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Turner EM, Wilkening G, Hutaff-Lee C, Wolfe KR. From Evidence-Based Guidelines to Clinical Practice: Pediatric Neuropsychology Care in Multidisciplinary Clinics. Arch Clin Neuropsychol 2024; 39:547-556. [PMID: 38205830 DOI: 10.1093/arclin/acad099] [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: 04/21/2023] [Revised: 10/31/2023] [Accepted: 12/04/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE High demand for pediatric neuropsychological care has highlighted the time- and resource-intensive nature of traditional comprehensive evaluations. Emerging care models address these constraints by facilitating tiered neuropsychological services provided in various contexts, including multidisciplinary clinics (MDCs). We aim to demonstrate feasibility and acceptability of tiered neuropsychological care in MDCs through examples from a single institution. METHODS A review of all current MDC practices at a tertiary pediatric care center was conducted to describe clinic workflow, services provided, and triage strategies. Pediatric neuropsychologists (n = 5) and other health care providers (n = 31) completed a survey focused on experience with neuropsychology consultation in MDCs. RESULTS Neuropsychologists provided care in 11 MDCs, including universal monitoring with consultative interviews and questionnaires, as well as targeted screening. Neuropsychologists (89%) and other health professionals (100%) reported that tiered neuropsychological services improved patient care within MDCs. Other health professionals reported utilizing results from neuropsychology MDC care to inform their clinical approach (48-90%), referrals (58%), and treatment or surveillance decisions (55-71%). CONCLUSION Tiered neuropsychological care in pediatric MDCs is feasible, and provider experience ratings indicate high acceptability. Practical steps for development of MDCs are provided, including identifying teams, clinic goals and outcomes, operational logistics, and billing.
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Affiliation(s)
- Elise M Turner
- Department of Pediatrics, Section of Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Greta Wilkening
- Department of Pediatrics, Section of Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Christa Hutaff-Lee
- Department of Pediatrics, Section of Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Kelly R Wolfe
- Department of Pediatrics, Section of Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO 80045, USA
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Lu Q, Dun S, Wang QH, Wang YY, Chen HM, Zhang Q, Zou LP. Challenges in the Management of Children and Adolescents With Epilepsy in China During the COVID-19 Pandemic: An Online Survey-Based Study. J Child Neurol 2023; 38:590-596. [PMID: 37624690 DOI: 10.1177/08830738231193229] [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] [Indexed: 08/27/2023]
Abstract
INTRODUCTION To investigate the challenges in the management of children and adolescents with epilepsy in China during the coronavirus disease (COVID-19) pandemic. METHODS We conducted a cross-sectional survey among 845 patients with epilepsy using an online-based questionnaire. The questionnaire focused on sociodemographic characteristics, epilepsy-related conditions, health care access, COVID-19 vaccination, and the mental health of caregivers. Depression was assessed using Patient Health Questionnaire-9. RESULTS During the pandemic, 24.73% of the patients had increased seizures. The majority of patients (68.89%) experienced difficulty obtaining antiseizure medications. In addition, 94.79% of the patients had difficulty consulting a doctor. A total of 52.78% of the patients selected telemedicine services, and most found these services to be helpful. Moreover, 76.11% of the patients failed to complete the COVID-19 vaccination. More than half of the caregivers had anxiety and depressive symptoms. The risk factors for depression comprised irregularity in taking antiseizure medications, difficulty in obtaining antiseizure medications, and failure to consult a doctor on time. CONCLUSIONS The COVID-19 pandemic presented a great challenge in the management of children and adolescents with epilepsy in China. The findings highlight the importance of improving health care systems and medication management and the mental health of their caregivers.
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Affiliation(s)
- Qian Lu
- Medical School of Chinese PLA, Beijing, China
- Department of Pediatrics, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shuo Dun
- Medical School of Chinese PLA, Beijing, China
- Department of Pediatrics, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qiu-Hong Wang
- Medical School of Chinese PLA, Beijing, China
- Department of Pediatrics, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yang-Yang Wang
- Department of Pediatrics, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hui-Min Chen
- Department of Pediatrics, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qi Zhang
- Medical School of Chinese PLA, Beijing, China
- Department of Pediatrics, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Li-Ping Zou
- Medical School of Chinese PLA, Beijing, China
- Department of Pediatrics, the First Medical Center of Chinese PLA General Hospital, Beijing, China
- Beijing Institute for Brain Disorders, Center for Brain Disorders Research, Capital Medical University, Beijing, China
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Kregel M, Coulson S, Nabavi Nouri M, Sorzano R, Andrade A. Families' Knowledge Change in Paediatric Drug Resistant Epilepsy: A Novel Clinic Model. Seizure 2023; 108:116-126. [PMID: 37146515 DOI: 10.1016/j.seizure.2023.04.019] [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: 01/30/2023] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Epilepsy is a chronic condition that affects approximately 95,000 Ontarians, of whom approximately 15,000 are children under the age of 18. Drug resistant epilepsy (DRE) will affect around 30% of these children who will require more advanced care due to their medical complexities. The purpose of this study is to determine if receiving care in a paediatric Comprehensive Epilepsy Clinic (CEC) is associated with positive outcomes for children living with DRE and their families by looking at three health outcomes: 1) families' knowledge of their child's diagnosis and treatment plan, 2) navigational access to both the hospital and community epilepsy services, and 3) health behaviours. METHODS This was a prospective cohort study in which families of children diagnosed with DRE would be exposed to a CEC care model for the first time and followed for 6-months after enrollment. This was analyzed by utilizing surveys from new families at baseline and 6 months post receiving care within a CEC. RESULTS Results revealed a statistical significance in change of knowledge in families' knowing the type of epilepsy their child has and what epilepsy co-morbidities are. Families' also had a significant change in utilizing hospital epilepsy resources and knowing who to contact in the community and hospital for their epilepsy related questions. CONCLUSION A CEC model improves families' knowledge about epilepsy diagnosis and treatment plan, navigational access to both the hospital and community epilepsy services, and health behaviours.
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Affiliation(s)
- Michelle Kregel
- Children's Hospital, London Health Sciences, 800 Commissioners Rd E, London, Ontario N6A 5W9, Canada; Lawson Health Research Institute, 750 Baseline Rd E, London, Ontario N6C 2R5, Canada.
| | - Sherry Coulson
- Department of Paediatrics, Western University, 1151 Richmond St, London, Ontario N6A 5C1, Canada
| | - Maryam Nabavi Nouri
- Department of Paediatrics, Schulich School of Medicine & Dentistry, 1151 Richmond St, London, Ontario N6A 5C1, Canada
| | - Rochelle Sorzano
- Lawson Health Research Institute, 750 Baseline Rd E, London, Ontario N6C 2R5, Canada
| | - Andrea Andrade
- Department of Paediatrics, Schulich School of Medicine & Dentistry, 1151 Richmond St, London, Ontario N6A 5C1, Canada
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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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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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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: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [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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