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Dimova PS, Metodiev D, Todorov T, Todorova A, Gabrovski K, Karazapryanov P, Penkov M, Todorov Y, Milenova Y, Stoyanova D, Minkin K. Clinical characteristics and multimodal imaging can help diagnosing and treating mild malformation of cortical development with oligodendroglial hyperplasia and epilepsy. Epileptic Disord 2024. [PMID: 38953904 DOI: 10.1002/epd2.20261] [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: 03/29/2024] [Revised: 06/03/2024] [Accepted: 06/20/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE Mild malformation of cortical development with oligodendroglial hyperplasia and epilepsy (MOGHE) is a recently described, histopathologically and molecularly defined (SLC35A2-mutated) type of cortical malformation. Although increasingly recognized, the diagnosis of MOGHE remains a challenge. We present the characteristics of the first six patients diagnosed in Bulgaria, with the aim to facilitate identification, proper presurgical evaluation, and surgical treatment approach in this disease. METHODS Revision of histopathological specimens of 202 patients operated on for drug-resistant focal epilepsy identified four cases with MOGHE. Another two were suggested, based on clinical characteristics and subsequently, were histologically confirmed. Sanger SLC35A2 sequencing on paraffin-embedded or fresh-frozen brain tissue was performed. Analysis of seizure types, neuropsychological profiles, electroencephalographic (EEG), imaging features and epilepsy surgery outcomes was done. RESULTS Three out of the six cases (50%) harbored pathogenic SLC35A2 mutations. One patient had a heterozygous somatic variant with uncertain significance. Clinical characteristics included epilepsy onset in infancy (in 100% under 3 years of age), multiple seizure types, and moderate or severe intellectual/developmental delay. Epileptic spasms with hypsarrhythmia on EEG were the initial seizure type in five patients. The subsequent seizure types resembled those in Lennox-Gastaut syndrome. The majority of the patients (n = 4) presented prominent and persisting autistic features. Magnetic resonance imaging (MRI) showed multilobar (n = 6) and bilateral (n = 3) lesions, affecting the frontal lobes (n = 5; bilaterally in three) and characterized by increased signal on T2/fluid-attenuated inversion recovery (FLAIR). Voxel-based morphometric MRI post-processing and positron emission tomography helped determining the localization and extent of the lesions and presumed epileptogenic zones. After surgery, four patients (66.7%) were seizure-free ≥2 years. Interestingly, all seizure-free patients carried somatic SLC35A2-alterations. SIGNIFICANCE Epileptic spasms, early prominent neuropsychological disturbances, MRI-T2/FLAIR hyperintense lesions with cortico-subcortical blurring, frequently multilobar and especially frontal, can preoperatively help to suspect MOGHE. Epilepsy surgery is still the only successful treatment option in MOGHE.
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Affiliation(s)
- Petia S Dimova
- Epilepsy Surgery Center, Neurosurgery Department, St. Ivan Rilski University Hospital, Sofia, Bulgaria
| | - Dimitar Metodiev
- Clinical Pathology, St. Ivan Rilski University Hospital, Sofia, Bulgaria
| | - Tihomir Todorov
- "Genica" Genetic and Medico-Diagnostic Laboratory, Sofia, Bulgaria
| | - Albena Todorova
- "Genica" Genetic and Medico-Diagnostic Laboratory, Sofia, Bulgaria
- Department of Medical Chemistry and Biochemistry, Medical University, Sofia, Bulgaria
| | - Kaloyan Gabrovski
- Epilepsy Surgery Center, Neurosurgery Department, St. Ivan Rilski University Hospital, Sofia, Bulgaria
- Medical University, Sofia, Bulgaria
| | - Peter Karazapryanov
- Epilepsy Surgery Center, Neurosurgery Department, St. Ivan Rilski University Hospital, Sofia, Bulgaria
| | - Marin Penkov
- Radiology Department, St. Ivan Rilski University Hospital, Sofia, Bulgaria
| | - Yuri Todorov
- Radiology Department, St. Ivan Rilski University Hospital, Sofia, Bulgaria
| | - Yoana Milenova
- Epilepsy Surgery Center, Neurosurgery Department, St. Ivan Rilski University Hospital, Sofia, Bulgaria
| | - Denitza Stoyanova
- Epilepsy Surgery Center, Neurosurgery Department, St. Ivan Rilski University Hospital, Sofia, Bulgaria
| | - Krassimir Minkin
- Epilepsy Surgery Center, Neurosurgery Department, St. Ivan Rilski University Hospital, Sofia, Bulgaria
- Medical University, Sofia, Bulgaria
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Jha R, Chua MMJ, Sarkis R, Tobochnik S, Rolston JD. Predictors of SOZ localization, subsequent surgical intervention, and seizure outcomes in iEEG. Ann Clin Transl Neurol 2024; 11:1787-1797. [PMID: 38831617 PMCID: PMC11251470 DOI: 10.1002/acn3.52084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/10/2024] [Accepted: 04/24/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE A third of the patients who undergo intracranial EEG (iEEG) for seizure-onset zone (SOZ) localization do not proceed to resective surgery for epilepsy, and over half of those who do continue to have seizures following treatment. To better identify candidates who are more likely to see benefits from undergoing iEEG, we investigated preoperative and iEEG peri-operative features associated with the localization of a putative SOZ, undergoing subsequent surgical treatment, and seizure outcomes. METHODS We conducted a retrospective cohort study of consecutive patients who underwent iEEG from 2001 to 2022 at two institutions. Outcomes included SOZ identification, proceeding to surgical treatment (resection vs. neuromodulation), and subsequent seizure freedom. RESULTS We identified 329 unique patients who were followed for a median of 3.9 (IQR:7) years, with a minimum of 2-year follow-up for seizure outcomes analyses. Multivariate analysis identified lateralized and lobar localization on scalp EEG (OR 3.8, p = 0.001) to be associated with SOZ localization. Patients with unilateral localization on scalp EEG (OR 3.0, p = 0.003), unilateral preimplantation hypothesis (OR 3.1, p = 0.001), and lesional preoperative MRI (OR 2.1, p = 0.033) were more likely to undergo resection than neuromodulation. Similarly, a unilateral pre-implantation hypothesis (OR 2.6, p < 0.001) favored seizure freedom, whereas prior neuromodulation (OR 0.3, p = 0.013) decreased the odds. Larger number of preoperative anti-seizure medications (ASMs) did not influence seizure freedom rates but did decrease favorable (Engel I, II) seizure outcomes (OR 0.7, p = 0.026). INTERPRETATION Non-invasive localization data prior to iEEG are associated with subsequent resection and seizure freedom, independent of iEEG localization. Factors predictive of SOZ localization are not necessarily predictive of post-operative seizure freedom.
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Affiliation(s)
- Rohan Jha
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Melissa M. J. Chua
- Department of NeurosurgeryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Rani Sarkis
- Department of NeurologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Steven Tobochnik
- Department of NeurologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - John D. Rolston
- Harvard Medical SchoolBostonMassachusettsUSA
- Department of NeurosurgeryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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Seneviratne NU, Ho SY, Correa DJ. Surveying neurologist perspectives and knowledge of epilepsy surgery to identify barriers to surgery referral. Epilepsia Open 2024; 9:960-968. [PMID: 38446338 PMCID: PMC11145599 DOI: 10.1002/epi4.12925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE Epilepsy surgery is an effective means of treating medically refractory epilepsy (MRE), but it remains underused. We aimed to analyze the perspectives and knowledge of referring neurologists in the New York metropolitan area, who serve a large epilepsy population. METHODS We adapted a previous Canadian survey by Roberts et al. (2015), adding questions regarding demographic descriptors, insurance coverage, training and practice details, and perceived social barriers for patients. We surveyed neurologists directly affiliated with Montefiore Medical Center and those referring to Montefiore's Comprehensive Epilepsy Center. Participants had 10 weeks to fill out an online Qualtrics survey with weekly reminders. RESULTS Of 117 neurologists contacted, 51 eligible neurologists completed the survey (63.8% Montefiore, 35.0% referring group). A high proportion of the results were from epilepsy-trained individuals (41.2%) and neurologists who graduated residency ≤19 years ago (80.4%). 80.4% of respondents felt that epilepsy surgery is safe, but only 56.9% would refer a patient for surgical workup after two failed trials of anti-seizure medications. Epileptologists and providers with a larger volume of epilepsy patients and electroencephalogram readings had better knowledge of the epilepsy surgery workup guidelines. When asked to rank social barriers to patients receiving surgery, participants were most concerned about lack of social support, financial insecurity, and a patient's dual role as a caregiver. SIGNIFICANCE Our study suggests continued reluctance of neurologists regarding epilepsy surgery, and deficiencies in the knowledge and adherence to the recommended guidelines. In the context of prior studies, these results showed improved understanding of the definition of MRE (80.4%) and an increased likelihood to refer eligible patients as early as possible (78.4%) in line with current consensus recommendations. The finding that epilepsy-trained and more epilepsy/electroencephalogram-facing neurologists showed better understanding of the guidelines suggests that increased education efforts should be targeted at non-epileptologists. PLAIN LANGUAGE SUMMARY Our study asked New York City doctors about their approach to epilepsy surgery. Many do not consider it as early as they could in treatment plans. The doctors with extra epilepsy training were better at knowing when to consider surgery.
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Affiliation(s)
| | - Sophey Y. Ho
- Mount Sinai Health SystemNew York CityNew YorkUSA
| | - Daniel J. Correa
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
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Yang L, Peng B, Gao W, A R, Liu Y, Liang J, Zhu M, Hu H, Lu Z, Pang C, Dai Y, Sun Y. Automated detection of MRI-negative temporal lobe epilepsy with ROI-based morphometric features and machine learning. Front Neurol 2024; 15:1323623. [PMID: 38356879 PMCID: PMC10864571 DOI: 10.3389/fneur.2024.1323623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024] Open
Abstract
Objective Temporal lobe epilepsy (TLE) predominantly originates from the anteromedial basal region of the temporal lobe, and its prognosis is generally favorable following surgical intervention. However, TLE often appears negative in magnetic resonance imaging (MRI), making it difficult to quantitatively diagnose the condition solely based on clinical symptoms. There is a pressing need for a quantitative, automated method for detecting TLE. Methods This study employed MRI scans and clinical data from 51 retrospective epilepsy cases, dividing them into two groups: 34 patients in TLE group and 17 patients in non-TLE group. The criteria for defining the TLE group were successful surgical removal of the epileptogenic zone in the temporal lobe and a favorable postoperative prognosis. A standard procedure was used for normalization, brain extraction, tissue segmentation, regional brain partitioning, and cortical reconstruction of T1 structural MRI images. Morphometric features such as gray matter volume, cortical thickness, and surface area were extracted from a total of 20 temporal lobe regions in both hemispheres. Support vector machine (SVM), extreme learning machine (ELM), and cmcRVFL+ classifiers were employed for model training and validated using 10-fold cross-validation. Results The results demonstrated that employing ELM classifiers in conjunction with specific temporal lobe gray matter volume features led to a better identification of TLE. The classification accuracy was 92.79%, with an area under the curve (AUC) value of 0.8019. Conclusion The method proposed in this study can significantly assist in the preoperative identification of TLE patients. By employing this method, TLE can be included in surgical criteria, which could alleviate patient symptoms and improve prognosis, thereby bearing substantial clinical significance.
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Affiliation(s)
- Lin Yang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bo Peng
- Suzhou Institute of Biomedical Engineering, Chinese Academy of Sciences, Suzhou, China
- Jinan Guoke Medical Engineering Technology Development Co., Ltd, Jinan, China
| | - Wei Gao
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Rixi A
- School of Life Science and Technology, Changchun University of Science and Technology, Changchun, China
| | - Yan Liu
- Suzhou Institute of Biomedical Engineering, Chinese Academy of Sciences, Suzhou, China
- Jinan Guoke Medical Engineering Technology Development Co., Ltd, Jinan, China
| | - Jiawei Liang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
- International Laboratory for Children’s Medical Imaging Research, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Mo Zhu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haiyang Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zuhong Lu
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Chunying Pang
- School of Life Science and Technology, Changchun University of Science and Technology, Changchun, China
| | - Yakang Dai
- Suzhou Institute of Biomedical Engineering, Chinese Academy of Sciences, Suzhou, China
- Jinan Guoke Medical Engineering Technology Development Co., Ltd, Jinan, China
| | - Yu Sun
- International Laboratory for Children’s Medical Imaging Research, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
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Spanos S, Hutchinson K, Ryder T, Rapport F, Goodwin N, Zurynski Y. Integrated Care in Epilepsy Management: A Scoping Review of the Models and Components of Health and Social Care Delivery. Int J Integr Care 2024; 24:18. [PMID: 38463746 PMCID: PMC10921962 DOI: 10.5334/ijic.7659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 02/13/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction Epilepsy is the most common neurological condition globally. Integrating health and social care is fundamental in epilepsy management, but the scope of progress in this area is unclear. This scoping review aimed to capture the range and type of integrated care components and models in epilepsy management. Methods Four databases were searched for articles published since 2010 that reported on integrated care in epilepsy. Data were extracted and synthesised into components of integrated care that had been implemented or recommended only. Models of integrated care were identified, and their components tabulated. Results Fifteen common and interrelated components of integrated care emerged that were aligned with four broad areas: healthcare staff and pathways (e.g., epilepsy nurses); tasks and services (e.g., care coordination); education and engagement (e.g., shared decision making); and technology for diagnosis and communication (e.g., telehealth). Twelve models of integrated care were identified; seven were implemented and five were recommended. Discussion There is a growing evidence-base supporting integrated, person-centred epilepsy care, but implementation is challenged by entrenched silos, underdeveloped pathways for care, and deficits in epilepsy education. Conclusion Integrating epilepsy care relies on changes to workforce development and policy frameworks to support whole-of-system vision for improving care.
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Affiliation(s)
- Samantha Spanos
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Karen Hutchinson
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Central Coast Local Health District, Gosford, NSW, Australia
| | - Tayhla Ryder
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- CanTeen Australia, Sydney, Australia
| | - Frances Rapport
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Nicholas Goodwin
- Central Coast Local Health District, Gosford, NSW, Australia
- Central Coast Research Institute for Integrated Care, University of Newcastle, Gosford, NSW, Australia
| | - Yvonne Zurynski
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Richardson RM, Yang JC. Evolution in Epilepsy Surgery and the Need to Address a Public Health Crisis of Underutilization. Neurosurg Clin N Am 2024; 35:xiii-xiv. [PMID: 38000847 DOI: 10.1016/j.nec.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Affiliation(s)
- R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Jimmy C Yang
- Department of Neurological Surgery, The Ohio State University College of Medicine, 480 Medical Center Drive, Columbus, OH 43210, USA.
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McLaren JR, Kahle KT, Richardson RM, Chu CJ. Epilepsy Surgery for Cognitive Improvement in Epileptic Encephalopathy. Neurosurg Clin N Am 2024; 35:49-59. [PMID: 38000841 DOI: 10.1016/j.nec.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
Epileptic encephalopathies are defined by the presence of frequent epileptiform activity that causes neurodevelopmental slowing or regression. Here, we review evidence that epilepsy surgery improves neurodevelopment in children with epileptic encephalopathies. We describe an example patient with epileptic encephalopathy without drug refractory seizures, who underwent successful diagnostic and therapeutic surgeries. In patients with epileptic encephalopathy, cognitive improvement alone is a sufficient indication to recommend surgical intervention in experienced centers.
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Affiliation(s)
- John R McLaren
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; Harvard Medical School
| | - Kristopher T Kahle
- Harvard Medical School; Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, Wang Building Room 333, Boston, MA 02114, USA
| | - R Mark Richardson
- Harvard Medical School; Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, Their Building, 4th Floor, Boston, MA 02114, USA
| | - Catherine J Chu
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; Harvard Medical School.
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Mir A, Jallul T, Alotaibi F, Amer F, Najjar A, Alhazmi R, Al Faraidy M, Alharbi A, Aldurayhim F, Barnawi Z, Fallatah B, Ali M, Almuhaish H, Almolani F, Suwailem A, Tuli M, Naim A, Hassan S, Hedgcock B, Bostanji G, Bashir S, AlBaradie R. Outcomes of resective surgery in pediatric patients with drug-resistant epilepsy: A single-center study from the Eastern Mediterranean Region. Epilepsia Open 2023; 8:930-945. [PMID: 37162422 PMCID: PMC10472393 DOI: 10.1002/epi4.12761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/07/2023] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVE Epilepsy surgery is widely accepted as an effective therapeutic option for carefully selected patients with drug-resistant epilepsy (DRE). There is limited data on the outcome of epilepsy surgery, especially in pediatric patients from the Eastern Mediterranean region. Hence, we performed a retrospective study examining the outcomes of resective surgery in 53 pediatric patients with focal DRE. METHODS Patients with focal DRE who had undergone epilepsy surgery were included in the present study. All patients underwent a comprehensive presurgical evaluation. Postoperative seizure outcomes were classified using the Engel Epilepsy Surgery Outcome Scale. RESULTS After surgery, 33 patients (62.2%) were Class I according to the Engel classification of surgical outcomes; eight patients (15.0%) were Class II, 11 (20.7%) were Class III, and one (1.8%) was Class IV. The relationships of presurgical, surgical, and postsurgical clinical variables to seizure outcomes were compared. Older age at seizure onset, older age at the time of surgery, the presence of focal to bilateral tonic-clonic seizures, seizure duration over 2 minutes, unsuccessful treatment with three or fewer antiseizure medications, lesions confined to one lobe (as demonstrated via magnetic resonance imaging [MRI]), surgical site in the temporal lobe, and histopathology including developmental tumors were significantly linked to an Engel Class I outcome. A univariate analysis of excellent surgical outcomes showed that lateralized semiology, localized interictal and ictal electroencephalogram (EEG) discharges, lateralized single-photon emission computed tomography and positron emission tomography findings, and temporal lobe resections were significantly related to excellent seizure outcomes. SIGNIFICANCE The results of our study are encouraging and similar to those found in other centers around the world. Epilepsy surgery remains an underutilized treatment for children with DRE and should be offered early.
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Affiliation(s)
- Ali Mir
- Department of Pediatric NeurologyKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Tarek Jallul
- Department of NeurosurgeryKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Faisal Alotaibi
- Neuroscience CentreKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Fawzia Amer
- Department of Pediatric NeurologyKing Fahad Specialist HospitalDammamSaudi Arabia
- Department of Pediatric Neurology and MetabolicCairo University Children HospitalCairoEgypt
| | - Ahmed Najjar
- Department of NeurosurgeryKing Fahad Specialist HospitalDammamSaudi Arabia
- Department of Surgery, College of MedicineTaibah UniversityAlmadinah AlmunawwarahSaudi Arabia
| | - Rami Alhazmi
- Department of Medical ImagingKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Mona Al Faraidy
- Anesthesia DepartmentKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Alanoud Alharbi
- Department of Pediatric NeurologyKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Fatimah Aldurayhim
- Department of Pediatric NeurologyKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Zakia Barnawi
- Department of NeurosurgeryKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Bassam Fallatah
- Department of NeurosurgeryKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Mona Ali
- Department of Pediatric NeurologyKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Husam Almuhaish
- Department of Medical ImagingKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Fadhel Almolani
- Department of Medical ImagingKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Abdullah Suwailem
- Department of Medical ImagingKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Mahmoud Tuli
- Department of Medical ImagingKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Abdulrahman Naim
- Department of Medical ImagingKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Suad Hassan
- Department of Mental HealthKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Brent Hedgcock
- Department of NeurophysiologyKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Ghadah Bostanji
- Department of Social WorkKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Shahid Bashir
- Neuroscience CentreKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Raidah AlBaradie
- Department of Pediatric NeurologyKing Fahad Specialist HospitalDammamSaudi Arabia
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Arredondo KH, Ahrens SM, Bagić AI, Bai S, Chapman KE, Ciliberto MA, Clarke DF, Eisner M, Fountain NB, Gavvala JR, Perry MS, Rossi KC, Wong-Kisiel LC, Herman ST, Ostendorf AP. Association Between Characteristics of National Association of Epilepsy Centers and Reported Utilization of Specific Surgical Techniques. Neurology 2023; 100:e719-e727. [PMID: 36323517 PMCID: PMC9969912 DOI: 10.1212/wnl.0000000000201526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Nearly one-third of persons with epilepsy will continue having seizures despite trialing multiple antiseizure medications. Epilepsy surgery may be beneficial in these cases, and evaluation at a comprehensive epilepsy center is recommended. Numerous palliative and potentially curative approaches exist, and types of surgery performed may be influenced by center characteristics. This article describes epilepsy center characteristics associated with epilepsy surgery access and volumes in the United States. METHODS We analyzed National Association of Epilepsy Centers 2019 annual report and supplemental survey data obtained with responses from 206 adult epilepsy center directors and 136 pediatric epilepsy center directors in the United States. Surgical treatment volumes were compiled with center characteristics, including US Census region. We used multivariable modeling with zero-inflated Poisson regression models to present ORs and incidence rate ratios of receiving a given surgery type based on center characteristics. RESULTS The response rate was 100% with individual element missingness less than 4% across 352 observations undergoing univariate analysis. Multivariable models included 319 complete observations. Significant regional differences were present. The rates of laser interstitial thermal therapy (LITT) were lower at centers in the Midwest (incidence rate ratio [IRR] 0.74, 95% CI 0.59-0.92; p = 0.006) and Northeast (IRR 0.77, 95% CI 0.61-0.96; p = 0.022) compared with those in the South. Conversely, responsive neurostimulation implantation rates were higher in the Midwest (IRR 1.45, 95% CI 1.1-1.91; p = 0.008) and West (IRR 1.91, 95% CI 1.49-2.44; p < 0.001) compared with the South. Center accreditation level, institution type, demographics, and resources were also associated with variations in access and rates of potentially curative and palliative surgical interventions. DISCUSSION Epilepsy surgery procedure volumes are influenced by US epilepsy center region and other characteristics. These variations may affect access to specific surgical treatments for persons with drug resistant epilepsy across the United States.
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Affiliation(s)
- Kristen H Arredondo
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - Stephanie M Ahrens
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - Anto I Bagić
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - Shasha Bai
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - Kevin E Chapman
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - Michael A Ciliberto
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - Dave F Clarke
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - Mariah Eisner
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - Nathan B Fountain
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - Jay R Gavvala
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - M Scott Perry
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - Kyle C Rossi
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - Lily C Wong-Kisiel
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - Susan T Herman
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
| | - Adam P Ostendorf
- From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX
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10
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Samanta D. Recent developments in stereo electroencephalography monitoring for epilepsy surgery. Epilepsy Behav 2022; 135:108914. [PMID: 36116362 DOI: 10.1016/j.yebeh.2022.108914] [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: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 11/03/2022]
Abstract
Recently the utilization of the stereo electroencephalography (SEEG) method has exploded globally. It is now the preferred method of intracranial monitoring for epilepsy. Since its inception, the basic tenet of the SEEG method remains the same: strategic implantation of intracerebral electrodes based on a hypothesis grounded on anatomo-electroclinical correlation, interpretation of interictal and ictal abnormalities, and formation of a surgical plan based on these data. However, there are recent advancements in all these domains-electrodes implantations, data interpretation, and therapeutic strategy- that can make the SEEG a more accessible and effective approach. In this narrative review, these newer developments are discussed and summarized. Regarding implantation, efficient commercial robotic systems are now increasingly available, which are also more accurate in implanting electrodes. In terms of ictal and interictal abnormalities, newer studies focused on correlating these abnormalities with pathological substrates and surgical outcomes and analyzing high-frequency oscillations and cortical-subcortical connectivity. These abnormalities can now be further quantified using advanced tools (spectrum, spatiotemporal, connectivity analysis, and machine learning algorithms) for objective and efficient interpretation. Another aspect of recent development is renewed interest in SEEG-based electrical stimulation mapping (ESM). The SEEG-ESM has been used in defining epileptogenic networks, mapping eloquent cortex (primarily language), and analyzing cortico-cortical evoked potential. Regarding SEEG-guided direct therapeutic strategy, several clinical studies evaluated the use of radiofrequency thermocoagulation. As the emerging SEEG-based diagnosis and therapeutics are better evolved, treatments aimed at specific epileptogenic networks without compromising the eloquent cortex will become more easily accessible to improve the lives of individuals with drug-resistant epilepsy (DRE).
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Affiliation(s)
- Debopam Samanta
- Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
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Joshi C. What Are the Chances That Epilepsy Surgery Will Allow My Child to Come Off Meds? Assessing Pediatric Epilepsy Surgery Outcomes: Data on ASM Freedom. Epilepsy Curr 2022; 22:339-341. [DOI: 10.1177/15357597221123458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
[Box: see text]
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Affiliation(s)
- Charuta Joshi
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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12
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Casciato S, Morano A, Ricci L, Asioli S, Barba C, Caulo M, Colicchio G, Cossu M, Consales A, de Palma L, Villani F, Zamponi N, Tassi L, Di Gennaro G, Beghi E, Marras CE. Knowledge and attitudes of neurologists toward epilepsy surgery: an Italian survey. Neurol Sci 2022; 43:4453-4461. [PMID: 35312881 PMCID: PMC8935880 DOI: 10.1007/s10072-022-06025-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/18/2022] [Indexed: 11/30/2022]
Abstract
The current study, conceived with the contribution of the Commission for Epilepsy Surgery of the Italian League Against Epilepsy (LICE) and the Epilepsy Study Group of the Italian Neurological Society (SIN), aimed to assess potential physician-related barriers to refer subjects for epilepsy surgery. All the members of SIN and LICE were invited by email to complete a 28-item online questionnaire. The survey items included: (1) individual and medical practice characteristics, (2) knowledge of current indications to select candidates for epilepsy surgery, (3) factors potentially affecting the attitude toward epilepsy surgery. Overall, 210 physicians completed the survey. More than half (63.3%) of the participants showed proper knowledge of the ILAE drug-resistance. Definition and almost two-thirds of them (71.9%) considered themselves adequately informed about indications, risks, and benefits of epilepsy surgery. Surgery was regarded as a valid option to be used as early as possible by 84.8% of the interviewees, and 71% of them estimated its complication rate to be low. However, more than half (63%) of the respondents reportedly referred patients for surgery only after the failure of 3–5 antiseizure medications. Overestimation of risks/complications of surgery and inadequate healthcare resources were identified as the main factor contrasting the patient referral for surgery by 43% and 40.5% of the participants, respectively. In conclusion, this survey confirms the existence of knowledge gap within both physicians and the healthcare system, as well as an educational need regarding epilepsy surgery. Further researches are warranted to define learning outcomes and optimize educational tools.
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Affiliation(s)
- Sara Casciato
- IRCCS NEUROMED, Via Atinense, 18, IS, 86170, Pozzilli, Italy
| | - Alessandra Morano
- Department of Human Neurosciences, "Sapienza" University, Rome, Italy
| | - Lorenzo Ricci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology "M. Malpighi", Bellaria Hospital, Bologna, Italy
| | - Carmen Barba
- Neuroscience Department, Meyer Children's Hospital-University of Florence, Florence, Italy
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | | | - Massimo Cossu
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | | | - Luca de Palma
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
| | - Flavio Villani
- Division of Neurophysiology and Epilepsy Centre, IRCCS San Martino Policlinic Hospital, Genoa, Italy
| | - Nelia Zamponi
- Child Psychiatry and Neurology Unit, G. Salesi Hospital, Ancona, Italy
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | | | - Ettore Beghi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Carlo Efisio Marras
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
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13
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The role of implementation science in improving epilepsy surgery utilization. Epilepsy Behav 2022; 130:108669. [PMID: 35334257 PMCID: PMC9064925 DOI: 10.1016/j.yebeh.2022.108669] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/24/2022]
Abstract
Randomized controlled studies demonstrated that patients with intractable epilepsy could benefit significantly more from epilepsy surgery than from continuing medical therapy. Unfortunately, robust efforts over the last few decades, including the formation and dissemination of guidelines and practice parameters, did not improve the utilization of epilepsy surgery. Epilepsy surgery remains one of the most underutilized evidence-based interventions in modern medicine. A new scientific study of methods has emerged to improve uptake of evidence-based practices, named implementation science (IS). Despite its tremendous rise in popularity in various domains, its usage to mitigate epilepsy surgery underutilization is very limited. In fact, the application of principles and methods of IS are somewhat restricted in the entire neuroscience field, where quality improvement (QI) efforts primarily drive the provision of high-quality health care. Although both QI efforts and IS have a similar goal of improving healthcare quality, they differ significantly in associated terminologies, concepts, and approaches. For implementing high-quality, evidence-based practices in routine clinical settings, we need a better understanding of IS methods and closer integration between QI and IS fields. Recognizing a dearth of awareness of IS in the neuroscience community, the first part of the review addresses the fundamentals of IS, focusing on multifaceted implementation strategies that neurologists can apply in their clinical practice. In the second part of the review, an entire illustrative case is presented to familiarize neurologists with the practical application of diverse implementation strategies to mitigate the underutilization of epilepsy surgery.
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Cole TS, Vadera S. Surgeon-Led Initiatives to Increase Access to Surgical Treatment of Epilepsy at an Academic Level 4 Epilepsy Center: An Observational Cohort Study. Neurosurgery 2022; 91:167-172. [PMID: 35384922 DOI: 10.1227/neu.0000000000001961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/30/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Underutilization of surgical treatment for epilepsy is multifactorial, and the multidisciplinary nature of caring for these patients represents a significant hurdle in expanding surgical treatment of epilepsy. OBJECTIVE To develop internal and external surgical referral relationships for patients with medically refractory epilepsy with the goal of improving access to care. METHODS To expand access to surgical epilepsy treatment at University of California (UC)-Irvine, 4 broad approaches focused on developing referral relationships and process improvement of surgical evaluation were undertaken in 2015 and 2016. The authors performed a retrospective review of all surgical epilepsy case referrals of the senior author from 2014 through 2020. RESULTS Epilepsy surgical volume at UC-Irvine increased from an average of 5.2 cases annually to 32 cases in the first year (2015) of implementation. There was continued case volume growth from 2015 through 2020 to 52 procedures in the most recent year (P = .03). Hospital payments for epilepsy procedures increased from $1.09M in 2015 to $2.02M and $1.8M in 2019 and 2020 (P < .01), respectively, while maintaining a diverse payer mix. 79.4% of these patients did not have a previously established option for surgical epilepsy care. CONCLUSION We outline strategies that level 4 epilepsy centers may use to strengthen collaborations and improve patient access for surgical epilepsy treatment. Increased collaboration can both improve the number of patients with epilepsy with access to specialized surgical care and produce reimbursement benefits for the centers caring for these patients, regardless of insurance source.
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Affiliation(s)
- Tyler S Cole
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Sumeet Vadera
- Department of Neurosurgery, UC Irvine Medical Center, Orange, California, USA
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Samanta D, Ostendorf AP, Singh R, Gedela S, Elumalai V, Hoyt ML, Perry MS, Bartolini L, Curran GM. Physicians' Perspectives on Presurgical Discussion and Shared Decision-Making in Pediatric Epilepsy Surgery. J Child Neurol 2022; 37:416-425. [PMID: 35312338 PMCID: PMC9086119 DOI: 10.1177/08830738221089472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective: To qualitatively explore the approach of pediatric epilepsy providers when counseling regarding surgical options for epilepsy, presenting risks and benefits of surgery, overcoming resistance to surgery, and fostering shared decision making with patients and families. Methods: We conducted in-depth interviews with 11 academic clinicians (5- neurologists, 5- epileptologists, 1- neurosurgeon) from a Level 4 pediatric epilepsy center to explore how physicians communicate and pursue surgical decision-making. Results: A blended inductive-deductive analysis revealed three key themes (with subthemes) of presurgical discussions: (1) Candidate selection and initial discussion about epilepsy surgery (neurologists compared to epileptologists, the timing of the discussion, reluctant families) (2) Detailed individualized counseling about epilepsy surgery (shared decision-making [enablers and barriers] and risk-benefit analysis [balancing risks and benefits, statistical benefit estimation, discussion about SUDEP, prognostication about cognitive and behavioral outcomes, risks of surgery]) (3) Tools to improve decision-making (educational interventions for patients and families and provider- and organization-specific interventions). Significance: Presurgical discussions lack uniformity among physicians who treat epilepsy. Despite general interest in collaborative decision-making, experts raised concern about lack of exposure to communication training and clinical tools for optimizing decision-making, a high number of families who do not feel equipped to share the decision making leaving the decision-making entirely to the physician, and paucity of practical resources for individualized risk-benefit counseling. Clinical practice guidelines should be developed to reduce existing practice variations in presurgical counseling. Further consensus is needed about when and how to initiate the conversation about epilepsy surgery, essential components of the discussion, and the utility of various tools to improve the utilization of epilepsy surgery.
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Affiliation(s)
- Debopam Samanta
- Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Adam P Ostendorf
- Division of Neurology, Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, OH, United States of America
| | - Rani Singh
- Department of Pediatrics, Atrium Health/Levine Children's Hospital
| | - Satyanarayana Gedela
- Department of Pediatrics, Emory University College of Medicine, Atlanta, GA, United States of America,Children's Healthcare of Atlanta
| | - Vimala Elumalai
- Division of Neurology, Arkansas Children's Hospital, United States of America
| | - Megan Leigh Hoyt
- Division of Neurology, Arkansas Children's Hospital, United States of America
| | - M. Scott Perry
- Justin Neurosciences Center, Cook Children's Medical Center, Fort Worth, Texas
| | - Luca Bartolini
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Geoffrey M Curran
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Bernstein J, Kashyap S, Kortz MW, Zakhary B, Takayanagi A, Toor H, Savla P, Wacker MR, Ananda A, Miulli D. Utilization of epilepsy surgery in the United States: A study of the National Inpatient Sample investigating the roles of race, socioeconomic status, and insurance. Surg Neurol Int 2021; 12:546. [PMID: 34877032 PMCID: PMC8645483 DOI: 10.25259/sni_824_2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/11/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Epilepsy is estimated to affect 70 million people worldwide and is medically refractory in 30% of cases. Methods: This is a retrospective cross-sectional study using a US database from 2012 to 2014 to identify patients aged ≥18 years admitted to the hospital with epilepsy as the primary diagnosis. The sampled population was weighted using Healthcare Cost and Utilization Project guidelines. Procedural ICD-9 codes were utilized to stratify the sampled population into two cohorts: resective surgery and implantation or stimulation procedure. Results: Query of the database yielded 152,925 inpatients, of which 8535 patients underwent surgical intervention. The nonprocedural group consisted of 76,000 White patients (52.6%) and 28,390 Black patients (19.7%) while the procedural group comprised 5550 White patients (64%) and 730 Black patients (8.6%) (P < 0.001). Patients with Medicare were half as likely to receive a surgical procedure (14.8% vs. 28.4%) while patients with private insurance were twice as likely to receive a procedure (53.4% vs. 29.3%), both were statistically significant (P < 0.01). Those in the lowest median household income quartile by zip code (<$40,000) were 68% less likely to receive a procedure (21.5% vs. 31.4%) while the highest income quartile was 133% more likely to receive a procedure (26.1% vs. 19.5%). Patients from rural and urban nonteaching hospitals were, by a wide margin, less likely to receive a surgical procedure. Conclusion: We demonstrate an area of need and significant improvement at institutions that have the resources and capability to perform epilepsy surgery. The data show that institutions may not be performing enough epilepsy surgery as a result of racial and socioeconomic bias. Admissions for epilepsy continue to increase without a similar trend for epilepsy surgery despite its documented effectiveness. Race, socioeconomic status, and insurance all represent significant barriers in access to epilepsy surgery. The barriers can be remedied by improving referral patterns and implementing cost-effective measures to improve inpatient epilepsy services in rural and nonteaching hospitals.
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Affiliation(s)
- Jacob Bernstein
- Department of Neurosurgery, Riverside University Health System, Riverside, California, United States
| | - Samir Kashyap
- Department of Neurosurgery, Riverside University Health System, Riverside, California, United States
| | - Michael W Kortz
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Bishoy Zakhary
- Department of Neurosurgery, Riverside University Health System, Riverside, California, United States
| | - Ariel Takayanagi
- Department of Neurosurgery, Riverside University Health System, Riverside, California, United States
| | - Harjyot Toor
- Department of Neurosurgery, Riverside University Health System, Riverside, California, United States
| | - Paras Savla
- Department of Neurosurgery, Riverside University Health System, Riverside, California, United States
| | - Margaret R Wacker
- Department of Neurosurgery, Riverside University Health System, Riverside, California, United States
| | - Ajay Ananda
- Department of Neurosurgery, Kaiser Sunset Medical Center, Los Angeles, California, United States
| | - Dan Miulli
- Department of Neurosurgery, Riverside University Health System, Riverside, California, United States
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Samanta D, Elumalai V, Desai VC, Hoyt ML. Conceptualization and implementation of an interdisciplinary clinic for children with drug-resistant epilepsy during the COVID-19 pandemic. Epilepsy Behav 2021; 125:108403. [PMID: 34781061 PMCID: PMC8639664 DOI: 10.1016/j.yebeh.2021.108403] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To describe the rapid conceptualization and implementation of an interdisciplinary epilepsy clinic for children with drug-resistant epilepsy (DRE) at Arkansas Children's Hospital (ACH) during the COVID 19 pandemic. METHODS Focusing on care design and care coordination for children with DRE, multiple stakeholder groups decided to implement a clinic after the systematic rating of constructs present in a theoretical meta-analytic framework. Based on the projected success, the new interdisciplinary clinic (composed of an epileptologist, a neurosurgeon, and a neuropsychologist and coordinated by a full-time nurse) was established. Clinic operations were further refined through discussions with patients, families, and care providers. We collected data retrospectively (August 2020 to June 2021) to determine referral patterns, clinic scheduling metrics, patient characteristics, clinical recommendations, and epilepsy quality metrics. RESULTS Of the 32 Consolidated Framework for Implementation Research constructs assessed, 24 were positively rated to predict a high probability of successful implementation of the clinic. For approximately 100 patient visits, appearance and usage rates were >75%, yielding a clinic utilization rate of approximately 60%. Among 76 unique patients (average age of 12 years, 60% focal epilepsy), 39 patients (51.3%) were deemed eligible for epilepsy surgery evaluation. The majority of the patients (53.9%) were advised for additional diagnostic testing, and 31.6% of patients were scheduled for vagus nerve stimulation. More patients (33%) had changes in their existing anti-seizure medication (ASM) regimen rather than an addition of a new ASM (7.9%). Standardized epilepsy quality measures showed >80% to 90% adherence in 3 (reproductive counseling, depression and anxiety screening, documentation of seizure frequency) out of 4 metrics. SIGNIFICANCE This is the first study to show that an interdisciplinary clinic can be a valuable attribute of care models in high-need children with DRE by enabling comprehensive one-stop service for diagnostic evaluation, surgical consideration, and brief assessment of psychiatric comorbidities without compromising consensus-based best practices.
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Affiliation(s)
- Debopam Samanta
- Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
| | | | - Vidya C Desai
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Samanta D, Hoyt ML, Perry MS. Parental experience and decision-making for epilepsy surgery: A systematic review of qualitative and quantitative studies. Epilepsy Behav 2021; 123:108263. [PMID: 34428615 PMCID: PMC8478881 DOI: 10.1016/j.yebeh.2021.108263] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/04/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE In selected children with drug-resistant epilepsy (DRE), epilepsy surgery is the most effective treatment option, but unfortunately remains highly underutilized. One of the critical obstacles to pursuing surgical therapy is parents/caregivers' decision against surgery or to delay the surgery until no other treatment option exists. Understanding caregiver decision-making around epilepsy surgery can improve patient/caregiver experience and satisfaction while facilitating appropriate decision-making that optimizes clinical outcomes. The current review systematically explores the existing evidence on caregiver experience and the decision-making process toward epilepsy surgery. METHODS The study was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic literature review. Databases (PubMed Ovid, PubMed Medline, Web of Science, CINHAL, PsycInfo) were systematically searched in February 2021 using a defined search strategy and inclusion/exclusion criteria. Total 1304 articles were screened for titles and abstracts, and 54 full-text articles were retrieved for further assessment. We included 14 articles with critical quality assessment using two different tools for qualitative and questionnaire-based studies. A qualitative content analysis was performed to characterize caregiver experience, perception, and decision-making toward favorable or unfavorable opinions of epilepsy surgery. RESULTS Four concepts generated from the analysis may act as enablers or barriers to decision-making around epilepsy surgery: 1. Access to knowledge and information, 2. Communication and coordination issues, 3. Caregiver's emotional state, and 4. Socioeconomic effects. Subsequently, we provided a narrative synthesis of practice recommendations and a conceptual framework to adopt multi-pronged interventions to overcome identified diverse barriers to effective caregiver decision-making. CONCLUSION Multiple influences impact how caregivers decide about epilepsy surgery for their children, with no single factor identified as the primary driver for or against surgery. However, limited research has explored these influences. Future studies should focus on quantitatively examining factors to identify significant variables most likely to influence caregiver decision-making, ultimately overcoming barriers that limit utilization of epilepsy surgery as a treatment tool.
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Affiliation(s)
- Debopam Samanta
- Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Megan Leigh Hoyt
- Division of Neurology, Arkansas Children’s Hospital, United States of America
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Samanta D, Leigh Hoyt M, Scott Perry M. Healthcare professionals' knowledge, attitude, and perception of epilepsy surgery: A systematic review. Epilepsy Behav 2021; 122:108199. [PMID: 34273740 PMCID: PMC8429204 DOI: 10.1016/j.yebeh.2021.108199] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The epilepsy surgery treatment gap is well defined and secondary to a broad range of issues, including healthcare professionals' (HCPs') knowledge, attitude, and perception (KAP) toward epilepsy surgery. However, no previous systematic reviews investigated this important topic. METHODS The systematic review was conducted according to Preferred Reporting Items for the Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We identified a total of 652 articles from multiple databases using database-specific queries and included 65 articles for full-text review after screening the titles and abstracts of the articles. Finally, we selected 11 papers for qualitative analysis. We critically appraised the quality of the studies using the Joanna Briggs critical appraisal tool. RESULTS The qualitative analysis of the content identified several key reasons causing healthcare professional-related barriers to epilepsy surgery: inadequate knowledge and awareness about the role of epilepsy surgery in drug-resistant epilepsy (DRE), poor identification and referral of patients with DRE, insufficient selection of candidates for presurgical workup, negative or ambivalent attitudes and perceptions regarding epilepsy surgery, deficient communication practices with patients regarding risk-benefit analysis of epilepsy surgery, and challenging coordination issues with the surgical referral. Neurologists with formal instruction in epilepsy, surgical exposure during training, participation in high volume epilepsy practice, or prior experience in surgical referral may refer more patients for surgical evaluation. CONCLUSIONS While significant work has been conducted in a limited number of studies to explore HCPs' knowledge gap and educational need regarding epilepsy surgery, further research is needed in defining the learning goals, assessing and validating specific learning gaps among providers, defining the learning outcomes, optimizing the educational format, content, and outcome measures, and appraising the achieved results following the educational intervention.
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Affiliation(s)
- Debopam Samanta
- Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Samanta D, Landes SJ. Implementation Science to Improve Quality of Neurological Care. Pediatr Neurol 2021; 121:67-74. [PMID: 34153816 PMCID: PMC8842973 DOI: 10.1016/j.pediatrneurol.2021.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 01/12/2023]
Abstract
Neurological disorders are the leading cause of disability and the second leading cause of death globally. To challenge this enormous disease burden, scientists are pursuing innovative solutions to maintain and improve the quality of neurological care. Despite the availability of many effective evidence-based practices, many patients with neurological disorders cannot access these (or receive them inefficiently after a long delay) and may be exposed to unnecessary, expensive, and potentially harmful treatments. To promote the systematic uptake of evidence-based practices into the real world, a new scientific study of methods has been developed: implementation science. In implementation science research, transdisciplinary research teams systematically (using theory, model, and framework) assess local barriers to facilitate the adoption of evidence-based practices and examine potential solutions using implementation strategies (interventions that help adoption of intended practices) targeting multiple levels in the health care system, including patient, provider, clinic, facility, organization, or broader community and policy environment. The success of these strategies (implementation outcomes) is measured by the extent and quality of the implementation. Implementation studies can be either observational or interventional but are distinct from traditional efficacy or effectiveness studies. Traditional neuroscience research and clinical trials, conducted in controlled settings, focus on discovering new insights with little consideration of translating those insights into the everyday practice of a resource-constrained and dynamic health care system. Thus, neurologists should become familiar with implementation science to reduce the knowledge-practice gap, maximize health care value, and improve management of brain disorders affecting public health.
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Affiliation(s)
- Debopam Samanta
- Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | - Sara J Landes
- University of Arkansas for Medical Sciences, Department of Psychiatry & Central Arkansas Veterans Healthcare System, Behavioral Health QUERI
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