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Ali A, Clarke DF. Digital measures in epilepsy in low-resourced environments. Expert Rev Pharmacoecon Outcomes Res 2024; 24:705-712. [PMID: 37818647 DOI: 10.1080/14737167.2023.2270163] [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: 07/14/2023] [Accepted: 10/09/2023] [Indexed: 10/12/2023]
Abstract
INTRODUCTION Digital measures and digital health-care delivery have been rarely implemented in lower-and-middle-income countries (LMICs), contributing to worsening global disparities and inequities. Sustainable ways to implement and use digital approaches will help to improve time to access, management, and quality of life in persons with epilepsy, goals that remain unreachable in under-resourced communities. As under-resourced environments differ in human and economic resources, no one approach will be appropriate to all LMICs. AREAS COVERED Digital health and tools to monitor and measure digital endpoints and metrics of quality of life will need to be developed or adapted to the specific needs of under-resourced areas. Portable technologies may partially address the urban-rural divide. Careful delineation of stakeholders and their engagement and alignment in all efforts is critically important if these initiatives are to be successfully sustained. Privacy issues, neglected in many regions globally, must be purposefully addressed. EXPERT OPINION Epilepsy care in under-resourced environments has been limited by the lack of relevant technologies for diagnosis and treatment. Digital biomarkers, and investigative technological advances, may finally make it feasible to sustainably improve care delivery and ultimately quality of life including personalized epilepsy care.
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Affiliation(s)
- Amza Ali
- Department of Medicine, Faculty of Medical Sciences, Mona, Kingston, Jamaica
| | - Dave F Clarke
- Dell Medical School, University of Texas at Austin, Austin, TX, USA
- Department of Pediatric Epilepsy, Dell Children's Medical Center of Central Texas, Austin, TX, USA
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2
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Singh H, Raja A, Chauhan A, Jain A, Prakash A, Bhatia A, Avti P, Medhi B. Unlocking the Therapeutic Potential: Sitagliptin's Multifaceted Approach in Drug-Resistant Epilepsy through a Novel Mechanism Inhibiting Protein Kinase C-γ and a Long-Term Potentiation Pathway. ACS Pharmacol Transl Sci 2024; 7:1856-1863. [PMID: 38898950 PMCID: PMC11184596 DOI: 10.1021/acsptsci.4c00073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/24/2024] [Accepted: 05/08/2024] [Indexed: 06/21/2024]
Abstract
Drug-resistant epilepsy is a prominent challenge in chronic neurological disorders. Valproate, commonly used to treat epilepsy, can fail due to various side effects and interactions, necessitating the exploration of alternative treatments. Our study primarily investigated sitagliptin's potential as a therapeutic agent for drug-resistant epilepsy. Employing computational modeling and enzyme assay testing, three lead compounds, emixustat, sitagliptin, and distigmine bromide, were evaluated against the target enzyme protein kinase C-γ. In vivo, experiments on a pentylenetetrazolium-induced lamotrigine-resistant epilepsy model were conducted to test sitagliptin's antiseizure effects, compared with the standard phenobarbital treatment. Emixustat and sitagliptin showcased strong inhibitory properties, while distigmine bromide was less effective in the enzyme assay. Mechanistic insights revealed sitagliptin's ability to modulate the seizure grade and first myoclonic jerk latency via oxidative stress markers, like reduced glutathione and glutathione peroxidase emphasizing its antioxidative role in epilepsy. Additionally, it demonstrated anti-inflammatory effects by significantly reducing proinflammatory markers interleukin-1β and interleukin-6. The modulation of key genes of the long-term potentiation pathway, particularly protein kinase C-γ and metabotropic glutamate receptor 5, was evident through mRNA expression levels. Finally, sitagliptin showed potential neuroprotective properties, limiting pentylenetetrazolium-induced neuronal loss in the hippocampal region. Collectively, our findings suggest sitagliptin's multidimensional therapeutic potential for drug-resistant epilepsy specifically via a long-term potentiation pathway by inhibiting protein kinase C-γ.
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Affiliation(s)
- Harvinder Singh
- Department
of Pharmacology, PGIMER, Chandigarh 160012, India
| | - Anupam Raja
- Department
of Pharmacology, PGIMER, Chandigarh 160012, India
| | - Arushi Chauhan
- Department
of Biophysics, PGIMER, Chandigarh 160012, India
| | - Ashish Jain
- Department
of Pharmacology, PGIMER, Chandigarh 160012, India
| | - Ajay Prakash
- Department
of Pharmacology, PGIMER, Chandigarh 160012, India
| | - Alka Bhatia
- Department
of Experimental Medicine and Biotechnology, PGIMER, Chandigarh 160012, India
| | - Pramod Avti
- Department
of Biophysics, PGIMER, Chandigarh 160012, India
| | - Bikash Medhi
- Department
of Pharmacology, PGIMER, Chandigarh 160012, India
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3
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Nanda P, Richardson RM. Evolution of Stereo-Electroencephalography at Massachusetts General Hospital. Neurosurg Clin N Am 2024; 35:87-94. [PMID: 38000845 DOI: 10.1016/j.nec.2023.09.007] [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] [Indexed: 11/26/2023]
Abstract
The practice of invasive monitoring for presurgical epilepsy workup has evolved at Massachusetts General Hospital (MGH) in parallel to the evolution in the field's understanding of epilepsy as a network disorder. Implantations have shifted from an emphasis on singularly finding single foci for the purpose of resection to a network-hypothesis-driven approach aiming to delineate patients' seizure networks with the goal of developing surgical interventions that disrupt critical nodes of these networks. Here, the authors review all invasive monitoring cases at MGH from April 2016 through June 2023 to describe how this paradigm shift has taken form.
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Affiliation(s)
- Pranav Nanda
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Neurosurgery, Harvard Medical School, Boston, MA 02115, USA.
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Neurosurgery, Harvard Medical School, Boston, MA 02115, USA
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Ostendorf AP. Epilepsy Impacts Families and Communities: Persistent Gaps and Inequities. Semin Pediatr Neurol 2023; 47:101084. [PMID: 37919034 DOI: 10.1016/j.spen.2023.101084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
EFFECT OF EPILEPSY ON FAMILIES, COMMUNITIES, AND SOCIETY Adam P. Ostendorf , Satyanarayana Gedela Seminars in Pediatric Neurology Volume 24, Issue 4, November 2017, Pages 340-347 The effect of epilepsy extends beyond those with the diagnosis and impacts families, communities and society. Caregiver and sibling quality of life is often negatively affected by frequent seizures, comorbid behavioral and sleep disorders and stigma surrounding the diagnosis. Furthermore, the negative effects can be magnified by individual coping styles and resources available to families of those with epilepsy. Beyond the family and immediate caregivers, epilepsy affects local communities by drawing additional resources from education systems. The direct costs of caring for an individual with epilepsy and the indirect costs associated with decreased productivity place financial strain on individuals and health care systems throughout the world. This review details factors affecting family and caregiver quality of life and provides several approaches through which health care providers may address these concerns. Furthermore, we examine the financial effect of epilepsy on society and review emerging strategies to lessen health care use for individuals with epilepsy.
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Affiliation(s)
- Adam P Ostendorf
- Neurology Division, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
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Sadanandan SA, Shreedevi AU, Padmanabha H. Parental KAP and its Relation with the Quality of Life in Children with Epilepsy. Ann Indian Acad Neurol 2023; 26:419-423. [PMID: 37970311 PMCID: PMC10645211 DOI: 10.4103/aian.aian_199_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/20/2023] [Accepted: 06/02/2023] [Indexed: 11/17/2023] Open
Abstract
Background Epilepsy is a chronic disorder with recurrent unprovoked seizures which can affect children at any age. A child's quality of life (QOL) is significantly impacted by an epilepsy diagnosis throughout their formative years. Adjustment and QOL for the child and family are highly correlated with parental knowledge, attitudes, and practices (KAP) regarding epilepsy. Objectives Determining the association between parental KAP and the QOL of children with epilepsy (CWE) and to study the association between them. Materials and Methods Using convenience sampling procedure, 30 CWE between the ages of 6 and 14-of either sex-and their 30 parents made up the sample. The knowledge, attitude, and practice (KAP) tool, which was given to parents, and the Quality of Life in Childhood Epilepsy Questionnaire-55 (QOLCE-55), which was given to CWE, were used to gather the data. Frequency distribution, percentage, and correlation coefficient tests were used to assess the measures. Results There were statistically significant relationships between the QOL and KAP domains and parental education, domicile, and socioeconomic position. The cognitive, emotional, and social domains of QOL were adversely connected with the knowledge domain in KAP, but the physical domain was positively correlated. Parents' behavior and physical QOL were found to be negatively correlated. Conclusion Although educated parents had sufficient information and a positive outlook, there was a discrepancy between recommended and actual practice, and KAP has an impact on the QOL of CWE. Parental education initiatives may significantly improve understanding and promote healthy behaviors.
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Affiliation(s)
- Sanithamol A. Sadanandan
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Athyadi U. Shreedevi
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Hansashree Padmanabha
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Sadashiva N, Kadam R, Arimappamagan A, Rao MB, Mundlamuri RC, Raghavendra K, Asranna A, Viswanathan LG, Mariyappa N, Kulanthaivelu K, Mangalore S, Nagaraj C, Saini J, Bharath RD, Rajeswaran J, Mahadevan A, Satishchandra P, Sinha S. Corpus Callosotomy for Non-Localizing Drug Resistant Epilepsy with Drop Attacks. World Neurosurg 2023; 171:e57-e63. [PMID: 36435385 DOI: 10.1016/j.wneu.2022.11.078] [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: 10/04/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Corpus callosotomy (CC) is a surgical palliative procedure done for a selected group of patients with drug resistant epilepsy (DRE) to stop drop attacks and prevent falls. METHODS We performed a retrospective chart review of consecutive patients who underwent CC for DRE with drop attacks at our center between 2015 and 2019. Clinical, imaging details and surgical findings were noted. Clinical outcomes and functional status were evaluated. RESULTS During the study period, 17 patients underwent corpus callosotomy (Male: Female 14:3). The mean age at surgery was 10.3 years (standard deviation - 5.85, interquartile range [IQR] = 6.5). The mean age at onset of seizure was 2.23 years (standard deviation - 3.42, IQR = 1.5). Preoperative seizure frequency ranged from 2 to 60 attacks per day (median: 20, IQR= 36). All patients had atonic seizures/drop attacks. One patient underwent anterior CC and 16 underwent complete CC. Three patients had complications in the postoperative period. The median follow-up was 26 months. All patients had cessation of drop attacks immediately following surgery. One patient with anterior CC had a recurrence of drop attacks for which she underwent completion CC. Another patient had recurrent drop attacks 3 years later and was found to have a residual callosal connection. Three patients had complete seizure freedom and 4 patients had a <50% reduction in seizure frequency. CONCLUSIONS Our study lends additional support to the efficacy of CC in patients with DRE, with the cessation of drop attacks. It also provided a reasonable reduction in seizure frequency. Complete CC led to better control of drop attacks.
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Affiliation(s)
- Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Raju Kadam
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Arivazhagan Arimappamagan
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - Malla Bhaskara Rao
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | | | - Kenchaiah Raghavendra
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Ajay Asranna
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | | | - Narayanan Mariyappa
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Karthik Kulanthaivelu
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Sandhya Mangalore
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Chandana Nagaraj
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Rose Dawn Bharath
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Jamuna Rajeswaran
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | | | - Sanjib Sinha
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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7
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Begley C, Wagner RG, Abraham A, Beghi E, Newton C, Kwon CS, Labiner D, Winkler A. The global cost of epilepsy: A systematic review and extrapolation. Epilepsia 2022; 63:892-903. [PMID: 35195894 DOI: 10.1111/epi.17165] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/29/2021] [Accepted: 12/29/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Global action for epilepsy requires information on the cost of epilepsy, which is currently unknown for most countries and regions of the world. To address this knowledge gap, the International League Against Epilepsy Commission on Epidemiology formed the Global Cost of Epilepsy Task Force. METHODS We completed a systematic search of the epilepsy cost-of-illness literature and identified studies that provided a comprehensive set of direct health care and/or indirect costs, followed standard methods of case identification and cost estimation, and used data on a representative population or subpopulation of people with epilepsy. Country-specific costs per person with epilepsy were extracted and adjusted to generate an average cost per person in 2019 US dollars. For countries with no cost data, estimates were imputed based on average costs per person of similar income countries with data. Per person costs for each country were then applied to data on the prevalence of epilepsy from the Global Burden of Disease collaboration adjusted for the treatment gap. RESULTS One hundred one cost-of-illness studies were included in the direct health care cost database, 74 from North America or Western Europe. Thirteen studies were used in the indirect cost database, eight from North America or Western Europe. The average annual cost per person with epilepsy in 2019 ranged from $204 in low-income countries to $11 432 in high-income countries based on this highly skewed database. The total cost of epilepsy, applying per person costs to the estimated 52.51 million people in the world with epilepsy and adjusting for the treatment gap, was $119.27 billion. SIGNIFICANCE Based on a summary and extrapolations of this limited database, the global cost of epilepsy is substantial and highly concentrated in countries with well-developed health care systems, higher wages and income, limited treatment gaps, and a relatively small percentage of the epilepsy population.
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Affiliation(s)
- Charles Begley
- School of Public Health, University of Texas Health Science Center, Houston, Texas, USA
| | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Parktown, South Africa
| | - Annette Abraham
- Department of Neurology, Center for Global Health, Technical University of Munich, Munich, Germany.,Faculty of Medicine, Center for Global Health, University of Oslo, Oslo, Norway
| | - Ettore Beghi
- Mario Negri Institute for Pharmacological Research, Milan, Italy
| | | | - Churl-Su Kwon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David Labiner
- Department of Neurology, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Andrea Winkler
- Department of Neurology, Center for Global Health, Technical University of Munich, Munich, Germany.,Faculty of Medicine, Center for Global Health, University of Oslo, Oslo, Norway
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8
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Choudhary PK, Chakrabarty B. Treatment of West Syndrome: From Clinical Efficacy to Cost-Effectiveness, the Juggernaut Rolls On. Indian J Pediatr 2022; 89:109-110. [PMID: 34837642 DOI: 10.1007/s12098-021-04037-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | - Biswaroop Chakrabarty
- Child Neurology Division, Department of Pediatrics, AIIMS, New Delhi, 110029, India.
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9
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Abstract
OBJECTIVE To evaluate the illness-related expenditure by families of children with West syndrome (WS) during the first year of illness and to explore the potential determinants of the financial drain. METHODS This cross-sectional study was conducted at a tertiary care hospital between July 2018 and June 2020. Eighty-five children with WS who presented within one year from the onset of epileptic spasms were included. The details of the treatment costs (direct medical and nonmedical) incurred during the first year from the onset of epileptic spasms were noted from a parental interview and case record review. Unit cost was fixed for drugs and specific services. Total cost was estimated by multiplying the unit cost by the number of times a drug or service was availed. The determinants of the financial burden were also explored. RESULTS The median monthly per-capita income of the enrolled families (n = 85) was INR 3000 (Q1, Q3, 2000, 6000). The median cost of treatment over one year was INR 27035 (Q1, Q3, 17,894, 39,591). Median direct medical and nonmedical expenses amounted to INR 18802 (Q1, Q3, 12,179, 25,580) and INR 6550 (Q1, Q3, 3500, 15,000), respectively. Seven families had catastrophic healthcare expenditure. Parental education and choice of first-line treatment were important determinants driving healthcare expenses. The age at onset of epileptic spasms, etiology, treatment lag, the initial response to treatment, and relapse following initial response did not significantly influence the illness-related expenditure by the families. CONCLUSION WS imposes a substantial financial burden on the families and indirectly on the healthcare system.
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Morris K, Nami M, Bolanos JF, Lobo MA, Sadri-Naini M, Fiallos J, Sanchez GE, Bustos T, Chintam N, Amaya M, Strand SE, Mayuku-Dore A, Sakibova I, Biso GMN, DeFilippis A, Bravo D, Tarhan N, Claussen C, Mercado A, Braun S, Yuge L, Okabe S, Taghizadeh-Hesary F, Kotliar K, Sadowsky C, Chandra PS, Tripathi M, Katsaros V, Mehling B, Noroozian M, Abbasioun K, Amirjamshidi A, Hossein-Zadeh GA, Naraghi F, Barzegar M, Asadi-Pooya AA, Sahab-Negah S, Sadeghian S, Fahnestock M, Dilbaz N, Hussain N, Mari Z, Thatcher RW, Sipple D, Sidhu K, Chopra D, Costa F, Spena G, Berger T, Zelinsky D, Wheeler CJ, Ashford JW, Schulte R, Nezami MA, Kloor H, Filler A, Eliashiv DS, Sinha D, DeSalles AAF, Sadanand V, Suchkov S, Green K, Metin B, Hariri R, Cormier J, Yamamoto V, Kateb B. Neuroscience20 (BRAIN20, SPINE20, and MENTAL20) Health Initiative: A Global Consortium Addressing the Human and Economic Burden of Brain, Spine, and Mental Disorders Through Neurotech Innovations and Policies. J Alzheimers Dis 2021; 83:1563-1601. [PMID: 34487051 DOI: 10.3233/jad-215190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Neurological disorders significantly impact the world's economy due to their often chronic and life-threatening nature afflicting individuals which, in turn, creates a global disease burden. The Group of Twenty (G20) member nations, which represent the largest economies globally, should come together to formulate a plan on how to overcome this burden. The Neuroscience-20 (N20) initiative of the Society for Brain Mapping and Therapeutics (SBMT) is at the vanguard of this global collaboration to comprehensively raise awareness about brain, spine, and mental disorders worldwide. This paper aims to provide a comprehensive review of the various brain initiatives worldwide and highlight the need for cooperation and recommend ways to bring down costs associated with the discovery and treatment of neurological disorders. Our systematic search revealed that the cost of neurological and psychiatric disorders to the world economy by 2030 is roughly $16T. The cost to the economy of the United States is $1.5T annually and growing given the impact of COVID-19. We also discovered there is a shortfall of effective collaboration between nations and a lack of resources in developing countries. Current statistical analyses on the cost of neurological disorders to the world economy strongly suggest that there is a great need for investment in neurotechnology and innovation or fast-tracking therapeutics and diagnostics to curb these costs. During the current COVID-19 pandemic, SBMT, through this paper, intends to showcase the importance of worldwide collaborations to reduce the population's economic and health burden, specifically regarding neurological/brain, spine, and mental disorders.
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Affiliation(s)
- Kevin Morris
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Mohammad Nami
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Iran.,Middle East Brain + Initiative, Los Angeles, CA, USA.,Neuroscience Center, Instituto de Investigaciones Científicas Servicios de Alta Tecnología, City of Knowledge, Panama City, Panama
| | - Joe F Bolanos
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Maria A Lobo
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Melody Sadri-Naini
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - John Fiallos
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Gilberto E Sanchez
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Teshia Bustos
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Nikita Chintam
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Marco Amaya
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Susanne E Strand
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Alero Mayuku-Dore
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Indira Sakibova
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Grace Maria Nicole Biso
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Alejandro DeFilippis
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Daniela Bravo
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Nevzat Tarhan
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Middle East Brain + Initiative, Los Angeles, CA, USA.,Department of Psychiatry, Faculty of Medicine, Uskudar University, Istanbul, Turkey
| | - Carsten Claussen
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Fraunhofer-Institute for Translational Research and Pharmacology, Hamburg, Germany
| | - Alejandro Mercado
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Department of Neurosurgery, Hospital Military Regional Mendoza, Mendoza, Argentina
| | | | - Louis Yuge
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Division of Bio-Environment Adaptation Sciences, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.,Cell Therapy Venture Company, Space Bio-Laboratories, Hiroshima, Japan
| | - Shigeo Okabe
- Brain Medical Science Collaboration Division, RIKEN Center for Brain Science Institution and Department: Cellular Neurobiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Konstantin Kotliar
- Department of Biomedical Engineering, Aachen University of Applied Sciences, Aachen, Germany
| | - Christina Sadowsky
- International Center for Spinal Cord Injury, Kennedy Krieger Institute-Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - P Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | | | - Vasileios Katsaros
- Department of Advanced Imaging Modalities, MRI Unit, General Anti-Cancer and Oncological Hospital of Athens "St. Savvas", Athens, Greece.,Departments of Neurosurgery and Neurology, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neuroradiology, University College of London, London, UK
| | - Brian Mehling
- T-Neuro Pharma, Inc., Albuquerque, NM, USA.,StemVax LLC, Chesterland, OH, USA
| | - Maryam Noroozian
- Middle East Brain + Initiative, Los Angeles, CA, USA.,Cognitive Neurology and Neuropsychiatry Division, Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Abbasioun
- Middle East Brain + Initiative, Los Angeles, CA, USA.,Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Amirjamshidi
- Middle East Brain + Initiative, Los Angeles, CA, USA.,Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholam-Ali Hossein-Zadeh
- Middle East Brain + Initiative, Los Angeles, CA, USA.,National Brain Mapping Laboratory, Tehran, Iran
| | - Faridedin Naraghi
- Middle East Brain + Initiative, Los Angeles, CA, USA.,Iranian Society for Brain Mapping & Therapeutics, Tehran, Iran
| | - Mojtaba Barzegar
- Middle East Brain + Initiative, Los Angeles, CA, USA.,Intelligent Quantitative Bio-Medical Imaging, Tehran, Iran, and Medical Physics Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali A Asadi-Pooya
- Middle East Brain + Initiative, Los Angeles, CA, USA.,Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sajad Sahab-Negah
- Middle East Brain + Initiative, Los Angeles, CA, USA.,Neuroscience Research Center, Mashhad University of Medical Sciences, Mashhad Iran.,Shefa Neuroscience Research Center, Khatam Alanbia Hospital, Tehran, Iran
| | - Saeid Sadeghian
- Middle East Brain + Initiative, Los Angeles, CA, USA.,Department of Pediatric Neurology, Golestan Medical, Educational, and Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Nesrin Dilbaz
- Department of Psychiatry, Faculty of Medicine, Uskudar University, Istanbul, Turkey
| | - Namath Hussain
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Loma Linda University, School of Medicine, Loma Linda, CA, USA
| | - Zoltan Mari
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Robert W Thatcher
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Applied Neuroscience Research Institute, St. Petersburg, FL, USA.,Applied Neuroscience, Inc., St. Petersburg, Fl, USA
| | - Daniel Sipple
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA.,Fraunhofer-Institute for Translational Research and Pharmacology, Hamburg, Germany
| | - Kuldip Sidhu
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA.,CK Cell Technologies Pty Ltd, Norwest, NSW, Australia.,Faculty of Medicine, Centre for Healthy Brain Ageing, University of New South Wales, Sydney, NSW, Australia.,Society for Brain Mapping and Therapeutics-Sydney, Sydney, NSW, Australia
| | | | - Francesco Costa
- IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Ted Berger
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,USC Department of Biomedical Engineering, Los Angeles, CA, USA
| | - Deborah Zelinsky
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,The Mind-Eye Institute, Northbrook, IL, USA
| | - Christopher J Wheeler
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Social Science Research Institute, Tokai University, Shibuya City, Tokyo, Japan
| | - J Wesson Ashford
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Reinhard Schulte
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Loma Linda University, School of Medicine, Loma Linda, CA, USA
| | - M A Nezami
- Sahel Oncology LLC, Newport Beach, CA, USA
| | - Harry Kloor
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Beyond Imagination, Los Angeles, CA, USA
| | - Aaron Filler
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA.,Institute for Nerve Medicine, Santa Monica, CA, USA
| | - Dawn S Eliashiv
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Department of Neurology, UCLA-David Geffen School of Medicine, Los Angeles, CA, USA
| | - Dipen Sinha
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA
| | - Antonio A F DeSalles
- Department of Neurosurgery, UCLA David Geffen School of Medicine, Los Angeles CA, USA.,NeuroSapiens - Rede D'Or São Luiz, Sao Paulo, Brazil.,Society for Brain Mapping and Therapeutics-Brazil, Sao Paulo, Brazil
| | - Venkatraman Sadanand
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Sergey Suchkov
- Applied Neuroscience, Inc., St. Petersburg, Fl, USA.,Society for Brain Mapping and Therapeutics-Russia, Moscow, Russia
| | - Ken Green
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA
| | - Barish Metin
- Middle East Brain + Initiative, Los Angeles, CA, USA.,Department of Psychiatry, Faculty of Medicine, Uskudar University, Istanbul, Turkey
| | - Robert Hariri
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA.,Celularity Corporation, Warren, NJ, USA.,Weill Cornell School of Medicine, Department of Neurosurgery, New York, NY, USA
| | - Jason Cormier
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Blue Horizon International, Hackensack, NJ, USA
| | - Vicky Yamamoto
- Society for Brain Mapping and Therapeutics, Los Angeles, CA, USA.,Brain Mapping Foundation, Los Angeles, CA, USA.,USC Keck School of Medicine, The USC Caruso Department of Otolaryngology-Head and Neck Surgery, Los Angeles, CA, USA.,USC-Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Babak Kateb
- Middle East Brain + Initiative, Los Angeles, CA, USA.,Loma Linda University, School of Medicine, Loma Linda, CA, USA.,National Center for Nanobioelectronics, Los Angeles, CA, USA.,Brain Technology and Innovation Park, Los Angeles, CA, USA
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11
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Melkamu P, Animut Y, Minyihun A, Atnafu A, Yitayal M. Cost of Illness of Epilepsy and Associated Factors in Patients Attending Adult Outpatient Department of University of Gondar Referral Hospital, Northwest Ethiopia. Risk Manag Healthc Policy 2021; 14:2385-2394. [PMID: 34113193 PMCID: PMC8187097 DOI: 10.2147/rmhp.s289113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 05/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background Epilepsy has significant economic implications on health care needs, premature death, and lost work productivity. Therefore, this study aimed to assess the cost of illness of epilepsy and its associated factors in the Outpatient Department of University of Gondar Referral Hospital, Northwest Ethiopia. Methods We conducted an institution-based cross-sectional study from March 2018 to April 2018. A total of 442 adult epileptic patients were selected from the chronic follow-up clinic using a systematic sampling technique. We fitted binary logistic regression to identify the associated factors, and significant variables in the multivariable logistic regression analysis were determined using P-value <0.05 and 95% CI. Results The study revealed that the mean total cost illness of epilepsy per patient per year was US$ 166±61.6, and 30.3% of patients incurred high cost. Age (AOR = 1.06; 95% CI: 1.03, 1.09), sex (AOR = 3.66; 95% CI: 1.94, 6.89), educational (AOR = 0.15; 95% CI: 0.005, 0.047), polytherapy (AOR = 4.66; 95% CI: 2.29, 9.46), seizure frequency (AOR = 4.48; 95% CI: 1.56, 12.8), place where AEDs were bought (AOR = 6.23; 95% CI: 2.7, 14.03) and disease duration (AOR = 0.11; 95% CI: 0.05, 0.25) were predictors of the cost of illness of epilepsy. Conclusion The total annual cost of illness of epilepsy was high, taking into account the per capita income of the individuals. The age, sex, and educational status of the patients, and the number of AED, seizure frequency, places where patients buy drugs, and disease duration were factors significantly associated with the cost of illness of epilepsy. Hence, creating an alternative source of income, socio-economic support, and affordable health care service for patients, especially for female and elderly patients, and strengthening and equipping nearby clinics, increasing drug availability in governmental pharmacies.
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Affiliation(s)
- Piniel Melkamu
- University of Gondar Specialized Referral Hospital, Gondar, Ethiopia
| | - Yaregal Animut
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amare Minyihun
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mezgebu Yitayal
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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12
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Abdelhady S, Shokri H, Fathy M, wahid el din MM. Evaluation of the direct costs of epilepsy in a sample of Egyptian patients following up in Ain Shams University Hospital. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00247-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Epilepsy is a chronic disorder of the brain, and it is considered as the 4th common neurological disorder. Epilepsy is associated with an economic burden by imposing a significant burden on both the individuals who have the condition and on those around them, as well as for the society.
Objective
Our objective is to study and evaluate the direct costs associated with the medical management of epilepsy, one of the most common neurological conditions.
Methods
Observational, cross-sectional 4-month study started in December 2018 till April 2019 in patients between 2 and 60 years of age with epilepsy without other concomitant diseases. The direct medical costs include the number of neurology and emergency room visits, number and type of diagnostic tests, days of hospitalization, and treatment administered for epilepsy.
Results
We studied data from 194 patients, with a mean age of 30.6 years; the mean cost for treatment with carbamazepine was 78.6 Egyptian pound (EGP); for valproate, the cost was 288.4 EGP, and for levetiracetam, the cost was 491 EGP. The mean cost of electroencephalogram (EEG) is 108 EGP, and for computer tomography scan (CT) of the brain and magnetic resonance imaging (MRI) of the brain, it is 149.4 and 423.7 EGP respectively. The mean cost for hospitalization was 610.5 EGP, and the cost for intensive care unit (ICU) stay was 515.4 EGP.
Conclusion
The economic cost of epilepsy constitutes a major burden for the patients as well as their families; most of the direct cost was attributed to the purchase of AEDs. This necessitates creating strategies to ensure regular access to affordable AEDs as well as introducing other varieties of AEDs more potent with less side effects.
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13
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Li A, Gong X, Guo K, Lin J, Zhou D, Hong Z. Direct economic burden of patients with autoimmune encephalitis in western China. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/6/e891. [PMID: 33008922 PMCID: PMC7577530 DOI: 10.1212/nxi.0000000000000891] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 08/19/2020] [Indexed: 01/17/2023]
Abstract
Objective To analyze the cost of autoimmune encephalitis (AE) in China for the first time. Methods Patients who were newly diagnosed with antibody-positive AE (anti-NMDA receptor [NMDAR], anti-γ aminobutyric acid type B receptor [GABABR], antileucine-rich glioma-inactivated 1 [LGI1], and anticontactin-associated protein-2 [CASPR2]) at West China Medical Center between June 2012 and December 2018 were enrolled, and a cost-of-illness study was performed retrospectively. Data on clinical characteristics, costs, and utilization of sources were collected from questionnaires and the hospital information system. Results Of the 208 patients reviewed, the mean direct cost per patient was renminbi (RMB) 94,129 (United States dollars [USD] 14,219), with an average direct medical cost of RMB 88,373 (USD 13,349). The average inpatient cost per patients with AE was RMB 86,810 (USD 13,113). The direct nonmedical cost was much lower than the direct medical cost, averaging RMB 5,756 (USD 869). The direct cost of anti-LGI1/CASPR2 encephalitis was significantly lower than that of anti-NMDAR encephalitis and anti-GABABR encephalitis. The length of stay in the hospital was significantly associated with the direct cost. Conclusions The financial burden of AE is heavy for Chinese patients, and there are significant differences between different types of AE.
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Affiliation(s)
- Aiqing Li
- From the Department of Neurology, West China Medical Center, Sichuan University, Chengdu.
| | - Xue Gong
- From the Department of Neurology, West China Medical Center, Sichuan University, Chengdu
| | - Kundian Guo
- From the Department of Neurology, West China Medical Center, Sichuan University, Chengdu
| | - Jingfang Lin
- From the Department of Neurology, West China Medical Center, Sichuan University, Chengdu
| | - Dong Zhou
- From the Department of Neurology, West China Medical Center, Sichuan University, Chengdu
| | - Zhen Hong
- From the Department of Neurology, West China Medical Center, Sichuan University, Chengdu.
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14
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Sarangi SC, Kaur N, Tripathi M. Need for pharmacoeconomic consideration of antiepileptic drugs monotherapy treatment in persons with epilepsy. Saudi Pharm J 2020; 28:1228-1237. [PMID: 33132717 PMCID: PMC7584808 DOI: 10.1016/j.jsps.2020.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 08/18/2020] [Indexed: 11/16/2022] Open
Abstract
Objective Newer antiepileptic drugs (AEDs) are expected to have less adverse effects (AEs) and drug interactions as compared to conventional AEDs but the high cost is the major limitation for their use. This study evaluated variation in the cost of treatment with newer and conventional AEDs through its correlation with treatment efficacy and AEs in persons with epilepsy (PWE). Methods This cross-sectional study included PWE (28.9 ± 9.9 years) having focal and generalized seizures on conventional [valproate, carbamazepine, phenytoin] or newer AEDs [levetiracetam, oxcarbazepine] for >6 months. Seizure frequency during the study (6 months) was compared to that within 6 months before the study. Other parameters assessed were Quality of life in epilepsy, Pittsburgh Sleep Quality Index, Gastrointestinal Quality of life Index, and Liverpool AEs Profile. The cost of treatment was determined as direct, indirect, and intangible costs. The incremental cost-effectiveness ratio (ICER) analysis was also performed. Results Out of 214 PWE, 51.4% were on newer AEDs. Newer and conventional AEDs did not differ significantly in seizure frequency reduction (60.29 vs. 53.09%), quality of life parameters, though these were improved significantly during the study period. The direct medical cost and total cost of treatment were lesser with conventional AEDs (p < 0.001 in both) than newer AEDs, but the intangible cost did not differ. The total cost of treatment was significantly influenced by factors (as per regression analysis) including the type of AEDs (significant difference between valproate, carbamazepine, and levetiracetam), frequency of seizures, cost of medicine (70.34% of total cost), hospital admission, and treatment of AEs. As per ICER, newer AEDs need an additional USD 8.39 per unit reduction in seizure frequency. Conclusion Newer AEDs have comparatively better efficacy, though not significant than conventional AEDs. However, the additional cost per unit improvement is quite high with newer AEDs, necessitating pharmacoeconomic consideration in epilepsy treatment.
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Affiliation(s)
- Sudhir C Sarangi
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Nivendeep Kaur
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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15
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Shah S, Abbas G, Hanif M, Anees-Ur-Rehman, Zaman M, Riaz N, Altaf A, Hassan SU, Saleem U, Shah A. Increased burden of disease and role of health economics: Asia-pacific region. Expert Rev Pharmacoecon Outcomes Res 2019; 19:517-528. [DOI: 10.1080/14737167.2019.1650643] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Shahid Shah
- Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Ghulam Abbas
- Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Muhammad Hanif
- Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Anees-Ur-Rehman
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Penang, Malaysia
| | - Muhammad Zaman
- Faculty of Pharmacy, University of Central Punjab, Lahore, Pakistan
| | - Nabeel Riaz
- Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Arslan Altaf
- Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Shams Ul Hassan
- Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Usman Saleem
- Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Abid Shah
- Pediatric Medicine Department, Mukhtar Ahmad Sheikh Hospital, Multan, Pakistan
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16
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Siewe Fodjo JN, Mandro M, Wonya'rossi D, Inaç Y, Ngave F, Lokonda R, Anyolito A, Verelst F, Colebunders R. Economic Burden of Epilepsy in Rural Ituri, Democratic Republic of Congo. EClinicalMedicine 2019; 9:60-66. [PMID: 31143883 PMCID: PMC6510724 DOI: 10.1016/j.eclinm.2019.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Epilepsy is still very prevalent in Sub-Saharan Africa, particularly in remote, poverty-confronted onchocerciasis-endemic villages. It constitutes a significant burden for the families and communities. However, the financial costs of managing persons with epilepsy (PWE) have not been assessed in these settings. Proper cost analyses will facilitate future health interventions. METHODS In November 2017, persons with epilepsy (PWE) and their caretakers were recruited at health centres of the Logo health zone in the Democratic Republic of Congo. A pre-tested questionnaire was administered to collect information on both direct and indirect costs of epilepsy, as well as household income of participants. FINDINGS The weighted mean cost of epilepsy was 241.2 USD per PWE per year (50.2% direct cost, 49.8% indirect cost). Epilepsy-related expenses represented 46.5% of the mean household income. Traditional medicine accounted for 68.2% of the direct cost. An estimated cumulative cost of 1929.6 USD attributable to epilepsy had been incurred by the populations of the Logo health zone for each PWE in the community. INTERPRETATION Almost half of the household revenue was spent on epilepsy care. Expenses on traditional medicine must be discouraged via education and regular provision of affordable anti-epileptic drugs. Prevention of onchocerciasis-associated epilepsy using optimal control measures will avert additional epilepsy-related costs on the community. Early diagnosis and proper management of epilepsy would be economically beneficial in the study villages.
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Affiliation(s)
- Joseph Nelson Siewe Fodjo
- Global Health Institute, University of Antwerp, Belgium
- Corresponding author at: Global Health Institute, University of Antwerp, Campus Drie Eiken, Gouverneur Kingsbergen Centrum, Doornstraat 331, 2610 Wilrijk, Antwerp, Belgium.
| | - Michel Mandro
- Division Provinciale de la Santé, Ituri, Democratic Republic of the Congo
| | | | - Yasemine Inaç
- Global Health Institute, University of Antwerp, Belgium
| | - Francoise Ngave
- Centre de Recherche en Maladies Tropicales, Rethy, Democratic Republic of the Congo
| | - Richard Lokonda
- Centre Neuropsycho-Pathologique, University of Kinshasa, Democratic Republic of the Congo
| | - Aimé Anyolito
- Hôpital Général de Référence de Logo, Democratic Republic of the Congo
| | - Frederik Verelst
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Belgium
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17
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Sang T, Xiang T, Zhu SN, Gao JY, Jiang YW, Wu Y. Treatment-Related Costs of Childhood Epilepsy in Mainland China: A Preliminary Study in a Tertiary Pediatric Epilepsy Center. J Child Neurol 2019; 34:68-73. [PMID: 30484357 DOI: 10.1177/0883073818811176] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to investigate the treatment-related annual cost of childhood epilepsy and its related factors in mainland China. A total of 244 cases were collected at the outpatient clinics of Peking University First Hospital Pediatrics from April 2010 to August 2013. The median annual epilepsy treatment-related costs per patient were estimated to be RMB7822 (US$1160), accounting for 43.72% (median) of urban residents' disposable income in China. Those who lived far away or with uncontrolled seizures yielded much higher costs. This study concluded that the treatment of children with epilepsy produces a heavy burden on both families and society in mainland China. The constitution ratio of antiepileptic drugs and travel expenses are much higher than those of other countries. Adjusting medical insurance coverage, balancing medical resource distribution, and taking good control of seizures might be effective in reducing the economic burden of childhood epilepsy in China.
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Affiliation(s)
- Tian Sang
- 1 Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Ting Xiang
- 1 Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Sai-Nan Zhu
- 2 Department of Medical Statistics, Peking University First Hospital, Beijing, China
| | - Jing-Yun Gao
- 1 Department of Pediatrics, Peking University First Hospital, Beijing, China.,3 Tang Shan Women and Children's Hospital, Tangshan, China
| | - Yu-Wu Jiang
- 1 Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Ye Wu
- 1 Department of Pediatrics, Peking University First Hospital, Beijing, China
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18
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Willems LM, Reif PS, Spyrantis A, Cattani A, Freiman TM, Seifert V, Wagner M, You SJ, Schubert-Bast S, Bauer S, Klein KM, Rosenow F, Strzelczyk A. Invasive EEG-electrodes in presurgical evaluation of epilepsies: Systematic analysis of implantation-, video-EEG-monitoring- and explantation-related complications, and review of literature. Epilepsy Behav 2019; 91:30-37. [PMID: 29907526 DOI: 10.1016/j.yebeh.2018.05.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/04/2018] [Accepted: 05/05/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Stereoelectroencephalography (sEEG) is a diagnostic procedure for patients with refractory focal epilepsies that is performed to localize and define the epileptogenic zone. In contrast to grid electrodes, sEEG electrodes are implanted using minimal invasive operation techniques without large craniotomies. Previous studies provided good evidence that sEEG implantation is a safe and effective procedure; however, complications in asymptomatic patients after explantation may be underreported. The aim of this analysis was to systematically analyze clinical and imaging data following implantation and explantation. RESULTS We analyzed 18 consecutive patients (mean age: 30.5 years, range: 12-46; 61% female) undergoing invasive presurgical video-EEG monitoring via sEEG electrodes (n = 167 implanted electrodes) over a period of 2.5 years with robot-assisted implantation. There were no neurological deficits reported after implantation or explantation in any of the enrolled patients. Postimplantation imaging showed a minimal subclinical subarachnoid hemorrhage in one patient and further workup revealed a previously unknown factor VII deficiency. No injuries or status epilepticus occurred during video-EEG monitoring. In one patient, a seizure-related asymptomatic cross break of two fixation screws was found and led to revision surgery. Unspecific symptoms like headaches or low-grade fever were present in 10 of 18 (56%) patients during the first days of video-EEG monitoring and were transient. Postexplantation imaging showed asymptomatic and small bleedings close to four electrodes (2.8%). CONCLUSION Overall, sEEG is a safe and well-tolerated procedure. Systematic imaging after implantation and explantation helps to identify clinically silent complications of sEEG. In the literature, complication rates of up to 4.4% in sEEG and in 49.9% of subdural EEG are reported; however, systematic imaging after explantation was not performed throughout the studies, which may have led to underreporting of associated complications.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany.
| | - Philipp S Reif
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Andrea Spyrantis
- Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany
| | - Adriano Cattani
- Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany
| | - Thomas M Freiman
- Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Volker Seifert
- Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany
| | - Marlies Wagner
- Department of Neuroradiology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Se-Jong You
- Department of Neuroradiology, Goethe-University, Frankfurt am Main, Germany
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Department of Neuropediatrics, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Sebastian Bauer
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Karl Martin Klein
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
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19
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Vinkeles Melchers NVS, Mollenkopf S, Colebunders R, Edlinger M, Coffeng LE, Irani J, Zola T, Siewe JN, de Vlas SJ, Winkler AS, Stolk WA. Burden of onchocerciasis-associated epilepsy: first estimates and research priorities. Infect Dis Poverty 2018; 7:101. [PMID: 30253788 PMCID: PMC6156959 DOI: 10.1186/s40249-018-0481-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 08/30/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Since the 1990s, evidence has accumulated of an increased prevalence of epilepsy in onchocerciasis-endemic areas in Africa as compared to onchocerciasis-free areas. Although the causal relationship between onchocerciasis and epilepsy has yet to be proven, there is likely an association. Here we discuss the need for disease burden estimates of onchocerciasis-associated epilepsy (OAE), provide them, detail how such estimates should be refined, and discuss the socioeconomic impact of OAE, including a cost-estimate for anti-epileptic drugs. MAIN BODY Providing OAE burden estimates may aid prevention of epilepsy in onchocerciasis- endemic areas by inciting and informing collaboration between onchocerciasis control programmes and mental health services. Epilepsy not only massively impacts the health of those affected, but it also carries a high socioeconomic burden for the households and communities involved. We used previously published geospatial estimates of onchocerciasis in Africa and a separately published logistic regression model quantifying the association between onchocerciasis and epilepsy to estimate the number of OAE cases. We then applied disability weights for epilepsy to quantify the burden in terms of years of life lived with disability (YLD) and estimate the cost of treatment. We estimate that in 2015 roughly 117 000 people were affected by OAE across onchocerciasis-endemic areas previously under the African Programme for Onchocerciases control (APOC) mandate where OAE has ever been reported or suspected, and another 264 000 persons in onchocerciasis-endemic areas where OAE has never been investigated before. The total number of YLDs due to OAE was 39 300 and 88 700 in these areas respectively, based on a weighted mean disability weight of 0.336. The burden of OAE is approximately 13% of the total YLDs attributable to onchocerciasis and 10% of total YLDs attributable to epilepsy. We estimated that by 2015 the total costs of treatment with anti-epileptic drug for OAE cases would have been a minimum of 12.4 million US$. CONCLUSIONS These estimates suggest a considerable health, social and economic burden of OAE in Africa. The treatment and care for people with epilepsy, especially in hyperendemic onchocerciasis areas with high epilepsy prevalence thus requires more financial and human resources.
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Affiliation(s)
- Natalie V S Vinkeles Melchers
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Sarah Mollenkopf
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA, 98121, USA
| | | | - Michael Edlinger
- Department of Medical Statistics, Informatics, and Health Economics, Medical University Innsbruck, Vienna, Austria
| | - Luc E Coffeng
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Julia Irani
- Department of Public Health, Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Trésor Zola
- Department of Tropical Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Joseph N Siewe
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Sake J de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Andrea S Winkler
- Centre for Global Health, Institute for Health and Society, Oslo, Norway.,Center for Global Health, Department of Neurology, Technical University of Munich, Munich, Germany
| | - Wilma A Stolk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. box 2040, 3000, CA, Rotterdam, The Netherlands
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20
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Diagnosis and treatment of bronchiolitis obliterans syndrome accessible universally. Bone Marrow Transplant 2018; 54:383-392. [PMID: 30038355 DOI: 10.1038/s41409-018-0266-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/23/2018] [Accepted: 06/07/2018] [Indexed: 12/17/2022]
Abstract
The incidence of bronchiolitis obliterans syndrome (BOS), a devastating manifestation of chronic graft-versus-host-disease, may rise globally due to steady increases in utilization of allogeneic hematopoietic cell transplantation (HCT). Though some advances have occurred in the past decade regarding understanding of the pathogenesis, diagnosis and treatment of BOS, the overall mortality and morbidity remain very high. We sought to determine the current diagnostic and therapeutic challenges, which can potentially hinder optimal management of BOS both in developed and developing countries. We performed a comprehensive systematic review of both modern diagnostic modalities and treatments and then assessed which of them would be universally accessible. The 2014 National Institutes of Health chronic GVHD criteria remains the gold standard tool for diagnosing BOS. Important elements of treatment involve early and accurate detection, as well as utilizing the treatment modalities with known (but variable efficacy) e.g. fluticasone-azithromycin-montelukast [FAM] combination, etanercept, extra-corporeal photopheresis [ECP], lung transplantation, and prompt treatment of complications including infections in sufferers of BOS. Our results indicate that optimum diagnostic tools are not readily available in some parts of the world for early detection, which include a lack of CT scanners, unavailability of pulmonary function testing tools, absence of sub-specialists, lack of certain effective treatments and late referral for lung transplant. We present a systematic review of current literature along with recommendations for available therapies to guide practitioners to optimize the long-term outcomes in HCT survivors regardless of access to experts and expensive therapies.
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21
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Li X, Zhou S, Qian Y, Xu Z, Yu Y, Xu Y, He Y, Zhang Y. The assessment of the eco-toxicological effect of gabapentin on early development of zebrafish and its antioxidant system. RSC Adv 2018; 8:22777-22784. [PMID: 35539713 PMCID: PMC9081491 DOI: 10.1039/c8ra04250k] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 06/02/2018] [Indexed: 12/11/2022] Open
Abstract
Gabapentin (GAB) is an emerging contaminant that is frequently detected in water bodies across the globe. The present study used zebrafish as a model organism to investigate the effects of GAB on the early development of zebrafish and on its antioxidant system. Acute toxicity tests indicated that the 96 h LC50 value of GAB for zebrafish embryos was 59.9 g L-1. Further, it was observed that GAB causes malformation of embryos such as hemagglutination and pericardial edema. Compared to the control group, a significant enhancement (p < 0.05) of heartbeat rates was found at GAB concentrations exceeding 50 mg L-1, while the swimming frequency was clearly increased upon exposure to GAB at a concentration of 100 mg L-1 (p < 0.05). Additionally, the development of the zebrafish embryo was also negatively impacted after exposure to GAB as demonstrated by significantly decreased body lengths. Exposure to GAB at concentrations exceeding 50 mg L-1 significantly influenced the development of zebrafish, leading to malformation of organs and abnormal movements. Although no significant developmental effects of GAB were observed at environmentally relevant concentrations (0.1 and 10 μg L-1), further research about the antioxidant system confirmed that severe oxidant injury happened inside the organisms. catalase (CAT), lactate dehydrogenase (LDH), glutathione S-transferase (GST), glutathione (GSH) and the ability of inhibition of hydroxyl radicals (IHR) were used as biomarkers in the present study to illustrate GAB toxicity at environmentally relevant concentrations. The results showed that activities of CAT, LDH and GST as well as IHR were all elevated after GAB exposure, which proved that ROS were formed in the body as derived from GAB exposure. Among all of these biomarkers, CAT was the most sensitive one to evaluate the influence of GAB, and showed a significant increase even at a very low exposure concentration (0.1 μg L-1).
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Affiliation(s)
- Xiuwen Li
- School of Environmental Sciences and Engineering, Nanjing Tech University Jiangsu 211816 P. R. China +86-25-58139656
| | - Shuangxi Zhou
- School of Environmental Sciences and Engineering, Nanjing Tech University Jiangsu 211816 P. R. China +86-25-58139656
| | - Yuting Qian
- School of Environmental Sciences and Engineering, Nanjing Tech University Jiangsu 211816 P. R. China +86-25-58139656
| | - Zhuoran Xu
- School of Environmental Sciences and Engineering, Nanjing Tech University Jiangsu 211816 P. R. China +86-25-58139656
| | - Yang Yu
- School of Environmental Sciences and Engineering, Nanjing Tech University Jiangsu 211816 P. R. China +86-25-58139656
| | - Yanhua Xu
- School of Environmental Sciences and Engineering, Nanjing Tech University Jiangsu 211816 P. R. China +86-25-58139656
| | - Yide He
- School of Environmental Sciences and Engineering, Nanjing Tech University Jiangsu 211816 P. R. China +86-25-58139656
- Hunan Provincial Key Laboratory of Renewable Energy Electric-Technology Changsha Hunan 410076 P. R. China
| | - Yongjun Zhang
- School of Environmental Sciences and Engineering, Nanjing Tech University Jiangsu 211816 P. R. China +86-25-58139656
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22
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Willems LM, Richter S, Watermann N, Bauer S, Klein KM, Reese JP, Schöffski O, Hamer HM, Knake S, Rosenow F, Strzelczyk A. Trends in resource utilization and prescription of anticonvulsants for patients with active epilepsy in Germany from 2003 to 2013 - A ten-year overview. Epilepsy Behav 2018; 83:28-35. [PMID: 29649671 DOI: 10.1016/j.yebeh.2018.03.025] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 03/14/2018] [Indexed: 11/30/2022]
Abstract
This study evaluated trends in resource use and prescription patterns in patients with active epilepsy over a 10-year period at the same outpatient clinic of a German epilepsy center. We analyzed a cross-sectional patient sample of consecutive adults with active epilepsy over a 3-month period in 2013 and compared them with equally acquired data from the years 2003 and 2008. Using validated patient questionnaires, data on socioeconomic status, course of epilepsy, as well as direct and indirect costs were recorded. A total of 198 patients (mean age: 39.6±15.0years, 49.5% male) were enrolled and compared with our previous assessments in 2003 (n=101) and 2008 (n=151). In the 2013 cohort, 75.8% of the patients had focal epilepsy, and the majority were taking antiepileptic drugs (AEDs) (39.9% monotherapy, 59.1% polytherapy). We calculated epilepsy-specific costs of €3674 per three months per patient. Direct medical costs were mainly due to anticonvulsants (20.9% of total direct costs) and to hospitalization (20.8% of total direct costs). The proportion of enzyme-inducing anticonvulsants and 'old' AEDs decreased between 2003 and 2013. Indirect costs of €1795 in 2013 were mainly due to early retirement (55.0% of total indirect costs), unemployment (26.5%), and days off due to seizures (18.2%). In contrast to our previous findings from 2003 and 2008, our data show a stagnating cost increase with slightly reduced total costs and balanced direct and indirect costs in patients with active epilepsy. These findings are accompanied by an ongoing cost-neutral increase in the prescription of 'newer' and non-enzyme-inducing AEDs. However, the number and distribution of indirect cost components remained unchanged.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany
| | - Saskia Richter
- Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany
| | - Nina Watermann
- Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany
| | - Sebastian Bauer
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany
| | - Karl Martin Klein
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany
| | - Jens-Peter Reese
- Coordinating Center for Clinical Trials, Philipps-University, Marburg, Germany
| | - Oliver Schöffski
- Department of Health Management, Friedrich-Alexander-University, Nuremberg, Germany
| | - Hajo M Hamer
- Epilepsy Center, Department of Neurology, Friedrich-Alexander-University, Erlangen, Germany
| | - Susanne Knake
- Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany.
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Wibecan L, Fink G, Tshering L, Bruno V, Patenaude B, Nirola DK, Dorji C, Dema U, Pokhrel D, Mateen FJ. The economic burden of epilepsy in Bhutan. Trop Med Int Health 2018; 23:342-358. [PMID: 29369457 DOI: 10.1111/tmi.13035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the economic impact of epilepsy in Bhutan, a lower-middle-income country with a universal health care system, but with limited access to neurological care. METHODS A cross-sectional survey was conducted of patients with epilepsy at the Jigme Dorji Wangchuk National Referral Hospital from January to August 2016. Data were collected on clinical features, cost of care, impact of epilepsy on school or work and household economic status of participants and matched comparisons (a sibling or neighbour from a household without epilepsy). RESULTS A total of 172 individuals were included in the study (130 adults and 42 children). One-third of adults and 20 (48%) children had seizures at least once per month. Mean direct out-of-pocket cost for epilepsy care was 6054 Bhutanese Ngultrum (BTN; 91 USD) per year, of which transportation formed the greatest portion (53%). Direct costs of epilepsy were an average of 3.2% of annual household income. Adults missed 6.8 (standard deviation [SD]: 9.0) days of work or school per year on average, and children missed 18.6 (SD: 34.7) days of school. Among adults, 23 (18%) abandoned employment or school because of epilepsy; seven children (18%) stopped school because of epilepsy. Households with a person with epilepsy had a lower monthly per-person income (6434 BTN) than comparison households without epilepsy (8892 BTN; P = 0.027). CONCLUSIONS In Bhutan, despite universal health care services, households of people with epilepsy face a significant economic burden. With many adults and children unable to attend school or work, epilepsy causes a major disruption to individuals' livelihoods.
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Affiliation(s)
- Leah Wibecan
- Harvard Medical School, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Massachusetts General Hospital, Boston, MA, USA
| | - Günther Fink
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lhab Tshering
- Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan
| | - Veronica Bruno
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Damber K Nirola
- Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan
| | - Chencho Dorji
- Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan
| | - Ugyen Dema
- Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan
| | - Dillram Pokhrel
- Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan
| | - Farrah J Mateen
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Boston, MA, USA
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24
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Ostendorf AP, Gedela S. Effect of Epilepsy on Families, Communities, and Society. Semin Pediatr Neurol 2017; 24:340-347. [PMID: 29249514 DOI: 10.1016/j.spen.2017.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The effect of epilepsy extends beyond those with the diagnosis and impacts families, communities and society. Caregiver and sibling quality of life is often negatively affected by frequent seizures, comorbid behavioral and sleep disorders and stigma surrounding the diagnosis. Furthermore, the negative effects can be magnified by individual coping styles and resources available to families of those with epilepsy. Beyond the family and immediate caregivers, epilepsy affects local communities by drawing additional resources from education systems. The direct costs of caring for an individual with epilepsy and the indirect costs associated with decreased productivity place financial strain on individuals and health care systems throughout the world. This review details factors affecting family and caregiver quality of life and provides several approaches through which health care providers may address these concerns. Furthermore, we examine the financial effect of epilepsy on society and review emerging strategies to lessen health care use for individuals with epilepsy.
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Affiliation(s)
- Adam P Ostendorf
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
| | - Satyanarayana Gedela
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH
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25
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Gao L, Hu H, Zhao FL, Li SC. Can the Direct Medical Cost of Chronic Disease Be Transferred across Different Countries? Using Cost-of-Illness Studies on Type 2 Diabetes, Epilepsy and Schizophrenia as Examples. PLoS One 2016; 11:e0147169. [PMID: 26814959 PMCID: PMC4731392 DOI: 10.1371/journal.pone.0147169] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 12/30/2015] [Indexed: 11/18/2022] Open
Abstract
Objectives To systematically review cost of illness studies for schizophrenia (SC), epilepsy (EP) and type 2 diabetes mellitus (T2DM) and explore the transferability of direct medical cost across countries. Methods A comprehensive literature search was performed to yield studies that estimated direct medical costs. A generalized linear model (GLM) with gamma distribution and log link was utilized to explore the variation in costs that accounted by the included factors. Both parametric (Random-effects model) and non-parametric (Boot-strapping) meta-analyses were performed to pool the converted raw cost data (expressed as percentage of GDP/capita of the country where the study was conducted). Results In total, 93 articles were included (40 studies were for T2DM, 34 studies for EP and 19 studies for SC). Significant variances were detected inter- and intra-disease classes for the direct medical costs. Multivariate analysis identified that GDP/capita (p<0.05) was a significant factor contributing to the large variance in the cost results. Bootstrapping meta-analysis generated more conservative estimations with slightly wider 95% confidence intervals (CI) than the parametric meta-analysis, yielding a mean (95%CI) of 16.43% (11.32, 21.54) for T2DM, 36.17% (22.34, 50.00) for SC and 10.49% (7.86, 13.41) for EP. Conclusions Converting the raw cost data into percentage of GDP/capita of individual country was demonstrated to be a feasible approach to transfer the direct medical cost across countries. The approach from our study to obtain an estimated direct cost value along with the size of specific disease population from each jurisdiction could be used for a quick check on the economic burden of particular disease for countries without such data.
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Affiliation(s)
- Lan Gao
- School of Biomedical Sciences & Pharmacy, The University of Newcastle, Callaghan, NSW, Australia
| | - Hao Hu
- School of Biomedical Sciences & Pharmacy, The University of Newcastle, Callaghan, NSW, Australia
| | - Fei-Li Zhao
- Access and Public Affair, Pfizer Australia, West Ryde, NSW, Australia
| | - Shu-Chuen Li
- School of Biomedical Sciences & Pharmacy, The University of Newcastle, Callaghan, NSW, Australia
- * E-mail:
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26
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Megiddo I, Colson A, Chisholm D, Dua T, Nandi A, Laxminarayan R. Health and economic benefits of public financing of epilepsy treatment in India: An agent-based simulation model. Epilepsia 2016; 57:464-74. [PMID: 26765291 PMCID: PMC5019268 DOI: 10.1111/epi.13294] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE An estimated 6-10 million people in India live with active epilepsy, and less than half are treated. We analyze the health and economic benefits of three scenarios of publicly financed national epilepsy programs that provide: (1) first-line antiepilepsy drugs (AEDs), (2) first- and second-line AEDs, and (3) first- and second-line AEDs and surgery. METHODS We model the prevalence and distribution of epilepsy in India using IndiaSim, an agent-based, simulation model of the Indian population. Agents in the model are disease-free or in one of three disease states: untreated with seizures, treated with seizures, and treated without seizures. Outcome measures include the proportion of the population that has epilepsy and is untreated, disability-adjusted life years (DALYs) averted, and cost per DALY averted. Economic benefit measures estimated include out-of-pocket (OOP) expenditure averted and money-metric value of insurance. RESULTS All three scenarios represent a cost-effective use of resources and would avert 800,000-1 million DALYs per year in India relative to the current scenario. However, especially in poor regions and populations, scenario 1 (which publicly finances only first-line therapy) does not decrease the OOP expenditure or provide financial risk protection if we include care-seeking costs. The OOP expenditure averted increases from scenarios 1 through 3, and the money-metric value of insurance follows a similar trend between scenarios and typically decreases with wealth. In the first 10 years of scenarios 2 and 3, households avert on average over US$80 million per year in medical expenditure. SIGNIFICANCE Expanding and publicly financing epilepsy treatment in India averts substantial disease burden. A universal public finance policy that covers only first-line AEDs may not provide significant financial risk protection. Covering costs for both first- and second-line therapy and other medical costs alleviates the financial burden from epilepsy and is cost-effective across wealth quintiles and in all Indian states.
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Affiliation(s)
- Itamar Megiddo
- Center for Disease Dynamics, Economics & Policy, Washington, District of Columbia, U.S.A.,Department of Management Science, University of Strathclyde, Glasgow, United Kingdom
| | - Abigail Colson
- Center for Disease Dynamics, Economics & Policy, Washington, District of Columbia, U.S.A.,Department of Management Science, University of Strathclyde, Glasgow, United Kingdom.,Princeton Environmental Institute, Princeton University, Princeton, New Jersey, U.S.A
| | - Dan Chisholm
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Tarun Dua
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Arindam Nandi
- Center for Disease Dynamics, Economics & Policy, Washington, District of Columbia, U.S.A.,Public Health Foundation of India, New Delhi, India
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, Washington, District of Columbia, U.S.A.,Department of Management Science, University of Strathclyde, Glasgow, United Kingdom.,Princeton Environmental Institute, Princeton University, Princeton, New Jersey, U.S.A
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27
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Math SB, Gupta A, Yadav R, Shukla D. The rights of persons with disability bill, 2014: Implications for neurological disability. Ann Indian Acad Neurol 2016; 19:S28-S33. [PMID: 27891022 PMCID: PMC5109757 DOI: 10.4103/0972-2327.192884] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
India ratified the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) in 2007. This is a welcome step toward realizing the rights of the persons with disability. The UNCRPD proclaims that disability results from interaction of impairments with attitudinal and environmental barriers, which hinders full and active participation in society on an equal basis with others. Further, the convention also mandates the signatory governments to make suitable changes in the existing laws of the country, to identify and eliminate obstacles and barriers, and to comply with the terms of the UNCRPD in order to protect the rights of the person with disabilities, hence the amendments of the national laws. Hence, the Government of India drafted the Right of Persons with Disabilities Bill (RPWD Bill), 2014. It is evident that neurological disorders are emerging as priority health problems worldwide. They not only contribute to mortality but also contribute to huge morbidity. Further, shortage of neurologists, huge treatment gap, and stigma add to the burden. The situation becomes worse with regard to providing quality care, comprehensive rehabilitation, and social welfare measures to persons with neurological disability. There is no doubt that persons with neurological disability do not get adequate representation, stigmatized and discriminated across the civil societies, which hinders full and active participation in society. Hence, this article is a critique of the RPWD Bill, 2014 from the perspective of persons with neurological and neurosurgical disability. Further, this article also discusses challenges in quantifying and certifying disability in neurological disability.
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Affiliation(s)
- Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Anupam Gupta
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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28
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Amudhan S, Gururaj G, Satishchandra P. Epilepsy in India II: Impact, burden, and need for a multisectoral public health response. Ann Indian Acad Neurol 2015; 18:369-81. [PMID: 26713005 PMCID: PMC4683872 DOI: 10.4103/0972-2327.165483] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Epilepsy is a common neurological disorder whose consequences are influenced socially and culturally, especially in India. This review (second of the two part series) was carried out to understand the social impact and economic burden to develop comprehensive program for control and prevention of epilepsy. Epilepsy is known to have adverse effect on education, employment, marriage, and other essential social opportunities. Economic burden associated with epilepsy is very high with treatment and travel costs emerging as an important contributing factor. A vicious cycle between economic burden and poor disease outcome is clear. There is no significant change in the perception, stigma, and discrimination of epilepsy across the country despite improvement in educational and social parameters over the time. The huge treatment gap and poor quality of life is further worsened by the associated comorbidities and conditions. Thus, a multidisciplinary response is needed to address the burden and impact of epilepsy which calls for an integrated and multipronged approach for epilepsy care, prevention, and rehabilitation. Service delivery, capacity building, integration into the existing program, mobilizing public support, and increasing public awareness will be the hallmarks of such an integrated approach in a public health model.
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Affiliation(s)
- Senthil Amudhan
- Department of Epidemiology, Centre for Public Health, Bangalore, Karnataka, India
| | - Gopalkrishna Gururaj
- Department of Epidemiology, Centre for Public Health, Bangalore, Karnataka, India
| | - Parthasarathy Satishchandra
- Director/Vice-chancellor and Professor of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Gao L, Xia L, Pan SQ, Xiong T, Li SC. Burden of epilepsy: A prevalence-based cost of illness study of direct, indirect and intangible costs for epilepsy. Epilepsy Res 2015; 110:146-56. [PMID: 25616467 DOI: 10.1016/j.eplepsyres.2014.12.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 11/17/2014] [Accepted: 12/02/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Lan Gao
- School of Biomedical Sciences & Pharmacy, The University of Newcastle, MS 128, Medical Sciences Building,Callaghan, NSW 2308, Australia.
| | - Li Xia
- Neurology Department, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan, Hubei 430060, China.
| | - Song-Qing Pan
- Neurology Department, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan, Hubei 430060, China.
| | - Tao Xiong
- Neurology Department, The Fifth Hospital of Wuhan, No. 5, Xianzheng Street, Hanyang District, Wuhan, Hubei 430050, China.
| | - Shu-Chuen Li
- School of Biomedical Sciences & Pharmacy, The University of Newcastle, MS 108, Medical Sciences Building, Callaghan, NSW 2308, Australia.
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30
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Brigo F, Igwe SC, Ausserer H, Tezzon F, Nardone R, Otte WM. Epilepsy-related stigma in European people with epilepsy: correlations with health system performance and overall quality of life. Epilepsy Behav 2015; 42:18-21. [PMID: 25513766 DOI: 10.1016/j.yebeh.2014.11.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 10/30/2014] [Accepted: 11/15/2014] [Indexed: 10/24/2022]
Abstract
We aimed to relate the percentages of encountered epilepsy-related stigma in people with epilepsy with quantitative indicators of the quality of health systems and quality of life by country in Europe. The epilepsy-related stigma percentages were obtained from the largest population-based study in people with epilepsy available. We correlated percentages of people with perceived stigma per European country with data on the country's overall health system performance, health expenditure per capita in international dollars, and the Economist Intelligence Unit's quality-of-life index. We found a nonsignificant trend towards negative correlation between the epilepsy-related stigma percentage and the overall health system performance (r=-0.16; p=0.57), the health expenditure per capita in international dollars (r=-0.24; p=0.4), and the Economist Intelligence Unit's quality-of-life index (r=-0.33; p=0.91). Living in a European country with a better health system performance and higher health expenditure per capita does not necessarily lead to a reduction in perceived epilepsy-related discrimination, unless the public health system invests on awareness programs to increase public knowledge and reduce stigma.
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Affiliation(s)
- Francesco Brigo
- Department of Neurological and Movement Sciences, Section of Clinical Neurology, University of Verona, Italy; Department of Neurology, Franz Tappeiner Hospital, Merano, Italy.
| | - Stanley C Igwe
- Department of Neuro-Psychiatry, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Harald Ausserer
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Frediano Tezzon
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Raffaele Nardone
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Willem M Otte
- Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands; Biomedical MR Imaging and Spectroscopy Group, Image Sciences Institute, University Medical Center Utrecht, The Netherlands
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Szilágyi T, Száva I, Metz EJ, Mihály I, Orbán-Kis K. Untangling the pathomechanisms of temporal lobe epilepsy—The promise of epileptic biomarkers and novel therapeutic approaches. Brain Res Bull 2014; 109:1-12. [DOI: 10.1016/j.brainresbull.2014.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 08/11/2014] [Accepted: 08/14/2014] [Indexed: 12/30/2022]
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Koshy G, Varghese RT, Naik D, Asha HS, Thomas N, Seshadri MS, Alexander M, Thomas M, Aaron S, Paul TV. Derangements in bone mineral parameters and bone mineral density in south Indian subjects on antiepileptic medications. Ann Indian Acad Neurol 2014; 17:272-6. [PMID: 25221394 PMCID: PMC4162011 DOI: 10.4103/0972-2327.138489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 01/14/2014] [Accepted: 02/12/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Although there are reports describing the association of alternations of bone and mineral metabolism in epileptic patients with long-term anticonvulsant therapy, there are only limited Indian studies which have looked at this aspect. OBJECTIVES This study was done to compare the prevalence of changes in bone mineral parameters and bone mineral density (BMD) in ambulant individuals on long-term anticonvulsant therapy with age- and body mass index (BMI)-matched healthy controls. MATERIALS AND METHODS There were 55 men (on medications for more than 6 months) and age- and BMI-matched 53 controls. Drug history, dietary calcium intake (DCI), and duration of sunlight exposure were recorded. Bone mineral parameters and BMD were measured. RESULTS The control group had a significantly higher daily DCI with mean ± SD of 396 ± 91 mg versus 326 ± 101 mg (P = 0.007) and more sunlight exposure of 234 ± 81 vs 167 ± 69 min (P = 0.05). BMD at the femoral neck was significantly lower in cases (0.783 ± 0.105 g/cm(2)) when compared to controls (0.819 ± 0.114 g/cm(2)). Majority of the patients (61%) had low femoral neck BMD (P = 0.04). There was no significant difference in the proportion of subjects with vitamin D deficiency (<20 ng/mL) between cases (n = 32) and controls (n = 37) (P = 0.234). CONCLUSIONS Vitamin D deficiency was seen in both the groups in equal proportions, highlighting the existence of a high prevalence of this problem in India. Low femoral neck BMD found in cases may stress the need for supplementing calcium and treating vitamin D deficiency in this specific group. However, the benefit of such intervention has to be studied in a larger proportion of epileptic patients.
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Affiliation(s)
- George Koshy
- Department of Endocrinology, Diabetes and Metabolism, Unit-III, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ron Thomas Varghese
- Department of Endocrinology, Diabetes and Metabolism, Unit-III, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dukhabandhu Naik
- Department of Endocrinology, Diabetes and Metabolism, Unit-III, Christian Medical College, Vellore, Tamil Nadu, India
| | - Hesargatta Shyamsunder Asha
- Department of Endocrinology, Diabetes and Metabolism, Unit-III, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Unit-III, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mandalam Subramaniam Seshadri
- Department of Endocrinology, Diabetes and Metabolism, Unit-III, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mathew Alexander
- Department of Neurological Science, Unit-III, Christian Medical College, Vellore, Tamil Nadu, India
| | - Maya Thomas
- Department of Neurological Science, Unit-III, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sanjith Aaron
- Department of Neurological Science, Unit-III, Christian Medical College, Vellore, Tamil Nadu, India
| | - Thomas Vizhalil Paul
- Department of Endocrinology, Diabetes and Metabolism, Unit-III, Christian Medical College, Vellore, Tamil Nadu, India
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Sadanand V. Economics of epilepsy surgery. Ann Indian Acad Neurol 2014; 17:S120-3. [PMID: 24791079 PMCID: PMC4001220 DOI: 10.4103/0972-2327.128685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 02/03/2014] [Accepted: 02/03/2014] [Indexed: 11/23/2022] Open
Abstract
Objective: Surgical decision-making is a complex process. First, a medical decision is made to determine if surgery is necessary. Second, another medical decision is made to determine the type of surgery. Third, a corporate decision is made if such a surgery is financially feasible. Finally, a legal decision is made to proceed or refuse the chosen surgery. This paper examines these issues in the case of surgery for medically intractable epilepsy and proposes a method of decision analysis to guide epilepsy surgery. Materials and Methods: A stochastic game of imperfect information using techniques of game theory and decision analysis is introduced as an analytical tool for surgical decision-making. Results: Surgery for appropriately chosen patients suffering from medically intractable epilepsy may not only be feasible, but may be the best medical option and the best financial option for the patient, families, society and the healthcare system. Such a situation would then make it legally or ethically difficult to reject or postpone surgery for these patients. Conclusions: A process to collect data to quantify the parameters used in the decision analysis is hereby proposed.
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Affiliation(s)
- Venkatraman Sadanand
- Department of Neurosurgery, Loma Linda University Health System, Loma Linda, California, USA, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
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Sauro KM, Macrodimitris S, Krassman C, Wiebe S, Pillay N, Federico P, Murphy W, Jetté N. Quality indicators in an epilepsy monitoring unit. Epilepsy Behav 2014; 33:7-11. [PMID: 24561652 DOI: 10.1016/j.yebeh.2014.01.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/10/2014] [Accepted: 01/24/2014] [Indexed: 10/25/2022]
Abstract
Examining and improving the quality of care in epilepsy monitoring units (EMUs) is essential to delivering the best possible care and to mitigating undesirable outcomes. Epilepsy monitoring units are unique in that an admission to an EMU often involves the induction of symptoms (seizures) rather than minimizing and/or treating symptoms, which can lead to an increased risk to patient safety. Very little research has addressed the quality of care and safety in EMUs. The objective of this study was to examine quality indicators in a large population of patients admitted to an EMU in a large health region. Data were collected prospectively on 396 consecutive patients admitted to the EMU for scalp EEG recording from 2008 to 2011 using a standardized data abstraction form. Variables examined included the following: patient demographics, baseline clinical characteristics, EMU admission statistics, and EMU quality indicators. We found that an admission to the EMU was a safe and effective tool in the management of patients with epilepsy and seizure-like events. The number of adverse events during the study period was low at 4.9%. The admission question was answered in 78.8% of cases, and it was partially answered in 6.6%. The need for systematically developed and validated quality indicators in EMUs is emphasized. The research in this area is sparse, and thus these data aid in supporting the utility of EMUs in the management and care of those with seizures and seizure-like events.
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Affiliation(s)
- Khara M Sauro
- Department of Clinical Neuroscience, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Canada; Institute for Public Health, University of Calgary, Calgary, Canada
| | - Sophie Macrodimitris
- Department of Clinical Neuroscience, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada; Department of Psychology, University of Calgary, Calgary, Canada
| | | | - Samuel Wiebe
- Department of Clinical Neuroscience, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Canada; Institute for Public Health, University of Calgary, Calgary, Canada
| | - Neelan Pillay
- Department of Clinical Neuroscience, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Paolo Federico
- Department of Clinical Neuroscience, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada; Department of Radiology, University of Calgary, Calgary, Canada
| | - William Murphy
- Department of Clinical Neuroscience, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Nathalie Jetté
- Department of Clinical Neuroscience, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Canada; Institute for Public Health, University of Calgary, Calgary, Canada.
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de Kinderen RJ, Evers SM, Rinkens R, Postulart D, Vader CI, Majoie MH, Aldenkamp AP. Side-effects of antiepileptic drugs: The economic burden. Seizure 2014; 23:184-90. [DOI: 10.1016/j.seizure.2013.11.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 11/11/2013] [Accepted: 11/12/2013] [Indexed: 01/02/2023] Open
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Treatment expenditure pattern of epileptic patients: a study from a tertiary care hospital, kolkata, India. Neurol Res Int 2014; 2014:869572. [PMID: 24707400 PMCID: PMC3953574 DOI: 10.1155/2014/869572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 10/28/2013] [Accepted: 10/29/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction. Neurological diseases are very important causes of prolonged morbidity and disability leading to profound financial loss. Epilepsy is one of the most important neurological disorders. It being a cost intensive disorder poses a significant economic burden to the country. Aims and Objectives. The study was conducted among the persons with epilepsy (PWE) to assess their expenditure pattern for epilepsy treatment and its rural urban difference. Materials and Methods. 315 PWE selected by systematic random sampling and their caregivers were interviewed with the predesigned, pretested semistructured proforma. Subsequently data were compiled and analyzed using SPSS 18.0 software. Results and Conclusion. Majority of the study population were in the age group of 16–30 years. Majority belonged to classes IV and V of Prasad socioeconomic status scale. Average total expenditure per month for treatment of epilepsy was 219 INR, mainly contributed by drugs, travel, investigations, and so forth. Rural population was having higher treatment expenditure for epilepsy specially for travel and food and lodging in order to get epilepsy treatment. Wage loss in the last three months was present in 42.86% study subjects which was both affected by seizure episodes and travel for visits. Better district care would have helped in this situation.
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Pillas, MSc D, Selai C. Economic aspects of epilepsy and antiepileptic treatment: a review of the literature. Expert Rev Pharmacoecon Outcomes Res 2014; 5:327-38. [DOI: 10.1586/14737167.5.3.327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Habib M, Khan SU, Hoque MA, Mondal MBA, Hasan ATMH, Chowdhury RN, Haque B, Rahman KM, Chowdhury AH, Ghose SK, Mohammad QD. Antiepileptic drug utilization in Bangladesh: experience from Dhaka Medical College Hospital. BMC Res Notes 2013; 6:473. [PMID: 24245810 PMCID: PMC4225505 DOI: 10.1186/1756-0500-6-473] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 11/11/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Epilepsy is a common health problem which carries a huge medical social psychological and economic impact for a developing country. The aim of this hospital-based study was to get an insight into the effectiveness and tolerability of low cost antiepileptic drugs (AEDs) in Bangladeshi people with epilepsy. METHODS This retrospective chart review was done from hospital records in weekly Epilepsy outdoor clinic of Department of Neurology, Dhaka Medical College Hospital (DMCH) from October 1998 to February 2013. A total of 854 epilepsy patients met the eligibility criteria (had a complete record of two years of follow up data) from hospital database. A checklist was used to take demographics (age and gender), epilepsy treatment and adverse event related data. At least two years of follow up data were considered for analysis. RESULTS Out of 854 patients selected, majority of the patients attending outdoor clinic were >11-30 years age group (55.2%) with a mean age of 20.3 ± 9 years and with a male (53%) predominance. Focal epilepsy were more common (53%), among whom secondary generalized epilepsy was the most frequent diagnosis (67%) followed by complex partial seizure (21%). Among those with Idiopathic Generalized Epilepsy (46%), generalized tonic clonic seizure was encountered in 74% and absence seizure was observed in 13%. The number of patients on monotherapy and dual AED therapy were 67% and 24% respectively and polytherapy (i.e. >3 AEDs) was used only in 9%. CBZ (67%) was the most frequently prescribed AED, followed by VPA (43%), PHB (17%), and PHT (8%). CBZ was prescribed in 37% patients as monotherapy followed by VPA in 21% and PHB in 8% patients. Newer generation drugs eg lemotrigine and topiramate were used only as add on therapy in combination with CBZ and VPA in only 2% patients. The treatment retention rates over the follow up period for the AEDs in monotherapy varied between 86 and 91% and were highest for CBZ, followed by VPA. Most of the combination regimens had a treatment retention rate of 100%. The effectiveness of AED in terms of reduction of seizure frequency was highest for PHT (100%) and PHB (98%) followed by CBZ (96%) and VPA (95%). PHB and PHT were the cheapest of all AEDs (42 I$ and 56 I$/ year respectively). The costs of VPA and CBZ were two times and LTG and TOP were six to eight times higher. Adverse drug reaction (ADR) were observed among 140 (24.5%) of those with monotherapy. PHT (64%) was the most common drug to cause ADR, CBZ was at the bottom of the list to cause adverse effect (11.6%). VPA and PHB caused weight gain commonly. Adjustment of drug dose or withdrawal due to ADRs was necessary in 39% with PHT and 26% with PHB. CONCLUSION Though PHT and PHB are cheapest and efficacious among all, CBZ and VPA are less costly, effective and well tolerated drug for seizure control in context of Bangladesh.
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Affiliation(s)
- Mansur Habib
- Department of Neurology, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | - Sharif Uddin Khan
- Department of Neurology, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | - Md Azhahul Hoque
- Department of Neurology, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | | | - ATM Hasibul Hasan
- Department of Medicine, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | | | - Badrul Haque
- Department of Neurology, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | | | | | - Swapon Kumar Ghose
- Department of Neurology, Dhaka Medical College Hospital, Dhaka, Bangladesh
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Lagunju IA, Imam ZO, Adedokun BO. Cost of epilepsy in children attending a tertiary centre in Nigeria. Int Health 2013; 3:213-8. [PMID: 24038373 DOI: 10.1016/j.inhe.2011.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Epilepsy is one of the leading paediatric neurological disorders in Nigeria and many other parts of the world. There is very little documented on the economic costs of epilepsy in Nigeria and other countries in sub-Saharan Africa. This study was carried out to estimate the total cost of childhood epilepsy in a cohort of Nigerian children and therefore provide essential information on the economic burden of childhood epilepsy in Nigeria. A cost of illness study was performed on a cohort of 215 consecutive cases of epilepsy seen and treated at the University College Hospital, Ibadan, Nigeria. Data on demographics, clinical characteristics, utilization of resources and costs were collected. The total annual cost of epilepsy ranged from Nigerian naira (N)23 200 (US$155) to N3 298 500 (US$21,900) with a median of N107 600 (US$717) per patient per year. Direct medical and non-medical costs accounted for 71.8% of the total mean annual cost of epilepsy. Anti-epileptic drug therapy and in-patient care accounted for 21.8% and 33.0% of the mean total annual cost respectively and more than half of the families expended over 20% of their total family income on the care of the child with epilepsy. The economic burden of childhood epilepsy in Nigeria is enormous with very high out-of-pocket expenses.
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Affiliation(s)
- I A Lagunju
- Department of Paediatrics, College of Medicine, University of Ibadan, & University College Hospital, Ibadan, Nigeria
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Kankeu HT, Saksena P, Xu K, Evans DB. The financial burden from non-communicable diseases in low- and middle-income countries: a literature review. Health Res Policy Syst 2013; 11:31. [PMID: 23947294 PMCID: PMC3751656 DOI: 10.1186/1478-4505-11-31] [Citation(s) in RCA: 229] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 07/18/2013] [Indexed: 11/17/2022] Open
Abstract
Non-communicable diseases (NCDs) were previously considered to only affect high-income countries. However, they now account for a very large burden in terms of both mortality and morbidity in low- and middle-income countries (LMICs), although little is known about the impact these diseases have on households in these countries. In this paper, we present a literature review on the costs imposed by NCDs on households in LMICs. We examine both the costs of obtaining medical care and the costs associated with being unable to work, while discussing the methodological issues of particular studies. The results suggest that NCDs pose a heavy financial burden on many affected households; poor households are the most financially affected when they seek care. Medicines are usually the largest component of costs and the use of originator brand medicines leads to higher than necessary expenses. In particular, in the treatment of diabetes, insulin--when required--represents an important source of spending for patients and their families. These financial costs deter many people suffering from NCDs from seeking the care they need. The limited health insurance coverage for NCDs is reflected in the low proportions of patients claiming reimbursement and the low reimbursement rates in existing insurance schemes. The costs associated with lost income-earning opportunities are also significant for many households. Therefore, NCDs impose a substantial financial burden on many households, including the poor in low-income countries. The financial costs of obtaining care also impose insurmountable barriers to access for some people, which illustrates the urgency of improving financial risk protection in health in LMIC settings and ensuring that NCDs are taken into account in these systems. In this paper, we identify areas where further research is needed to have a better view of the costs incurred by households because of NCDs; namely, the extension of the geographical scope, the inclusion of certain diseases hitherto little studied, the introduction of a time dimension, and more comparisons with acute illnesses.
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Affiliation(s)
- Hyacinthe Tchewonpi Kankeu
- Aix-Marseille University (Aix-Marseille School of Economics), CNRS & EHESS, Centre de la Vieille Charité, 2 Rue de la Charité, 13236 Marseille, Cedex 2, France
| | - Priyanka Saksena
- Department of Health Systems Financing, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Ke Xu
- WHO Regional Office for the Western Pacific Region, P.O. Box 2932, 1000 Manila, Philippines
| | - David B Evans
- Department of Health Systems Financing, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
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Strzelczyk A, Haag A, Reese JP, Nickolay T, Oertel WH, Dodel R, Knake S, Rosenow F, Hamer HM. Trends in resource utilization and prescription of anticonvulsants for patients with active epilepsy in Germany. Epilepsy Behav 2013; 27:433-8. [PMID: 23591262 DOI: 10.1016/j.yebeh.2013.03.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 03/09/2013] [Accepted: 03/11/2013] [Indexed: 10/27/2022]
Abstract
This study evaluated trends in the resource use of patients with active epilepsy over a 5-year period at an outpatient clinic of a German epilepsy center. Two cross-sectional cohorts of consecutive adults with active epilepsy were evaluated over a 3-month period in 2003 and 2008. Data on socioeconomic status, course of epilepsy, as well as direct and indirect costs were recorded using validated patient questionnaires. We enrolled 101 patients in 2003 and 151 patients in 2008. In both cohorts, 76% of the patients suffered from focal epilepsy, and the majority was on antiepileptic drug (AED) polytherapy (mean AED number: 1.7 (2003), 1.8 (2008)). We calculated epilepsy-specific costs of € 2955 in 2003 and € 3532 in 2008 per 3 months per patient. Direct medical costs were mainly due to anticonvulsants in 2003 (59.4% of total direct costs, 34.0% in 2008) and to hospitalization in 2008 (46.9% of total direct costs, 27.7% in 2003). The proportion of enzyme-inducing anticonvulsants and 'old' AEDs decreased between 2003 and 2008. Indirect costs of € 1689 and € 1847 were mainly due to early retirement (48.4%; 46.0% of total indirect costs in 2003; 2008), unemployment (26.1%; 24.2%), and days off due to seizures (25.5%; 29.8%). This study showed a shift in distribution of direct cost components with increased hospital costs as well as a cost-neutral increase in the prescription of 'newer' AEDs. The amount and distribution of indirect cost components remained unchanged.
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Affiliation(s)
- Adam Strzelczyk
- Department of Neurology and Epilepsy Center Hessen, Philipps-University, Marburg, Germany.
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Strzelczyk A, Reese JP, Oertel WH, Dodel R, Rosenow F, Hamer HM. Costs of epilepsy and their predictors: Cross-sectional study in Germany and review of literature. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.epilep.2013.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Liu J, Liu Z, Meng F. The economic burden of epilepsy in a sample of people with epilepsy in China. Epilepsy Res 2013; 103:288-93. [DOI: 10.1016/j.eplepsyres.2012.07.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Revised: 07/12/2012] [Accepted: 07/15/2012] [Indexed: 10/28/2022]
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Economic differences in direct and indirect costs between people with epilepsy and without epilepsy. Med Care 2013; 50:928-33. [PMID: 23047781 DOI: 10.1097/mlr.0b013e31826c8613] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To provide generalizable estimates of economic burden in epilepsy and nonepilepsy populations and a comprehensive accounting for employment-based lost productivity associated with epilepsy in current US health care systems as compared with other chronic diseases. RESEARCH DESIGN We use the nationally representative data source (Medical Expenditure Panel Survey) from 1998 to 2009 to create a retrospective cohort of people diagnosed with epilepsy by a health professional and a comparison cohort of people with no epilepsy. MEASURES Health care utilization and direct costs for all components of treatment, including prescription medications, wages, employment, educational attainment, family income, and lost productivity were outcomes. RESULTS We observed economic disparities associated with epilepsy in the United States despite high rates of modern treatments (89% on anticonvulsant therapies). Only 42% of the people with epilepsy over age 18 reported employment compared with 70% of people with no epilepsy; among those, people with epilepsy reported missing an average of 12 days of work because of illness or injury as compared with 4 days in the nonepilepsy cohort. Holding other variables constant, people with epilepsy had a loss of productivity of $9504 in 2011 dollars compared with people with no epilepsy. In comparison, diabetes was associated with annual average lost productivity valued at $3358 and depression at $3182. CONCLUSIONS Lost wage-based productivity associated with epilepsy was nearly equal to combined wage losses associated with diabetes, depression, anxiety, and asthma together. To evaluate societal burden of illness, results illustrate the importance of indirect costs in addition to treated prevalence and direct medical costs.
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Salih MR, Bahari MB, Shafie AA, Hassali MAA, Al-lela OQB, Abd AY, Ganesan VM. Medical care costs of newly diagnosed children with structural-metabolic epilepsy: A one year prevalence-based approached. Seizure 2012; 21:764-9. [DOI: 10.1016/j.seizure.2012.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 08/11/2012] [Accepted: 08/13/2012] [Indexed: 11/29/2022] Open
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Tripathi M, Jain DC, Devi MG, Jain S, Saxena V, Chandra PS, Radhakrishnan K, Behari M, Gupta M, Puri V, Mehndiratta MM, Bala K, Anand KS, Rawat S, Shah PU, Gulati S, Johri S, Nadkarni VV, Chandra PS, Bachani D. Need for a national epilepsy control program. Ann Indian Acad Neurol 2012; 15:89-93. [PMID: 22566719 PMCID: PMC3345606 DOI: 10.4103/0972-2327.94989] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 02/08/2012] [Accepted: 02/14/2012] [Indexed: 11/29/2022] Open
Abstract
This article briefly outlines the proposed national epilepsy control program. The content of the article is based on four meetings held by invitation of the Ministry of Health. Invitees by ministry – Drs. D. C. Jain, M. Gourie Devi, V. Saxena, S. Jain, P. Satish. Chandra, M. Gupta, K. Bala, V. Puri, K. S. Anand, S. Gulati, S. Johri, P. S. Chandra, M. Behari, K. Radhakrishnan, D. Bachani. Presentations were made by Dr. M. Tripathi.The program will involve all neurologists across the country in teaching and training at state levels and a central monitoring committee.
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Affiliation(s)
- M Tripathi
- Department of Neurology, All India Institute of Medical Sciences, Delhi, India
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Sinha A, Mallik S, Sanyal D, Sengupta P, Dasgupta S. Healthcare-seeking behavior of patients with epileptic seizure disorders attending a tertiary care hospital, kolkata. Indian J Community Med 2012; 37:25-9. [PMID: 22529536 PMCID: PMC3326803 DOI: 10.4103/0970-0218.94018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 08/27/2011] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Neurological diseases are very important causes of prolonged morbidity and disability, leading to profound financial loss. Epilepsy is one of the most important neurological disorders Healthcare seeking by epilepsy patients is quite diverse and unique. AIMS AND OBJECTIVES The study was conducted among the epilepsy patients, to assess their healthcare-seeking behavior and its determinants. MATERIALS AND METHODS Three hundred and fifteen epilepsy patients, selected by systematic random sampling, in the neuromedicine outpatient department of a tertiary care hospital were interviewed with a predesigned, pretested, semi-structured proforma. RESULTS AND CONCLUSION More than 90% sought healthcare just after the onset of a seizure. The majority opted for allopathic medicine and the causes for not seeking initial care from allopaths were ignorance, faith in another system, constraint of money, and so on. A significant association existed between rural residence and low social status of the patients with initial care seeking from someone other than allopaths. No association was found among sex, type of seizure, educational status of the patients, and care seeking. The mean treatment gap was 2.98 ± 10.49 months and the chief motivators were mostly the family members. Patients for anti epileptic drugs preferred neurologists in urban areas and general practitioners in rural areas. District care model of epilepsy was proposed in the recommendation.
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Affiliation(s)
- Abhik Sinha
- Department of Community Medicine, Calcutta National Medical College, Kolkata, India
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Strzelczyk A, Nickolay T, Bauer S, Haag A, Knake S, Oertel WH, Reif PS, Rosenow F, Reese JP, Dodel R, Hamer HM. Evaluation of health-care utilization among adult patients with epilepsy in Germany. Epilepsy Behav 2012; 23:451-7. [PMID: 22381385 DOI: 10.1016/j.yebeh.2012.01.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 01/09/2012] [Indexed: 10/28/2022]
Abstract
This study evaluated the resource use of patients with epilepsy in the German district of Marburg-Biedenkopf. A cross-sectional cohort of consecutive adults with epilepsy, irrespective of seizure severity, duration of illness and epilepsy syndrome, was investigated in all health-care sectors. Costs of inpatient and outpatient treatment were derived from billing data of participating hospitals and office-based physicians. Data on socioeconomic status, course of epilepsy and further direct and indirect costs were recorded using patient questionnaires. We enrolled 366 patients from the district of Marburg-Biedenkopf and calculated annual epilepsy-specific costs of €7738 per patient. Direct costs contributed 31.1% (€2406) and indirect costs 68.9% (€5332) of the total costs. Direct medical costs were mainly due to hospitalization (33.2% of total direct costs) and anticonvulsants (26.7%). Costs of admissions were due to status epilepticus (24.4%), video-EEG monitoring (14.8%), newly diagnosed patients (14.4%) and seizure-related injuries (8.8%). Indirect costs were mainly due to early retirement (38.0%), unemployment (35.9%) and days off due to seizures (26.2%). The mean costs of epilepsy found in our study were lower than those found in studies conducted at European epilepsy centers due to the inclusion of patients in all health-care sectors.
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Affiliation(s)
- Adam Strzelczyk
- Department of Neurology and Epilepsy Center Hessen, Philipps-University, Marburg, Germany.
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Begley CE, Diop AG. Economic aspects of epilepsy. HANDBOOK OF CLINICAL NEUROLOGY 2012; 108:1001-1004. [PMID: 22939081 DOI: 10.1016/b978-0-444-52899-5.00043-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Charles E Begley
- School of Public Health, The University of Texas Health Science Center, Houston, TX, USA.
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Alexander A, John KR, Jayaraman T, Oommen A, Venkata Raghava M, Dorny P, Rajshekhar V. Economic implications of three strategies for the control of taeniasis. Trop Med Int Health 2011; 16:1410-6. [DOI: 10.1111/j.1365-3156.2011.02850.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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