Pediatric epilepsy surgery patients show normal psychosocial development at long-term follow-up despite dissatisfying family dynamics

WeChat-based remote follow-up management reduces the burden of home care and anxiety on parents of children with refractory epilepsy: A randomized controlled study

OBJECTIVE

The present research was designed to study the effect of WeChat-based remote follow-up management on the burden of home care and anxiety on parents of children with refractory epilepsy.

METHODS

161 refractory epileptic children were included in this study. They were divided into control group and WeChat group according to their management protocols after discharge, namely, control group with traditional follow-up (n = 81) and WeChat group with remote follow-up based on WeChat (n = 81). We evaluated home care burden by family caregiver task Inventory (FCTI) scale and zarit burden interview (ZBI) scale, and evaluated negative emotion by self-rating anxiety Scale (SAS) scale and self-Rating depression scale (SDS) scale.

RESULTS

There was no significant difference in the demographic characteristics of epileptic children and their parents and the scores of FCTI, ZBI, SAS and SDS before treatment between the 2 groups (all P > .05), and the score of FCTI (20.86 ± 4.26), ZBI (39.63 ± 4.46), SAS (44.49 ± 4.15) and SDS (50.02 ± 4.13) in WeChat group were all significantly lower than the score of FCTI (25.25 ± 3.71), ZBI (45.47 ± 4.61), SAS (52.75 ± 4.93) and SDS (54.51 ± 6.59) in control group (all P < .05).

CONCLUSION

WeChat-based remote follow-up management reduces the burden of home care and anxiety on parents of children with refractory epilepsy.

Recent advances in epilepsy surgery

PURPOSE OF REVIEW

Technological innovations in the preoperative evaluation, surgical techniques and outcome prediction in epilepsy surgery have grown exponentially over the last decade. This review highlights and emphasizes relevant updates in techniques and diagnostic tools, discussing their context within standard practice at comprehensive epilepsy centres.

RECENT FINDINGS

High-resolution structural imaging has set an unprecedented opportunity to detect previously unrecognized subtle abnormalities. Machine learning and computer science are impacting the methodologies to analyse presurgical and surgical outcome data, building more accurate prediction models to tailor treatment strategies. Robotic-assisted placement of depth electrodes has increased the safety and ability to sample epileptogenic nodes within deep structures, improving our understanding of the seizure networks in drug-resistant epilepsy. The current available minimally invasive techniques are reasonable surgical alternatives to ablate or disrupt epileptogenic regions, although their sustained efficacy is still an active area of research.

SUMMARY

Epilepsy surgery is still underutilized worldwide. Every patient who continues with seizures despite adequate trials of two well selected and tolerated antiseizure medications should be evaluated for surgical candidacy. Collaboration between academic epilepsy centres is of paramount importance to answer long-standing questions in epilepsy surgery regarding the understanding of spatio-temporal dynamics in epileptogenic networks and its impact on surgical outcomes.

Timing of referral to evaluate for epilepsy surgery: Expert Consensus Recommendations from the Surgical Therapies Commission of the International League Against Epilepsy

Epilepsy surgery is the treatment of choice for patients with drug-resistant seizures. A timely evaluation for surgical candidacy can be life-saving for patients who are identified as appropriate surgical candidates, and may also enhance the care of nonsurgical candidates through improvement in diagnosis, optimization of therapy, and treatment of comorbidities. Yet, referral for surgical evaluations is often delayed while palliative options are pursued, with significant adverse consequences due to increased morbidity and mortality associated with intractable epilepsy. The Surgical Therapies Commission of the International League Against Epilepsy (ILAE) sought to address these clinical gaps and clarify when to initiate a surgical evaluation. We conducted a Delphi consensus process with 61 epileptologists, epilepsy neurosurgeons, neurologists, neuropsychiatrists, and neuropsychologists with a median of 22 years in practice, from 28 countries in all six ILAE world regions. After three rounds of Delphi surveys, evaluating 51 unique scenarios, we reached the following Expert Consensus Recommendations: (1) Referral for a surgical evaluation should be offered to every patient with drug-resistant epilepsy (up to 70 years of age), as soon as drug resistance is ascertained, regardless of epilepsy duration, sex, socioeconomic status, seizure type, epilepsy type (including epileptic encephalopathies), localization, and comorbidities (including severe psychiatric comorbidity like psychogenic nonepileptic seizures [PNES] or substance abuse) if patients are cooperative with management; (2) A surgical referral should be considered for older patients with drug-resistant epilepsy who have no surgical contraindication, and for patients (adults and children) who are seizure-free on 1-2 antiseizure medications (ASMs) but have a brain lesion in noneloquent cortex; and (3) referral for surgery should not be offered to patients with active substance abuse who are noncooperative with management. We present the Delphi consensus results leading up to these Expert Consensus Recommendations and discuss the data supporting our conclusions. High level evidence will be required to permit creation of clinical practice guidelines.

Changes in caregiver depression, anxiety, and satisfaction with family relationships in families of children who did and did not undergo resective epilepsy surgery

OBJECTIVE

To evaluate longitudinal changes in caregiver depression, anxiety, and family relationships following resective surgery for pediatric drug-resistant epilepsy (DRE).

METHODS

This multicenter cohort study involved 177 caregivers of children with DRE aged 4-18 years (63 surgical and 114 nonsurgical). Caregivers completed measures of depression (Quick Inventory of Depressive Symptomatology), anxiety (Generalized Anxiety Disorder 7-item scale), and satisfaction with family relationships (Family Adaptability, Partnership, Growth, Affective, and Resolve scale) at baseline, 6 months, and 1 year. Additional data collected at baseline included child, caregiver, and family sociodemographic and clinical factors as well as family environment (demands and resources).

RESULTS

At 1 year, 64% and 27% of surgical and nonsurgical patients were seizure-free, respectively. Linear mixed-effects models found a reduction in caregiver depression (b = -0.85, P = .004) and anxiety (b = -1.09, P = .003), but not family satisfaction (b = 0.18, P = .31) over time. There was no effect of treatment. When seizure outcome was added to the model, seizure freedom was associated with fewer depressive symptoms (b = -1.15, P = .005) and greater family satisfaction (b = 0.65, P = .006), but not anxiety (b = -0.41, P = .42). A greater proportion of caregivers of patients who achieved seizure freedom (32%) versus continued seizures (18%) reported clinically meaningful improvement in depression at 1 year (P = .03). Lower baseline depression (β = 0.42, P < .001), greater family resources (β = -0.18, P = .04), and male caregiver (β = 0.15, P = .02) predicted lower caregiver depression, and lower baseline anxiety (β = 0.47, P < .001), greater family resources (β = -0.24, P = .01), and higher education (β = -0.13, P = .04) predicted lower caregiver anxiety at 1 year. Baseline functioning was the only predictor of family relationships at 1 year (β = 0.49, P < .001).

SIGNIFICANCE

Caregivers of children who achieved seizure freedom, irrespective of surgical treatment, report fewer depressive symptoms and greater satisfaction with family relationships. Baseline functioning is the strongest predictor of outcome; however, caregivers of families with fewer resources and supports are also at risk of poor psychosocial outcomes.