarbeiten.
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15
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Willems LM, Balcik Y, Noda AH, Siebenbrodt K, Leimeister S, McCoy J, Kienitz R, Kiyose M, Reinecke R, Schäfer JH, Zöllner JP, Bauer S, Rosenow F, Strzelczyk A. SARS-CoV-2-related rapid reorganization of an epilepsy outpatient clinic from personal appointments to telemedicine services: A German single-center experience. Epilepsy Behav 2020; 112:107483. [PMID: 33181898 PMCID: PMC7537633 DOI: 10.1016/j.yebeh.2020.107483] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION When the SARS-CoV-2 pandemic reached Europe in 2020, a German governmental order forced clinics to immediately suspend elective care, causing a problem for patients with chronic illnesses such as epilepsy. Here, we report the experience of one clinic that converted its outpatient care from personal appointments to telemedicine services. METHODS Documentations of telephone contacts and telemedicine consultations at the Epilepsy Center Frankfurt Rhine-Main were recorded in detail between March and May 2020 and analyzed for acceptance, feasibility, and satisfaction of the conversion from personal to telemedicine appointments from both patients' and medical professionals' perspectives. RESULTS Telephone contacts for 272 patients (mean age: 38.7 years, range: 17-79 years, 55.5% female) were analyzed. Patient-rated medical needs were either very urgent (6.6%, n = 18), urgent (23.5%, n = 64), less urgent (29.8%, n = 81), or nonurgent (39.3%, n = 107). Outpatient service cancelations resulted in a lack of understanding (9.6%, n = 26) or anger and aggression (2.9%, n = 8) in a minority of patients, while 88.6% (n = 241) reacted with understanding, or relief (3.3%, n = 9). Telemedicine consultations rather than a postponed face-to-face visit were requested by 109 patients (40.1%), and these requests were significantly associated with subjective threat by SARS-CoV-2 (p = 0.004), urgent or very urgent medical needs (p = 0.004), and female gender (p = 0.024). Telemedicine satisfaction by patients and physicians was high. Overall, 9.2% (n = 10) of patients reported general supply problems due to SARS-CoV-2, and 28.4% (n = 31) reported epilepsy-specific problems, most frequently related to prescriptions, or supply problems for antiseizure drugs (ASDs; 22.9%, n = 25). CONCLUSION Understanding and acceptance of elective ambulatory visit cancelations and the conversion to telemedicine consultations was high during the coronavirus disease 2019 (COVID-19) lockdown. Patients who engaged in telemedicine consultations were highly satisfied, supporting the feasibility and potential of telemedicine during the COVID-19 pandemic and beyond.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Yunus Balcik
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Anna H Noda
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Kai Siebenbrodt
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Sina Leimeister
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jeannie McCoy
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ricardo Kienitz
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Makoto Kiyose
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Raphael Reinecke
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jan-Hendrik Schäfer
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Johann Philipp Zöllner
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Sebastian Bauer
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany.
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Nishida T, Kawai K, Tachimori H. Risks of seizure with fatal traffic crash at wheel in people with epilepsy. Seizure 2020; 76:110-115. [PMID: 32062321 DOI: 10.1016/j.seizure.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The Japanese authorities require a 2-year seizure-free period for a driver's license in people with epilepsy. To evaluate the stringency of the criteria, we calculated the risk of fatal traffic crashes by epileptic seizure and compared that to the risk of fatal traffic crashes among the general population. METHODS Nation-wide questionnaire surveys to physicians and their patients with epilepsy were conducted to determine the rate of seizure recurrence after given seizure-free periods, average driving time and the rate of traffic crashes by epileptic seizures. The risk of fatal traffic crashes by epileptic seizures was calculated using the method proposed by the Driving License Committee of the EU. The risk of fatal traffic crashes among subgroups of the general population was calculated using the national statistics available. RESULTS Valid answers were obtained from a total of 548 patients of 138 epilepsy-specialists and 102 non epilepsy-specialist physicians. The relative risks of fatal traffic crashes in people with epilepsy with 1-year and 2-year seizure-free periods were 1.22 and 1.15, compared to the general population, while the ones in males in their twenties, people aged 60 and over, people aged 65 and over, and people aged 75 and over among the general population were 1.71, 1.31, 1.52 and 2.69, respectively. CONCLUSION The risk of fatal traffic crashes in people with epilepsy for 1-year and 2-year seizure-free periods was estimated to be lower than that of some age groups in the general population. The increased risk in 1-year seizure freedom from that in 2-year seizure freedom was relatively small.
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Affiliation(s)
- Takuji Nishida
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, 886 Urushiyama, Aoi-ku, Shizuoka 420-8688, Japan
| | - Kensuke Kawai
- Epilepsy Center and Department of Neurosurgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
| | - Hisateru Tachimori
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8553, Japan
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Facilitating ethical, legal, and professional deliberations to resolve dilemmas in daily healthcare practice: A case of driver with breakthrough seizures. Epilepsy Behav 2020; 102:106703. [PMID: 31786471 DOI: 10.1016/j.yebeh.2019.106703] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The present study was conducted among pharmacy students to use an 8-step systematic approach to facilitate discussions, deliberations, and decision-making on what to do when facing a dilemma of a patient with epilepsy who drives while having breakthrough seizures. METHODS A hypothetical case was developed using the 12-tips for developing dilemma case-based assessments in health education. A mixed method was used in this study. A serial group discussions based on the nominal group technique (NGT) method were applied. A thorough review of the literature and interviews with key experts in the domain (n = 12) were conducted to obtain pertinent data to inform discussions, deliberations, and decision-making. The analytic hierarchy process (AHP) was used to pairwise compare countervailing arguments and alternative courses of action. RESULTS In this study, 3 nominal groups were held, and for each 3, discussion rounds were conducted. A total of 27 panelists took part in the nominal groups. Compared with other alternative courses of action, significantly higher weight scores (p-value < 0.001) were given to the course action, "the pharmacist could counsel/educate the patient on the dangers/risks of driving while experiencing breakthrough seizures, inform the patient to refrain from driving in this period, and make a shared decision with the patient to refrain from driving in this period and inform the state authorities". CONCLUSION This study demonstrates that the 8-step approach when combined with the AHP can be a handy method in facilitating decision-making while addressing and resolving ethical/legal/professional dilemmas in daily healthcare practice.
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Algahtani H, Shirah B, Algahtani R, Algahtani R. Epilepsy and driving: Local experience from Saudi Arabia. Epilepsy Behav 2019; 99:106401. [PMID: 31454705 DOI: 10.1016/j.yebeh.2019.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/29/2019] [Accepted: 07/03/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The issue of epilepsy and driving has legal, social, and psychological implications. Many countries in the world restrict driving to people prone to epilepsy. There is no data from Saudi Arabia regarding the prevalence of driving among patients with epilepsy and their driving practices. In addition, to the best of our knowledge, there are no local laws or guidelines concerning driving for patients with epilepsy in Saudi Arabia. This study aimed to determine the prevalence of driving among male patients with epilepsy at King Abdulaziz Medical City in Jeddah, Saudi Arabia and determine the barriers and difficulties that they are suffering from especially when it comes to driving. METHODS This is a cross-sectional study that was conducted between July 2017 and June 2018 at King Abdulaziz Medical City in Jeddah, Saudi Arabia. The inclusion criteria of this study were male patients with epilepsy 18 years of age or above. The exclusion criteria were female patients at any age (since they were not allowed to drive at the time of the study) and male patients less than 18 years of age. This study utilized a self-made self-administered 25-item questionnaire. RESULTS A total of 182 surveys were distributed, and 164 individuals completed the survey (90.1% response rate). Most of the participants have a driving license (95.7%) and drive a car (98.8%). Almost all participants (99.4%) mentioned that nobody asked them whether they have epilepsy or not when issuing a driver's license. In addition, 94.5% were never told not to drive after the diagnosis of epilepsy. Regarding restrictions to driving, 98.7% reported that they drive at all times without any restrictions, and 92.7% reported that they drive both inside and outside the city. CONCLUSION This study showed that the number of male patients with epilepsy driving cars was extremely high, accounting for almost all the patients in this study, with most of them doing several wrong practices during driving. Other major issues include the lack of specific laws regulating driving for patients with epilepsy and no counseling from physicians about driving after the diagnosis of epilepsy. We recommend developing the Saudi driving regulations for patients with epilepsy, and this study is considered an urgent call for action for the formation of a local driving regulations taskforce. Health education about the risk of driving should be disseminated, especially for patients with uncontrolled epilepsy.
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Affiliation(s)
- Hussein Algahtani
- King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
| | - Bader Shirah
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Raneem Algahtani
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Raghad Algahtani
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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Willems LM, Kondziela JM, Knake S, Schulz J, Neif B, Schade B, Gerlinger S, Neubauer BA, Brunst B, Schubert-Bast S, Fuchs S, Staab-Kupke H, Kniess T, Rosenow F, Strzelczyk A. Counseling and social work for people with epilepsy in Germany: A cross-sectional multicenter study on demand, frequent content, patient satisfaction, and burden-of-disease. Epilepsy Behav 2019; 92:114-120. [PMID: 30654230 DOI: 10.1016/j.yebeh.2018.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 12/06/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The diagnosis of epilepsy is accompanied by relevant personal, interpersonal, and professional restrictions for patients and their caregivers. Specialized epilepsy counseling services (ECS) have been introduced to inform, advise, and support patients with disease-related problems. AIM AND SCOPE The objective of this cross-sectional, multicenter study was to determine the demand, typical content, and outcomes of ECS in children, adolescents, and adults in two adjacent German regions of Hessen and Lower Franconia. All ECS sites in these regions participated in 2014 and 2015, offering a total population of 7.5 million inhabitants. RESULTS A total number of 435 patients [323 adults (74.3%), 51.7% female, mean age: 40.3 ± 14.7 years and 112 children/adolescents (25.7%), 52.7% female, mean age: 9.4 ± 4.6 years] were enrolled at six ECS sites. The most common reasons for counseling were general information needs (n = 304; 69.9%), administrative help (n = 208; 47.8%), problems with education or work (n = 176; 40.5%), and recreational activities (n = 119; 27.3%). In addition, 6.2% reported epilepsy-related questions on family planning as a specific reason for desiring counseling. Recommendation by the treating physicians was the most frequent reason for receiving counseling through ECS (62.5%), and most patients preferred to receive a personal consultation (73.1%). Patient satisfaction as measured by the ZUF-8 client satisfaction score was high with a mean of 29.7 points (standard deviation: ±2.7 points, median: 29.9 points), and 83.9% of patients said they would recommend ECS. Disease-related job loss or change in school was avoided in 72% of 82 patients. Suggestions for improvement of ECS included an extension of service hours (58.6%) and a better availability of more sites located nearby (32.8%). CONCLUSION Epilepsy counseling services are necessary, valued, and effective institutions for people with epilepsy complementing outpatient and inpatient care. To improve the care for people with epilepsy, access to and availability of ECS should be improved.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Jacqueline M Kondziela
- Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Susanne Knake
- Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Juliane Schulz
- Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Birgit Neif
- Department of Neurology, Hephata-Klinik, Schwalmstadt-Treysa, Germany
| | - Bernd Schade
- Department of Neurology, Hephata-Klinik, Schwalmstadt-Treysa, Germany
| | - Stefan Gerlinger
- Department of Pediatric Neurology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Bernd A Neubauer
- Department of Pediatric Neurology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Bernhard Brunst
- Epilepsy Counseling Diakonisches Werk Hochtaunus, Frankfurt am Main, Germany
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany; Department of Neuropediatrics, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Simone Fuchs
- Epilepsy Counseling Unterfranken, Stiftung Juliusspital, Würzburg, Germany
| | | | - Tobias Kniess
- Department of Neurology, Campus Rhön Klinikum AG, Bad Neustadt a.d. Saale, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany; Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany.
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Rosenow F, Strzelczyk A. Individualized epilepsy management: Medicines, surgery, and beyond. Epilepsy Behav 2019; 91:1-3. [PMID: 30482732 DOI: 10.1016/j.yebeh.2018.09.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 09/27/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany; Center for Personalized Translational Epilepsy Research (CePTER) Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany; Center for Personalized Translational Epilepsy Research (CePTER) Goethe-University Frankfurt, Frankfurt am Main, Germany.
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Kondziela JM, Schulz J, Brunst B, Fuchs S, Gerlinger S, Neif B, Staab-Kupke H, Vasileiadis S, Brodisch P, Knake S, Kniess T, Schade B, Neubauer BA, Rosenow F, Schubert-Bast S, Strzelczyk A, Willems LM. [Acceptance, demand, reasons for consultation and outcome of counseling on epilepsy in Hesse and Lower Franconia]. DER NERVENARZT 2019; 90:832-839. [PMID: 30694366 DOI: 10.1007/s00115-019-0676-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM The diagnosis of epilepsy is often accompanied by relevant restrictions for patients, which may result in disease-specific daily problems that need targeted and professional counseling. Specialized epilepsy counseling services (ECS) were introduced in some German states since 1996 to provide an additional and independent service for epilepsy-related problems. The objective of this prospective, multicenter cohort study at six ECS was to determine and analyze the acceptance, demand and frequent reasons for consultation in Hesse and Lower Franconia. RESULTS A total of 435 clients were enrolled during the 12-month observation period (June 2014-May 2015) of which 74.3% were adults (n = 323, mean age 40.3 ± 14.7 years, range 18-76 years, 51.7% female) and 25.7% children and adolescents (n = 112, mean age 9.4 ± 4.8 years, range 1-17 years, 52.7% female). The mean number of outpatient consultations per year was 2.5 (median 2.0, SD ± 2.8, range 1-20), whereby a general counseling on dealing with epilepsy (adults 55.7%, children and adolescents 51.8%), clarification and information about the disease (43.7% and 41.1%, respectively) and assistance in applying for support (39.0% and 46.4%, respectively) were the most frequent issues. The distance from the place of residence to the ECS was significantly shorter in Lower Franconia compared to Hesse (p < 0.002). Client satisfaction was high with a mean patient satisfaction questionnaire (ZUF-8) score of 29.0 (maximum score 32). Overall 96.4% of the clients rated the quality of counseling as good or very good and 96.6% would consider consulting the ECS again in case of new problems. In cases of threatened workplace, training position or situation at school, counseling helped to avoid negative consequences in 72.0% of cases. CONCLUSION The ECS are frequently used, appreciated and effective institutions for adults and children with epilepsy as well as for their caregivers. The ECS complements the existing comprehensive specialized outpatient and inpatient care for epilepsy in Germany; however, in view of their limited numbers and inhomogeneous allocation, the number and the availability of ECS should be expanded on the national level.
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Affiliation(s)
- Jacqueline M Kondziela
- Epilepsiezentrum Hessen und Klinik für Neurologie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Juliane Schulz
- Epilepsiezentrum Hessen und Klinik für Neurologie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Bernhard Brunst
- Epilepsieberatung Diakonisches Werk Hochtaunus, Frankfurt am Main, Deutschland
| | - Simone Fuchs
- Epilepsieberatung Unterfranken, Stiftung Juliusspital, Würzburg, Deutschland
| | - Stefan Gerlinger
- Abteilung für Kinderneurologie und Sozialpädiatrie, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - Birgit Neif
- Klinik für Neurologie, Hephata-Klinik, Schwalmstadt-Treysa, Deutschland
| | - Henrike Staab-Kupke
- Epilepsieberatung Unterfranken, Stiftung Juliusspital, Würzburg, Deutschland
| | - Silke Vasileiadis
- Epilepsiezentrum Hessen und Klinik für Neurologie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Peter Brodisch
- Epilepsieberatung, Innere Mission München, Diakonie in München und Oberbayern e. V., München, Deutschland
| | - Susanne Knake
- Epilepsiezentrum Hessen und Klinik für Neurologie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Tobias Kniess
- Klinik für Neurologie, Campus Rhön Klinikum AG, Bad Neustadt a.d. Saale, Deutschland
| | - Bernd Schade
- Klinik für Neurologie, Hephata-Klinik, Schwalmstadt-Treysa, Deutschland
| | - Bernd A Neubauer
- Abteilung für Kinderneurologie und Sozialpädiatrie, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - Felix Rosenow
- Epilepsiezentrum Frankfurt Rhein-Main, Zentrum der Neurologie und Neurochirurgie, Goethe-Universität Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Deutschland
| | - Susanne Schubert-Bast
- Epilepsiezentrum Frankfurt Rhein-Main, Zentrum der Neurologie und Neurochirurgie, Goethe-Universität Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Deutschland.,Schwerpunkt Neurologie, Neurometabolik, und Prävention der Klinik für Kinder- und Jugendmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Adam Strzelczyk
- Epilepsiezentrum Hessen und Klinik für Neurologie, Philipps-Universität Marburg, Marburg, Deutschland. .,Epilepsiezentrum Frankfurt Rhein-Main, Zentrum der Neurologie und Neurochirurgie, Goethe-Universität Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Deutschland.
| | - Laurent M Willems
- Epilepsiezentrum Frankfurt Rhein-Main, Zentrum der Neurologie und Neurochirurgie, Goethe-Universität Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Deutschland
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Prevalence, risk factors and therapeutic aspects of injuries and accidents in women with epilepsy. Eur J Trauma Emerg Surg 2018; 45:375-381. [DOI: 10.1007/s00068-018-1030-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 10/08/2018] [Indexed: 11/26/2022]
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Willems LM, Kay L, Rosenow F, Strzelczyk A. Krankheitskosten und Outcome: Versorgungsrealität des Status epilepticus. ZEITSCHRIFT FUR EPILEPTOLOGIE 2018. [DOI: 10.1007/s10309-018-0205-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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