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Fawcett J, Davis S, Manford M. Further advances in epilepsy. J Neurol 2023; 270:5655-5670. [PMID: 37458794 DOI: 10.1007/s00415-023-11860-6] [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: 05/31/2023] [Revised: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 10/15/2023]
Abstract
In 2017, one of us reviewed advances in epilepsy (Manford in J Neurol 264:1811-1824, 2017). The current paper brings that review up to date and gives a slight change in emphasis. Once again, the story is of evolution rather than revolution. In recognition that most of our current medications act on neurotransmitters or ion channels, and not on the underlying changes in connectivity and pathways, they have been renamed as antiseizure (ASM) medications rather than antiepileptic drugs. Cenobamate is the one newly licensed medication for broader use in focal epilepsy but there have been a number of developments for specific disorders. We review new players and look forward to new developments in the light of evolving underlying science. We look at teratogenicity; old villains and new concerns in which clinicians play a vital role in explaining and balancing the risks. Medical treatment of status epilepticus, long without evidence, has benefitted from high-quality trials to inform practice; like buses, several arriving at once. Surgical treatment continues to be refined with improvements in the pre-surgical evaluation of patients, especially with new imaging techniques. Alternatives including stereotactic radiotherapy have received further focus and targets for palliative stimulation techniques have grown in number. Individuals' autonomy and quality of life continue to be the subject of research with refinement of what clinicians can do to help persons with epilepsy (PWE) achieve control. This includes seizure management but extends to broader considerations of human empowerment, needs and desires, which may be aided by emerging technologies such as seizure detection devices. The role of specialist nurses in improving that quality has been reinforced by specific endorsement from the International League against Epilepsy (ILAE).
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Affiliation(s)
- Joanna Fawcett
- Department of Neurology, Royal United Hospital, Bath, UK
| | - Sarah Davis
- Department of Neurology, Royal United Hospital, Bath, UK
| | - Mark Manford
- Department of Neurology, Royal United Hospital, Bath, UK.
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Fontaine S, Gautier L, Diependaele AS, Hamieh M, Morello R, Guillouët S, Bertran F. Impact of educational actions on the quality of life of patients with epilepsy: A randomised controlled trial. Epilepsy Res 2023; 192:107128. [PMID: 37027966 DOI: 10.1016/j.eplepsyres.2023.107128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/08/2023] [Accepted: 03/20/2023] [Indexed: 04/07/2023]
Abstract
INTRODUCTION Epilepsy is a common and disabling disease for patients and their families. The care of these patients is no longer limited to the simple control of seizures, but considers, in a more global way, their quality of life (QOL). Improving the QOL is precisely one of the main objectives of therapeutic education. The aim of this study was to evaluate the impact of educational actions on the global QOL of patients with epilepsy. MATERIALS AND METHODS This study was carried out between October 2016 and August 2018. 80 patients were included over 18 years old with an epileptic condition diagnosed for at least 6 months and treated in the University Hospital of Caen Normandy in France. They were randomised to either the control group with usual care or the experimental group with the group educational sessions. The overall score for the QOLIE-31 survey was assessed from the inclusion (M0) and 6 months late. RESULTS At the M0 mark, the score of the control group (58.1 ± 12.3) was significantly lower than that of the experimental group (61.1 ± 14.3). After 6 months, the overall QOL score, was significantly higher for the experimental group compared to the control group (p = 0.002). In the experimental group, the overall score went from 61.1 ± 14.3-69 ± 14.2 and in the control group it went from 58.1 ± 12.3-58 ± 16.2. DISCUSSION The quality-of-life overall score for patients having participated in educational actions provided by epilepsy specialist nurses improved significantly. Complementary research is necessary to assess the sustainability of these effects and interactions with the caregivers.
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Ma X, Li Y, Li J, Zhou D, Yang R. Construction of nursing-sensitive quality indicators for epilepsy in China: A Delphi consensus study. Seizure 2023; 107:71-80. [PMID: 36989923 DOI: 10.1016/j.seizure.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 03/22/2023] Open
Abstract
OBJECTIVE The quality and safety of epilepsy care are of great importance because seizures are unpredictable. The aim of this study was to develop a set of nursing-sensitive quality indicators (NSQIs) for assessing and improving the quality of epilepsy nursing care in China. METHODS An international literature review, a cross-sectional survey and a qualitative study were conducted to identify candidate NSQIs for epilepsy care and compile a questionnaire. Then, two rounds of electronic Delphi studies were conducted with a panel of 27 independent experts to identify the final NSQIs for epilepsy. RESULTS Thirty-nine candidate NSQIs were extracted for the Delphi process. The recovery rates in the first and second rounds of expert consultations were 92.6% and 96.2%, respectively. The experts' authority coefficients of the two rounds were 0.876 and 0.878, respectively. The Kendall W value of the two rounds ranged between 0.094 and 0.200 (p<0.001). Eight structure indicators, 9 process indicators and 7 outcome indicators that represented the following three domains were included in the set of NSQIs for epilepsy: nursing resource allocation, implementation of nursing care, and outcomes of patients with epilepsy. CONCLUSION These NSQIs for epilepsy provide a primary foundation for monitoring and improving the quality of epilepsy nursing care in China. However, the effects of these indicators on improvements in epilepsy care and outcomes in patients need to be verified in clinical practice.
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Hutchinson K, Ryder T, Coleman H, Nullwala R, Herkes G, Bleasel A, Nikpour A, Wong C, Todd L, Ireland C, Shears G, Bartley M, Groot W, Kerr M, Vagholkar S, Braithwaite J, Rapport F. Determining the role and responsibilities of the community epilepsy nurse in the management of epilepsy. J Clin Nurs 2022. [PMID: 36494199 DOI: 10.1111/jocn.16582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/28/2022] [Accepted: 10/26/2022] [Indexed: 12/14/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study is to enhance the understanding of the core elements and influencing factors on the community-based epilepsy nurse's role and responsibilities. BACKGROUND Internationally, epilepsy nurse specialists play a key role in providing person-centred care and management of epilepsy but there is a gap in understanding of their role in the community. DESIGN A national three-stage, mixed-method study was conducted. METHODS One-on-one, in-depth semi-structured qualitative interviews were conducted online with 12 community-based epilepsy nurses (Stage 1); retrospective analysis of data collected from the National Epilepsy Line, a nurse-led community helpline (Stage 2); and focus group conducted with four epilepsy nurses, to delve further into emerging findings (Stage 3). A thematic analysis was conducted in Stages 1 and 3, and a descriptive statistical analysis of Stage 2 data. Consolidated Criteria for Reporting Qualitative studies checklist was followed for reporting. RESULTS Three key themes emerged: (1) The epilepsy nurse career trajectory highlighted a lack of standardised qualifications, competencies, and career opportunities. (2) The key components of the epilepsy nurse role explored role diversity, responsibilities, and models of practice in the management of living with epilepsy, and experiences navigating complex fragmented systems and practices. (3) Shifting work practices detailed the adapting work practices, impacted by changing service demands, including COVID-19 pandemic experiences, role boundaries, funding, and resource availability. CONCLUSION Community epilepsy nurses play a pivotal role in providing holistic, person-centred epilepsy management They contribute to identifying and addressing service gaps through innovating and implementing change in service design and delivery. RELEVANCE TO CLINICAL PRACTICE Epilepsy nurses' person-centred approach to epilepsy management is influenced by the limited investment in epilepsy-specific integrated care initiatives, and their perceived value is impacted by the lack of national standardisation of their role and scope of practice. NO PATIENT OR PUBLIC CONTRIBUTION Only epilepsy nurses' perspectives were sought.
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Affiliation(s)
- Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Tayhla Ryder
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Honor Coleman
- Melbourne School of Psychological Science, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Ruqaiya Nullwala
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Geoffrey Herkes
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Andrew Bleasel
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Armin Nikpour
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Chong Wong
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Lisa Todd
- Epilepsy Action Australia, North Ryde, New South Wales, Australia
| | - Carol Ireland
- Epilepsy Action Australia, North Ryde, New South Wales, Australia
| | | | - Melissa Bartley
- Department of Neurology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Wendy Groot
- Epilepsy Australia, Melbourne, Victoria, Australia.,Epilepsy Tasmania, Launceston, Tasmania, Australia
| | - Michael Kerr
- Department of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Sanjyot Vagholkar
- MQ Health General Practice, Macquarie University, North Ryde, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
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Michaelis R, Schlömer S, Popkirov S, Krämer G, Lindemann A, Cosentino M, Reuber M, Heinen G, Wellmer J, Grönheit W, Wehner T, Schlegel U, Scott AJ, Gandy M. German translation and validation of the brief Epilepsy Anxiety Survey Instrument (brEASI). Epilepsy Behav 2022; 134:108857. [PMID: 35907288 DOI: 10.1016/j.yebeh.2022.108857] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/14/2022] [Accepted: 07/14/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Anxiety disorders remain undiagnosed in routine clinical practice in up to two thirds of affected patients with epilepsy despite their significant impact on medical and psychosocial outcomes. The study objective was to translate and validate the German 8-item "brief Epilepsy Anxiety Survey Instrument" (brEASI) to facilitate effective screening for the presence of anxiety disorders in German-speaking patients. METHODS After expert translation into German, the brEASI was completed by consecutive adult inpatients with epilepsy hospitalized for seizures at an academic reference epilepsy center. Patients also completed the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), the Generalized Anxiety Disorder scale (GAD-7) for external validity, and underwent a standardized interview (Mini-DIPS-OA) as a gold standard to determine the presence of an ICD-10 anxiety disorder (generalized anxiety disorder (GAD), panic disorder, agoraphobia, and social phobia). Receiver operating characteristics (ROC) were calculated to determine the diagnostic accuracy of the brEASI, including the associated area under the curve (AUC) statistics to determine the potential of the brEASI to identify ICD-10 anxiety disorders diagnosed by interview. For comparative purposes, these analyses were also conducted for the GAD-7. RESULTS Of 80 recruited adult inpatients with epilepsy, 18 (23 %) were found to have a current anxiety disorder through standardized interview. In this study, both brEASI and GAD-7 showed a better diagnostic performance at a cutoff of >5 than at the previously reported cutoff values of >6 and >9, respectively. The AUC of the German brEASI was outstanding (AUC = 0.90, 95 % confidence interval (CI) = 0.82-0.96) for detecting all anxiety disorders and excellent for detecting non-GAD disorders (AUC = 0.85, CI = 0.76-0.92) at a cutoff of >5. At this optimal cutoff of >5 the brEASI demonstrated better sensitivity and specificity (89 % and 84 %) for identifying anxiety disorders than the GAD-7 (83 % and 74 %). The final German version of the brEASI is free to download at https://www.v-neuro.de/veroeffentlichungen/. CONCLUSION The German version of the brEASI represents a valid and reliable epilepsy-specific anxiety screening instrument. A positive screening result should be followed by further diagnostic procedures. Appropriate therapeutic steps should be initiated if the presence of an anxiety disorder or other psychiatric disorders is confirmed.
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Affiliation(s)
- Rosa Michaelis
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany; Faculty of Health, Witten/Herdecke University, Germany.
| | - Sabine Schlömer
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Stoyan Popkirov
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | | | - Anja Lindemann
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany; Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Maya Cosentino
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | | | - Jörg Wellmer
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany; Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Wenke Grönheit
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany; Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Tim Wehner
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany; Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Uwe Schlegel
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Amelia J Scott
- The School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Milena Gandy
- The School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
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Persistent knowledge gaps between 2005 and 2020 in women with epilepsy: Comparison of multicenter studies from Germany. Seizure 2022; 100:36-43. [PMID: 35749829 DOI: 10.1016/j.seizure.2022.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/01/2022] [Accepted: 06/12/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Epilepsy is a chronic condition that can affect patients of all ages. Women with epilepsy (WWE) require access to specific counseling and information regarding issues related to contraception, pregnancy, and hormonal effects on seizure control and bone mineral density. This study investigated the knowledge among WWE regarding their condition, and whether epilepsy-specific knowledge has improved over the last 15 years. METHODS A total of 280 WWE aged 18 to 82 years participated in this multicenter, questionnaire-based study. The study was conducted at four epilepsy centers in Germany, between October 2020 and December 2020. Sociodemographic and epilepsy-specific data for participating women were analyzed and compared with the results of a similar survey performed in 2003-2005 among 365 WWE in Germany. RESULTS The questionnaire-based survey revealed considerable knowledge deficits without significant improvements over the last 15 years, particularly among those with less education and with regards to information on the more pronounced effects of epilepsy in older WWE (>50 years), including interactions with menopause and osteoporosis. In WWE ≤29 years, a significant increase in the knowledge score was observed in 2020 compared with this age group in 2005 (mean 7.42 vs. 6.5, p = .036). Mothers frequently reported epilepsy-related concerns regarding childrearing, particularly of seizures scaring their child and the need to rely on other people. CONCLUSION WWE continue to demonstrate inadequate epilepsy-related knowledge. Despite increasing information availability and the aspiration toward better awareness among medical professionals, overall knowledge has not increased sufficiently compared with the levels observed in recent studies.
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Gao Y, Tang X, Wen Y, Qian D, Pan X, Zhang L. Effects of the hospital-community-family ternary linkage continuous nursing model on compliance, cognitive function, resilience, and quality of life for children with epilepsy: a retrospective study. Transl Pediatr 2022; 11:239-248. [PMID: 35282024 PMCID: PMC8905107 DOI: 10.21037/tp-22-21] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/11/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Epilepsy is a chronic disease that can reduce the quality of life in children because it can cause memory loss, learning difficulties, mental and behavioral abnormalities, and social disorders. The purpose of this study was to explore the effect of the hospital-community-family linkage continuous nursing model in the nursing of children with epilepsy. METHODS Data for 136 children with epilepsy who were hospitalized in the neurology clinic or neurology ward of Wuxi Children's Hospital from January 2018 to January 2021 were retrospectively analyzed. According to the nursing mode after discharge, the children were divided into 65 cases in the observation group (hospital-community-family linkage continuous nursing model) and 71 cases in the control group (routine nursing model). The compliance with nursing, cognitive function, resilience, and quality of life of the two groups were compared before and after intervention, and the influencing factors of children's quality of life were analyzed. RESULTS The follow-up visit 6 months after discharge found that the scores for compliance, resilience, and quality of life in the observation group were significantly higher than those in the control group (P<0.05). The correlation analysis between quality of life, each child's general data, and the nursing model found that the total score of quality of life was correlated with incidence frequency, family per capita income, and the nursing model. CONCLUSIONS The adoption of a hospital-community-family linkage continuous nursing model can improve the compliance, resilience, and quality of life of children with epilepsy.
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Affiliation(s)
- Yali Gao
- Department of Neurology, Wuxi Children's Hospital, Wuxi, China
| | - Xiaohong Tang
- Department of Neurology, Wuxi Children's Hospital, Wuxi, China
| | - Yiyi Wen
- Department of Neurology, Wuxi Children's Hospital, Wuxi, China
| | - Daijing Qian
- Department of Neurology, Wuxi Children's Hospital, Wuxi, China
| | - Xingnan Pan
- Department of Science and Education, Wuxi Children's Hospital, Wuxi, China
| | - Linhui Zhang
- Department of Neurology, Wuxi Children's Hospital, Wuxi, China
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Michaelis R, Schlömer S, Lindemann A, Behrens V, Grönheit W, Pertz M, Rammé S, Seidel S, Wehner T, Wellmer J, Schlegel U, Popkirov S. Screening for Psychiatric Comorbidities and Psychotherapeutic Assessment in Inpatient Epilepsy Care: Preliminary Results of an Implementation Study. Front Integr Neurosci 2021; 15:754613. [PMID: 34712125 PMCID: PMC8546318 DOI: 10.3389/fnint.2021.754613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/21/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Anxiety and depression remain underdiagnosed in routine clinical practice in up to two thirds of epilepsy patients despite significant impact on medical and psychosocial outcome. Barriers to adequate mental health care for epilepsy and/or psychogenic non-epileptic seizures (PNES) include a lack of integrated mental health specialists and standardized procedures. This naturalistic study outlines the procedures and outcome of a recently established psychotherapeutic service. Methods: Routine screening included the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E, cut-off value > 13) and Generalized Anxiety Disorder scale (GAD-7, cut-off value > 5). Positively (above cut-off in at least one questionnaire) screened patients were seen for a standardized interview for mental health disorders and the development of a personalized treatment plan. PNES patients were seen irrespective of their screening score. Resources were provided to support self-help and access to psychotherapy. Patients were contacted 1 month after discharge to evaluate adherence to therapeutic recommendations. Results: 120 patients were screened. Overall, 56 of 77 positively screened patients (77%) were found to have a psychiatric diagnosis through standardized interview. More epilepsy patients with an anxiety disorder had previously been undiagnosed compared to those with a depressive episode (63% vs. 30%); 24 epilepsy patients (62%) with a psychiatric comorbidity and 10 PNES patients (59%) were not receiving any mental health care. At follow-up, 16/17 (94%) epilepsy patients and 7/7 PNES patients without prior psychiatric treatment were adhering to therapeutic recommendations. Conclusion: Integrating mental health specialists and establishing standardized screening and follow-up procedures improve adherence to mental health care recommendations in epilepsy and PNES patients.
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Affiliation(s)
- Rosa Michaelis
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany.,Faculty of Health, Witten/Herdecke University, Witten-Herdecke, Germany
| | - Sabine Schlömer
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Anja Lindemann
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany.,Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Vanessa Behrens
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Wenke Grönheit
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany.,Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Milena Pertz
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Stephanie Rammé
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Sabine Seidel
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Tim Wehner
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany.,Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Jörg Wellmer
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany.,Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Uwe Schlegel
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Stoyan Popkirov
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
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Chen HF, Tsai YF, Fan JY, Chen MC, Hsi MS, Hua MS. Evaluation of a self-management intervention for adults with epilepsy in Taiwan: A longitudinal randomized controlled trial. Epilepsy Behav 2021; 117:107845. [PMID: 33621815 DOI: 10.1016/j.yebeh.2021.107845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Epilepsy is a neurological disease that causes recurrent seizures and can have a significant impact on a person's quality of life (QOL). A self-management intervention (SMI) can allow adults with epilepsy to modify behaviors in order to manage their seizures and evaluate the impact of medication and treatments on their daily lives. The purpose of this study was to investigate the effects of a SMI for adults with epilepsy. METHODS This was a longitudinal randomized controlled trial. Adults with epilepsy between the age of 20 and 65 years were recruited from a medical center in northern Taiwan. Participants were assigned to an intervention group (IG) or control group (CG) through simple randomization. Data regarding demographic and clinical characteristics were collected at baseline (T0). In addition, participants answered nine validated self-report questionnaires, which were used as outcome measures. Following collection of baseline data, the CG received routine monthly counseling over the next 3 months. The IG received the routine monthly counseling, as well as individual face-to-face health counseling on self-management 1 h/month and remote counseling via the phone or computer network at least twice per month. After the first month (T1) and at the end of the third (T2) and sixth months (T3) participants answered the nine questionnaires again. Differences in outcomes between the IGs and CGs were analyzed by comparing scores for the nine outcome variables at T0 with scores at T1, T2, and T3 with generalized estimating equations. RESULTS A total of 210 adults agreed to participate in the study; however, only 155 participants completed the questionnaires for all three time points: 75 in the CG and 80 in the IG. The mean age of the 155 participants was 39.6 years (SD = 10.9). There was no significant difference between demographic or clinical variables between the two groups. The only difference in baseline scores (T0) among the nine self-report questionnaires was in epilepsy knowledge, measured with the Epilepsy Knowledge Profile questionnaire, which were significantly higher for the CG (mean = 32.28, SD = 3.92) than the IG (mean = 23.01, SD = 2.79) (p < 0.001). Generalized estimating equations (GEE) analysis showed scores decreased significantly at T3 from baseline for the CG for epilepsy knowledge and QOL (p < 0.001). Improvements in scores for sleep quality, anxiety, depression, self-efficacy, coping, and social support did not differ between groups. Classification of the IG by gender showed a significantly greater increase for males compared with females from baseline to T3 for epilepsy knowledge (p < 0.001). If we further classified the IGs by seizure frequency, participants with a seizure frequency of ≥1 per year had a more significant increase in epilepsy knowledge and increase in QOL compared with participants with a seizure frequency of <1 per year at T3 compared with T0. CONCLUSION The lack of improvement in health-related quality of life (HRQoL) following the SMI may indicate that additional time is required to change behaviors that impact this variable for patients with epilepsy. Additional research should focus on variables associated with medication compliance, epilepsy knowledge, medicine symptom distress, self-efficacy, anxiety, and HRQoL.
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Affiliation(s)
- Hsiu-Fang Chen
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan; Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Yun-Fang Tsai
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan; School of Nursing, Chang Gung University, Tao-Yuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.
| | - Jun-Yu Fan
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan; Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Min-Chi Chen
- Graduate Institute of Biomedical Sciences, Chang Gung University, Tao-Yuan, Taiwan
| | - Mo-Song Hsi
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Mau-Sun Hua
- Department of Psychology, National Taiwan University, Taipei, Taiwan
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10
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Manzanares I, Sevilla Guerra S, Peña-Ceballos J, Carreño M, Palanca M, Lombraña M, Conde-Blanco E, Centeno M, Donaire A, Gil-Lopez F, Khawaja M, López Poyato M, Zabalegui A. The emerging role of the advanced practice epilepsy nurse: A comparative study between two countries. J Clin Nurs 2021; 30:1263-1272. [PMID: 33471366 DOI: 10.1111/jocn.15669] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 12/11/2020] [Accepted: 01/07/2021] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES The aim of the study was to compare advanced practice in epilepsy nurses in Spain and United Kingdom, identifying differences in the domains of standard advanced practice. BACKGROUND Europe has recently faced the challenge of providing high-quality care for patients with epilepsy, a disease that generates many health demands. In some countries, such as the United Kingdom, advanced practice nursing is well established and could serve as a guide for implantation in countries where it is still in development, as is the case of Spain. DESIGN A multicentre cross-sectional descriptive cohort study compared differences in the roles of advanced practice nurses in Spain and the United Kingdom. METHODS The Advanced Practice Role Delineation Tool and its validated Spanish version were administered using an online questionnaire in a cohort of advanced practice epilepsy nurses in both countries. A convenience sample was recruited between January to December 2019. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. RESULTS Most United Kingdom nurses in our sample came from community environments, in contrast to Spanish nurses who worked in hospital. All domains analysed in the survey had significantly higher scores in the United Kingdom than in the Spanish cohort, especially in the research and leadership domains. CONCLUSIONS The advanced practice role in Spain is underdeveloped compared with the United Kingdom. Differences in the settings of advanced roles in epilepsy nurses may be explained by greater community practice in the United Kingdom and differences in organisational and health systems. RELEVANCE TO CLINICAL PRACTICE Our study showed the need to implement specific policies to develop advance practice nurse roles in Spain to improve the quality of care of patients with epilepsy.
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Affiliation(s)
- Isabel Manzanares
- Epilepsy Unit, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sonia Sevilla Guerra
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Hospital Clínic de Barcelona, Barcelona, Spain
| | - Javier Peña-Ceballos
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Mar Carreño
- Epilepsy Unit, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - María Palanca
- Refractory Epilepsy Unit, Department of Neurology, Hospital Universitari i Politècnic La Fe de Valencia, Valencia, Spain
| | - María Lombraña
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Hospital Clínic de Barcelona, Barcelona, Spain
| | - Estefanía Conde-Blanco
- Epilepsy Unit, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - María Centeno
- Epilepsy Unit, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Antonio Donaire
- Epilepsy Unit, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francisco Gil-Lopez
- Epilepsy Unit, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mariam Khawaja
- Epilepsy Unit, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mireia López Poyato
- Department of Nursing, Facultad de Medicina i Ciencias de la Salud, Universidad de Barcelona, Barcelona, Spain.,Primary Care Centre Les Corts, Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
| | - Adelaida Zabalegui
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Hospital Clínic de Barcelona, Barcelona, Spain
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11
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Locatelli G, Ausili D, Stubbings V, Di Mauro S, Luciani M. The epilepsy specialist nurse: A mixed-methods case study on the role and activities. Seizure 2021; 85:57-63. [PMID: 33486343 DOI: 10.1016/j.seizure.2020.12.013] [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] [Received: 08/11/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To describe the role and activities of epilepsy specialist nurses (ESNs) operating as a team in the setting of a hospital specialising in the diagnosis and management of seizure disorders. METHODS We conducted a descriptive mixed-methods embedded single case study. We recruited 9 ESNs, 14 of their professional colleagues and 9 'key informants' to analyse their perceptions of the role and activities of ESNs. We collected data through interviews, questionnaires, observations, and documentation. The study was conducted at the Filadelfia Epilepsy Hospital, Denmark. RESULTS The team of ESNs offers holistic care to patients and their caregivers regarding the clinical, social, and emotional aspects of epilepsy. The ESNs are integrated in a multidisciplinary team and promote collaboration among the team members. ESNs also contribute to organisational aspects and perform research activities. CONCLUSION A structured group of ESNs can operate effectively and extensively in a specialised hospital setting. Our findings contribute to clarifying the description of the ESN's role, and provide an example of how ESNs can be incorporated into a hospital's organisational structure.
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Affiliation(s)
- G Locatelli
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy; Department of Biomedicine and Prevention, University of Roma Tor Vergata, Via Montpellier 1, 00133, Rome, Italy; Faculty of Health Sciences, Australian Catholic University, Fitzroy Victoria 3065, 115 Victoria Parade, Melbourne, Australia.
| | - D Ausili
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - V Stubbings
- Filadelfia Epilepsy Hospital, Kolonivej 1, 4293, Dianalund, Denmark
| | - S Di Mauro
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - M Luciani
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
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12
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Patient satisfaction with information provided by epilepsy specialist nurses: Results of an online survey. Epilepsy Behav 2020; 112:107273. [PMID: 32846308 DOI: 10.1016/j.yebeh.2020.107273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 11/23/2022]
Abstract
The aim of this study was to investigate the perspective of Norwegian patients with epilepsy regarding the information that they have received about epilepsy-related issues and to determine whether there was a difference in information received between those who had been followed up by an epilepsy specialist nurse (ESN) and those who had not. Further, were there differences regarding satisfaction with the information between the two groups? We conducted an online survey in close collaboration with the Norwegian Epilepsy Association. A total of 1859 respondents (1182 patients with epilepsy and 677 carers for patients with epilepsy) completed a web-based questionnaire. They were asked about epilepsy-related issues on which they had received information, the extent to which they were satisfied with this information, and whether they were being followed up by an ESN or not. Significantly more patients followed up by an ESN had received information about the epilepsy diagnosis, antiseizure drugs (ASDs), routine use of ASD, and risk of seizure-related injuries as compared to those not followed up by an ESN. In addition, patients followed by an ESN were more likely to be satisfied with the information they received. Just above or under half of the respondents had received or were satisfied with information about depression, anxiety, premature death, and sexual wellbeing. Our results indicate that follow-up by ESNs results in improvements in the information provided to patients with epilepsy; ESNs should be an integral part of comprehensive epilepsy service.
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13
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Michaelis R, Tang V, Nevitt SJ, Wagner JL, Modi AC, LaFrance WC, Goldstein LH, Gandy M, Bresnahan R, Valente K, Donald KA, Reuber M. Psychological treatments for people with epilepsy. Cochrane Database Syst Rev 2020; 8:CD012081. [PMID: 35653266 PMCID: PMC8409429 DOI: 10.1002/14651858.cd012081.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Given the significant impact epilepsy may have on the health-related quality of life (HRQOL) of individuals with epilepsy and their families, there is increasing clinical interest in evidence-based psychological treatments, aimed at enhancing psychological and seizure-related outcomes for this group. This is an updated version of the original Cochrane Review published in Issue 10, 2017. OBJECTIVES To assess the impact of psychological treatments for people with epilepsy on HRQOL outcomes. SEARCH METHODS For this update, we searched the following databases on 12 August 2019, without language restrictions: Cochrane Register of Studies (CRS Web), which includes randomized or quasi-randomized controlled trials from the Specialized Registers of Cochrane Review Groups including Epilepsy, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid, 1946 to 09 August 2019), and PsycINFO (EBSCOhost, 1887 onwards), and from PubMed, Embase, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (ICTRP). We screened the references from included studies and relevant reviews, and contacted researchers in the field for unpublished studies. SELECTION CRITERIA We considered randomized controlled trials (RCTs) and quasi-RCTs for this review. HRQOL was the main outcome. For the operational definition of 'psychological treatments', we included a broad range of skills-based psychological treatments and education-only interventions designed to improve HRQOL, seizure frequency and severity, as well as psychiatric and behavioral health comorbidities for adults and children with epilepsy. These psychological treatments were compared to treatment as usual (TAU), an active control group (such as social support group), or antidepressant pharmacotherapy. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 36 completed RCTs, with a total of 3526 participants. Of these studies, 27 investigated skills-based psychological interventions. The remaining nine studies were education-only interventions. Six studies investigated interventions for children and adolescents, three studies investigated interventions for adolescents and adults, and the remaining studies investigated interventions for adults. Based on satisfactory clinical and methodological homogeneity, we pooled data from 11 studies (643 participants) that used the Quality of Life in Epilepsy-31 (QOLIE-31) or other QOLIE inventories (such as QOLIE-89 or QOLIE-31-P) convertible to QOLIE-31. We found significant mean changes for the QOLIE-31 total score and six subscales (emotional well-being, energy and fatigue, overall QoL, seizure worry, medication effects, and cognitive functioning). The mean changes in the QOLIE-31 total score (mean improvement of 5.23 points, 95% CI 3.02 to 7.44; P < 0.001), and the overall QoL score (mean improvement of 5.95 points, 95% CI 3.05 to 8.85; P < 0.001) exceeded the threshold of minimally important change (MIC: total score: 4.73 points; QoL score: 5.22 points), indicating a clinically meaningful postintervention improvement in HRQOL. We downgraded the certainty of the evidence provided by the meta-analysis due to serious risks of bias in some of the included studies. Consequently, these results provided moderate-certainty evidence that psychological treatments for adults with epilepsy may enhance overall HRQOL. AUTHORS' CONCLUSIONS Implications for practice: Skills-based psychological interventions improve HRQOL in adults and adolescents with epilepsy. Adjunctive use of skills-based psychological treatments for adults and adolescents with epilepsy may provide additional benefits in HRQOL when these are incorporated into patient-centered management. We judge the evidence to be of moderate certainty. IMPLICATIONS FOR RESEARCH Investigators should strictly adhere to the CONSORT guidelines to improve the quality of reporting on their interventions. A thorough description of intervention protocols is necessary to ensure reproducibility. When examining the effectiveness of psychological treatments for people with epilepsy, the use of standardized HRQOL inventories, such as the Quality of Life in Epilepsy Inventories (QOLIE-31, QOLIE-31-P, and QOLIE-89) would increase comparability. Unfortunately, there is a critical gap in pediatric RCTs and RCTs including people with epilepsy and intellectual disabilities. Finally, in order to increase the overall quality of RCT study designs, adequate randomization with allocation concealment and blinded outcome assessment should be pursued. As attrition is often high in research that requires active participation, an intention-to-treat analysis should be carried out. Treatment fidelity and treatment competence should also be assessed. These important dimensions, which are related to 'Risk of bias' assessment, should always be reported.
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Affiliation(s)
- Rosa Michaelis
- Department of Neurology Gemeinschaftskrankenhaus Herdecke, University of Witten/Herdecke, Herdecke, Germany
| | - Venus Tang
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hospital Authority, Hong Kong
- Department of Clinical Psychology, Prince of Wales Hospital, Hospital Authority, Hong Kong
| | - Sarah J Nevitt
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Janelle L Wagner
- College of Nursing, Medical University of South Carolina, Charleston, USA
| | - Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, USA
| | - William Curt LaFrance
- Departments of Psychiatry and Neurology, Brown University, Providence, Rhode Island, USA
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Milena Gandy
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Rebecca Bresnahan
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Kette Valente
- Faculty of Medicine, University of São Paulo (HCFMUSP), Sao Paulo, Brazil
| | - Kirsten A Donald
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
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14
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Higgins A, Murphy R, Downes C, Varley J, Begley C, Elliott N. Factors influencing the implementation of Epilepsy Specialist Nurse role: Using the Consolidation Framework for Implementation Research. J Clin Nurs 2020; 29:1352-1364. [PMID: 31972049 DOI: 10.1111/jocn.15197] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/20/2019] [Accepted: 01/10/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Research to support the added value of including Epilepsy Specialist Nurses as members of the multidisciplinary team is developing, yet little information exists on factors influencing the translation of these roles into practice. AIM To describe the enabling and inhibiting factors to the implementation of the Epilepsy Specialist Nurse role in the Republic of Ireland. METHODS A qualitative design involving semi-structure interviews, observation and analysis of documents, such as portfolios was used. The sample included 12 Epilepsy Specialist Nurses, 24 multidisciplinary team members, and 35 individuals with epilepsy and family members. Data were analysed using the Consolidation Framework for Implementation Research. Reporting rigour is demonstrated using the COREQ checklist (See Appendix S1). RESULTS While there was overwhelming support for the role, barriers and enablers were identified across all domains of the Consolidation Framework for Implementation Research. Enablers included national policies and guidelines, leadership from senior nursing and medical colleagues, climate of learning and mentorship, networking opportunities, infrastructural supports and competence of Epilepsy Specialist Nurses. Barriers included the limited consideration of service expansion and the increasingly complex nature of clinical cases on workload capacity. Deficits in infrastructural supports, challenges in relation to role preparation, role implementation and role responsibility, including concerns around lone practitioner models and concerns that the role was a cost-saving measure, also emerged as potential barriers to future sustainability. CONCLUSION The Consolidation Framework for Implementation Research offers researchers a pragmatic typology for analysing interrelationships between enabling and inhibiting factors that impact implementation of advanced practice roles, across different evidence sources, disciplines and boundaries. RELEVANCE TO CLINICAL PRACTICE In order to secure role sustainability, managers need to address the rate of service expansion, models of role development, deficits in supports and perceived motivations for role development on the quality, acceptability and sustainability of services provided.
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Affiliation(s)
- Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Rebecca Murphy
- ALL Institute, Department of Psychology, National University of Ireland Maynooth, Maynooth, Ireland
| | - Carmel Downes
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Jarlath Varley
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Naomi Elliott
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Braga P, Mifsud J, D'Souza C, Clarke M, Honein A, Tovuudorj A, Pfäfflin M. Education and epilepsy: Examples of good practice and cooperation. Report of the IBE Commission on Education. Epilepsy Behav 2020; 103:106653. [PMID: 31761687 DOI: 10.1016/j.yebeh.2019.106653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 10/14/2019] [Indexed: 12/31/2022]
Abstract
Education for patients, for families, for professionals, and for officials is one of the most important tools for improving knowledge about epilepsy and fighting discrimination. There are many educational initiatives worldwide, but they are often known only at a local level. Studies on epilepsy educational programs are rare and therefore published to a limited extent. The newly established International Bureau for Epilepsy (IBE) Education Commission enforces the exchange of educational activities and best practices, discussing education content and topics, target groups, and their educational needs, timing, tutors, and funding. A brief review of examples of all continents will be given. The needs for studies and for more exchange and closer cooperation will be addressed with proposals for further actions.
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Affiliation(s)
- Patricia Braga
- Neurological Institute, Facultad de Medicina, Universidad de la República, Uruguay
| | - Janet Mifsud
- Dep. of Clinical Pharmacology and Therapeutics, Univ. of Malta Msida, Malta
| | | | - Marina Clarke
- National Office Epilepsy, IBE Chapter, Cape Town, South Africa
| | - Arlette Honein
- AVANCE - School and Association for children with epilepsy and special needs, Lebanon
| | - Avirmed Tovuudorj
- Dep. of Neurology, Mongolian National University of Medical Sciences, Mongolia
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16
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Manzanares I, Sevilla Guerra S, Lombraña M, Gil-López F, Conde-Blanco E, Zabalegui A, Pfäfflin M, May TW, Kostov B, Moreno-Poyato A, Donaire A, Guio L, Beltran O, Cuzco C, Carreño M. Spanish version of the Satisfaction with Epilepsy Care questionnaire: Adaptation and psychometric properties. Epilepsy Behav 2020; 102:106812. [PMID: 31830723 DOI: 10.1016/j.yebeh.2019.106812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/14/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The objective of this study was to perform a cross-cultural adaption and psychometric evaluation of the Spanish version of the Satisfaction with Epilepsy Care (SEC) questionnaire and analyze patient satisfaction with epilepsy care. METHODS Transcultural adaptation and validation of the SEC were carried out using translation and back-translation with pilot testing and an expert panel. The SEC-E (Spanish) was analyzed in 213 patients with epilepsy to examine construct and criterion validity and internal consistency. RESULTS The SEC-E achieved conceptual, semantic, and content equivalence with the original version. For content validity, one question was eliminated from the original questionnaire as it has little relevance in our cultural setting. Positive correlations for criterion validity were obtained using the gold standard measure (Satisfaction in Hospitalized Patients scale). Construct validity replicated the three dimensions of the original questionnaire. The scale showed adequate reliability through internal consistency (Cronbach's α of 0.94) and temporal stability on retest (n = 85). Patients scored (0 to 100) 77.5 [standard deviation (SD): 19.9] for satisfaction with communication, 76.9 (SD: 17) for organization, and 67.2 (SD: 22.1) for information. SIGNIFICANCE The SEC-E is a valid and reliable tool for the assessment of educational interventions aiming to improve the quality of care in patients with epilepsy in Spanish clinical practice. The results showed a good level of patient satisfaction with epilepsy care.
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Affiliation(s)
- Isabel Manzanares
- Epilepsy Unit, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Sonia Sevilla Guerra
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Nursing Direction, Hospital Clínic de Barcelona, Spain
| | - María Lombraña
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Nursing Direction, Hospital Clínic de Barcelona, Spain
| | - Francisco Gil-López
- Epilepsy Unit, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Estefanía Conde-Blanco
- Epilepsy Unit, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Adelaida Zabalegui
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Nursing Direction, Hospital Clínic de Barcelona, Spain
| | - Margarete Pfäfflin
- Society for Epilepsy Research, Epilepsy Center Bethel, Bielefeld, Germany
| | - Theordor W May
- Society for Epilepsy Research, Epilepsy Center Bethel, Bielefeld, Germany
| | - Belchin Kostov
- Primary Healthcare Transversal Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Antonio Moreno-Poyato
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, University of Barcelona, Spain
| | - Antonio Donaire
- Epilepsy Unit, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Laura Guio
- Epilepsy Unit, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Olga Beltran
- Epilepsy Unit, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Cecilia Cuzco
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mar Carreño
- Epilepsy Unit, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Zheng Y, Ding X, Guo Y, Chen Q, Wang W, Zheng Y, Wang S, Ding Y, Ding M. Multidisciplinary management improves anxiety, depression, medication adherence, and quality of life among patients with epilepsy in eastern China: A prospective study. Epilepsy Behav 2019; 100:106400. [PMID: 31634729 DOI: 10.1016/j.yebeh.2019.07.001] [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] [Received: 06/08/2019] [Revised: 07/01/2019] [Accepted: 07/03/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The objective of this study was to investigate the effect of a multidisciplinary program on anxiety, depression, medication adherence, and quality of life in patients with epilepsy in eastern China. METHODS A cohort of 184 patients with epilepsy from the epilepsy clinic of a tertiary hospital in eastern China completed this program, out of which 92 were randomized into the intervention group and 92 the control group. Patients in both groups received standard antiepileptic drugs (AEDs), while those of the intervention group received an additional 12-month multidisciplinary program developed by a group of the epileptologist, pharmacist, psychiatrist, and epilepsy specialist nurse. Patients were assessed both before and after the 12-month period. The Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and the eight-item Morisky Medication Adherence Scale (MMAS-8) were used to assess the severity of depression, anxiety, and medication adherence, respectively, along with Quality of life in Epilepsy-31 (QOLIE-31) and self-reported seizure frequency for life quality and seizure severity. RESULTS The 12-month multidisciplinary program significantly reduced the number of patients with severe depression (p = 0.013) and anxiety (p = 0.002), increased the number of patients with moderate-to-high AED adherence (p = 0.006) and the overall QOLIE-31 score (p < 0.001) in the intervention group. Both groups demonstrated a significant increase in the number of patients with a low seizure frequency after the 12-month period (p < 0.001). CONCLUSION The 12-month multidisciplinary program offers an effective management strategy in improving psychiatric comorbidities, medication adherence, and quality of life in patients with epilepsy in eastern China.
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Affiliation(s)
- Yang Zheng
- Department of Neurology, Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
| | - Xiaoyan Ding
- Department of Neurology, Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
| | - Yi Guo
- Department of Neurology, Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China.
| | - Qiaozhen Chen
- Department of Psychiatry, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
| | - Weijun Wang
- Department of Pharmacy, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
| | - Yuanyuan Zheng
- Department of Neurology, Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
| | - Shan Wang
- Department of Neurology, Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
| | - Yao Ding
- Department of Neurology, Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
| | - Meiping Ding
- Department of Neurology, Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
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Higgins A, Downes C, Varley J, Doherty CP, Begley C, Elliott N. Supporting and empowering people with epilepsy: Contribution of the Epilepsy Specialist Nurses (SENsE study). Seizure 2019; 71:42-49. [DOI: 10.1016/j.seizure.2019.06.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/28/2019] [Accepted: 06/08/2019] [Indexed: 11/25/2022] Open
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Jamy R, Kaur M, Pizarro D, Toth E, Pati S. Practice trends and the outcome of neuromodulation therapies in epilepsy: A single-center study. Epilepsia Open 2019; 4:493-497. [PMID: 31440731 PMCID: PMC6698690 DOI: 10.1002/epi4.12345] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/18/2019] [Accepted: 05/29/2019] [Indexed: 11/23/2022] Open
Abstract
Neuromodulation therapies (VNS, RNS, and DBS) can improve seizure control in persons with epilepsy. However, there is a significant service gap in integrating these therapies in clinical care. Our epilepsy center has established an epilepsy neuromodulation clinic to improve access to patients, communication with referring physicians, track outcome and train future providers in programming neuromodulation devices. We report the (a) treatment outcome of the available neuromodulation therapies (ie, reduction in seizure frequency over 6-12 months follow-up); and (b) demonstrate the benefit of the specialized clinic (rapid titration, continuity of care, superior access for patient and vendors). In this single-center, retrospective study, forty-three adults (VNS = 27; RNS = 16) with drug-resistant epilepsy were followed in the clinic during the 19 months study period. About 44-69% of patients reported > 60% decrease in seizure. All patients were scheduled in the clinic within 2-4 weeks, and stimulations were optimized rapidly. About 40% of patients participated in research while 28% were referred for additional diagnostic studies. Nineteen students and fellows were trained in programming neurostimulator. Epilepsy neuromodulation clinic can serve as an optimal solution for patients as well as providers due to rapid access, better continuity of care, higher recruitment for research studies, and training health professionals.
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Affiliation(s)
- Rabia Jamy
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAL
| | - Manmeet Kaur
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAL
| | - Diana Pizarro
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAL
- Epilepsy and Cognitive Neurophysiology LaboratoryUniversity of Alabama at BirminghamBirminghamAL
| | - Emilia Toth
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAL
- Epilepsy and Cognitive Neurophysiology LaboratoryUniversity of Alabama at BirminghamBirminghamAL
| | - Sandipan Pati
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAL
- Epilepsy and Cognitive Neurophysiology LaboratoryUniversity of Alabama at BirminghamBirminghamAL
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Prevos-Morgant M, Leavy Y, Chartrand D, Jurasek L, Osborne Shafer P, Shinnar R, Goodwin M. Benefits of the epilepsy specialist nurses (ESN) role, standardized practices and education around the world. Rev Neurol (Paris) 2019; 175:189-193. [PMID: 30683450 DOI: 10.1016/j.neurol.2018.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/20/2018] [Accepted: 10/15/2018] [Indexed: 11/27/2022]
Abstract
Epilepsy, often considered as a stigmatizing disease, affects 65 million people worldwide and is frequently associated with comorbidities that increase both direct and indirect costs. The degree of impact on quality of life and the cost of care differs depending on the social and health care organizations in place, political, medico-economic and/or socio-cultural contexts. Across the globe, healthcare is provided by nurses in primary care, urgent or emergency care, and within specialized domains of practice. In Epilepsy the global care could be enhanced by developing standardized nursing education in close collaboration with other caregivers. The impact of epilepsy nursing care has been documented in some developed countries, but the diversity of nursing practices and professional education of nurses raise difficulties in generalizing these findings. Specialized education in epilepsy will improve access, treatment and ultimately the quality of life of patients.
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Affiliation(s)
- M Prevos-Morgant
- Medical center « La Teppe », 25, avenue de la Bouteme, 26602 Tain-l'Hermitage, France; Institute of epilepsy IDEE, 59, boulevard Pinel, 69500 Bron, France.
| | - Y Leavy
- NHS Lothian, Edinburgh, Scotland, United Kingdom
| | - D Chartrand
- Ste Justine University Hospital, Montreal, Canada
| | - L Jurasek
- Alberta Health Services, Alberta, Canada
| | | | - R Shinnar
- Montefiore Medical Center, New York, United States
| | - M Goodwin
- Northampton General Hospital, United Kingdom
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21
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Higgins A, Downes C, Varley J, Doherty CP, Begley C, Elliott N. Rising to the challenge: Epilepsy specialist nurses as leaders of service improvements and change (SENsE study). Seizure 2018; 63:40-47. [PMID: 30399460 DOI: 10.1016/j.seizure.2018.10.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/05/2018] [Accepted: 10/25/2018] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To report the leadership role and change activities of epilepsy specialist nurses (ESNs) in Ireland; findings from the SENsE study. METHOD A mixed methods study design was used, involving 12 epilepsy specialist nurses working in five units in Ireland, 24multidisciplinary team members working with them, and 35 people with epilepsy and their family members. Data were collected using individual and focus group interviews, observation and documentary analysis. RESULTS Five key areas in which ESNs demonstrated leading on the change agenda were identified. These included: Initiating new clinical practice developments; Building capability within the multidisciplinary team; Developing education programmes and resources for people with epilepsy, family and the public; Exerting influence through membership of committees and lobbying; and Advancing the ESN role. CONCLUSION Though the epilepsy specialist nurse role was first established in the UK in 1988, much of the literature that discusses or describes the ESN role is founded on anecdotal evidence, or focusses on their clinical expertise. Findings from this study provide empirical evidence that the ESNs were involved as key players in leading changes within the services, in the education of others, and the continuous advancement of epilepsy care.
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Affiliation(s)
- Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland.
| | - Carmel Downes
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland.
| | - Jarleth Varley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland.
| | - Colin P Doherty
- Department of Neurology, St. James's Hospital, James's Street, Dublin 8, Ireland.
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland.
| | - Naomi Elliott
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland.
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22
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Patients with epilepsy care experiences: Comparison between services with and without an epilepsy specialist nurse. Epilepsy Behav 2018; 85:85-94. [PMID: 29920427 DOI: 10.1016/j.yebeh.2018.05.038] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/23/2018] [Accepted: 05/23/2018] [Indexed: 11/21/2022]
Abstract
The aim of this study was to determine whether there were differences in experiences of care, satisfaction with care and quality of life between those who were in receipt of care from a service with an epilepsy specialist nurse (ESN) and those who were receiving care from a service that did not include an ESN. A comparative design was used, which involved the completion of a confidential, self-completed survey. The survey was administered to a nonprobability convenience sample of patients with epilepsy who were attending services with an ESN (n = 244) and services where the treatment team did not include an ESN (n = 261) from each of the four health areas in Ireland. This study found that, in comparison to people with epilepsy (PWE) who attended a service without an ESN, PWE who attended a service with an ESN reported receiving greater amount of information, were more involved in their care, perceived care to be better coordinated, and had greater confidence in the information provided and greater comfort in discussing issues with an ESN. They also reported higher rates of satisfaction with the emotional and practical support offered. Thus, it may be concluded that models of care involving the input of ESNs enhance the quality of epilepsy care and care processes. The findings also emphasize the need to have an ESN as part of the multidisciplinary team.
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23
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Michaelis R, Tang V, Goldstein LH, Reuber M, LaFrance WC, Lundgren T, Modi AC, Wagner JL. Psychological treatments for adults and children with epilepsy: Evidence-based recommendations by the International League Against Epilepsy Psychology Task Force. Epilepsia 2018; 59:1282-1302. [PMID: 29917225 DOI: 10.1111/epi.14444] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2018] [Indexed: 12/12/2022]
Abstract
Given the significant impact that psychosocial factors and epilepsy treatments can have on the health-related quality of life (HRQOL) of individuals with epilepsy and their families, there is great clinical interest in the role of psychological evaluation and treatments to improve HRQOL and comorbidities. Therefore, the International League Against Epilepsy (ILAE) charged the Psychology Task Force with the development of recommendations for clinical care based on evaluation of the evidence from their recent Cochrane review of psychological treatments in individuals with epilepsy. The literature search for a recent Cochrane review of randomized controlled trials investigating psychological treatments for individuals with epilepsy constitutes the key source of evidence for this article. To provide practical guidance to service providers, we provide ratings on study research designs based on (1) the American Academy of Neurology's Level of Evidence system and (2) the Grading of Recommendations, Assessment, Development, and Evaluation system. This paper is the culmination of an international collaboration process involving pediatric and adult psychologists, neurologists, psychiatrists, and neuropsychiatrists. The process and conclusions were reviewed and approved by the ILAE Executive Committee. The strongest evidence for psychological interventions was identified for the most common mental health problems, including depression, neurocognitive disturbances, and medication adherence. Psychological interventions targeting the enhancement of HRQOL and adherence and a decrease in comorbidity symptoms (anxiety, depression) should be incorporated into comprehensive epilepsy care. There is a range of psychological strategies (ie, cognitive behavioral therapy and mindfulness-based therapies) that show promise for improving the lives of persons with epilepsy, and clinical recommendations are provided to assist epilepsy health care providers in treating the comorbidities and challenges associated with epilepsy and its treatments.
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Affiliation(s)
- Rosa Michaelis
- Department of Neurology, Herdecke Community Hospital, University of Witten/Herdecke, Herdecke, Germany.,Integrated Curriculum for Anthroposophical Medicine (ICURAM), Witten/Herdecke University, Herdecke, Germany.,Department of Neurology, Center for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
| | - Venus Tang
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong.,Department of Clinical Psychology, Prince of Wales Hospital, Shatin, Hong Kong
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Markus Reuber
- Academic Neurology Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
| | - William Curt LaFrance
- Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, RI, USA
| | - Tobias Lundgren
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden
| | - Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Janelle L Wagner
- College of Nursing and Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
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24
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Michaelis R, Tang V, Wagner JL, Modi AC, LaFrance WC, Goldstein LH, Lundgren T, Reuber M. Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life. Epilepsia 2018; 59:315-332. [DOI: 10.1111/epi.13989] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Rosa Michaelis
- Department of Neurology; Herdecke Community Hospital; University of Witten/Herdecke; Herdecke Germany
- Department of Psychiatry; St. Marien-Hospital Hamm; Hamm Germany
| | - Venus Tang
- Department of Clinical Psychology; Prince of Wales Hospital; Hong Kong
- Division of Neurosurgery; Department of Surgery; Faculty of Medicine; Chinese University of Hong Kong; Hong Kong
| | - Janelle L. Wagner
- College of Nursing and Department of Pediatrics; Medical University of South Carolina; Charleston SC USA
| | - Avani C. Modi
- Division of Behavioral Medicine and Clinical Psychology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - W. Curt LaFrance
- Departments of Psychiatry and Neurology; Rhode Island Hospital; Brown University; Providence RI USA
| | - Laura H. Goldstein
- Department of Psychology; Institute of Psychiatry, Psychology, and Neuroscience; King's College London; London UK
| | - Tobias Lundgren
- Department of Clinical Neuroscience; Center for Psychiatry Research; Karolinska Institute; Stockholm Sweden
| | - Markus Reuber
- Academic Neurology Unit; Royal Hallamshire Hospital; University of Sheffield; Sheffield UK
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25
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Strzelczyk A, Griebel C, Lux W, Rosenow F, Reese JP. The Burden of Severely Drug-Refractory Epilepsy: A Comparative Longitudinal Evaluation of Mortality, Morbidity, Resource Use, and Cost Using German Health Insurance Data. Front Neurol 2017; 8:712. [PMID: 29312132 PMCID: PMC5743903 DOI: 10.3389/fneur.2017.00712] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 12/11/2017] [Indexed: 01/14/2023] Open
Abstract
Purpose To evaluate long-term outcome of three years and treatment patterns of patients suffering from severely drug-refractory epilepsy (SDRE). Methods This analysis was population-based and retrospective, with data collected from four million individuals insured by statutory German health insurance. ICD-10 codes for epilepsy (G40*) and intake of anticonvulsants were used to identify prevalent cases, which were then compared with a matched cohort drawn from the population at large. Insurance data were available from 2008 to 2013. Any patient who had been prescribed with at least four different antiepileptic drugs (AEDs) in an 18-month period was defined as an SDRE case. Results A total of 769 patients with SDRE were identified. Of these, 19% were children and adolescents; the overall mean age was 42.3 years, 45.4% were female and 54.6% male. An average of 2.7 AEDs per patient was prescribed during the first follow-up year. The AEDs most commonly prescribed were: levetiracetam (53.5%), lamotrigine (41.4%), valproate (41.3%), lacosamide (20.4%), and topiramate (17.8%). During 3-year follow-up, there was an annual rate of hospitalization in the range 42.7 to 55%, which was significantly higher than the 11.6–12.8% (p < 0.001) for the matched controls. Admissions to hospital because of epilepsy ranged between 1.7 and 1.9 per year, with an average duration for each epilepsy-caused hospitalization of 10–11.1 days. The number of comorbidities for SDRE patients was significantly increased compared with the matched controls: depression (28% against 10%), vascular disorders (22% against 5%), and injury rates were also higher (head 16% against 3%, trunk and limbs 16% against 8%). The 3-year mortality rate for SDRE patients was 14% against 2.1% in the matched cohort. Conclusion SDRE patients are treated with AED polytherapy for all of the 3-year follow-up period. They are hospitalized more frequently than the general population and show increased morbidity levels and a sevenfold increase in mortality rate over 3 years. Further examination is required of ways in which new approaches to treatment could lead to better outcomes in severely affected patients.
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Affiliation(s)
- 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, Marburg, Germany
| | | | - Wolfram Lux
- HGC GesundheitsConsult GmbH, Düsseldorf, 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, Marburg, Germany
| | - Jens-Peter Reese
- Institute of Health Service Research and Clinical Epidemiology, Coordinating Center for Clinical Trials, Philipps-University Marburg, Marburg, Germany
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26
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Michaelis R, Tang V, Wagner JL, Modi AC, LaFrance Jr WC, Goldstein LH, Lundgren T, Reuber M. Psychological treatments for people with epilepsy. Cochrane Database Syst Rev 2017; 10:CD012081. [PMID: 29078005 PMCID: PMC6485515 DOI: 10.1002/14651858.cd012081.pub2] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Given the significant impact epilepsy can have on the health-related quality of life (HRQoL) of individuals with epilepsy and their families, there is great clinical interest in evidence-based psychological treatments, aimed at enhancing psychological well-being in people with epilepsy. A review of the current evidence was needed to assess the effects of psychological treatments for people with epilepsy on HRQoL outcomes, in order to inform future therapeutic recommendations and research designs. OBJECTIVES To assess the effects of psychological treatments for people with epilepsy on HRQoL outcomes. SEARCH METHODS We searched the following databases on 20 September 2016, without language restrictions: Cochrane Epilepsy Group Specialized Register, CENTRAL, MEDLINE PsycINFO, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP). We screened the references from included studies and relevant reviews, and contacted researchers in the field for unpublished studies. SELECTION CRITERIA We considered randomized controlled trials (RCTs) and quasi-RCTs for this review. HRQoL was the main outcome measure. For the operational definition of 'psychological treatments', we included a broad range of treatments that used psychological or behavioral techniques designed to improve HRQoL, seizure frequency and severity, and psychiatric comorbidities for adults and children with epilepsy, compared to treatment as usual (TAU) or an active control group. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by the Cochrane Collaboration. MAIN RESULTS We included 24 completed RCTs, with a total of 2439 participants. Eleven studies investigated psychological interventions, such as cognitive, behavioral, and mindfulness-based interventions. The remaining studies were classified as educational interventions (N = 7), self-management interventions (N = 3), adherence interventions (N = 1), and mixed interventions (N = 2). Two studies investigated interventions for children and adolescents, and five studies investigated interventions for adolescents and adults. Based on satisfactory clinical and methodological homogeneity, we pooled data from six adult studies, two studies on adolescents and adults, and one on adolescents and young adults (468 participants) for HRQoL, measured with the Quality of Life in Epilepsy-31 (QOLIE-31). We found significant mean changes for the QOLIE-31 total score and six subscales (emotional well-being, energy and fatigue, overall QoL, seizure worry, medication effects, and cognitive functioning). The mean changes of the QOLIE-31 total score (mean improvement of 5.68 points (95% CI 3.11 to 8.24; P < 0.0001), and three subscales, emotional well-being (mean improvement of 7.03 points (95% CI 2.51 to 11.54; P = 0.002); energy and Fatigue (mean improvement of 6.90 points (95% CI 3.49 to 10.31; P < 0.0001); and overall QoL (mean improvement of 6.47 points (95% CI 2.68 to 10.25; P = 0.0008) exceeded the threshold of minimally important change (MIC), indicating a clinically meaningful post-intervention improvement of QoL. We downgraded the quality of the evidence provided by the meta-analysis because of serious risk of bias in some of the included studies. Consequentially, these results provided evidence of moderate quality that psychological treatments for adults with epilepsy may enhance overall QoL in people with epilepsy. AUTHORS' CONCLUSIONS Implications for practice: Psychological interventions and self-management interventions improved QoL, and emotional well-being, and reduced fatigue in adults and adolescents with epilepsy. Adjunctive use of psychological treatments for adults and adolescents with epilepsy may provide additional benefits to QoL in those who incorporate patient-centered management. IMPLICATIONS FOR RESEARCH Authors should strictly adhere to the CONSORT guidelines to improve the quality of reporting on their interventions. A thorough description of the intervention protocol is necessary to ensure reproducibility.When researching psychological treatments for people with epilepsy, the use of Quality of Life in Epilepsy Inventories (QOLIE-31, QOLIE-31-P, and QOLIE-89) would increase comparability. There is a critical gap in pediatric RCTs for psychological treatments, particularly those that use an epilepsy-specific measure of HRQoL.Finally, in order to increase the overall quality of study designs, adequate randomization with allocation concealment and blinded outcome assessment should be pursued when conducting RCTs. As attrition is often high in research that requires active participant participation, an intention-to-treat analysis should be carried out.
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Affiliation(s)
- Rosa Michaelis
- Gemeinschaftskranhaus Herdecke University of Witten/HerdeckeDepartment of NeurologyHerdeckeHerdeckeGermany
| | | | - Janelle L Wagner
- Medical University of South CarolinaCollege of Nursing & Department of Pediatrics99 Johnathan Lucas StreetMSC 160CharlestonUSASC 29425‐1600
| | - Avani C Modi
- University of Cincinnati College of MedicineDivision of Behavioral Medicine and Clinical PsychologyCincinnatiUSA
| | | | - Laura H Goldstein
- Institute of Psychiatry, Psychology and Neuroscience, King's College LondonDepartment of PsychologyDe Crespigny ParkLondonUKSE5 8AF
| | - Tobias Lundgren
- Karolinska InstitutetCenter for Psychiatry Reseach, Department of Clinical NeuroscienceStockholm Health Care ServicesStockholm County CouncilStockholmSweden
| | - Markus Reuber
- University of Sheffield, Royal Hallamshire HospitalAcademic Neurology UnitGlossop RoadSheffieldUKS10 2JF
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Characteristics associated with quality of life among people with drug-resistant epilepsy. J Neurol 2017; 264:1174-1184. [PMID: 28550480 PMCID: PMC5486549 DOI: 10.1007/s00415-017-8512-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/19/2017] [Accepted: 05/06/2017] [Indexed: 12/02/2022]
Abstract
Quality of Life (QoL) is the preferred outcome in non-pharmacological trials, but there is little UK population evidence of QoL in epilepsy. In advance of evaluating an epilepsy self-management course we aimed to describe, among UK participants, what clinical and psycho-social characteristics are associated with QoL. We recruited 404 adults attending specialist clinics, with at least two seizures in the prior year and measured their self-reported seizure frequency, co-morbidity, psychological distress, social characteristics, including self-mastery and stigma, and epilepsy-specific QoL (QOLIE-31-P). Mean age was 42 years, 54% were female, and 75% white. Median time since diagnosis was 18 years, and 69% experienced ≥10 seizures in the prior year. Nearly half (46%) reported additional medical or psychiatric conditions, 54% reported current anxiety and 28% reported current depression symptoms at borderline or case level, with 63% reporting felt stigma. While a maximum QOLIE-31-P score is 100, participants’ mean score was 66, with a wide range (25–99). In order of large to small magnitude: depression, low self-mastery, anxiety, felt stigma, a history of medical and psychiatric comorbidity, low self-reported medication adherence, and greater seizure frequency were associated with low QOLIE-31-P scores. Despite specialist care, UK people with epilepsy and persistent seizures experience low QoL. If QoL is the main outcome in epilepsy trials, developing and evaluating ways to reduce psychological and social disadvantage are likely to be of primary importance. Educational courses may not change QoL, but be one component supporting self-management for people with long-term conditions, like epilepsy.
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28
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Drees C, Sillau S, Brown MG, Abosch A. Preoperative evaluation for epilepsy surgery: Process improvement. Neurol Clin Pract 2017; 7:205-213. [PMID: 30107011 DOI: 10.1212/cpj.0000000000000357] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Epilepsy surgery (ES) can improve seizure outcome. A prolonged duration of presurgical evaluation contributes to epilepsy-related morbidity and mortality. We introduced process changes to decrease evaluation time (ET) and increase ES numbers (excluding vagus nerve stimulation). Methods The University of Colorado Hospital patient database was searched for ESs between January 2009 and May 2016. Measures to reduce ET included (1) increasing patient care conference (PCC) frequency; (2) faster intracarotid amobarbital test (IAT) scheduling; (3) dedicated ES clinic; and (4) adding a nurse navigator. ET from noninvasive video-EEG monitoring (P1) to IAT, PCC, and ES, and ES volume were determined and compared for a baseline group (P1 January 2009-March 2013) and a group exposed to process changes (P1 after March 2013), the postchanges group, to assess the effect of these measures. Results ES number was 61 for the baseline group and 77 for the postchanges group, increasing the annual rate at 3 years after changes from 14.4 to 36.8 (p = 0.0008; 37% yearly increase postchanges). Interventions lowered average ET by 96 days (p ≤ 0.0001), P1 to IAT by 39 days (p = 0.0011), and P1 to PCC by 58 days (p = 0.0002). Conclusions Simple process changes, including more frequent patient care conferences, faster scheduling, a dedicated ES clinic, and a nurse navigator significantly decreased evaluation times and increased ES numbers. Centers could utilize similar strategies to improve process and surgical volume and thereby increase patient seizure control and safety.
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Affiliation(s)
| | | | | | - Aviva Abosch
- University of Colorado School of Medicine, Denver
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29
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Callanan M, Spencer DC. Measuring the Value of Epilepsy Nurses. Epilepsy Curr 2016; 16:384-385. [PMID: 27857617 PMCID: PMC5106099 DOI: 10.5698/1535-7511-16.6.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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