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Jhanji K, Shivji Z, Lazaj M, Lomax LB, Winston GP, Shukla G. Quality of life and cannabis use among patients with drug-resistant epilepsy-An observational study from a Canadian tertiary care referral center. Epileptic Disord 2024. [PMID: 39235763 DOI: 10.1002/epd2.20276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 08/13/2024] [Accepted: 08/25/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVE Very few publications have reported the impact of artisanal cannabis use on overall quality of life among people with drug-resistant epilepsy. This study aimed to evaluate the association of artisanal cannabis use among adults with drug-resistant epilepsy with quality of life, and to determine if an association exists between Quality-of-Life in Epilepsy Inventory-31 (QOLIE-31) 'T scores' and different clinical variables. METHODS This study included patients admitted to a Canadian tertiary care epilepsy center as part of a larger study. These patients were confirmed to have drug-resistant epilepsy by an epileptologist at the Ambulatory Epilepsy Clinic. Patients were categorized into cannabis users (CAN group) (n = 25) and Non-cannabis users (Non-CAN group) (n = 21). Data was collected on RedCap® for epilepsy and cannabis use details. These were analyzed for an association using a binary multivariable logistic regression model between QOLIE-31 'T scores' and age, sex, epilepsy duration, age at initiation of use, duration of cannabis use and psychiatric related comorbidity for all patients. Additionally, different 'T subscores' of the questionnaire were compared between the CAN group and Non-CAN group. RESULTS A statistically significant difference between the CAN group and Non-CAN group for the T subscore 'energy and fatigue' (p = .004) was found, with the CAN group scoring higher. However, for the 'overall T score' between the two groups there was no statically significant difference (p = .11). Additionally, a significant negative correlation between 'overall T score' and cannabis use disorder (p = .032) was found. SIGNIFICANCE This study provides new data on association of quality of life in epilepsy with cannabis use and can serve as a foundation for larger future studies to better assess this association.
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Affiliation(s)
- Kanika Jhanji
- Division of Neurology, Department of Medicine, Queen's University and Kingston Health Sciences Center, Kingston, Ontario, Canada
| | - Zaitoon Shivji
- Division of Neurology, Department of Medicine, Queen's University and Kingston Health Sciences Center, Kingston, Ontario, Canada
| | - Marion Lazaj
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Lysa Boisse Lomax
- Division of Neurology, Department of Medicine, Queen's University and Kingston Health Sciences Center, Kingston, Ontario, Canada
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Gavin P Winston
- Division of Neurology, Department of Medicine, Queen's University and Kingston Health Sciences Center, Kingston, Ontario, Canada
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Garima Shukla
- Division of Neurology, Department of Medicine, Queen's University and Kingston Health Sciences Center, Kingston, Ontario, Canada
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
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Ortiz de Zarate Z, Fonseca E, Abraira L, Santamarina E, Campos-Fernández D, Quintana M, Sánchez J, Goméz-Andrés D, Sala J, Raspall M, Felipe-Rucián A, Del Toro M, Macaya A, Toledo M. EPITRANS. Quality assessment of the epilepsy transition process. Eur J Paediatr Neurol 2024; 48:121-128. [PMID: 38241904 DOI: 10.1016/j.ejpn.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/14/2023] [Accepted: 01/11/2024] [Indexed: 01/21/2024]
Abstract
OBJECTIVE To analyze the differences in clinical management during the epilepsy transition process from pediatric to adult care and to determine the quality of life and degree of satisfaction of patients and caregivers during the transition. METHODS This is a longitudinal study including patients with epilepsy transferred from pediatric to adult epilepsy care between 2013 and 2017. Patients had a minimum follow-up of 3 years before the transition visit and at least 3 years consulting in the adults section. Clinical characteristics were retrieved from the medical chart. Quality of life and satisfaction questionnaires were administered by online access to patients and caregivers at the end of the adult follow-up period. RESULTS 99 patients (50.5 % women, mean transition age 16.5 ± 1 years old) were included. Before the transition visit, 90 % of patients received a transition discussion and 88 % had a formal clinical report. In the pediatric period, patients were visited more frequently, had more EEGs and genetic studies, and were seen by the same neuropediatrician (P<0.05). In the adult period, patients underwent a larger number of prolonged video EEGs and were prescribed polytherapy more often (P<0.05). Quality of life remained steady during the entire transition, but satisfaction with the care received was significantly higher during the pediatric period. CONCLUSIONS Significant differences were seen in epilepsy care during transition from pediatric to adult management, and this had an impact on the degree of satisfaction reported by patients and caregivers. Our results provide evidence of the potential value of development and early implementation of a protocolled transition program.
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Affiliation(s)
- Z Ortiz de Zarate
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain; Department of Pediatric Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - E Fonseca
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain; Research Group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Spain.
| | - L Abraira
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain; Research Group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Spain
| | - E Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain; Research Group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Spain
| | - D Campos-Fernández
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain; Research Group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Spain
| | - M Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain; Research Group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Spain
| | - J Sánchez
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain; Research Group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Spain
| | - D Goméz-Andrés
- Department of Pediatric Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - J Sala
- Department of Pediatric Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - M Raspall
- Department of Pediatric Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - A Felipe-Rucián
- Department of Pediatric Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - M Del Toro
- Department of Pediatric Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - A Macaya
- Department of Pediatric Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - M Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain; Research Group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Spain
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Tanveer M, Tahir AH, Iqbal M, Aslam F, Ahmed A. Health-related quality of life and medication adherence of people living with epilepsy in Pakistan: A cross-sectional study. Brain Behav 2023; 13:e3127. [PMID: 37515419 PMCID: PMC10498081 DOI: 10.1002/brb3.3127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/05/2023] [Accepted: 06/06/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION The primary purpose of this study was to determine adherence and health-related quality of life (HRQoL) in PWE. Secondary aims were to assess association between adherence and HRQoL and determine predictors of HRQoL in PWE in Pakistan. METHODS A descriptive cross-sectional study was conducted among PWE receiving treatment from two tertiary care hospitals of Pakistan. The HRQoL and adherence were assessed with Urdu versions of Quality of Life in Epilepsy-31 (QOLIE-31), and Medication Adherence Rating Scale (MARS). Relationship between HRQoL and adherence was assessed by Pearson's product-moment correlation coefficient. Forced entry multiple linear models were used to determine relationship of independent variables with HRQoL. RESULTS 219 PWE with a mean (±standard deviation) age, 34.18 (± 13.710) years, participated in this study. The overall weighted mean HRQoL score was (51.60 ± 17.10), and mean score for adherence was 6.17 (± 2.31). There was significant association between adherence and HRQoL in PWE (Pearson's correlation = 0.820-0.930; p ≤ .0001). Multiple linear regression found adherence (B = 16.8; p ≤ .0001), male gender (B = 10.0; p = .001), employment status (employed: B = 7.50; p = .030), level of education (Tertiary: B = 0.910; p = .010), duration of epilepsy (>10 years: B = -0.700; p ≤ .0001), and age (≥46 years: B = -0.680; p ≤ .0001), and ASM therapy (polypharmacy: B = 0.430; p = .010) as independent predictors of HRQoL in PWE from Pakistan. CONCLUSIONS The findings suggest PWE from our center have suboptimal adherence which affects HRQoL. Independent factors such as male gender, employment status and duration of epilepsy are predictors of HRQoL.
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Affiliation(s)
- Maria Tanveer
- Department of PharmacyQuaid‐I‐Azam UniversityIslamabadPakistan
| | - Azhar Hussain Tahir
- Department of PharmacyQuaid‐I‐Azam UniversityIslamabadPakistan
- Primary and Secondary Healthcare DepartmentGovernment of PunjabLahorePakistan
| | - Mansoor Iqbal
- Neurology DepartmentPakistan Institute of Medical Sciences (PIMS)IslamabadPakistan
| | - Faiza Aslam
- Department of PsychiatryRawalpindi Medical UniversityRawalpindiPakistan
| | - Ali Ahmed
- Department of PharmacyQuaid‐I‐Azam UniversityIslamabadPakistan
- Riphah Institute of Pharmaceutical SciencesRiphah International UniversityIslamabadPakistan
- Monash University Health Economics Group (MUHEG)School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
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He X, Yang Y, Yuan X, Sun Y, Li Y. Chemical composition and anticonvulsant activities of herb pair of Gastrodia elata Blume-Acorus tatarinowii Schott decoction on experimentally induced seizures in mice. Metab Brain Dis 2023; 38:1877-1893. [PMID: 37043151 DOI: 10.1007/s11011-023-01211-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/02/2023] [Indexed: 04/13/2023]
Abstract
Epilepsy is a serious public health problem in the world. At present, over 30% of affected patients remain refractory to currently available treatment. Medicinal plants as pharmaceuticals and healthcare treatments have been frequently used in the management of epilepsy in China for many centuries. Gastrodia elata-Acous tatarinowii (GEAT), as a classic and most commonly used herb pair in traditional Chinese medicine (TCM), has been employed to control seizures for thousands of years. However, the animal experiment data on its anticonvulsant effect is limited in the literature. Thus, this study aimed to reveal the therapeutic actions of GEAT decoction against seizures in mice. UHPLC-MS/MS was performed to analyze the chemical components of GEAT decoction. The mice were given GEAT decoction for 7 days, and MES, PTZ, and 3-MP injection was given 30 min after the last administration. Video monitoring was performed for comparisons. In addition, the PTZ-induced kindling models were conducted to investigate the seizure severity, anxiety and cognitive profile, inflammation, and oxidative stress parameters in mice. The results showed that GEAT decoction dose-dependently protected mice against MES, 3-MP, and PTZ-induced acute seizures. Furthermore, GEAT decoction significantly ameliorated seizure severity, decreased the accumulation of inflammatory mediators TNF-α, IL-1β, and IL-6, mitigated oxidative stress, as well as alleviated anxious-like behavior and cognitive deficits in PTZ-kindled mice. These results suggest that GEAT decoction possesses certain anticonvulsant properties, which might be clinically useful as phytotherapy alone or as an adjunct therapy for the prevention and treatment of seizures and epilepsy.
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Affiliation(s)
- Xirui He
- College of Bioengineering, Zhuhai Campus of Zunyi Medical University, Zhuhai, Guangdong, 519041, People's Republic of China.
| | - Yan Yang
- College of Bioengineering, Zhuhai Campus of Zunyi Medical University, Zhuhai, Guangdong, 519041, People's Republic of China
| | - Xufang Yuan
- College of Bioengineering, Zhuhai Campus of Zunyi Medical University, Zhuhai, Guangdong, 519041, People's Republic of China
| | - Yin Sun
- Key Laboratory of Resource Biology and Biotechnology in Western China (Northwest University), Ministry of Education, Xi'an, Shaanxi, 710169, People's Republic of China
| | - Yongsheng Li
- Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, People's Republic of China.
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Sullivan-Baca E, Rehman R, Towne AR, Haneef Z. Psychiatric co-morbidity of drug-resistant epilepsy in Veterans. Epilepsy Behav 2023; 139:109059. [PMID: 36577335 DOI: 10.1016/j.yebeh.2022.109059] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/24/2022] [Accepted: 12/09/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Psychiatric conditions are frequently co-morbid in epilepsy and studies examining Veterans with epilepsy suggest this population may present with unique psychiatric and clinical features Drug-resistant epilepsy (DRE) may confer a greater risk of psychiatric dysfunction; however, there is a paucity of literature documenting this. To expand our clinical understanding of Veterans with DRE, we assessed a comprehensive Veterans Health Administration (VHA)-wide sample, describing psychiatric conditions, medications, and healthcare utilization. METHODS Psychiatric and hospitalization data were collected on 52,579 Veterans enrolled in VHA healthcare between FY2014-2ndQtr.FY2020 from the VHA Corporate Data Warehouse administrative data. Data examined include psychiatric diagnosis, psychotropic medication use, and utilization of hospital services. RESULTS At least one psychiatric diagnosis was present in 70.2% of patients, while 49.8% had two or more diagnoses. Depression (51.7%), posttraumatic stress disorder (PTSD) (38.8%), and anxiety (38.0%) represented the most common psychiatric co-morbidities. Psychiatric medication use was present in 73.3%. Emergency room (ER) visits were highest in those with suicidality (mean 14.9 visits), followed by bipolar disorder (10.3), and schizophrenia (12.1). Psychiatric-related hospitalizations were highest for schizophrenia (mean 2.5 admissions) and bipolar disorder (2.3). Females had more psychiatric diagnoses (2.4 vs. 1.6, p < 0.001), psychiatric medications (3.4 vs. 2.3, p < 0.001), and ER utilization than males (6.9 vs. 5.5, p < 0.001). SIGNIFICANCE A substantial psychiatric burden exists among Veterans with DRE. Compared to prior epilepsy literature, results suggest that Veterans with DRE evidence more prevalent psychiatric comorbidity, emergency care usage, and inpatient psychiatric admissions. Females were especially impacted, with greater rates of psychiatric conditions and treatment. Considering the relationship of psychiatric comorbidities in epilepsy with psychosocial functioning and quality of life, our findings highlight the need for screening and provision of services for those with DRE.
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Affiliation(s)
- Erin Sullivan-Baca
- Department of Neurology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States.
| | - Rizwana Rehman
- Durham VA Medical Center, 508 Fulton St., Durham, NC 27705, United States; Epilepsy Centers of Excellence, Veteran's Health Administration, United States.
| | - Alan R Towne
- Epilepsy Centers of Excellence, Veteran's Health Administration, United States; Department of Neurology, Virginia Commonwealth University School of Medicine, Richmond, VA, United States; Epilepsy Centers of Excellence, Hunter Holmes McGuire VA Medical Center, United States.
| | - Zulfi Haneef
- Department of Neurology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States; Epilepsy Centers of Excellence, Veteran's Health Administration, United States; Neurology Care Line, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, United States.
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Mecarelli O, Di Gennaro G, Vigevano F. Unmet needs and perspectives in management of drug resistant focal epilepsy: An Italian study. Epilepsy Behav 2022; 137:108950. [PMID: 36347069 DOI: 10.1016/j.yebeh.2022.108950] [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: 05/18/2022] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022]
Abstract
This study aimed to evaluate the consensus level between a representative group of Italian neurologists and people with Drug-Resistant Epilepsy (DRE) regarding a series of statements about different aspects involved in the management of epilepsy to identify the unmet needs of the People with Epilepsy (PwE) and the future perspectives for the management of this disease. This observational study was conducted using a classic Delphi technique. A 19-statement questionnaire was administered anonymously through an online platform to a panel of expert clinicians and a panel of PwE, analyzing three main topics of interest: drug resistance, access to care, and PwE's experience. The consensus was achieved on 8 of the 19 statements administered to the panel of medical experts and on 4 of the 14 submitted to the panel of PwE, particularly on the definition of DRE and its consequences on treatment, Quality of Life (QoL), and autonomy of PwE. Most of the items, however, did not reach a consensus and highlighted the lack of a shared univocal view on some topics, such as accessibility to care throughout the country and the role of emerging tools such as telemedicine, narrative medicine, and digital devices. In many cases, the two panels expressed different views on the statements. The results outlined many fields of possible intervention, such as the need for educational initiatives targeted at physicians and PwE - for example, regarding telemedicine, digital devices, and narrative medicine - as well as the spread of better knowledge about epilepsy among the general population, in order to reduce epilepsy stigma. Institutions, moreover, could take a cue from this survey to develop facilities aimed at enhancing PwE's autonomy and promoting more equal access to care throughout the country.
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Affiliation(s)
- Oriano Mecarelli
- Department of Human Neurosciences, Sapienza University, Rome and Past President of LICE, Italian League Against Epilepsy, Rome, Italy.
| | | | - Federico Vigevano
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network EpiCARE, Rome, Italy.
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Gugger JJ, Kennedy E, Panahi S, Tate DF, Roghani A, Van Cott AC, Lopez MR, Altalib H, Diaz-Arrastia R, Pugh MJ. Multimodal Quality of Life Assessment in Post-9/11 Veterans With Epilepsy: Impact of Drug Resistance, Traumatic Brain Injury, and Comorbidity. Neurology 2022; 98:e1761-e1770. [PMID: 35387856 PMCID: PMC9071370 DOI: 10.1212/wnl.0000000000200146] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/18/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Epilepsy is defined by the occurrence of multiple unprovoked seizures, but quality of life (QOL) in people with epilepsy is determined by multiple factors, in which psychiatric comorbidities play a pivotal role. Therefore, understanding the interplay between comorbidities and QOL across epilepsy phenotypes is an important step towards improved outcomes. Here, we report the impact of QOL across distinct epilepsy phenotypes in a cohort of post-9/11 veterans with high rates of traumatic brain injury (TBI). METHODS This observational cohort study from the Veterans Health Administration included post-9/11 Veterans with epilepsy. A process integrating an epilepsy identification algorithm, chart abstraction, and self-reported measures was used to classify patients into one of four groups: 1. Epilepsy controlled with medications, 2. Drug resistant epilepsy (DRE), 3. Post-traumatic epilepsy (PTE), or 4. Drug resistant post-traumatic epilepsy (PT-DRE). Summary scores for six QOL measures were compared across the groups, adjusting for age, sex, and number of comorbidities. RESULTS A total of 529 survey respondents with epilepsy were included in the analysis: 249 controls (i.e., epilepsy without DRE or PTE), 124 with DRE, 86 with PTE, and 70 with PT-DRE. Drug resistant epilepsy was more common in those with PTE compared with non-traumatic epilepsy (45% vs. 33%, odds ratio 1.6 (95% CI: [1.1-2.4], p=0.01)). Patients with PTE and PT-DRE had significantly more comorbid conditions in health records than those with nontraumatic epilepsy. Those with both PTE and DRE reported the lowest QOL across all six measures, and this persisted after adjustment for comorbidities, and in further linear analyses. DISCUSSION Among those with PTE, DRE prevalence was significantly higher than for non-traumatic epilepsies. PTE was also associated with higher burden of comorbidity, and worse overall QOL compared to those with non-traumatic epilepsies. People with PTE are distinctly vulnerable to the comorbidities associated with TBI and epilepsy. This at-risk group should be the focus of future studies aimed at elucidating the factors associated with adverse health outcomes and developing anti-epileptogenic therapies.
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Affiliation(s)
- James J Gugger
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
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Alanazi AM, Alenazi NSN, Alanazi HSK, Almadhari SAF, Almadani HAM. Status Epilepticus in Pediatric Patients in Saudi Arabia: A Systematic Review. ARCHIVES OF PHARMACY PRACTICE 2022. [DOI: 10.51847/tol3efkk8d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Gonzalez‐Martinez A, Planchuelo‐Gómez Á, Vieira Campos A, Martínez‐Dubarbie F, Vivancos J, De Toledo‐Heras M. Medium-term changes in patients with epilepsy during the COVID-19 pandemic. Acta Neurol Scand 2021; 144:450-459. [PMID: 34195984 DOI: 10.1111/ane.13481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/26/2021] [Accepted: 05/20/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The novel coronavirus disease (COVID-19) pandemic has led to social distancing measures and impaired medical care of chronic neurological diseases, including epilepsy, which may have adversely affected well-being and quality of life of patients with epilepsy (PWE). The objective of this study is to evaluate the impact of the COVID-19 pandemic in the levels of anxiety, depression, somnolence, and quality of life using validated scales in PWE in real-life clinical practice. MATERIALS & METHODS Self-administered scales of anxiety disorders (GAD-7), depression (NDDI-E), somnolence (Epworth Sleepiness Scale; ESS), and quality of life (QOLIE-31-P) in PWE treated in a Refractory Epilepsy Unit were longitudinally analyzed. Data were collected before the beginning (December 2019 - March 2020) and during the COVID-19 pandemic (September 2020-January 2021). RESULTS 158 patients (85 from the first round and 73 from the second round) 45.0 ± 17.3 years of age, 43.2% women, epilepsy duration 23.0 ± 14.9 years, number of antiepileptic drugs 2.1 ± 1.4, completed the survey. Significant longitudinal reduction of QOLIE-31-P (from 58.9 ± 19.7 to 56.2 ± 16.2, p = .035) and GAD-7 scores (from 8.8 ± 6.2 to 8.3 ± 5.9, corrected p = .024) was identified. No statistically significant longitudinal changes in the number of seizures (from 0.9 ± 1.9 to 2.5 ± 6.2, p = .125) or NDDI-E scores (from 12.3 ± 4.3 to 13.4 ± 4.4, p = .065) were found. Significant longitudinal increase of ESS (from 4.9 ± 3.7 to 7.4 ± 4.9, p = .001) was found. CONCLUSIONS During the COVID-19 pandemic, quality of life and anxiety levels were lower in PWE, and sleepiness levels were raised, without seizure change.
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Affiliation(s)
- Alicia Gonzalez‐Martinez
- Neurology Department Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria La Princesa Madrid Spain
| | | | - Alba Vieira Campos
- Epilepsy Unit Neurology Department Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria La Princesa Madrid Spain
| | | | - José Vivancos
- Neurology Department Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria La Princesa Madrid Spain
| | - María De Toledo‐Heras
- Epilepsy Unit Neurology Department Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria La Princesa Madrid Spain
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Avila EK. Antiepileptic drugs in patients with brain tumor-related epilepsy: The need for a community standard. Neurooncol Pract 2021; 8:499-500. [PMID: 34594565 PMCID: PMC8475228 DOI: 10.1093/nop/npab048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Edward K Avila
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Srikanth P, Vranda MN, Thomas PT, Raghvendra K. Quality of Life and Stigma among Women with Epilepsy during Their Reproductive Years. J Epilepsy Res 2021; 11:63-71. [PMID: 34395225 PMCID: PMC8357557 DOI: 10.14581/jer.21009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Purpose The purpose of this study was to understand the relationship between quality of life and stigma among reproductive age group women with epilepsy. Methods A cross-sectional descriptive study was conducted to assess the data from the 49 women with epilepsy from a tertiary care hospital in India. Quality of life was evaluated with the quality of life in epilepsy-31 questionnaire and stigma was evaluated with the stigma scale of epilepsy. Data also included socio-demographic and clinical characteristics. Results The mean age of the participants was 24.67±3.72 years. Quality of life total score (r=−0.485**) and seizure worry domain (r=−0.427**) were significantly negatively correlated with stigma total score at p<0.01 level. Being uneducated, married, unemployed, having children, having generalized tonic-clonic seizures, duration of illness (>10 years), and consuming levetiracetam, anti-epileptic drug (AED), were the significant contributing factors for low quality of life among women with epilepsy during the reproductive age group. Belonging to lower socio-economic status and taking more than two AEDs were also associated with lower quality of life among women with epilepsy, which are trending towards significance. Conclusions The study assessed the relationship between the quality of life and the Stigma scale of epilepsy and demonstrated the impact of stigma and quality of life on socio-demographic and clinical variables of women with epilepsy under the reproductive age group. To enhance the quality of life and reduce the stigma levels among women with epilepsy, some of the modifiable parameters can be considered by the multidisciplinary health care professionals from the findings of the current research.
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Hermann BP, Struck AF, Dabbs K, Seidenberg M, Jones JE. Behavioral phenotypes of temporal lobe epilepsy. Epilepsia Open 2021; 6:369-380. [PMID: 34033251 PMCID: PMC8166791 DOI: 10.1002/epi4.12488] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/21/2021] [Accepted: 03/28/2021] [Indexed: 12/17/2022] Open
Abstract
Objective To identity phenotypes of self‐reported symptoms of psychopathology and their correlates in patients with temporal lobe epilepsy (TLE). Method 96 patients with TLE and 82 controls were administered the Symptom Checklist 90‐Revised (SCL‐90‐R) to characterize emotional‐behavioral status. The nine symptom scales of the SCL‐90‐R were analyzed by unsupervised machine learning techniques to identify latent TLE groups. Identified clusters were contrasted to controls to characterize their association with sociodemographic, clinical epilepsy, neuropsychological, psychiatric, and neuroimaging factors. Results TLE patients as a group exhibited significantly higher (abnormal) scores across all SCL‐90‐R scales compared to controls. However, cluster analysis identified three latent groups: (1) unimpaired with no scale elevations compared to controls (Cluster 1, 42% of TLE patients), (2) mild‐to‐moderate symptomatology characterized by significant elevations across several SCL‐90‐R scales compared to controls (Cluster 2, 35% of TLE patients), and (3) marked symptomatology with significant elevations across all scales compared to controls and the other TLE phenotype groups (Cluster 3, 23% of TLE patients). There were significant associations between cluster membership and demographic (education), clinical epilepsy (perceived seizure severity, bitemporal lobe seizure onset), and neuropsychological status (intelligence, memory, executive function), but with minimal structural neuroimaging correlates. Concurrent validity of the behavioral phenotype grouping was demonstrated through association with psychiatric (current and lifetime‐to‐date DSM IV Axis 1 disorders and current treatment) and quality‐of‐life variables. Significance Symptoms of psychopathology in patients with TLE are characterized by a series of discrete phenotypes with accompanying sociodemographic, cognitive, and clinical correlates. Similar to cognition in TLE, machine learning approaches suggest a developing taxonomy of the comorbidities of epilepsy.
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Affiliation(s)
- Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Aaron F Struck
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Neurology, William S Middleton Veterans Administration Hospital, Madison, WI, USA
| | - Kevin Dabbs
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Mike Seidenberg
- Department of Psychology, Rosalind Franklin University of Science and Medicine, North Chicago, IL, USA
| | - Jana E Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Kassie AM, Abate BB, Kassaw MW, Getie A, Wondmieneh A, Tegegne KM, Ahmed M. Quality of life and its associated factors among epileptic patients attending public hospitals in North Wollo Zone, Northeast Ethiopia: A cross-sectional study. PLoS One 2021; 16:e0247336. [PMID: 33621251 PMCID: PMC7901738 DOI: 10.1371/journal.pone.0247336] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/05/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Epilepsy is thought to be caused by witchcraft, evil spirit, and God's punishment for sins in many developing countries. As a result, people with epilepsy and their families usually suffer from stigma, discrimination, depression, and other psychiatric problems. Thus, this study aimed to assess the quality of life and its associated factors among epileptic patients attending public hospitals in North Wollo Zone, Northeast Ethiopia. METHODS An institution-based cross-sectional study design was employed in this study. A simple random sampling technique was utilized. Health-related quality of life was measured based on the total score of the Quality of Life in Epilepsy Inventory (QOLIE-31) instrument. Data were entered into Epi-data 3.1 statistical package and exported to SPSS Version 20 for further analysis. Linear regression models were used to assess the relationship between quality of life and the independent variables. Statistically significant values were declared at a P-value of < 0.05. RESULTS A total of 395 patients participated in the study making the response rate 98.5%. The mean age of the participants was 32.39 ±10.71 years. More than half, 199 (50.4%) of epileptic patients had an overall weighted average health related quality of life score of mean and above. Male sex (B = 4.34, 95%CI, 0.41, 8.27, P = 0.03), higher educational status (B = 7.18, 95%CI, 1.39, 13.00, P = 0.015) and age at onset of epilepsy (B = 0.237, 95%CI, 0.02, 0.45, P = 0.035) were associated with increased health related quality of life score. On the other hand, family history of epilepsy (B = -4.78, 95%CI,-9.24,-0.33, P = 0.035), uncontrolled seizure (B = -11.08, 95%CI,-15.11,-7.05, P < 0.001), more than 5 pre-treatment number of seizures (B = -4.86, 95%CI,-8.91,-0.81, P = 0.019), poor drug adherence (B = -11.65, 95%CI,-16.06,-7.23, P < 0.001), having moderate (B = -4.526, 95%CI,-8.59,-0.46, P = 0.029) to sever (B = -12.84, 95%CI,-18.30,-7.37, P < 0.001) anxiety and depression, believing that epilepsy is caused by evil spirit (B = -7.04, 95%CI,-11.46,-2.61, P = 0.002), drinking alcohol (B = -5.42, 95%CI,-10.72,-0.13, P = 0.045), and having other co-morbidities (B = -9.35, 95%CI,-14.35,-4.36, P < 0.001) were significantly negatively associated with the health related quality of life score among epileptic patients. CONCLUSIONS Only around half of the epileptic patients have a good health-related quality of life. In addition, multiple variables including family history, uncontrolled seizure, and poor drug adherence were associated with quality of life among epileptic patients. Hence, targeting these variables in epilepsy management is recommended.
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Affiliation(s)
| | - Biruk Beletew Abate
- School of Nursing, College of Health Sciences, Woldia University, Woldia, Amhara, Ethiopia
| | - Mesfin Wudu Kassaw
- School of Nursing, College of Health Sciences, Woldia University, Woldia, Amhara, Ethiopia
| | - Addisu Getie
- School of Nursing, College of Health Sciences, Woldia University, Woldia, Amhara, Ethiopia
| | - Adam Wondmieneh
- School of Nursing, College of Health Sciences, Woldia University, Woldia, Amhara, Ethiopia
| | - Kindie Mekuria Tegegne
- School of Nursing, College of Health Sciences, Woldia University, Woldia, Amhara, Ethiopia
| | - Mohammed Ahmed
- School of Public Health, College of Health Sciences, Woldia University, Woldia, Amhara, Ethiopia
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Campos-Fernández D, Fonseca E, Olivé-Gadea M, Quintana M, Abraira L, Seijo-Raposo I, Santamarina E, Toledo M. The mediating role of epileptic seizures, irritability, and depression on quality of life in people with epilepsy. Epilepsy Behav 2020; 113:107511. [PMID: 33129044 DOI: 10.1016/j.yebeh.2020.107511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/16/2020] [Accepted: 09/20/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Psychiatric comorbidity is common in epilepsy and has a considerable impact on patient quality of life (QoL). This study aimed to analyze the relationship between seizure frequency, irritability, and depression and describe how they mediate each other's effect on QoL in epilepsy. METHODS This is a cross-sectional study of consecutive adults seen at an outpatient epilepsy clinic of a tertiary hospital in Barcelona, Spain. All the patients were evaluated for psychiatric comorbidity and administered the State-Trait Anger Expression Inventory-2 (STAXI-2), the Hospital Anxiety and Depression Scale (HADS), and the Quality Of Life in Epilepsy Inventory-10 (QOLIE-10). Mediation analysis with multiple linear regression followed by the Sobel test was performed. RESULTS We studied 157 patients. Seizure frequency (R = -0.193, P = .053), irritability (R = 0.216, P = .039), and depression (R = -0.598, P < .001) had all a negative effect on QoL. In the adjusted linear regression model, depression was the only independent predictor of impaired QoL (B = -2.453 [95% confidence interval (CI): -3.161, -1.744], P < .001). The Sobel test showed that depression exerted a significant mediating effect on seizure frequency (Z = -1.984; P = .047) and irritability (Z = -3.669; P < .001) in their influence on QoL. CONCLUSION Depression is an independent predictor of worse QoL and significantly mediated the effects of irritability and poor seizure control on QoL impairment in patients with epilepsy.
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Affiliation(s)
- Daniel Campos-Fernández
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Elena Fonseca
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain.
| | - Marta Olivé-Gadea
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Laura Abraira
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Iván Seijo-Raposo
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
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Psychiatric co-morbidities and factors associated with psychogenic non-epileptic seizures: a case–control study. Seizure 2020; 81:325-331. [DOI: 10.1016/j.seizure.2020.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 01/03/2023] Open
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Deleo F, Quintas R, Pastori C, Pappalardo I, Didato G, Di Giacomo R, de Curtis M, Villani F. Quality of life, psychiatric symptoms, and stigma perception in three groups of persons with epilepsy. Epilepsy Behav 2020; 110:107170. [PMID: 32512366 DOI: 10.1016/j.yebeh.2020.107170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/11/2020] [Accepted: 05/11/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The current study aimed to describe quality of life (QoL) levels, psychiatric symptoms prevalence, and perceived stigma levels in persons with either drug-resistant epilepsy (DRE) or drug-sensitive epilepsy (DSE) and in persons with epilepsy (PwE) with DRE that underwent epilepsy surgery (DREES). METHODS Persons with epilepsy diagnosed as having DRE according to International League Against Epilepsy (ILAE) criteria, DSE, and DREES were enrolled at the Epilepsy Unit of the Neurological Institute Carlo Besta of Milan. Sociodemographic and clinical data, Quality of Life in Epilepsy Inventory (QOLIE-31), Symptom Checklist-90 (SCL-90), and the Epilepsy Stigma Scale (ESS) were collected based on self-reported information and on medical records. RESULTS Sociodemographic, medical, and psychological data were obtained from 181 PwE: 80 with DRE, 31 with DSE, and 70 with DREES. We found that QoL is higher and psychiatric symptoms are lower in persons with DSE compared with DRE and that patients with DREES, who were drug-resistant before surgery, are in between DSE and DRE for both measures. Perceived stigma level is different in DSE and in DRE, that report the highest levels of stigma, and is between the other two groups in DREES. SIGNIFICANCE This study suggests that low QoL levels and high psychiatric symptoms prevalence in drug-resistant PwE may be significantly improved after epilepsy surgery and suggests the importance of a biopsychosocial approach when planning therapeutic intervention.
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Affiliation(s)
- Francesco Deleo
- Epilepsy Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Rui Quintas
- Epilepsy Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy.
| | - Chiara Pastori
- Epilepsy Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Irene Pappalardo
- Epilepsy Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy; Neurology Department, ASL AL, Casale Monferrato, Italy
| | - Giuseppe Didato
- Epilepsy Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Roberta Di Giacomo
- Epilepsy Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Marco de Curtis
- Epilepsy Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Flavio Villani
- Epilepsy Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy; Division of Clinical Neurophysiology and Epilepsy Center, IRCCS Ospedale San Martino, Largo R. Benzi 10, 16132 Genova, Italy
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Sheikh SR, Thompson N, Frech F, Malhotra M, Jehi L. Quantifying the burden of generalized tonic-clonic seizures in patients with drug-resistant epilepsy. Epilepsia 2020; 61:1627-1637. [PMID: 32658343 DOI: 10.1111/epi.16603] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Compared to other seizure types, generalized tonic-clonic (GTC) seizures may be disproportionately related to increased morbidity, and reducing seizure frequency could translate into improvements across measures of morbidity in medically treated patients with drug-resistant epilepsy (DRE). The primary objective of this analysis was to quantify the burden of patients with DRE who experience GTC seizures (GTC+) compared to patients with DRE who do not experience GTC seizures (GTC-). METHODS Adult patients from the Cleveland Clinic Epilepsy Center-Neurological Institute from 2012-2016 with DRE with epilepsy for at least 1 year were eligible for inclusion and were divided into GTC ± groups based on whether the patient had experienced a GTC seizure in the year preceding the first visit. Epilepsy duration, comorbidities, antiepileptic drug use, patient-reported outcomes (PROs) and seizure type, frequency, and etiology were captured. Generalized linear models, negative binomial regression, logistic regression, and linear regression were used as appropriate for multivariate analyses. RESULTS A total of 379 patients met inclusion criteria and had data at 1-year follow-up after their baseline visit (192 GTC+ and 187 GTC-). Although DRE patients experiencing GTC seizures had fewer seizures per day over the preceding 6 months than those not experiencing GTC seizures, seizure severity and levels of depression and anxiety were greater. GTC+ patients who reported five or more seizures in the preceding 4 weeks had 82% lower odds (1-0.18 = 0.82) of working than patients with no seizures. SIGNIFICANCE Patients with DRE experience a significant burden and decreased quality of life. Multivariate analysis is necessary to understand the complex relationship between seizure type, frequency, and impact on health-related quality of life (HRQoL) and changes over time. Effective treatments to reduce the burden for DRE patients who experience GTC seizures continue to be needed.
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Affiliation(s)
- Shehryar R Sheikh
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Nicholas Thompson
- Cleveland clinic neurological institute, Cleveland clinic, Cleveland, OH, USA
| | - Feride Frech
- Neurology Business Group, Eisai, Inc., Woodcliff Lake, NJ, USA
| | - Manoj Malhotra
- Neurology Business Group, Eisai, Inc., Woodcliff Lake, NJ, USA
| | - Lara Jehi
- Cleveland clinic neurological institute, Cleveland clinic, Cleveland, OH, USA
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