Evidence-based standards of care for adults with epilepsy—a literature review

Epilepsy Care in Latin America and the Caribbean: Overcoming Challenges and Embracing Opportunities

The burden of epilepsy in the Latin America and the Caribbean (LAC) region causes a profound regional impact on the health care system and significantly contributes to the global epilepsy burden. As in many other resource-limited settings worldwide, health care professionals and patients with epilepsy in LAC countries face profound challenges due to a combination of factors, including high disease prevalence, stigmatization of epilepsy, disparities in access to care, limited resources, substantial treatment gaps, insufficient training opportunities for health care providers, and a diverse patient population with varying needs. This article presents an overview of the epidemiology of epilepsy and discusses the principal obstacles to epilepsy care and key contributors to the epilepsy diagnosis and treatment gap in the LAC region. We conclude by highlighting various initiatives across different LAC countries to improve epilepsy care in marginalized communities, listing strategies to mitigate treatment gaps and facilitate better health care access for patients with epilepsy by enhancing the epilepsy workforce.

Guidelines for Specialized Epilepsy Centers: Executive Summary of the Report of the National Association of Epilepsy Centers Guideline Panel

The National Association of Epilepsy Centers first published the guidelines for epilepsy centers in 1990, which were last updated in 2010. Since that update, epilepsy care and the science of guideline development have advanced significantly, including the importance of incorporating a diversity of stakeholder perspectives such as those of patients and their caregivers. Currently, despite extensive published data examining the efficacy of treatments and diagnostic testing for epilepsy, there remain significant gaps in data identifying the essential services needed for a comprehensive epilepsy center and the optimal manner for their delivery. The trustworthy consensus-based statements (TCBS) process produces unbiased, scientifically valid guidelines through a transparent process that incorporates available evidence and expert opinion. A systematic literature search returned 5937 relevant studies from which 197 articles were retained for data extraction. A panel of 41 stakeholders with diverse expertise evaluated this evidence and drafted recommendations following the TCBS process. The panel reached consensus on 52 recommendations covering services provided by specialized epilepsy centers in both the inpatient and outpatient settings in major topic areas including epilepsy monitoring unit care, surgery, neuroimaging, neuropsychology, genetics, and outpatient care. Recommendations were informed by the evidence review and reflect the consensus of a broad panel of expert opinions.

Impact of an Epilepsy Educational Programme on Coping Mechanism, Attitude, Knowledge and Awareness: A Rural Sabah Experience

Epilepsy is a disabling disease which has not been adequately emphasised as a public health concern. Patients are often left in the dark about their disease, affecting their ability to cope and live a normal life. This study aimed to explore and evaluate the effects of a structured epilepsy education programme (EEP) on awareness, knowledge and attitude (AKA) and coping mechanism of patients. Recruited participants were required to complete the modified Malay AKA epilepsy questionnaire and Malay brief coping orientation to problem experienced (Brief COPE)-27. Upon completion, they received a structured EEP conducted by trained personnel using validated materials. Participants were then followed up for a period of 6 months and reassessed at 1, 3 and 6 months to measure any changes in their AKA and coping mechanisms. Twenty-two participants were successfully recruited. Total AKA score of participants showed a significant increase (mean score difference = 16.3, p = 0.021, 95% CI: 3.0, 28.1) at 6 months post-EEP. This improvement was mostly contributed by the increase in both knowledge and attitude scores. Religion was the most preferred coping mechanism (82.5%), followed by instrumental support, emotional support, active coping and acceptance at 75.0%, respectively. Only three domains showed significant differences after the educational programme: planning: 62.5% versus 77.5%, p = 0.026; denial: 57.5% versus 37.5%, p = 0.004; venting: 62.5% versus 52.5%, p = 0.004. The EEP was effective in improving attitude and knowledge while bringing about changes in coping skills of patients over a period of time. Educational programmes should be part of epilepsy standard of care, especially as they are inexpensive and brief yet impactful

Reported service needs at diagnosis of epilepsy and implications for quality of life

AIM

This paper reports on contributing factors to Quality of Life (QoL) in an Australian community sample of people with epilepsy (PWE).

METHOD

Three hundred and ninety-three respondents or 29.6% of people on the Australian Epilepsy Research Register participated in Wave 4 of a longitudinal survey. A quantitative analysis was undertaken and a qualitative investigation examined open-ended responses by 44 PWE on the support services that they received following diagnosis of epilepsy.

RESULTS

Total Quality of Life in Epilepsy-31 Items (QOLIE-31) score for the community-based sample was 55.99 (SD 19.85) [Range 6.34-96.20]. Age, paid employment, seizure frequency, number of antiepileptic drugs (AEDs), and perceived prosperity had significant impacts on QoL. In addition, use of support services showed that availability of a first seizure clinic, accurate information on support services and peer support were associated with the highest QoL. A qualitative investigation revealed that on first diagnosis, a lack of information was the main theme. Furthermore, PWE reported a lack of understanding of available supports by a range of health professionals, schools, and in the general community.

DISCUSSION

Psychosocial factors were important in explaining QoL, and the positive effects of first seizure clinics, accurate information on support services, and of peer support have been confirmed in the literature. The lack of knowledge of support services on being diagnosed with epilepsy is a problem evident in the community and pathways are required to support people dealing with their epilepsy.

CONCLUSION

More emphasis is needed in providing availability of supports to enhance the future wellbeing and QoL of people when epilepsy is diagnosed.

Development of the Epilepsy Risk Awareness scale (ERA scale) for people with epilepsy

PURPOSE

Quality of life in people with epilepsy depends on balancing protection from risks and avoiding unnecessary restrictions. The Epilepsy Risk Awareness Checklist (ERAC) was developed to summarise an individual's safety, health care and quality of life and to facilitate communication between professionals. Although effective, the existing Checklist required quantification and shortening to increase its utility, particularly as a longitudinal tool for measuring and communicating changes over time.

METHODS

5 clinical experts, 3 people with epilepsy and 5 carers assessed the importance of each item on the ERAC questionnaire in a two-round Delphi survey. The refined Epilepsy Risk Awareness scale (ERA scale) was piloted in 30 patients to obtain an overall and sub-scale score for personal safety, health care, and quality of life domains, and was compared with the validated Seizure Severity Scale and Epilepsy Self-Management Scale.

RESULTS

ERAC was shortened from 69 to 48 items to take 15-20min for completion. Pilot results showed good internal consistency for the overall ERA scale, for the Personal Safety and Health Care subscales, but less for the Quality of Life subscale. There was strong association between ERA scale and the Epilepsy Self-Management Scale, but little relationship with Seizure Severity Scale scores, which focus on individual seizures. User ratings were high.

CONCLUSIONS

The ERA scale has been shortened and quantified to provide an objective measure of the risks and safety profile in people with epilepsy. The scale will be further tested for intra-rater variability and utility.

Implementation of an evidence-based seizure algorithm in intellectual disability nursing: A pilot study

Based on the results of the Surrogate Decision-Making Self Efficacy Scale (Lopez, 2009a), this study sought to determine whether nurses working in the field of intellectual disability (ID) experience increased confidence when they implemented the American Association of Neuroscience Nurses (AANN) Seizure Algorithm during telephone triage. The results of the study indicated using the AANN Seizure Algorithm increased self-confidence for many of the nurses in guiding care decisions during telephone triage. The treatment effect was statistically significant -3.169(p < 0.01) for a small sample of study participants. This increase in confidence is clinically essential for two reasons. Many individuals with ID and epilepsy reside within community-based settings. ID nurses provide seizure guidance to this population living in community-based settings via telephone triage. Evidenced-based training tools provide a valuable mechanism by guiding nurses via best practices. Nurses may need to be formally trained for seizure management due to high epilepsy rates in this population.

Epilepsy services in Ireland: 'A survey of people with epilepsy in relation to satisfaction, preferences and information provision'

BACKGROUND

A challenge facing modern health care systems is to develop and implement new models of service that deliver increased capacity while providing a higher-quality, more cost-effective service within resource constraints. Incorporating the experience of people with epilepsy must be seen as central to the effectiveness of service design and delivery. This paper, therefore, reports the views of people with epilepsy with regards to health service delivery in Ireland.

METHOD

A cross-sectional descriptive survey design involving both quantitative and qualitative items was administered to a convenience sample of one hundred and two people with epilepsy (n=102) attending an epilepsy specialist centre.

RESULTS

Despite high levels of satisfaction with hospital and primary care, participants offered several suggestions to improve healthcare delivery, such as: less delay in accessing specialist care and hospital appointments; better communication; and easier access to investigatory services. Findings demonstrate that for people with epilepsy the burden of the disorder is substantial and complex encompassing social, psychological and structural difficulties. Poor information provision particularly among women is reported. Furthermore, a lack of empowerment in people with epilepsy is highlighted.

CONCLUSION

This study has implications for the reform and development of epilepsy services in relation to practice, education and research. It provides a basis for an evaluation of current practice and identifies opportunities for future service reorganization to improve the quality and efficiency of healthcare provision.

Impact of health education on drug adherence and self-care in people with epilepsy with low education

PURPOSE

This study was conducted to observe the effect of a structured educational program on drug adherence and self-care management in people with epilepsy in a developing country.

METHODS

A total of 180 consecutive people with epilepsy were enrolled from the epilepsy clinic of a tertiary care hospital in North India. Out of these, 90 were randomized to the epilepsy health education group and received the educational program and 90 were in the control group and received the standard of care but did not receive any structured educational program. The modified Morisky Medication Adherence Scale (MMAS) and Epilepsy Self-Efficacy Scale (ESES) were administered to assess drug adherence and self-care, respectively, on the day of enrollment. The patients enrolled in the epilepsy health education group received 4 sessions of the structured educational program. The MMAS and ESES questionnaires were again administered to both groups after 6months.

STATISTICAL METHODS

Continuous and categorical variables were compared between control and epilepsy health education groups using a chi-square test, with p value less than 0.05 considered significant. A comparison between pretest and posttest MMAS scores and ESES scores was done using a paired t-test.

RESULTS

In the epilepsy health education group, the pretest mean MMAS score was 6.58 whereas the posttest mean MMAS score was 7.53; the difference was significant (p=0.001). The mean MMAS scores for the control group's pretest and posttest were 6.46 and 6.58, respectively, which were not significantly different (p=0.224). On comparing the ESES scores at the beginning of the study and after 6months, there was no significant change in both groups.

CONCLUSIONS

The present study proves the efficacy of a structured educational program in improving drug adherence in a cohort of people with epilepsy with low educational background.

The health care journeys experienced by people with epilepsy in Ireland: what are the implications for future service reform and development?

Opportunities exist to significantly improve the quality and efficiency of epilepsy care in Ireland. Historically, epilepsy research has focused on quantitative methodologies that often fail to capture the invaluable insight of patient experiences as they negotiate their health care needs. Using a phenomenological approach, we conducted one-to-one interviews with people with epilepsy, reporting on their understanding of their health care journey from onset of symptoms through to their first interaction with specialist epilepsy services. Following analysis of the data, five major themes emerged: delayed access to specialist epilepsy review; uncertainty regarding the competency and function of primary care services; significant unmet needs for female patients with epilepsy; disorganization of existing epilepsy services; and unmet patient information needs. The findings reveal important insights into the challenges experienced by people with epilepsy in Ireland and identify the opportunities for future service reorganization to improve the quality and efficiency of care provided.

A structured, nurse-led intervention program improves quality of life in patients with epilepsy: a randomized, controlled trial

We tested the hypothesis that structured epilepsy nursing improves quality of life (QOL). One hundred fourteen adult patients with uncontrolled epilepsy were randomly assigned to either an intervention group or a control group. The intervention group was offered an interactive, 1-day group education program followed by extended nurse follow-up and counseling. The nurse was present at as many outpatient consultations as possible and performed repeated consultations by telephone. All patients completed the QOLIE-89 before randomization and after 2 years. QOL was significantly improved from inclusion to completion of study in the intervention group (P=0.019), mainly in the subitems for Health Discouragement (P=0.01), Medication Effects (P=0.035), and Physical Role Limitations (P=0.05). To our knowledge, this is the first study to demonstrate a significant effect of a structured nurse-led intervention program in QOL of patients with epilepsy.