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Glauser T, Becker DA, Long L, Detyniecki K, Penovich P, Sirven J, Peters JM, Rabinowicz AL, Carrazana E. Short-Term Impact of Seizures and Mitigation Opportunities. Curr Neurol Neurosci Rep 2024; 24:303-314. [PMID: 38940995 PMCID: PMC11258047 DOI: 10.1007/s11910-024-01350-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE OF REVIEW The burden of epilepsy is complex and consists of elements directly related to acute seizures as well as those associated with living with a chronic neurologic disorder. The purpose of this systematic review was to characterize short-term burdens of seizures and to explore the potential value of acute treatments to mitigate these burdens apart from reducing the risk of status epilepticus. RECENT FINDINGS A systematic literature search was conducted using PubMed to identify articles published from January 1, 2017, to June 22, 2023, that described short-term burdens and acute treatments of seizures. Primary outcomes included those related to short-term burdens of seizures and the benefits of acute treatments to reduce short-term burdens. Of the 1332 articles identified through PubMed and 17 through other sources, 27 had relevant outcomes and were included in the qualitative synthesis. Seizure emergencies negatively affected short-term quality of life and the ability to conduct normal daily living activities and were associated with physical (injury) and financial (emergency transport, hospitalization) burdens. The use of acute treatment was associated with a rapid return (≤ 1 h) to normal function/self for both patients and caregivers and potentially lower healthcare utilization and costs. Seizure action plans may improve knowledge and comfort with seizure care, empowering patients and caregivers. The short-term burden of seizures can create a substantial negative impact on patients and caregivers. Acute treatments may reduce the short-term burdens of seizures in addition to their well-described role to reduce seizure activity and the risk for status epilepticus.
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Affiliation(s)
- Tracy Glauser
- Comprehensive Epilepsy Center, Cincinnati Children's Hospital, Cincinnati, OH, USA.
| | - Danielle A Becker
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lucretia Long
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kamil Detyniecki
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Joseph Sirven
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
| | - Jurriaan M Peters
- Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Adrian L Rabinowicz
- Neurelis, Inc, San Diego, CA, USA
- Center for Molecular Biology and Biotechnology, Charles E. Schmidt College of Science, Florida Atlantic University, Jupiter, FL, USA
| | - Enrique Carrazana
- Neurelis, Inc, San Diego, CA, USA
- University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA
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Santilli N, Dewar S, Guerra C, Misra SN, Rabinowicz AL, Carrazana E. Use of intranasal rescue therapy for seizure clusters in students with epilepsy: Nurses' knowledge, perceptions, and practice. Epilepsy Behav Rep 2023; 22:100604. [PMID: 37448486 PMCID: PMC10337358 DOI: 10.1016/j.ebr.2023.100604] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 07/15/2023] Open
Abstract
School nurses play a crucial role in the prompt, appropriate response to epilepsy-related seizure emergencies among students in the school setting. Two intranasal benzodiazepine rescue therapies are now approved and offer potential benefits of being easy to use and socially acceptable. In July 2021, a survey was sent to 49,314 US school nurses to assess knowledge, perceptions, and practice with seizure rescue therapy. Responses were received from 866 (1.8% response rate). Of respondents, 45.7% had used rectal diazepam gel; 9.3%, midazolam nasal spray; and 6.0%, diazepam nasal spray. The majority (58.7%) had not delegated authority to administer rescue therapy, with state/local regulations and lack of willingness of school personnel being the most common barriers to delegation (37.7% and 20.1%, respectively). Additional training of nurses and school staff and progress on delegation policies may help optimize appropriate use of intranasal rescue therapy for seizures and enhance care of students with epilepsy in schools.
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Affiliation(s)
- Nancy Santilli
- Human Care Systems, 720-84 State St, Boston, MA 02109, United States
| | - Sandra Dewar
- Department of Neurology, Virginia Commonwealth University School of Medicine, 1101 E Marshall St, Richmond, VA 23298-0599, United States
| | - Cynthia Guerra
- Neurelis, Inc., 300-3430 Carmel Mountain Rd, San Diego, CA 92121, United States
| | - Sunita N Misra
- Neurelis, Inc., 300-3430 Carmel Mountain Rd, San Diego, CA 92121, United States
| | - Adrian L Rabinowicz
- Neurelis, Inc., 300-3430 Carmel Mountain Rd, San Diego, CA 92121, United States
| | - Enrique Carrazana
- Neurelis, Inc., 300-3430 Carmel Mountain Rd, San Diego, CA 92121, United States
- John A. Burns School of Medicine, University of Hawaii, 651 Ilalo St, Honolulu, HI 96813, United States
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Stredny CM, Sheehan T, Clark J, Tishel C, Gagnon C, Kelly T, Cahill C, O'Connell B, Graber K, Loan G, Wilson S, Forbes PW, Loddenkemper T, Weinstock PH. Creation of a Novel Child Simulator and Curriculum to Optimize Administration of Seizure Rescue Medication. Simul Healthc 2023:01266021-990000000-00067. [PMID: 37094370 DOI: 10.1097/sih.0000000000000727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
INTRODUCTION Although most cases of pediatric convulsive status epilepticus start in the prehospital setting, many patients do not receive treatment. The use of prehospital seizure rescue medications by caregivers is crucial, but studies suggest a lack of proper training on medication use. METHODS We created a novel proof of principle mannequin and simulation for training proper administration of rectal diazepam, with a scoring paradigm to standardize and assess the educational process. RESULTS Twenty-three health care providers (nurses and nurse practitioners, residents/fellows, and attending physicians) and 5 patient guardians/parents were included in the study. The rectal diazepam simulator displayed a high degree of physical and emotional realism (mean ≥ 4/5 on Likert scale survey) that effectively decreased time to treatment (-12.3 seconds; SD, 16.3) and improved the accuracy of medication delivery in a simulation setting (-4.2 points; SD, 3.1). The scoring technique had appropriate interrater reliability (≥86% on all but 2 prompts) and was a feasible instrument to assess the effectiveness of the educational intervention. CONCLUSIONS A unique procedure-focused child simulator and rescue medication score offer an innovative and effective means to train caregivers on the use of lifesaving seizure rescue medications.
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Affiliation(s)
- Coral M Stredny
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (C.M.S., T.S., J.C., C.T., C.G., T.K., C.C., T.L.), Boston Children's Hospital, Boston, MA; Immersive Design Systems (B.O'C., K.G., G.L., S.W., P.H.W.), Boston Children's Hospital, Boston, MA; Clinical Research Center (P.W.F.), Boston Children's Hospital, Boston, MA; Department of Anesthesiology, Critical Care and Pain Medicine (P.H.W.), Boston Children's Hospital, MA; and Harvard Medical School (C.M.S., P.H.W., T.L.), Boston, MA
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Brief video enhances teacher trainees' knowledge of epilepsy. Epilepsy Behav 2021; 118:107963. [PMID: 33866125 DOI: 10.1016/j.yebeh.2021.107963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/14/2021] [Accepted: 03/27/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Relative to the general population, children with epilepsy (CWE) demonstrate difficulties in aspects of cognition and mental health. Previous studies have found that teachers have poor knowledge about epilepsy, which may lead to inadequate management of CWE's comorbidities and seizures, potentially impacting CWE's school performance, social development, and safety. The current study aimed to evaluate whether a brief training program improves teachers' epilepsy knowledge. METHOD Participants included pre-service teachers enrolled in the Faculty of Education at Western University (London, Ontario, Canada). There were no exclusion criteria. Pre-service teachers completed a questionnaire evaluating their experiences and knowledge of epilepsy prior to, and two weeks following, the training program. The training program consisted of a 10.5-min video and booklet that described the characteristics of seizures, seizure first aid, and the cognitive, psychological, and social consequences of epilepsy. RESULTS Pre-service teachers' knowledge about epilepsy, seizure safety, and common comorbidities associated with epilepsy significantly improved after participating in the training program. Furthermore, pre-service teachers indicated greater self-reported knowledge about epilepsy and greater preparedness to handle a seizure in the classroom. CONCLUSION The results of the current study demonstrated that a brief, cost-effective training program significantly enhances teachers' knowledge about epilepsy, seizure safety, and the comorbidities associated with epilepsy. Enhancing teachers' knowledge about epilepsy has the potential to improve children's academic and social success in school.
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Qiu L, Shen L, Wang J, Ren F, Xu M, Jiang F, Sheng X, Li F, Li F. Knowledge and attitudes among preschools staff in Shanghai, China, regarding epilepsy. BMC Pediatr 2020; 20:477. [PMID: 33050899 PMCID: PMC7550838 DOI: 10.1186/s12887-020-02376-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/07/2020] [Indexed: 12/02/2022] Open
Abstract
Background Epilepsy is one of the most common neurological problems among children. The aim of this survey was to assess the knowledge and attitude among preschool staff in Shanghai regarding epilepsy. Methods A cross-sectional survey was carried out among the staff at selected preschools. A stratified random sampling method was first used to identify suitable subjects. Data were obtained using a self-completed questionnaire. A standardized collection of demographic information was performed, and participants were given a questionnaire about their knowledge and attitudes regarding epilepsy. Results A total of 1069 subjects completed the questionnaire. In this survey, 387 (36.2%) staff members had previously participated in related training. 17.6% of teachers knew how to provide appropriate first aid for seizures. Correct responses regarding first aid for seizures, such as laying the person on his or her side (24.9%), moving harmful objects out of the way (20.7%), protecting the head (36.1%), waiting until the seizure ends (7.9%), and dialing the emergency number (40.1%), were low. The staff members had different attitudes towards children with epilepsy: some subjects had a positive attitude, some had a negative attitude. Conclusions The level of first-aid knowledge among preschool staff in Shanghai relevant to epilepsy was low. There is an urgent need to educate staff about epilepsy and appropriate first-aid practices for seizures.
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Affiliation(s)
- Liyan Qiu
- Department of developmental behavioral pediatric & children healthcare, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Rd, Shanghai, 200092, China
| | - Lixiao Shen
- Department of developmental behavioral pediatric & children healthcare, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Rd, Shanghai, 200092, China
| | - Junli Wang
- Department of developmental behavioral pediatric & children healthcare, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Rd, Shanghai, 200092, China
| | - Fang Ren
- Department of developmental behavioral pediatric & children healthcare, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Rd, Shanghai, 200092, China
| | - Mingyu Xu
- Department of developmental behavioral pediatric & children healthcare, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Rd, Shanghai, 200092, China
| | - Fan Jiang
- Department of Developmental and Behavioral Pediatrics, Shanghai Pediatric Translational Research Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University, MOE-Shanghai Key Laboratory of Children's Environmental Health, 1678 Dongfang Rd, Shanghai, 200127, China
| | - Xiaoyang Sheng
- Department of developmental behavioral pediatric & children healthcare, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Rd, Shanghai, 200092, China
| | - Fei Li
- Department of developmental behavioral pediatric & children healthcare, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Rd, Shanghai, 200092, China
| | - Feng Li
- Department of developmental behavioral pediatric & children healthcare, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Rd, Shanghai, 200092, China.
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