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Kanner AM, Carrazana E, Munger Clary HM, Rabinowicz AL, Faught E. Anticipatory anxiety of seizures in epilepsy: A common, complex, and underrecognized phenomenon? Epileptic Disord 2024; 26:273-281. [PMID: 38624139 DOI: 10.1002/epd2.20224] [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: 11/03/2023] [Revised: 03/01/2024] [Accepted: 03/30/2024] [Indexed: 04/17/2024]
Abstract
The diagnosis of epilepsy is associated with loss of predictability, which invariably results in the fear of when and if future seizures will occur. For a subset of patients with epilepsy (PWE), there may be a pathological persistent fear of seizure occurrence, resulting in limitations to daily activities through avoidant behaviors. Paradoxically, the research of anticipatory anxiety of seizures (AAS; also referred to as seizure phobia) has been practically nonexistent and, not surprisingly, this condition remains underrecognized by clinicians. The available data are derived from three small case series of patients followed in tertiary epilepsy centers. In this study, we review the available data on the reported clinical manifestations of AAS in PWE, and of the potential role of variables associated with it, such as personal and family psychosocial and psychiatric history and epilepsy-related variables. In addition, we review the need for the creation of screening tools to identify patients at risk of AAS and discuss potential treatment strategies, which could be considered as part of the comprehensive management for PWE.
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Affiliation(s)
- Andres M Kanner
- Comprehensive Epilepsy Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Enrique Carrazana
- Neurelis, Inc., San Diego, California, USA
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Heidi M Munger Clary
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Edward Faught
- Emory Epilepsy Program, Emory University School of Medicine, Atlanta, Georgia, USA
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Joshi C. Seizure Detection Devices in Children: One Step Closer. Epilepsy Curr 2024; 24:31-33. [PMID: 38327538 PMCID: PMC10846510 DOI: 10.1177/15357597231211710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
Multimodal Nocturnal Seizure Detection in Children With Epilepsy: A Prospective, Multicenter, Long-Term, In-Home Trial van Westrhenen A, Lazeron RHC, van Dijk JP, Leijten FSS, Thijs RD; Dutch TeleEpilepsy Consortium. Epilepsia. 2023;64(8):2137-2152. doi:10.1111/epi.17654 Objective: There is a pressing need for reliable automated seizure detection in epilepsy care. Performance evidence on ambulatory non-electroencephalography-based seizure detection devices is low, and evidence on their effect on caregiver’s stress, sleep, and quality of life (QoL) is still lacking. We aimed to determine the performance of NightWatch, a wearable nocturnal seizure detection device, in children with epilepsy in the family home setting and to assess its impact on caregiver burden. Methods: We conducted a phase 4, multicenter, prospective, video-controlled, in-home NightWatch implementation study (NCT03909984). We included children aged 4-16 years, with ≥1 weekly nocturnal major motor seizure, living at home. We compared a 2-month baseline period with a 2-month NightWatch intervention. The primary outcome was the detection performance of NightWatch for major motor seizures (focal to bilateral or generalized tonic-clonic [TC] seizures, focal to bilateral or generalized tonic seizures lasting >30 s, hyperkinetic seizures, and a remainder category of focal to bilateral or generalized clonic seizures and “TC-like” seizures). Secondary outcomes included caregivers’ stress (Caregiver Strain Index [CSI]), sleep (Pittsburgh Quality of Sleep Index), and QoL (EuroQol five-dimension five-level scale). Results: We included 53 children (55% male, mean age = 9.7 ± 3.6 years, 68% learning disability) and analyzed 2310 nights (28 173 h), including 552 major motor seizures. Nineteen participants did not experience any episode of interest during the trial. The median detection sensitivity per participant was 100% (range = 46%-100%), and the median individual false alarm rate was .04 per hour (range = 0-.53). Caregiver’s stress decreased significantly (mean total CSI score = 8.0 vs. 7.1, p = .032), whereas caregiver’s sleep and QoL did not change significantly during the trial. Significance: The NightWatch system demonstrated high sensitivity for detecting nocturnal major motor seizures in children in a family home setting and reduced caregiver stress.
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Affiliation(s)
- Charuta Joshi
- Department of Pediatrics, UTSW, Childrens Health, Dallas
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van Westrhenen A, Lazeron RHC, van Dijk JP, Leijten FSS, Thijs RD. Multimodal nocturnal seizure detection in children with epilepsy: A prospective, multicenter, long-term, in-home trial. Epilepsia 2023; 64:2137-2152. [PMID: 37195144 DOI: 10.1111/epi.17654] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE There is a pressing need for reliable automated seizure detection in epilepsy care. Performance evidence on ambulatory non-electroencephalography-based seizure detection devices is low, and evidence on their effect on caregiver's stress, sleep, and quality of life (QoL) is still lacking. We aimed to determine the performance of NightWatch, a wearable nocturnal seizure detection device, in children with epilepsy in the family home setting and to assess its impact on caregiver burden. METHODS We conducted a phase 4, multicenter, prospective, video-controlled, in-home NightWatch implementation study (NCT03909984). We included children aged 4-16 years, with ≥1 weekly nocturnal major motor seizure, living at home. We compared a 2-month baseline period with a 2-month NightWatch intervention. The primary outcome was the detection performance of NightWatch for major motor seizures (focal to bilateral or generalized tonic-clonic [TC] seizures, focal to bilateral or generalized tonic seizures lasting >30 s, hyperkinetic seizures, and a remainder category of focal to bilateral or generalized clonic seizures and "TC-like" seizures). Secondary outcomes included caregivers' stress (Caregiver Strain Index [CSI]), sleep (Pittsburgh Quality of Sleep Index), and QoL (EuroQol five-dimension five-level scale). RESULTS We included 53 children (55% male, mean age = 9.7 ± 3.6 years, 68% learning disability) and analyzed 2310 nights (28 173 h), including 552 major motor seizures. Nineteen participants did not experience any episode of interest during the trial. The median detection sensitivity per participant was 100% (range = 46%-100%), and the median individual false alarm rate was .04 per hour (range = 0-.53). Caregiver's stress decreased significantly (mean total CSI score = 8.0 vs. 7.1, p = .032), whereas caregiver's sleep and QoL did not change significantly during the trial. SIGNIFICANCE The NightWatch system demonstrated high sensitivity for detecting nocturnal major motor seizures in children in a family home setting and reduced caregiver stress.
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Affiliation(s)
- Anouk van Westrhenen
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede and Zwolle, the Netherlands
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Richard H C Lazeron
- Academic Center of Epileptology Kempenhaeghe, Heeze, the Netherlands
- Faculty of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Johannes P van Dijk
- Academic Center of Epileptology Kempenhaeghe, Heeze, the Netherlands
- Faculty of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
- Department of Orthodontics, Ulm University, Ulm, Germany
| | - Frans S S Leijten
- Brain Center, Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Roland D Thijs
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede and Zwolle, the Netherlands
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, the Netherlands
- UCL Queen Square Institute of Neurology, London, UK
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Huang X, Kang Y, Wang M, Liu Q, Wang F, Zeng M. WeChat-based remote follow-up management reduces the burden of home care and anxiety on parents of children with refractory epilepsy: A randomized controlled study. Medicine (Baltimore) 2023; 102:e34070. [PMID: 37352033 PMCID: PMC10289595 DOI: 10.1097/md.0000000000034070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/08/2023] [Accepted: 06/01/2023] [Indexed: 06/25/2023] Open
Abstract
OBJECTIVE The present research was designed to study the effect of WeChat-based remote follow-up management on the burden of home care and anxiety on parents of children with refractory epilepsy. METHODS 161 refractory epileptic children were included in this study. They were divided into control group and WeChat group according to their management protocols after discharge, namely, control group with traditional follow-up (n = 81) and WeChat group with remote follow-up based on WeChat (n = 81). We evaluated home care burden by family caregiver task Inventory (FCTI) scale and zarit burden interview (ZBI) scale, and evaluated negative emotion by self-rating anxiety Scale (SAS) scale and self-Rating depression scale (SDS) scale. RESULTS There was no significant difference in the demographic characteristics of epileptic children and their parents and the scores of FCTI, ZBI, SAS and SDS before treatment between the 2 groups (all P > .05), and the score of FCTI (20.86 ± 4.26), ZBI (39.63 ± 4.46), SAS (44.49 ± 4.15) and SDS (50.02 ± 4.13) in WeChat group were all significantly lower than the score of FCTI (25.25 ± 3.71), ZBI (45.47 ± 4.61), SAS (52.75 ± 4.93) and SDS (54.51 ± 6.59) in control group (all P < .05). CONCLUSION WeChat-based remote follow-up management reduces the burden of home care and anxiety on parents of children with refractory epilepsy.
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Affiliation(s)
- Xiaofen Huang
- Department of Neurosurgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Yueming Kang
- Department of Neurosurgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Meixin Wang
- Department of Neurosurgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Qianqian Liu
- Department of Neurosurgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Feng Wang
- Department of Neurosurgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Mingzhu Zeng
- Department of Neurosurgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Department of Neurosurgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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An economic evaluation of the NightWatch for children with refractory epilepsy: Insight into the cost-effectiveness and cost-utility. Seizure 2022; 101:156-161. [PMID: 36030593 DOI: 10.1016/j.seizure.2022.08.003] [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: 03/24/2022] [Revised: 08/12/2022] [Accepted: 08/14/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We performed an economic evaluation, from a societal perspective, to examine the cost-utility and cost-effectiveness of a wearable multimodal seizure detection device: NightWatch. METHODS We collected data between November 2018 and June 2020 from the PROMISE trial (NCT03909984), including children aged 4-16 years with refractory epilepsy living at home. Caregivers completed questionnaires on stress, quality of life, health care consumption and productivity costs after two-month baseline and two-month intervention with NightWatch. We used costs, stress levels and quality-adjusted life years (QALYs) to calculate incremental cost-effectiveness ratios (ICERs). Missing items were handled by mean imputation. Sensitivity analyses were performed to examine the robustness of the results including bootstrap sampling. RESULTS We included 41 children (44% female; mean age 9.8 years, standard deviation (SD) 3.7 years). Total societal costs of the baseline period (T1) were on average €3,238 per patient, whereas after intervention (T2) this reduced to 2,463 (saving €775). The QALYs were similar between both periods (mean QALY 0.90 per participant, SD at T1 0.10, SD at T2 0.13). At a ceiling ratio of €50.000, NightWatch showed a 72% cost-effective probability. Univariate sensitivity analyses, on the perspective and imputation method, demonstrated result robustness. CONCLUSION Our study suggests that NightWatch might be a cost-effective addition to current standard care for children with refractory epilepsy living at home. Further research with an additional target group for a large timeframe may support the findings of this research.
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Strzelczyk A, Schwab C, Knake S, von Podewils F, Seifart C, Schubert-Bast S, Rosenow F. Reply to: "All patients with epilepsy, whether at high or low risk of SUDEP, should have access to individually tailored SUDEP information" by Oliver Henning, Karl O. Nakken, and Morten I. Lossius. Epilepsy Behav 2022; 127:108534. [PMID: 35027303 DOI: 10.1016/j.yebeh.2021.108534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 12/27/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany; Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany.
| | - Christina Schwab
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Susanne Knake
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Felix von Podewils
- Epilepsy Center and Department of Neurology, University of Greifswald, Greifswald, Germany
| | - Carola Seifart
- Institutional Review Board, Medical Faculty, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Susanne Schubert-Bast
- Department of Neuropediatrics, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany
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