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Van Patten R, Blum A, Correia S, Philip NS, Allendorfer JB, Gaston TE, Goodman A, Grayson LP, Tocco K, Vogel V, Martin A, Fry S, Bolding M, Ver Hoef L, Baird GL, Szaflarski JP, LaFrance WC. One-year follow-up of neurobehavioral therapy in functional seizures or epilepsy with traumatic brain injury: A nonrandomized controlled trial. Epilepsia 2024. [PMID: 39388338 DOI: 10.1111/epi.18137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 09/19/2024] [Accepted: 09/20/2024] [Indexed: 10/12/2024]
Abstract
OBJECTIVE Patients with traumatic brain injury (TBI) often present with seizures (functional and/or epileptic), but treatments for patients with TBI and seizures are limited. We examined treatment phase and 1-year post-enrollment outcomes following neurobehavioral therapy (NBT) for patients with TBI + functional seizures (FS) and TBI + epilepsy. METHODS In this multicenter, prospective, three-group, nonrandomized, controlled trial, with 1-year post-enrollment follow-up, three cohorts of adults were recruited: TBI + video-electroencephalography (EEG)-confirmed FS (n = 89), TBI + EEG-confirmed epilepsy (n = 29), and chart/history-confirmed TBI without seizures (n = 75). Exclusion criteria were recent psychotic or self-injurious behavior, current suicidal ideation, pending litigation or long-term disability, active substance use disorder, and inability to participate in study procedures. TBI + FS and TBI + epilepsy groups completed NBT for seizures, an evidence-based, 12-session, multimodal psychotherapy, whereas TBI without seizures participants received standard medical care. The primary outcome was change in seizure frequency; secondary outcomes were changes in mental health, TBI-related symptoms, disability, and quality of life. RESULTS Reductions in average monthly seizures occurred during treatment in TBI + FS participants (p = .002) and were significant from baseline (mean = 16.75; 95% confidence interval [CI] = 11.44-24.53) to 12 months post-enrollment (mean = 7.28, 95% CI = 4.37-12.13, p = .002, d = .38). Monthly seizures decreased during treatment in TBI + epilepsy participants (p = .002); reductions were not statistically significant from baseline (mean = 2.38, 95% CI = 1.12-5.04) to 12-month postenrollment (mean = .98, 95% CI = .40-2.42, p = .07, d = .22). Regarding treatment-phase changes in secondary outcome measures, TBI + FS participants improved significantly on 10 of 19 variables (52.6%), TBI + epilepsy participants improved on five of 19 (26.3%), and TBI-only comparisons improved on only one of 19 (5.3%). SIGNIFICANCE NBT benefited patients with TBI + FS and TBI + epilepsy. Improvements were demonstrated at 1 year post-enrollment in those with TBI + FS. NBT may be a clinically useful treatment for patients with seizures.
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Affiliation(s)
- Ryan Van Patten
- VA Providence Healthcare System, Center forNeurorestoration and Neurotechnology, and Brown University, Providence, Rhode Island, USA
| | - Andrew Blum
- Rhode Island Hospital and Brown University, Providence, Rhode Island, USA
| | - Stephen Correia
- VA Providence Healthcare System, Center forNeurorestoration and Neurotechnology, and Brown University, Providence, Rhode Island, USA
| | - Noah S Philip
- VA Providence Healthcare System, Center forNeurorestoration and Neurotechnology, and Brown University, Providence, Rhode Island, USA
| | | | - Tyler E Gaston
- University of Alabama, Birmingham, Alabama, USA
- Birmingham VA Medical Center, Birmingham, Alabama, USA
| | | | - Leslie P Grayson
- University of Alabama, Birmingham, Alabama, USA
- Birmingham VA Medical Center, Birmingham, Alabama, USA
| | - Krista Tocco
- VA Providence Healthcare System, Center forNeurorestoration and Neurotechnology, and Brown University, Providence, Rhode Island, USA
- Rhode Island Hospital and Brown University, Providence, Rhode Island, USA
| | - Valerie Vogel
- VA Providence Healthcare System, Center forNeurorestoration and Neurotechnology, and Brown University, Providence, Rhode Island, USA
- Rhode Island Hospital and Brown University, Providence, Rhode Island, USA
| | - Amber Martin
- University of Alabama, Birmingham, Alabama, USA
- Birmingham VA Medical Center, Birmingham, Alabama, USA
| | | | | | - Lawrence Ver Hoef
- University of Alabama, Birmingham, Alabama, USA
- Birmingham VA Medical Center, Birmingham, Alabama, USA
| | - Grayson L Baird
- Rhode Island Hospital and Brown University, Providence, Rhode Island, USA
| | | | - W Curt LaFrance
- VA Providence Healthcare System, Center forNeurorestoration and Neurotechnology, and Brown University, Providence, Rhode Island, USA
- Rhode Island Hospital and Brown University, Providence, Rhode Island, USA
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Meyer B, Betz LT, Brückner K, Holtkamp M. Enhancing quality of life in epilepsy with a digital intervention (emyna): Results of the ELAINE randomized controlled trial. Epilepsia Open 2024; 9:1758-1771. [PMID: 39167060 PMCID: PMC11450619 DOI: 10.1002/epi4.13014] [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: 03/20/2024] [Revised: 05/23/2024] [Accepted: 06/17/2024] [Indexed: 08/23/2024] Open
Abstract
OBJECTIVE Despite the availability of pharmacological treatment for seizures, people with epilepsy (PwE) commonly experience impairments in quality of life (QoL). Given the limited access to psychosocial treatments for PwE, digital interventions could bridge treatment gaps and help improve QoL. The objective of this study was to examine the effectiveness of emyna, a fully automated digital intervention based on cognitive behavioral therapy (CBT) techniques, in improving health-related QoL among PwE who reported impairments in QoL. A previous trial showed that emyna was effective in improving depressive symptoms among PwE with a comorbid depressive disorder, but its effects on QoL among PwE without comorbid depression remain unknown. METHODS A pragmatic randomized controlled trial was conducted with N = 438 PwE (mean age = 37.5, 70.3% women, physician-verified diagnoses) who were assigned to the intervention group (n = 216), which used emyna alongside treatment as usual (TAU), or the control group (n = 222), which received TAU only. QoL and secondary outcomes such as general self-efficacy, medication adherence, general distress, and epilepsy-related work and social adjustment were assessed at baseline, 3 months, and 6 months. The primary outcome was QoL assessed with the Quality of Life in Epilepsy [QOLIE-31] total score at 3 months post-randomization. RESULTS Findings from the intent-to-treat analyses showed that after 3 months, participants in the intervention group experienced significant and clinically relevant improvements in health-related QoL compared to the control group (baseline-adjusted group difference = 4.5; 95% CI = [2.0, 6.9], p < 0.001; Cohen's d = 0.32). Effects on secondary outcomes did not reach statistical significance. SIGNIFICANCE This study extends previous research by demonstrating that emyna facilitates improvements in QoL in a diverse group of PwE treated in routine care settings. This CBT-based digital intervention therefore presents a convenient and cost-effective addition to healthcare providers' treatment repertoire. PLAIN LANGUAGE SUMMARY In our study, we tested a digital program called emyna, which conveys cognitive behavioral therapy (CBT) techniques to help improve the quality of life for people living with epilepsy. We found that those who used emyna alongside their usual treatments felt better about their quality of life compared to those who did not use the program. Emyna offers a new, convenient way for people with epilepsy to manage their condition, which can be used alongside currently available treatments.
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Affiliation(s)
- Björn Meyer
- Research & Development DepartmentGAIA GroupHamburgGermany
| | - Linda T. Betz
- Research & Development DepartmentGAIA GroupHamburgGermany
| | - Katja Brückner
- Department of Neurology and Epileptology, Epilepsy Center HamburgEvangelical Hospital AlsterdorfHamburgGermany
| | - Martin Holtkamp
- Department of Neurology, Epilepsy‐Center Berlin‐BrandenburgCharité‐Universitätsmedizin BerlinBerlinGermany
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Munger Clary HM, Snively BM, Kumi-Ansu Y, Alexander HB, Kimball J, Duncan P, Conner K, Christopher J, Lohana P, Brenes GA. Quality of life during usual epilepsy care for anxiety or depression symptoms: Secondary patient-reported outcomes in a randomized trial of remote assessment methods. Epilepsy Res 2024; 204:107396. [PMID: 38908323 PMCID: PMC11457121 DOI: 10.1016/j.eplepsyres.2024.107396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/28/2024] [Accepted: 06/13/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND AND OBJECTIVES Anxiety and depression are highly prevalent and impactful in epilepsy. American Academy of Neurology quality measures emphasize anxiety and depression screening and quality of life (QOL) measurement, yet usual epilepsy care QOL and anxiety/depression outcomes are poorly characterized. The main objective was to assess 6-month QOL, anxiety and depression during routine care among adults with epilepsy and baseline anxiety or depression symptoms; these were prespecified secondary outcomes within a pragmatic randomized trial of remote assessment methods. METHODS Adults with anxiety or depression symptoms and no suicidal ideation were recruited from a tertiary epilepsy clinic via an electronic health record (EHR)-embedded process. Participants were randomized 1:1 to 6 month outcome collection via patient portal EHR questionnaires vs. telephone interview. This report focuses on an a priori secondary outcomes of the overall trial, focused on patient-reported health outcomes in the full sample. Quality of life, (primary health outcome), anxiety, and depression measures were collected at 3 and 6 months (Quality of Life in Epilepsy-10, QOLIE-10, Generalized Anxiety Disorder-7, Neurological Disorders Depression Inventory-Epilepsy). Change values and 95 % confidence intervals were calculated. In post-hoc exploratory analyses, patient-reported anxiety/depression management plans at baseline clinic visit and healthcare utilization were compared with EHR-documentation, and agreement was calculated using the kappa statistic. RESULTS Overall, 30 participants (15 per group) were recruited and analyzed, of mean age 42.5 years, with 60 % women. Mean 6-month change in QOLIE-10 overall was 2.0(95 % CI -6.8, 10.9), and there were no significant differences in outcomes between the EHR and telephone groups. Mean anxiety and depression scores were stable across follow-up (all 95 % CI included zero). Outcomes were similar regardless of whether an anxiety or depression action plan was documented. During the baseline interview, most participants with clinic visit EHR documentation indicating action to address anxiety and/or depression reported not being offered a treatment(7 of 12 with action plan, 58 %), and there was poor agreement between patient report and EHR documentation (kappa=0.22). Healthcare utilization was high: 40 % had at least one hospitalization or emergency/urgent care visit reported and/or identified via EHR, but a third (4/12) failed to self-report an EHR-identified hospitalization/urgent visit. DISCUSSION Over 6 months of usual care among adults with epilepsy and anxiety or depression symptoms, there was no significant average improvement in quality of life or anxiety/depression, suggesting a need for interventions to enhance routine neurology care and achieve quality of life improvement for this group.
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Affiliation(s)
- Heidi M Munger Clary
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Beverly M Snively
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Yaw Kumi-Ansu
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Halley B Alexander
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - James Kimball
- Department of Psychiatry, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Pamela Duncan
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Kelly Conner
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Physician Assistant Studies, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jerryl Christopher
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Paneeni Lohana
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Gretchen A Brenes
- Department of Internal Medicine, Section of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Shi B, Li G, Wu S, Ge H, Zhang X, Chen S, Pan Y, He Q. Assessing the Effectiveness of eHealth Interventions to Manage Multiple Lifestyle Risk Behaviors Among Older Adults: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e58174. [PMID: 39083787 PMCID: PMC11325121 DOI: 10.2196/58174] [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: 03/08/2024] [Revised: 05/24/2024] [Accepted: 06/01/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Developing adverse lifestyle behaviors increases the risk of a variety of chronic age-related diseases, including cardiovascular disease, obesity, and Alzheimer disease. There is limited evidence regarding the effectiveness of eHealth-based multiple health behavior change (MHBC) interventions to manage lifestyle risk behaviors. OBJECTIVE The purpose of this systematic evaluation was to assess the effectiveness of eHealth MHBC interventions in changing ≥2 major lifestyle risk behaviors in people aged ≥50 years. METHODS The literature search was conducted in 6 electronic databases-PubMed, Embase, Web of Science, Scopus, Cochrane Library, and SPORTDiscus-from inception to May 1, 2024. Eligible studies were randomized controlled trials of eHealth interventions targeting ≥2 of 6 behaviors of interest: alcohol use, smoking, diet, physical activity (PA), sedentary behavior, and sleep. RESULTS A total of 34 articles with 35 studies were included. eHealth-based MHBC interventions significantly increased smoking cessation rates (odds ratio 2.09, 95% CI 1.62-2.70; P<.001), fruit intake (standardized mean difference [SMD] 0.18, 95% CI 0.04-0.32; P=.01), vegetable intake (SMD 0.17, 95% CI 0.05-0.28; P=.003), self-reported total PA (SMD 0.22, 95% CI 0.02-0.43; P=.03), and objectively measured moderate to vigorous PA (SMD 0.25, 95% CI 0.09-0.41; P=.002); in addition, the interventions decreased fat intake (SMD -0.23, 95% CI -0.33 to -0.13; P<.001). No effects were observed for alcohol use, sedentary behavior, or sleep. A sensitivity analysis was conducted to test the robustness of the pooled results. Moreover, the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework. CONCLUSIONS eHealth-based MHBC interventions may be a promising strategy to increase PA, improve diet, and reduce smoking among older adults. However, the effect sizes were small. Further high-quality, older adult-oriented research is needed to develop eHealth interventions that can change multiple behaviors. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42023444418; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023444418.
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Affiliation(s)
- Beibei Shi
- School of Physical Education, Shandong University, Jinan, China
| | - Guangkai Li
- School of Physical Education, Shandong University, Jinan, China
| | - Shuang Wu
- School of Physical Education, Shandong University, Jinan, China
| | - Hongli Ge
- School of Physical Education, Shandong University, Jinan, China
| | - Xianliang Zhang
- School of Physical Education, Shandong University, Jinan, China
| | - Si Chen
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yang Pan
- School of Physical Education, Shandong University, Jinan, China
| | - Qiang He
- School of Physical Education, Shandong University, Jinan, China
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Marchi A, Guex R, Denis M, El Youssef N, Pizzo F, Bénar CG, Bartolomei F. Neurofeedback and epilepsy: Renaissance of an old self-regulation method? Rev Neurol (Paris) 2024; 180:314-325. [PMID: 38485630 DOI: 10.1016/j.neurol.2024.02.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 04/28/2024]
Abstract
Neurofeedback is a brain-computer interface tool enabling the user to self-regulate their neuronal activity, and ultimately, induce long-term brain plasticity, making it an interesting instrument to cure brain disorders. Although this method has been used successfully in the past as an adjunctive therapy in drug-resistant epilepsy, this approach remains under-explored and deserves more rigorous scientific inquiry. In this review, we present early neurofeedback protocols employed in epilepsy and provide a critical overview of the main clinical studies. We also describe the potential neurophysiological mechanisms through which neurofeedback may produce its therapeutic effects. Finally, we discuss how to innovate and standardize future neurofeedback clinical trials in epilepsy based on evidence from recent research studies.
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Affiliation(s)
- A Marchi
- Epileptology and Cerebral Rhythmology, Timone Hospital, AP-HM, Marseille, France.
| | - R Guex
- Inserm, INS, institut de neuroscience des systèmes, Aix-Marseille University, Marseille, France
| | - M Denis
- Epileptology and Cerebral Rhythmology, Timone Hospital, AP-HM, Marseille, France
| | - N El Youssef
- Epileptology and Cerebral Rhythmology, Timone Hospital, AP-HM, Marseille, France
| | - F Pizzo
- Epileptology and Cerebral Rhythmology, Timone Hospital, AP-HM, Marseille, France; Inserm, INS, institut de neuroscience des systèmes, Aix-Marseille University, Marseille, France
| | - C-G Bénar
- Inserm, INS, institut de neuroscience des systèmes, Aix-Marseille University, Marseille, France
| | - F Bartolomei
- Epileptology and Cerebral Rhythmology, Timone Hospital, AP-HM, Marseille, France; Inserm, INS, institut de neuroscience des systèmes, Aix-Marseille University, Marseille, France
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Mercier A, Dorris L. A systematic review of psychosocial interventions for children and young people with epilepsy. Eur J Paediatr Neurol 2024; 49:35-44. [PMID: 38364750 DOI: 10.1016/j.ejpn.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Epilepsy is a lifelong neurological disorder that has a profound impact on the lives of millions of children and young people throughout the world, and is linked with mental ill-health and a poorer quality of life. Psychosocial interventions have showed promise for children and young people with epilepsy (CYPE), however there is an absence of large-scale RCT's that would add robustness to the evidence base. The present systematic review provides an update and extension of findings from an earlier review by Corrigan et al. to assess the state of the literature in 2023. METHODS The present systematic review carried out a search of six electronic databases. Forward and backward chaining was carried out on review articles as well as the studies returned through the search to source additional studies. In total, ten articles were included in this review and appraised for quality using the Crowe Critical Appraisal Tool (CCAT). RESULTS Forty percent (4/10) of the included studies were rated as high quality according to the CCAT, which represents a significant proportional increase since Corrigan et al.'s review. A meta-analysis of results was not possible due to significant methodological heterogeneity, and the variability of outcome measures, however effect sizes were reported or calculated for the majority of studies (7/10), which facilitated comparison. Despite the issues of relatively small samples, there are promising findings with regard to psychosocial interventions increasing epilepsy knowledge, coping strategies, self-efficacy, and quality of life markers. CONCLUSIONS There is a growing evidence base supporting the efficacy of psychosocial interventions for children and young people with epilepsy. This evidence base is also increasing in quality. Particular components of treatment that prove to be effective include psychoeducation, components based on cognitive behavioural therapy principles, as well as mindfulness techniques. This aligns with the evidence-based recommendations for adult populations. Intervention goals centre around improving quality of life, reducing symptom distress, and increasing knowledge and skills. The instruments used to measure these outcomes are predominantly standardised, however remain heterogeneous between studies which impacts the overall robustness of the evidence base.
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Affiliation(s)
| | - Liam Dorris
- School of Health and Wellbeing, University of Glasgow, UK; Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK.
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Choudhary N, Kumar A, Sharma V, Kaur K, Singh Kharbanda P, Baishya J, Kumar D, Sharma A, Chakravarty K. Effectiveness of CBT for reducing depression and anxiety in people with epilepsy: A systematic review and meta-analysis of randomized controlled trials. Epilepsy Behav 2024; 151:109608. [PMID: 38183927 DOI: 10.1016/j.yebeh.2023.109608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/18/2023] [Accepted: 12/21/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Patients with epilepsy suffer from depression and anxiety that reduces quality of life. Cognitive behavioral therapy (CBT) among various non pharmacological treatment recommended for depression and anxiety. Since there are several articles reporting CBT treatment for depression in patients with epilepsy, we conduct a meta-analysis to evaluate the effectiveness of CBT for adult patients with epilepsy. METHODS Four electronic databases PubMed, Scopus, Embase, and the Cochrane library searched for relevant studies. A detailed "RISK of bias" assessment has been done for included studies. Funnel plot was used for assessing publication Bias. R Software- RStudio 2022 was used to calculate standard mean difference (SMD). The study has been registered in PROSPERO (CRD42023447655). RESULTS Eventually, a Total 13 studies involving 1222 patients met the eligibility criteria. There was decline in the Patient Health Questionnaire (PHQ) [SMD = -0.42, 95 % CI = -0.63 to -0.22], Neurologic Disorder Depression Inventory-Epilepsy (NDDI-E) [SMD = -0.53, 95 % CI = -0.75 to -0.31], Beck depression Inventory (BDI) [SMD = -0.69, 95 % CI = -1.08 to -0.30], Hospital Anxiety and Depression Scale-Depression (HADS-D) [SMD = -0.73 , 95 % CI = -0.94 to -0.52] and Hospital Anxiety and Depression Scale Anxiety subscale (HADS-A) [SMD = -0.66, 95 % CI = -0.87 to -0.45] score of the CBT group than that of the control group at post-intervention. The results showed that the improvement in QOLIE-31 score of the CBT group than that of the control group [SMD = 0.67, 95 % CI = 1.33] at post-intervention. CONCLUSION The result of our study showed that Cognitive behavioral therapy is a superior therapy for treating anxiety and depression in epilepsy patients. CBT was effective in improving Quality of life in patients with epilepsy. However, the sample size varied across the trials, additional high-quality studies are needed in the future.
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Affiliation(s)
- Neetu Choudhary
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok Kumar
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vaishali Sharma
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kirandeep Kaur
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Jitupam Baishya
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Devender Kumar
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Akhilesh Sharma
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kamalesh Chakravarty
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Lewis AK, Taylor NF, Carney PW, Bryson A, Sethi M, Ooi S, Tse GT, Harding KE. Sustainability of an intervention to reduce waiting for access to an epilepsy outpatient clinic. Heliyon 2024; 10:e23346. [PMID: 38169770 PMCID: PMC10758808 DOI: 10.1016/j.heliyon.2023.e23346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
Purpose Delays in outpatient specialist neurologist care for people with epilepsy are common despite recommendations for prompt access. There is evidence to suggest that there are interventions that can minimise waitlists and waiting time. However, little is known about whether such interventions can result in sustained improvements in waiting. The aim of this study was to determine the extent to which an intervention to reduce waiting in an epilepsy specialist outpatient clinic demonstrated sustained outcomes two years after the intervention was implemented. Methods This observational study analysed routinely collected epilepsy clinic data over three study periods: pre-intervention, post-intervention and at two-year follow-up. The intervention, Specific Timely Assessment and Triage (STAT), combined a short-term backlog reduction strategy and creation of protected appointments for new referrals based on analysis of demand. After the initial intervention, there was no further active intervention in the following two years. The primary outcome was waiting measured by 1.) waiting time for access to a clinic appointment, defined as the number of days between referral and first appointment for all patients referred to the epilepsy clinic during the three study periods; and 2.) a snapshot of the number of patients on the waitlist at two time points for each of the three study periods. Results Two years after implementing the STAT model in an epilepsy clinic, median waiting time from post-intervention to two-year follow-up was stable (52-51 days) and the interquartile range of days waited reduced from 37 to 77 days post-intervention to 45-57 days at two-year follow-up, with a reduction in the most lengthy wait times observed. After a dramatic reduction of the total number of patients on the waitlist immediately following the intervention, a small rise was seen at two years (n = 69) which remained well below the pre-intervention level (n = 582). Conclusion The STAT model is a promising intervention for reducing waiting in an epilepsy clinic. While there was a small increase in the waitlist after two years, the median waiting time was sustained.
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Affiliation(s)
- Annie K. Lewis
- Eastern Health, Melbourne, Australia
- La Trobe University, Melbourne, Australia
| | - Nicholas F. Taylor
- Eastern Health, Melbourne, Australia
- La Trobe University, Melbourne, Australia
| | - Patrick W. Carney
- Eastern Health, Melbourne, Australia
- Monash University, Melbourne, Australia
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Alexander Bryson
- Eastern Health, Melbourne, Australia
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Moksh Sethi
- Eastern Health, Melbourne, Australia
- Northern Health, Melbourne, Australia
| | - Suyi Ooi
- Eastern Health, Melbourne, Australia
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
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Goh SL, Harding KE, Lewis AK, Taylor NF, Carney PW. Self-management strategies for people with epilepsy: An overview of reviews. Epilepsy Behav 2024; 150:109569. [PMID: 38071829 DOI: 10.1016/j.yebeh.2023.109569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/26/2023] [Accepted: 11/28/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVE This overview of systematic reviews aimed to appraise evidence regarding self-management strategies on health-related quality of life, self-efficacy, medication compliance, seizure status and psychosocial outcomes compared to usual care for people with epilepsy. METHODS Databases were searched until September 2022 using MeSH terms included OVID Medline, Embase and Cochrane. Following application of eligibility criteria, data were extracted and quality of articles was assessed using the AMSTAR2 checklist. A narrative synthesis of evidence included certainty of evidence evaluated using a Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS The 12 selected reviews contained three meta-analyses and 91 unique primary studies. One review considered only epilepsy with intellectual disability and three considered paediatrics. Interventions included technologically-based interventions, small group discussion, or counselling and educational programs. There was high certainty evidence to suggest self-management is associated with improvement in health-related quality of life and moderate certainty evidence to suggest improvement in depression symptoms. There was low certainty evidence to suggest a modest reduction in negative health events and a minimal increase in the satisfaction with life. There was no evidence of benefit favouring self-management on measures of adherence epilepsy self-management, perception of self-efficacy, medication adherence or seizure status. SIGNIFICANCE Despite high certainty evidence to suggest that self-management strategies for people with epilepsy improve health-related quality of life, benefits have not been demonstrated for outcomes that would be expected to be associated with these improvements, such as seizure status. These results provide support for self-management strategies to supplement usual care for people with epilepsy.
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Affiliation(s)
- Sarah L Goh
- Monash Health, Clayton, VIC 3168, Australia; Eastern Health Clinical School, Monash University, Box Hill, VIC 3128, Australia
| | - Katherine E Harding
- Allied Health Clinical Research Office, Eastern Health, 5 Arnold Street, Box Hill, VIC 3128, Australia; La Trobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia
| | - Annie K Lewis
- Allied Health Clinical Research Office, Eastern Health, 5 Arnold Street, Box Hill, VIC 3128, Australia; La Trobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, 5 Arnold Street, Box Hill, VIC 3128, Australia; La Trobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia
| | - Patrick W Carney
- Eastern Health Clinical School, Monash University, Box Hill, VIC 3128, Australia; Department of Neurosciences, Eastern Health, 5 Arnold St, Box Hill, VIC 3128, Australia; The Florey Institute for Neuroscience and Mental Health, Melbourne Brain Centre, Burgundy Street, Heidelberg, VIC 3084, Australia.
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Wu G, Ji Q, Shi Y. A systematic review and meta-analysis of the efficacy of N95 respirators and surgical masks for protection against COVID-19. Prev Med Rep 2023; 36:102414. [PMID: 37736310 PMCID: PMC10509348 DOI: 10.1016/j.pmedr.2023.102414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/15/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023] Open
Abstract
Former meta-analyses concluded that there was not sufficient evidence to determine the effect of surgical masks and N95 respirators. We collected randomized controlled trials (RCTs) and conducted a systematic review and meta-analysis to evaluate the efficacy of N95 respirators and surgical masks for protection against COVID-19. We retrieved relevant RCTs published between January 2019 and January 2023 by searching the PubMed, EMBASE, and Cochrane CENTRAL. Study quality was evaluated using the Cochrane Risk of Bias tool with the RevMan 5.4 software. Meta-analyses were conducted to calculate pooled estimates using the RevMan 5.4 software. A total of six RCTs were finally included. The findings revealed that wearing a mark made little difference in preventing COVID-19 [odds ratio (OR) = 0.10; 95% confidence interval (CI): 0.01-0.93; P = 0.04]. Subgroup analysis showed that the heterogeneity of data was I2 = 64% (OR = 0.32; 95% CI: 0.06-1.77; P = 0.19) for surgical mask use and I2 = 0% (OR = 0.03; 95 %CI: 0.01-0.15; P < 0.01) for N95 respirator use. The heterogeneity of data for medical staff was I2 = 0% (OR = 0.03; 95 %CI: 0.01-0.12; P < 0.01). Meta-analysis indicated a protective effect of N95 respirators against COVID-19, particularly for medical staff. The use of surgical masks is not associated with a lower risk of COVID-19. However, the subgroup using N95 respirators, particularly medical staff, showed a significant protective. These findings suggest that N95 respirators should be reserved for high-risk medical staff in the absence of sufficient resources during an epidemic. But the number of included studies was small, more studies in future analyses is required to reduce the risk of distribution bias.
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Affiliation(s)
- Gaohong Wu
- Department of Neonatology, Zhuhai Center for Maternal and Child Health Care, Zhuhai, China
- Department of Neonatology Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China Chongqing, China
| | - Qingyang Ji
- Department of Breast Surgery, Zhuhai Center for Maternal and Child Health Care, Zhuhai, China
| | - Yuan Shi
- Department of Neonatology Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China Chongqing, China
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11
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Chi H, Song M, Zhang J, Zhou J, Liu D. Relationship between acute glucose variability and cognitive decline in type 2 diabetes: A systematic review and meta-analysis. PLoS One 2023; 18:e0289782. [PMID: 37656693 PMCID: PMC10473499 DOI: 10.1371/journal.pone.0289782] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/25/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Cognitive decline is one of the most widespread chronic complications of diabetes, which occurs in more than half of the patients with type 2 diabetes (T2DM). Emerging evidences have suggested that glucose variability (GV) is associated with the pathogenesis of diabetic complications. However, the influence of acute GV on cognitive dysfunction in T2DM is still controversial. The aim of the study was to evaluate the association between acute GV and cognitive defect in T2DM, and provide a most recent and comprehensive summary of the evidences in this research field. METHODS PubMed, Cochrane library, EMBASE, Web of science, Sinomed, China National Knowledge Infrastructure (CNKI), and Wanfang were searched for articles that reported on the association between acute GV and cognitive impairment in T2DM. RESULTS 9 eligible studies were included, with a total of 1263 patients with T2DM involved. Results showed that summary Fisher's z value was -0.23 [95%CI (-0.39, -0.06)], suggesting statistical significance (P = 0.006). Summary r value was -0.22 [95%CI (-0.37, -0.06)]. A lower cognitive performance was found in the subjects with greater glucose variation, which has statistical significance. Mean amplitude of glycemic excursions (MAGE) was associated with a higher risk of poor functional outcomes. Fisher's z value was -0.35 [95%CI (-0.43, -0.25)], indicating statistical significance (P = 0.011). Sensitivity analyses by omitting individual studies showed stability of the results. CONCLUSIONS Overall, higher acute GV is associated with an increased risk of cognitive impairment in patients with T2DM. Further studies should be required to determine whether targeted intervention of reducing acute GV could prevent cognitive decline.
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Affiliation(s)
- Haiyan Chi
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Department of Endocrinology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, China
| | - Min Song
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jinbiao Zhang
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, China
| | - Junyu Zhou
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Deshan Liu
- Department of Traditional Chinese Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, China
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12
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Lopes Neri LDC, Guglielmetti M, De Giorgis V, Pasca L, Zanaboni MP, Trentani C, Ballante E, Grumi S, Ferraris C, Tagliabue A. Validation of an Italian Questionnaire of Adherence to the Ketogenic Dietary Therapies: iKetoCheck. Foods 2023; 12:3214. [PMID: 37685147 PMCID: PMC10486753 DOI: 10.3390/foods12173214] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/19/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Ketogenic dietary therapies (KDTs) are an effective and safe non-pharmacological treatment for drug-resistant epilepsy, but adherence can be challenging for both patients and caregivers. In Europe, there are no adequate tools to measure it other than monitoring ketosis. This study aimed to adapt and validate the Brazilian adherence questionnaire, Keto-check, into the Italian version: iKetoCheck. Using the Delphi technique, 12 judges validated the contents through agreement rates and the Content Validity Index (CVI). The iKetocheck was self-completed electronically by 61 drug-resistant epilepsy or GLUT1 deficiency patients within an interval of 15 days to measure its reproducibility. The test-retest reliability was evaluated using Pearson's correlation and relative significance test. Exploratory and confirmatory factorial analyses were made using Factor software version 12.03.02. The final tool, iKetoCheck, consists of 10 questions with 5-point Likert scale answers. It evaluates various aspects such as informing caregivers about the diet, organization of meals, measurement of ketosis, weighing food consumed, diet negligence, use of carbohydrate-free medications, attending follow-up visits, reading food labels, consulting an expert for dietary concerns, and cooking at home. The factorial analysis resulted in three factors: "attention," "organization," and "precision," with satisfactory results for indices in exploratory and confirmatory analyses. Although higher mean values of ketonemia measurement were observed in patients with a higher adherence score, these values were not statistically significant (p = 0.284). In conclusion, despite the small sample size, iKetoCheck is a valid tool for evaluating KDTs' adherence in Italian drug-resistant epilepsy or GLUT1 deficiency patients. It can provide valuable information to improve patient management and optimize the effectiveness of KDTs.
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Affiliation(s)
- Lenycia de Cassya Lopes Neri
- Faculty of Medicine, Department of Pediatrics, University of São Paulo, São Paulo 05403-000, Brazil;
- Ketogenic Metabolic Therapy Laboratory, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (M.G.); (C.T.); (C.F.); (A.T.)
| | - Monica Guglielmetti
- Ketogenic Metabolic Therapy Laboratory, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (M.G.); (C.T.); (C.F.); (A.T.)
- Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Valentina De Giorgis
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (L.P.); (M.P.Z.)
- Department of Brain and Behavior Neuroscience, University of Pavia, 27100 Pavia, Italy
| | - Ludovica Pasca
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (L.P.); (M.P.Z.)
- Department of Brain and Behavior Neuroscience, University of Pavia, 27100 Pavia, Italy
| | - Martina Paola Zanaboni
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (L.P.); (M.P.Z.)
| | - Claudia Trentani
- Ketogenic Metabolic Therapy Laboratory, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (M.G.); (C.T.); (C.F.); (A.T.)
| | - Elena Ballante
- BioData Science Unit, Department of Political and Social Sciences, University of Pavia, Mondino Foundation, 27100 Pavia, Italy;
| | - Serena Grumi
- Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Cinzia Ferraris
- Ketogenic Metabolic Therapy Laboratory, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (M.G.); (C.T.); (C.F.); (A.T.)
- Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Anna Tagliabue
- Ketogenic Metabolic Therapy Laboratory, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (M.G.); (C.T.); (C.F.); (A.T.)
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Chen M, Zhang X, Xiong Y, Xu G. Efficacy of low or heavy rituximab‑based protocols and comparison with seven regimens in idiopathic membranous nephropathy: a systematic review and network meta-analysis. Int Urol Nephrol 2023; 55:641-651. [PMID: 36161550 DOI: 10.1007/s11255-022-03372-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 08/21/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Numerous studies have demonstrated the efficiency of tacrolimus + rituximab and rituximab in idiopathic membranous nephropathy (IMN). But optimal dosages of rituximab for IMN are still controversial. This network meta-analysis (NMA) was conducted to compare the efficacy of different rituximab dosages and other main treatments in IMN treatment. METHODS Randomized controlled trials (RCTs) and observational studies analyzing nine therapeutic regimens for IMN were included from some databases. Network comparisons were performed to analyze the rates of total remission (TR) and relapse rate. The surface under the cumulative ranking area (SUCRA) was calculated to rank interventions. RESULTS Twelve RCTs and 12 observational studies involving 1724 patients were pooled for comparison of 9 interventions. This NMA demonstrated steroids + tacrolimus was ranked first in the aspect of total remission at 6 months (92%) and 12 months (81.3%). The total remission rate associated with tacrolimus + rituximab increased rapidly between the sixth (SUCRA 22.5%) and the twelfth month (SUCRA 63.9%). Tacrolimus and cyclosporine A were associated with higher total remission at 6 months (78.8% and 65.4%, separately) and decreased at 12 months (58.1 and 34.9%, separately). Steroids + cyclophosphamide, rituximab (Heavy dose) and rituximab (Low dose) had stable remission rates at 6 (63.7%, 46.6%, and 19.4%) and 12 months (SUCRA 66.9%, 39.6%, and 28.8%). Tacrolimus and cyclosporine A were associated with a significantly higher risk of relapse than that with steroids + cyclophosphamide, rituximab (Heavy dose), and rituximab (Low dose). CONCLUSIONS For IMN in adults, steroids + tacrolimus was ranked first in the aspect of total remission, followed by steroids + cyclophosphamide and steroids + cyclosporine A. The TR associated with rituximab (Heavy and Low dosage) at 12 months was higher than that at 6 months. And rituximab (Heavy dose) achieves a higher rate of total remission than that of rituximab (Low dose).
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Affiliation(s)
- Miaomiao Chen
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, 330006, No. 1, Minde Road, Donghu District, Nanchang, Jiangxi, China
- Grade 2018, The First Clinical Medical College of Nanchang University, Nanchang, Jiangxi, China
| | - Xuehan Zhang
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, 330006, No. 1, Minde Road, Donghu District, Nanchang, Jiangxi, China
| | - Yi Xiong
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, 330006, No. 1, Minde Road, Donghu District, Nanchang, Jiangxi, China
| | - Gaosi Xu
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, 330006, No. 1, Minde Road, Donghu District, Nanchang, Jiangxi, China.
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Lecce F, Smith CR, Burbach FR. Digital mental health interventions for people with epilepsy: a systematic review. Seizure 2023; 107:91-103. [PMID: 37001253 DOI: 10.1016/j.seizure.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/06/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE Although mental health difficulties are common in people with epilepsy, their assessment and treatment are rarely incorporated into routine medical care, with detrimental effects on quality of life. Several barriers to access traditional face to face interventions have been identified, including travel restriction and shortage of appropriately trained mental health clinicians. Digital mental health interventions offer the potential to improve access to mental health treatment. The main aim of the present study is to systematically review the empirical literature to identify what digital mental health interventions for adults, children and young people with epilepsy are currently available, as well as exploring if these interventions are effective in improving mental health and wellbeing. METHODS Searches were conducted using the MEDLINE, PsycINFO, Web of Science and Embase. The reference lists of papers collected were examined in order to identify any further relevant articles cited in peer-reviewed journals. A total of 1490 papers were identified; of these 11 were included in this review. The protocol was registered in the PROSPERO database (CRD42022318658) and the PRISMA 2020 statement was followed. RESULTS Seven digital interventions were identified. All interventions were based predominantly on CBT and mindfulness techniques and showed promising results in reducing symptoms of depression, with some studies also reporting encouraging results in reducing anxiety and improving satisfaction with life and the quality of life of adults and children and young people with epilepsy. CONCLUSIONS In summary, digital mental health interventions for people with epilepsy seem to be effective and have the potential to improve access to psychological interventions and reach underserved clinical populations. However, further well-powered and methodological rigorous studies are needed to confirm the effect of such interventions for people with epilepsy.
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15
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Escoffery C, Patel A, Leung J, Anderson M, McGee R, Sajatovic M, Johnson EK, Jobst B, Kiriakopoulos ET, Shegog R, Fraser R, Quarells RC. MEW network self-management program characteristics and lessons learned through the RE-AIM framework. Epilepsy Behav 2023; 140:109111. [PMID: 36804716 PMCID: PMC10941971 DOI: 10.1016/j.yebeh.2023.109111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 12/23/2022] [Accepted: 01/24/2023] [Indexed: 02/18/2023]
Abstract
RATIONALE The promotion of evidence-based self-management support for people living with chronic conditions such as epilepsy is a public health priority. Epilepsy self-management encompasses three general areas: (1) treatment management, (2) seizure management, and (3) lifestyle management. Interventions focusing on self-management have increased quality of life and adherence to treatment. This study assesses and synthesizes the Managing Epilepsy Well Network (MEWN) program implementation experiences using the RE-AIM framework. This research informs the quality and rigor of MEWN program dissemination and implementation efforts to assess whether these programs are being implemented and their scalability. METHODS The study data were derived from a MEWN Self-management Program Survey conducted with currently active MEWN researchers through an online survey and review of program publications and archival documents. Survey data were obtained from either the principal investigator or study team for the UPLIFT, HOBSCOTCH, SMART, MINDSET, TIME, and PACES programs. The survey questionnaire included 6 sections consisting of 68 questions and focused on the RE-AIM dimensions and respondent characteristics. The RE-AIM dimensions included: (1) Reach, (2) Effectiveness, (3) Adoption (number of and type of adopting sites), (4) Implementation (retention rate, barriers to implementation), and (5) Maintenance. RESULTS Across the MEWN programs, participation (44-120 individuals) and delivery methods (community, clinic, or asynchronous; group or individual) ranged with most programs predominantly reaching White or African American participants. Common program outcome measures included clinical outcomes (e.g., depression, quality of life, seizure frequency) and indicators of self-management behaviors (e.g., problem-solving; self-efficacy). Initial efficacy trials suggested programs were effective in changing some of their targeted outcomes (effectiveness). Most programs were implemented in clinical settings and several programs are being replicated or adapted to different geographical (e.g., urban, rural, suburban) or demographic (e.g., race, age) settings (adoption). Program delivery methods involved a mixture of program staff, peer educators, and researchers. Implementation enabling factors included partnerships with local epilepsy organizations and the inclusion of peer educators. Retention rates for all programs averaged 83.6%. Internal barriers included recruitment and lack of sufficient resources for participants. External barriers included clinical staff buy-in, staffing, and insufficient funding for support staff. Despite uncertain funding, all programs offered next steps to sustain their initiatives such as packaging their programs, initiating adoption with regional organizations, and supporting organizational readiness (maintenance). Dissemination efforts included partnering with other organizations, provision of training and technical assistance, and partnering with national organizations on grant opportunities to scale up existing programs. CONCLUSION These data showcase the impact of the MEWN self-management interventions on health and quality of life. These programs are employing training, readiness assessment, technical assistance, and development of partnerships to increase program scalability. Finally, program adaptations are being conducted to expand the interventions to other populations to address health inequalities. The lessons learned are critical for other interventions attempting to increase the translation of their programs to other settings.
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Affiliation(s)
- Cam Escoffery
- Emory University, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA 30322, United States.
| | - Archna Patel
- Emory University, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - Jerik Leung
- Emory University, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - Molly Anderson
- Emory University, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - Robin McGee
- Emory University, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - Martha Sajatovic
- Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, United States
| | - Erica K Johnson
- University of Washington, Health Promotion Research Center, 1107 NE 45(th) St #200, Seattle, WA 98105, United States
| | - Barbara Jobst
- Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03766, United States
| | - Elaine T Kiriakopoulos
- Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03766, United States
| | - Ross Shegog
- University of Texas School of Public Health, 7000 Fannin St #1200, Houston, TX 77030, United States
| | - Robert Fraser
- University of Washington, Health Promotion Research Center, 1107 NE 45(th) St #200, Seattle, WA 98105, United States
| | - Rakale C Quarells
- Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA 30310, United States
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16
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Wang LL, Zhang PH, Yan HH. Functional foods and dietary supplements in the management of non-alcoholic fatty liver disease: A systematic review and meta-analysis. Front Nutr 2023; 10:1014010. [PMID: 36866059 PMCID: PMC9971819 DOI: 10.3389/fnut.2023.1014010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023] Open
Abstract
Objective In this systematic review and meta-analysis, we aimed to clarify the overall effects of functional foods and dietary supplements in non-alcoholic fatty liver disease (NAFLD) patients. Methods Randomized controlled trials (RCTs) published in PubMed, ISI Web of Science, Cochrane library, and Embase from January 1, 2000 to January 31, 2022 were systematically searched to assess the effects of functional foods and dietary supplements in patients with NAFLD. The primary outcomes were liver-related measures, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), and hepatic fibrosis and steatosis, while the secondary outcomes included body mass index (BMI), waist circumference (WC), triacylglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). These indexes were all continuous variables, so the mean difference (MD) was used for calculating the effect size. Random-effects or fixed-effects models were used to estimate the mean difference (MD). The risk of bias in all studies was assessed with guidance provided in the Cochrane Handbook for Systematic Reviews of Interventions. Results Twenty-nine articles investigating functional foods and dietary supplements [antioxidants (phytonutrients and coenzyme Q10) = 18, probiotics/symbiotic/prebiotic = 6, fatty acids = 3, vitamin D = 1, and whole grain = 1] met the eligibility criteria. Our results showed that antioxidants could significantly reduce WC (MD: -1.28 cm; 95% CI: -1.58, -0.99, P < 0.05), ALT (MD: -7.65 IU/L; 95% CI: -11.14, -4.16, P < 0.001), AST (MD: -4.26 IU/L; 95% CI: -5.76, -2.76, P < 0.001), and LDL-C (MD: -0.24 mg/dL; 95% CI: -0.46, -0.02, P < 0.05) increased in patients with NAFLD but had no effect on BMI, TG, and TC. Probiotic/symbiotic/prebiotic supplementation could decrease BMI (MD: -0.57 kg/m2; 95% CI: -0.72, -0.42, P < 0.05), ALT (MD: -3.96 IU/L; 95% CI: -5.24, -2.69, P < 0.001), and AST (MD: -2.76; 95% CI: -3.97, -1.56, P < 0.0001) levels but did not have beneficial effects on serum lipid levels compared to the control group. Moreover, the efficacy of fatty acids for treating NAFLD was full of discrepancies. Additionally, vitamin D had no significant effect on BMI, liver transaminase, and serum lipids, while whole grain could reduce ALT and AST but did not affect serum lipid levels. Conclusion The current study suggests that antioxidant and probiotic/symbiotic/prebiotic supplements may be a promising regimen for NAFLD patients. However, the usage of fatty acids, vitamin D, and whole grain in clinical treatment is uncertain. Further exploration of the efficacy ranks of functional foods and dietary supplements is needed to provide a reliable basis for clinical application. Systematic review registration https://www.crd.york.ac.uk/prospero, identifier: CRD42022351763.
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Affiliation(s)
- Lei-lei Wang
- Department of Clinical Nutrition, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Pian-hong Zhang
- Department of Clinical Nutrition, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hui-hui Yan
- Department of Gastroenterology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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The diagnostic performance of 2-[18F]FDG PET/CT for the recurrent colorectal cancer in patients with elevated CEA versus normal CEA: a systematic review and meta-analysis. Clin Transl Imaging 2022. [DOI: 10.1007/s40336-022-00536-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Feng W, Zhou J, Lei Y, Chen W, Miao Y, Fu X, Pi J, Zhang M, Na Z, Lou W. Impact of rapid rehabilitation surgery on perioperative nursing in patients undergoing cardiac surgery: A meta-analysis. J Card Surg 2022; 37:5326-5335. [PMID: 36448468 PMCID: PMC10099735 DOI: 10.1111/jocs.17226] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/24/2022] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To systematically evaluate the effect of enhanced recovery after surgery (ERAS) on perioperative nursing of patients undergoing cardiac surgery. METHODS A systematic literature search was performed in PubMed, Embase, Web of science, Cochrane, CNKI, Wanfang, and VIP using predefined search strings from inception of database to May 2021. Randomized control trials (RCTs) with sample size >40 on cardiac surgery with either ERAS nursing or routine nursing reporting extubation (trachea) time, length of stay, out of bed activity time, and nursing satisfaction were included in the analysis. Stata SE 12.0 software was used for statistical analysis. RESULTS A total of 27 RCTs were included. All the included studies were Chinese due to lack of studies in English. The results of meta-analysis showed that the extubation time standardized mean difference ([SMD] = -3.11; 95% confidence interval [CI]: -3.77, -2.45; p < .001), out of bed activity time (SMD = -2.89; 95% CI: -3.34, -2.44; p < .001), and hospitalization time (SMD = -2.08; 95% CI: -2.37, -1.79; p < .001) of cardiac surgery patients with ERAS nursing was significantly shorter than those with routine nursing. The patient's satisfaction after surgery with ERAS was higher than that of routine nursing relative risk ([RR] = 1.24; 95% CI: 1.18, 1.30; p < .001). CONCLUSION ERAS nursing can accelerate perioperative rehabilitation of patients undergoing cardiac surgery and highly accepted by patients.
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Affiliation(s)
- Wenjuan Feng
- Cardiac Surgery DepartmentYan'an HospitalKunmingChina
| | - Jing Zhou
- Department of StomatologyKunming Yanan HospitalKunmingChina
- Key Laboratory of Tumor Immunological Prevention and Treatment of Yunnan ProvinceYan'an HospitalKunmingYunnanChina
| | - Yu Lei
- Cardiac Surgery DepartmentYan'an HospitalKunmingChina
| | - Wenmin Chen
- Cardiac Surgery DepartmentYan'an HospitalKunmingChina
| | - Yongpin Miao
- Cardiac Surgery DepartmentYan'an HospitalKunmingChina
| | - Xintong Fu
- Cardiac Surgery DepartmentYan'an HospitalKunmingChina
| | - Jinghong Pi
- Cardiac Surgery DepartmentYan'an HospitalKunmingChina
| | - Min Zhang
- Cardiac Surgery DepartmentYan'an HospitalKunmingChina
| | - Zhuhui Na
- Cardiac Surgery DepartmentYan'an HospitalKunmingChina
| | - Wenrong Lou
- E.N.T. DepartmentYan'an HospitalKunmingYunnanChina
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19
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Escoffery C, Haardoerfer R, Bamps Y, McGee R, Geiger D, Quarells RC, Thompson NJ, Patel A, Anderson M, LaFrance WC. Reduction of the Adult Epilepsy Self-Management Measure Instrument (AESMMI). Epilepsy Behav 2022; 131:108692. [PMID: 35526460 PMCID: PMC10903544 DOI: 10.1016/j.yebeh.2022.108692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/03/2022]
Abstract
Managing one's own symptoms, medications, treatments, lifestyle, and psychological and social aspects of chronic disease is known as self-management. The Institute of Medicine has identified three categories of epilepsy self-management, including medication management, behavior management, and emotional support. Overall, there has been limited research of interventions measuring epilepsy self-management behaviors. The present study aimed to develop an abbreviated version of the full, previously published, Adult Epilepsy Self-Management Measurement Instrument (AESMMI) using confirmatory factor analysis. Data come from a cross-sectional survey of people with epilepsy. The sample included adults with epilepsy (n = 422), who reported that a clinician diagnosed them with epilepsy or a seizure disorder. We ran confirmatory factor analyses in testing the abbreviated scale. The scale was reduced using a theory-driven data-informed approach. The full AESMMI length was reduced by 40% (from 65 to 38 items) with an overall internal consistency of 0.912. The abbreviated AESMMI retained the 11 subdomains, with Cronbach's alphas from 0.535 to 0.878. This reduced item scale can be useful for assessing self-management behaviors for people with epilepsy or measuring outcomes in self-management research.
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Affiliation(s)
- Cam Escoffery
- Emory University, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA 30322, United States.
| | - Regine Haardoerfer
- Emory University, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - Yvan Bamps
- Emory University, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - Robin McGee
- Emory University, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - Demetrius Geiger
- Morehouse School of Medicine, 720 Westview Dr. SW, Atlanta, GA 30310, United States
| | - Rakale C Quarells
- Morehouse School of Medicine, 720 Westview Dr. SW, Atlanta, GA 30310, United States
| | - Nancy J Thompson
- Emory University, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - Archna Patel
- Emory University, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - Molly Anderson
- Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, United States
| | - W Curt LaFrance
- Brown University, Rhode Island Hospital, 593 Eddy Street, Potter 3, Providence, RI 02903, United States
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Streltzov NA, Schmidt SS, Schommer LM, Zhao W, Tosteson TD, Mazanec MT, Kiriakopoulos ET, Chu F, Henninger HL, Nagle K, Roth RM, Jobst B. Effectiveness of a Self-Management Program to Improve Cognition and Quality of Life in Epilepsy: A Pragmatic, Randomized, Multicenter Trial. Neurology 2022; 98:e2174-e2184. [PMID: 35387855 PMCID: PMC9169940 DOI: 10.1212/wnl.0000000000200346] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 02/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We conducted a multisite, pragmatic replication trial at 4 New England epilepsy centers to determine the effectiveness of Home-Based Self-Management and Cognitive Training Changes Lives (HOBSCOTCH) in a real-world setting and to assess feasibility of a virtual intervention. METHODS HOBSCOTCH is an 8-session intervention addressing cognitive impairment and quality of life (QoL) for people with epilepsy (PWE). Participants were recruited from epilepsy centers in 4 states and block-randomized into the following groups: in-person HOBSCOTCH (H-IP), virtual HOBSCOTCH (H-V), and waitlist control. Outcome measures were assessed for all groups at baseline, 3 months, and 6 months; intervention groups received long-term follow-up at 9 and 12 months. RESULTS A total of 108 participants were recruited, of whom 85 were included in this analysis (age at baseline 47.5 ± 11.5 years; 68% female). Participants completing the in-person intervention (H-IP) had a 12.4-point improvement in QoL score compared with controls (p < 0.001). Pairwise comparisons found a 6.2-point treatment effect for subjective cognition in the H-IP group (p < 0.001). There were no meaningful group differences in objective cognition or health care utilization at any time points and the treatment effect for QoL diminished by 6 months. The virtual intervention demonstrated feasibility but did not significantly improve outcomes compared with controls. Within-group analysis found improvements in QoL for both H-V and H-IP. DISCUSSION This study replicated the effectiveness of the HOBSCOTCH program in improving QoL for PWE. The study was conducted prior to the COVID-19 pandemic, but the distance-delivered intervention may be particularly well-suited for the current environment. Future research will explore modifications designed to improve the efficacy of H-V and the sustainability of HOBSCOTCH's treatment effect. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov (NCT02394509). CLASSIFICATION OF EVIDENCE This study provides Class III evidence that in-person HOBSCOTCH delivery improved subjective measures of cognition in persons with epilepsy.
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Affiliation(s)
- Nicholas A Streltzov
- From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington
| | - Samantha S Schmidt
- From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington
| | - Lindsay M Schommer
- From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington
| | - Wenyan Zhao
- From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington
| | - Tor D Tosteson
- From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington
| | - Morgan T Mazanec
- From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington
| | - Elaine T Kiriakopoulos
- From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington
| | - Felicia Chu
- From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington
| | - Heidi L Henninger
- From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington
| | - Keith Nagle
- From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington
| | - Robert M Roth
- From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington
| | - Barbara Jobst
- From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington
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21
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Davoudi M, Lundgren T, Jansson-Fröjmark M, Saeedipour Z, Badinlou F. The Psychological Flexibility in Epilepsy Questionnaire (PFEQ): Psychometric properties of the Persian version. Epilepsy Behav 2022; 130:108672. [PMID: 35367724 DOI: 10.1016/j.yebeh.2022.108672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 11/03/2022]
Abstract
The present study aimed to evaluate the psychometric properties of a Persian version of the Psychological Flexibility Epilepsy Questionnaire (P-PFEQ). Transcultural adaptation and validation of the Persian version of the PFEQ were performed using translation and back-translation with pilot testing (on 17 patients) and expert evaluation. Participants in the current study involved 100 patients with an EEG-verified epilepsy diagnosis and an average age of 30.96 years (SD ± 6.46) (63% were female). Data collection included a sociodemographic questionnaire, epilepsy-specific questionnaire, the Depression-Anxiety-stress scale (DASS-21), the Insomnia Severity Index (ISI), the 31-item Quality-of-Life questionnaire in Epilepsy (QOLIE-31), the Acceptance and Action Questionnaire (AAQ), the Committed Action Questionnaire (CAQ), and the short form of the Freiburg Mindfulness Inventory (FMI). Descriptive and inferential analyses were conducted by SPSS software V.26. The P-PFEQ demonstrated semantic, conceptual, and content validity in equivalence with the Swedish version. Based on Exploratory Factor Analysis (EFA), five items were eliminated and unidimensional scale of PFEQ with 12 items, explaining 50.38% of the total variance, was accepted. The scale showed good reliability through internal consistency (Cronbach's α of 0.9) and temporal stability on retest (n = 85, Intraclass correlation = 0.92). Convergent and divergent validity findings were acceptable for the P-PFEQ. The findings show that the P-PFEQ is a reliable and valid scale for assessing psychological flexibility in the Iranian patients with epilepsy. Also, it can be confidently recommended as a useful instrument in clinical practice.
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Affiliation(s)
- Mohammadreza Davoudi
- Department of Clinical Psychology, Faculty of Behavioral Science, University of Social Welfare and Rehabilitation Sciences, 1985713871 Tehran, Iran
| | - Tobias Lundgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, The Centre for Psychotherapy, Education & Research, Liljeholmstorget 7, SE-117 63 Stockholm, Sweden
| | - Markus Jansson-Fröjmark
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, The Centre for Psychotherapy, Education & Research, Liljeholmstorget 7, SE-117 63 Stockholm, Sweden
| | - Zahra Saeedipour
- Department of Clinical Psychology, Faculty of Behavioral Science, University of Social Welfare and Rehabilitation Sciences, 1985713871 Tehran, Iran
| | - Farzaneh Badinlou
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, The Centre for Psychotherapy, Education & Research, Liljeholmstorget 7, SE-117 63 Stockholm, Sweden.
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22
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Mula M, Coleman H, Wilson SJ. Neuropsychiatric and Cognitive Comorbidities in Epilepsy. Continuum (Minneap Minn) 2022; 28:457-482. [PMID: 35393966 DOI: 10.1212/con.0000000000001123] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article discusses psychiatric and cognitive comorbidities of epilepsy over the lifespan and illustrates opportunities to improve the quality of care of children and adults with epilepsy. RECENT FINDINGS One in 3 people with epilepsy have a lifetime history of psychiatric disorders, and they represent an important prognostic marker of epilepsy. Contributors are diverse and display a complex relationship. Cognitive comorbidities are also common among those living with epilepsy and are increasingly recognized as a reflection of changes to underlying brain networks. Among the cognitive comorbidities, intellectual disability and dementia are common and can complicate the diagnostic process when cognitive and/or behavioral features resemble seizures. SUMMARY Comorbidities require consideration from the first point of contact with a patient because they can determine the presentation of symptoms, responsiveness to treatment, and the patient's day-to-day functioning and quality of life. In epilepsy, psychiatric and cognitive comorbidities may prove a greater source of disability for the patient and family than the seizures themselves, and in the case of essential comorbidities, they are regarded as core to the disorder in terms of etiology, diagnosis, and treatment.
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Liu J, Jia W, Yu C. Safety and Efficacy of Spironolactone in Dialysis-Dependent Patients: Meta-Analysis of Randomized Controlled Trials. Front Med (Lausanne) 2022; 9:828189. [PMID: 35372414 PMCID: PMC8970057 DOI: 10.3389/fmed.2022.828189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background Patients with end-stage renal disease (ESRD) are characterized with high risk of heart failure. Although mineralocorticoid receptor antagonists have beneficial effect on relieving cardiac fibrosis and, thus, reduce the incidence of cardiovascular disease and cardiac death, the therapeutic benefits and adverse effects are still controversial. We conducted a meta-analysis to measure the safety and efficacy of spironolactone in patients undergoing dialysis. Methods A systematic search for randomized controlled trials (RCTs) was performed in PubMed, Embase, and Cochrane databases. Primary outcomes included changes in all-cause mortality (ACM), serum potassium concentration, incidence of hyperkalemia and gynecomastia (GYN). Secondary outcomes included changes in blood pressure (BP), left ventricular mass index (LVMI) and left ventricular ejection fraction (LVEF). Subgroup analysis and sensitivity analysis were further conducted. This research was registered with PROSPERO (International Prospective Register of Systematic Reviews; No. CRD42021287493). Results Fifteen RCTs with 1,258 patients were enrolled in this pooled-analysis. Spironolactone treatment significantly decreased ACM (RR = 0.42, P < 0.0001), CCV (RR = 0.54, P = 0.008) and LVMI (MD = −6.28, P = 0.002), also increased occurrence of GYN (RR = 4.36, P = 0.0005). However, LVEF (MD = 2.63, P = 0.05), systolic BP (MD = −4.61, P = 0.14) and diastolic BP (MD = −0.12, P = 0.94) did not change between two groups after treatment. Although serum potassium concentration was increased (MD = 0.22, P < 0.0001) after spironolactone supplement, the risk of hyperkalemia remained unchanged (RR = 1.21, P = 0.31). Further subgroup analysis found more obvious advantageous as well as disadvantageous effects in Asian subjects than European or American ones. Also, with more than 9 months of treatment duration, patients achieved more favorable influence than shorter duration. Conclusions These results highlight the therapeutic effects of spironolactone on cardiovascular indexes, including ACM, CCV, and LVMI. However, the unignorable increase of GYN incidence and serum potassium level indicate that close monitor in dialysis-dependent patients, especially Asian patients, is essential.
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Affiliation(s)
- Jing Liu
- Department of Nephrology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - WanYu Jia
- Department of Pediatrics, Clinical Center of Pediatric Nephrology of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chen Yu
- Department of Nephrology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Chen Yu
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24
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Tumienė B, del Toro Riera M, Grikiniene J, Samaitiene-Aleknienė R, Praninskienė R, Monavari AA, Sykut-Cegielska J. Multidisciplinary Care of Patients with Inherited Metabolic Diseases and Epilepsy: Current Perspectives. J Multidiscip Healthc 2022; 15:553-566. [PMID: 35387391 PMCID: PMC8977775 DOI: 10.2147/jmdh.s251863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/17/2022] [Indexed: 11/25/2022] Open
Abstract
More than 650 inherited metabolic diseases may present with epilepsy or seizures. These diseases are often multisystem, life-long and induce complex needs of patients and families. Multidisciplinary care involves all stages of disease management: diagnostics, specific or symptomatic, acute and chronic treatments, and integrated care that takes into account not only medical, but also manifold psychosocial, educational, vocational and other needs of patients and their caregivers. Care coordination is indispensable to ensure smooth transitions of care across life and disease stages, including management of emergencies, transition from pediatric to adult services and palliative care. Care pathways are highly diverse and have to find the right balance between highly specialized and locally provided services. While multidisciplinary teams consist of many professionals, a named supervising physician in a highly specialized healthcare setting and a care coordinator are highly important. As the greatest burden of care always falls onto the shoulders of patients and/or families, patient empowerment should be a part of every care pathway and include provision of required information, involvement into common decision-making, patient’s and family’s education, support for self-management, liaison with peer support groups and emotional/ psychological support. Due to the rarity and complexity of these diseases, sufficient expertise may not be available in a national healthcare system and cross-border services (virtual or physical) in the recently developed European Reference Networks should be ensured through the proper organization of referral systems in each EU and EEA country. Finally, digital technologies are particularly important in the provision of services for patients with rare diseases and can significantly increase the availability of highly specialized services and expertise.
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Affiliation(s)
- Birutė Tumienė
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Vilnius University Hospital Santaros klinikos, Vilnius, Lithuania
- Correspondence: Birutė Tumienė, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Santariskiu str. 2, Vilnius, LT-06681, Lithuania, Tel +370 614 45026, Email
| | - Mireia del Toro Riera
- Pediatric Neurology Department, Unit of Hereditary Metabolic Disorders, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Jurgita Grikiniene
- Clinic of Children’s Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rūta Samaitiene-Aleknienė
- Clinic of Children’s Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rūta Praninskienė
- Clinic of Children’s Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ahmad Ardeshir Monavari
- National Centre for Inherited Metabolic Disorders, Children’s Health Ireland at Temple Street Dublin, Dublin, Ireland
- University College Dublin, Dublin, Ireland
| | - Jolanta Sykut-Cegielska
- Department of Inborn Errors of Metabolism and Paediatrics, the Institute of Mother and Child, Warsaw, Poland
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25
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Lopez MR, Kanner AM. Neuropsychiatric Treatments for Epilepsy: Nonpharmacological Approaches. Semin Neurol 2022; 42:182-191. [PMID: 35213901 DOI: 10.1055/s-0042-1742582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Neuropsychiatric conditions are frequently found in patients with epilepsy (PWE). These entities can be as disabling as epilepsy resulting in a significant negative impact on the quality of life of this population if not addressed and treated appropriately. In this article, we provide an overview of non-pharmacological treatments currently available to these patients-and review their effect on mood and anxiety disorders as well as epilepsy. These treatment strategies will allow the practitioner to optimize clinical care during the initial evaluation, which begins with the recognition of the neuropsychiatric condition followed by the appropriate individualized psychotherapeutic approach and/or neuromodulation therapy. To plan a comprehensive treatment for PWE, practitioners must be familiar with these therapeutic tools. Additional clinical research is needed to further create a multidisciplinary team in the assessment and management of neuropsychiatric disorders in PWE.
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Affiliation(s)
- Maria Raquel Lopez
- Division of Epilepsy and Comprehensive Epilepsy Center, Department of Neurology, University of Miami, Miller School of Medicine, Miami, Florida.,Department of Neurology. Division of Epilepsy, Epilepsy Center of Excellence, Miami VA Medical Center, Miami, Florida
| | - Andres M Kanner
- Division of Epilepsy and Comprehensive Epilepsy Center, Department of Neurology, University of Miami, Miller School of Medicine, Miami, Florida
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26
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Liu J, Zhong J, Yang H, Wang D, Zhang Y, Yang Y, Xing G, Kon V. Biotic Supplements in Patients With Chronic Kidney Disease: Meta-Analysis of Randomized Controlled Trials. J Ren Nutr 2022; 32:10-21. [PMID: 34666930 PMCID: PMC9793596 DOI: 10.1053/j.jrn.2021.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 07/01/2021] [Accepted: 08/10/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Gut flora imbalance characterizes patients with chronic kidney disease (CKD). Although biotic supplementation has been proposed to lessen inflammation and oxidative stress and, thus, reduce the risk of progressive kidney damage and cardiovascular disease, the effects remain controversial. We conducted a meta-analysis to assess the therapeutic benefits of biotics in CKD. METHODS PubMed, Embase, and Cochrane databases were systematically searched for randomized controlled trials that evaluated any biotic (prebiotic, probiotic, synbiotics) supplements in patients with CKD (CKD, stage 3-4 to end-stage renal disease). Primary endpoints included changes in renal function, markers of inflammation, and oxidative stress. Secondary endpoints included changes in levels of uremic toxins and variations in lipid metabolism. RESULTS Twenty-three eligible studies included 842 participants. In a pooled-analysis, biotics did not change estimated glomerular filtration rate (mean difference [MD] = 0.08, P = .92) or serum albumin (MD = -0.01, P = .86), although prebiotics reduced serum creatinine (standardized mean difference [SMD] = -0.23, P = .009) and blood urea nitrogen (MD = -6.05, P < .00001). Biotics improved total antioxidative capacity (SMD = 0.37, P = .007) and malondialdehyde (SMD = -0.96, P = .006) and reduced the inflammatory marker interleukin-6 (SMD = -0.30, P = .01) although not C-reactive protein (SMD = -0.22, P = .20). Biotic intervention reduced some uremic toxins, including p-cresol sulfate (SMD = -2.18, P < .0001) and indoxyl sulfate (MD = -5.14, P = .0009), which decreased in dialysis-dependent patients. Another toxin, indole-3-acetic acid (MD = -0.22, P = .63), did not change. Lipids were unaffected by biotic intervention (total cholesterol: SMD = -0.01, P = .89; high-density lipoprotein: SMD = -0.08, P = .76; low-density lipoprotein: MD = 3.54, P = .28; triglyceride: MD = -2.26, P = .58). CONCLUSION The results highlight the favorable influence of biotics on circulating markers of creatinine, oxidant stress (malondialdehyde, total antioxidative capacity), inflammation (interleukin-6), and uremic toxins (p-cresol sulfate) in patients with CKD. Biotics did not affect estimated glomerular filtration rate, albumin, indole-3-acetic acid, or lipids in either predialysis or dialysis patients.
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Affiliation(s)
- Jing Liu
- Department of Nephrology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University Institute of Nephrology, Zhengzhou, China.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - JianYong Zhong
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.,Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - HaiChun Yang
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.,Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - DongQin Wang
- Dongjing Town Health Service Center, Songjiang District, Shanghai, China
| | - Ying Zhang
- Department of Nephrology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University Institute of Nephrology, Zhengzhou, China
| | - YuMeng Yang
- Department of Nephrology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University Institute of Nephrology, Zhengzhou, China
| | - GuoLan Xing
- Department of Nephrology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University Institute of Nephrology, Zhengzhou, China
| | - Valentina Kon
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
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Liu Z, Liu B, Yang H, Zhao L. Staples versus sutures for skin closure in hip arthroplasty: a meta-analysis and systematic review. J Orthop Surg Res 2021; 16:735. [PMID: 34952612 PMCID: PMC8705165 DOI: 10.1186/s13018-021-02870-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/05/2021] [Indexed: 11/10/2022] Open
Abstract
Objective The purpose of the present study was to estimate complications and other outcomes associated with staple and suture closure after hip arthroplasty through meta-analysis techniques and a systematic review. Methods We searched for articles in EMBASE, PubMed, Medline, Web of Science and the Cochrane Library. To determine the eligibility of the searched trials, Cochrane Collaboration's Review Manager software was used to perform the meta-analysis. Results Five randomized controlled trials and one retrospective cohort trial were included in our study. Our study indicated that for skin closure after hip arthroplasty, the risks of superficial infection and prolonged discharge were higher with staples than with sutures. There was no significant difference between the two groups in terms of allergic reaction, dehiscence, inflammation, abscess formation, the Hollander Wound Evaluation Scale or patient's satisfaction with skin closure methods. However, suturing required a longer operating time. Conclusions Closure with sutures is associated with lower risks of superficial infection and prolonged discharge than closure with staples following hip arthroplasty, but it may take more time.
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Affiliation(s)
- Zirui Liu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450003, Henan, China
| | - Binfeng Liu
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Hao Yang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450003, Henan, China
| | - Liang Zhao
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450003, Henan, China.
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Lei H, Wang W, Cao Y, Ma Y, Xue X. Efficacy and safety evaluation of bright light therapy in patients with post-stroke insomnia: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e27937. [PMID: 34918641 PMCID: PMC8677890 DOI: 10.1097/md.0000000000027937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Post-stroke insomnia (PSI) is a common and severe illness among the complications of stroke. Although there are plenty of drugs currently used for PSI treatment, they generate several side effects and other problems. Bright light therapy (BLT) is thought to be relatively safe and effective in treating PSI patients. Despite this, there is still a lack of systematic review on BLT in the treatment of PSI. Allowing for this, the aim of this study is to assess the efficacy and safety of BLT for PSI. METHODS The meta-analysis and systematic review will perform a comprehensive electronic search for items fulfilling the required criteria in Web of Science, Google Scholar, Wan Fang database, MEDLINE, Baidu Scholar, PubMed, SinoMed, Embase, Chinese Biomedical Literature Database (CBM), China national knowledge infrastructure database (CNKI), Cochrane Library Central Register of Controlled Trials (CENTRAL), and Wei Pu database from establishment to January 1, 2022. We will select articles, collect data, and assess the methodology quality. And we will set the primary outcome and secondary outcomes in this research. RevMan 5.3 software will be used to analyze the data for this investigation. RESULTS The work of this research will be published in peer-reviewed scientific journals. CONCLUSION The aim of this study is to assess the efficacy and safety of BLT for PSI and present robust scientific evidence concerning BLT for PSI. REGISTRATION INPLASY2021100065.
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Cuneo AZ, Maisha K, Minen MT. Strategies for Behavioral Research in Neurology: Lessons Learned During the COVID-19 Pandemic and Applications for the Future. Curr Neurol Neurosci Rep 2021; 21:63. [PMID: 34705122 PMCID: PMC8548698 DOI: 10.1007/s11910-021-01146-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/29/2022]
Abstract
Purpose of Review Behavioral therapies are proven treatments for many neurologic conditions. However, the COVID-19 pandemic has posed significant challenges for conducting behavioral research. This article aims to (1) highlight the challenges of running behavioral clinical trials during the pandemic, (2) suggest approaches to maximize generalizability of pandemic-era studies, and (3) offer strategies for successful behavioral trials beyond the pandemic. Recent Findings Thousands of clinical trials have been impacted by the COVID-19 pandemic, from undergoing protocol revisions to suspension altogether. Furthermore, for ongoing trials, recruitment of diverse populations has suffered, thereby exacerbating existing inequities in clinical research. Patient adherence and retention have been affected by a myriad of pandemic-era restraints, and medical, psychiatric, and other complications from the pandemic have the potential to have long-term effects on pandemic-era study results. Summary In the development of post-pandemic study protocols, attention should be given to designing studies that incorporate successful aspects of pre-pandemic and pandemic-era strategies to (1) broaden recruitment using new techniques, (2) improve access for diverse populations, (3) expand protocols to include virtual and in-person participation, and (4) increase patient adherence and retention.
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Affiliation(s)
- Ami Z Cuneo
- Neurology, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
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Wu G, Ji Q, Huang H, Zhu X. The efficacy of fish oil in preventing coronary heart disease: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e27253. [PMID: 34664872 PMCID: PMC8448057 DOI: 10.1097/md.0000000000027253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Coronary heart disease (CHD) is one of the most common causes of death and disease burden in the world. Current fish oil aiming to prevent and treat CHD have shown a large variety of effects with low levels of evidence. OBJECTIVE To evaluate the efficacy of fish oil for protection against CHD, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the use of fish oil for protection against CHD. METHODS We retrieved relevant articles published from January 1966 to January 2020 by searching the PubMed, EMBASE, Cochrane CENTRAL, and Web of Science databases. RCTs of fish oil in preventing CHD were selected. The study quality was evaluated using the Cochrane Risk of Bias tool with RevMan 5.3 software. The first selection involved 360 citations. After screening and evaluation of suitability, 19 RCTs adjusted for clustering were included in the meta-analysis. All selected manuscripts considered that fish oil was effective in preventing CHD, secondary outcome measures included angina, sepsis and death. RESULTS Compared with the control group, fish oil may confer significant protection against CHD (odds ratio = 0.84; 95% confidence interval: 0.72-0.98). There was no significant difference in the incidence of secondary outcomes between the observation group and the control group (P > .05). CONCLUSION The above results show that fish oil plays an important role in reducing CHD and cardiovascular events. However, because of the suboptimal quality of the studies included into the meta-analysis, these results do not justify adding fish oils systematically to the heavy pharmaceutical assortment already recommended in CHD patients. REGISTRATION DETAILS CRD42020183719.
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Affiliation(s)
- Gaohong Wu
- Department of Neonatology, Zhuhai Women and Children's Hospital, Zhuhai, China
| | - Qingyang Ji
- Department of Neonatology, Zhuhai Women and Children's Hospital, Zhuhai, China
| | - Huiwen Huang
- Department of Neonatology, Zhuhai Women and Children's Hospital, Zhuhai, China
| | - Xueping Zhu
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, China
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Peng W, Ding J, Zhan S, Wang X. A survey on doctors' cognition of depression in patients with epilepsy. Brain Behav 2021; 11:e2232. [PMID: 34087951 PMCID: PMC8413820 DOI: 10.1002/brb3.2232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/28/2021] [Accepted: 05/19/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE This survey aimed to assess doctors' cognition on depressive symptoms in patients with epilepsy in Shanghai China. METHODS Questionnaires were handed out to doctors who have taken part in the epilepsy care, covering those from all third-grade hospitals and several second-grade hospitals in Shanghai China. Respondents were asked to make choices for their demographic profiles, clinical practices, acquired knowledge of, and attitudes toward the comorbidity of epilepsy and depression. RESULTS A total of 282 questionnaires were collected from 16 hospitals in Shanghai China, of which 280 copies were included in the statistical analysis. Respondents were mainly less than 50 years (260, 92.8%), mostly residents and attendings (206, 73.6%), and mostly master and doctor's degrees (225, 80.3%). The ratio of epileptologists and nonepileptologists was 56 (20.1%):224 (79.9%). Compared to nonepileptologists and residents, epileptologists and doctors with higher professional titles were more likely to answer that they received a higher percentage of patients with the comorbidity of epilepsy and depression (≥30%), and they knew very well about the knowledge, and held the view that depression exacerbated seizures (p < .05). Surprisingly, most doctors including chief doctors and epileptologists answered that they had difficulties in prescribing antidepressants. Quite a few doctors from lower class hospitals even preferred to use tricyclic antidepressants for controlling depressive symptoms in patients with epilepsy. SIGNIFICANCE Doctors, especially younger doctors and nonepileptologists, need more training to get knowledge of the comorbidity of epilepsy and depression. However, the therapeutic methods for depressive symptoms in patients with epilepsy were still limited and in a challenge.
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Affiliation(s)
- Weifeng Peng
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jing Ding
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shaokang Zhan
- Department of The State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, China
| | - Xin Wang
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China.,Institute of Statistics and Public Health, Shanghai Medical College, Fudan University, Shanghai, China
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- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
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Yin Q, Xun X, Yang G, Cui H, Liu H. Efficacy of Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors in the Adjuvant Setting for Patients with Resected Epidermal Growth Factor Receptor Mutant Non-Small Cell Lung Cancer: A Meta-Analysis with 11 Trials. Oncol Res Treat 2021; 44:344-353. [PMID: 33951671 DOI: 10.1159/000515230] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/15/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) have recently become the standard first-line therapy for advanced non-small cell lung cancer (NSCLC) patients harboring EGFR mutations. This study aimed to define the role of EGFR-TKI treatment in the adjuvant setting of patients with resected EGFR-mutant NSCLC. METHODS Three online databases (PubMed, Embase, and the Cochrane Library) were used to conduct systematic research to search for studies published before June 1, 2020. The disease-free survival (DFS) and overall survival (OS) of patients with resected EGFR-mutant NSCLC after radical surgery treated with EGFR-TKIs versus non-EGFR-TKIs in the adjuvant setting were compared. Based on rigorous self-defined inclusion and exclusion criteria, studies were selected, and a meta-analysis was performed using hazard rate (HR) and 95% CIs as effective measures. RESULTS Eleven studies, published between 2011 and 2020, with a total of 1,900 patients, were included in this meta-analysis. EGFR-TKI treatment showed a significant beneficial effect on DFS (HR 0.42; 95% CI 0.31-0.57) and OS (HR 0.62; 95% CI 0.45-0.86) for patients with resected EGFR-mutant NSCLC after radical resection in the adjuvant setting. CONCLUSION Our meta-analysis results suggested that EGFR-TKI treatment improved the DFS and OS of completely resected patients with EGFR-mutant NSCLC compared with non-EGFR-TKI treatment in the adjuvant setting. In the future, our conclusion should be confirmed by additional large-scale and well-designed clinical trials.
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Affiliation(s)
- Qifan Yin
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, China
| | - Xuejiao Xun
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang, China
| | - Guang Yang
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, China
| | - Hongshang Cui
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, China
| | - Huining Liu
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, China
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Lai ST, Lim KS, Tang V, Low WY. Mindfulness-based intervention to promote psychological wellbeing in people with epilepsy: A randomized controlled trial. Epilepsy Behav 2021; 118:107916. [PMID: 33743343 DOI: 10.1016/j.yebeh.2021.107916] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/24/2021] [Accepted: 02/27/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND We investigated the efficacy of mindfulness-based intervention (MBI) in promoting psychological wellbeing in people with epilepsy (PWE) using an assessor-blinded randomized controlled design. METHODS A total of 28 PWE were randomly assigned to either intervention (n = 14 cases) or control group (n = 14 controls). The intervention group received a six 2.5-hour weekly MBI, while the control group did not receive any intervention. They were assessed at three timepoints (T0: before intervention, T1: immediately after intervention, and T2: 6 weeks after intervention). Repeated measures of analyses of variance (RM-ANOVAs) were used for inter-group comparisons to determine intervention effect from baseline -to T1 and -to T2 for all outcome measures. The individual changes were calculated using the reliable change index (RCI). Key outcomes included depression (BDI-II), anxiety (BAI), epilepsy-related quality of life (QOLIE-31), satisfaction with life (SWLS), and level of mindfulness (MAAS). RESULTS Participants who participated in the MBI showed significant reduction in BDI-II (p = 0.001), significant increases in MAAS (p = 0.027) and QOLIE-31 (p = 0.001) at T1 when compared with the control group. However, BAI and SWLS were not significant. The trend was similar at 6-week follow-up, all outcome measures of MBI remained significant (p < 0.05) except for BAI and SWLS. Beyond the 6-week intervention, RCI analysis showed a significant improvement in levels of mindfulness (45.45% vs. 21.43%, p = 0.009), depression (45.45% vs. 0.00%, p = 0.016), quality of life (45.45% vs. 14.29%, p = 0.017) with MBI, as compared to the no-intervention phase. CONCLUSION Mindfulness-based intervention is effective in reducing psychological distress and improving the quality of life in PWE.
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Affiliation(s)
- Siew-Tim Lai
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kheng-Seang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Venus Tang
- Department of Clinical Psychology, Prince of Wales Hospital, Hospital Authority, Hong Kong; Division of Neurosurgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Wah-Yun Low
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Asia-Europe Institute, University of Malaya, Kuala Lumpur, Malaysia
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Neuroticism and extraversion affect health-related quality of life of persons with epilepsy independently from depression and anxiety symptoms. Epilepsy Behav 2021; 117:107858. [PMID: 33640563 DOI: 10.1016/j.yebeh.2021.107858] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 01/31/2023]
Abstract
PURPOSE We determined whether neuroticism and extraversion are associated with health-related quality of life (HRQoL) independently from other psychological factors in persons with epilepsy. METHODS This was a cross-sectional study of 357 adults with epilepsy. The Quality of Life in Epilepsy Inventory-31 (QOLIE-31), short form of the Eysenck Personality Questionnaire-Revised, Hospital Anxiety Depression Scale, Rosenberg Self-esteem Scale, and Stigma Scale for Epilepsy were used. A hierarchical linear regression analysis and Sobel test were performed. RESULTS The final model explained 64.2% of the variance in the QOLIE-31. Demographic factors, entered in step 1 of the hierarchical linear regression, explained <1% of the variance. Social factors entered in step 2 and epilepsy-related factors in step 3 explained an additional 9.3% and 9.6% of the variance, respectively. Psychological factors, entered in the final step, explained 44.7% of the variance. Except for extraversion, all psychological factors assessed were independently associated with QOLIE-31 scores. When entered in step 1 of the regression analysis, neuroticism explained 36.1% of the variance, following only depression (49.0%) and anxiety (44.9%) according to the Hospital Anxiety Depression Scale. Both neuroticism (B = -0.264, p = 0.001) and extraversion (B = 0.189, p = 0.009) had indirect effects on QOLIE-31 scores mediated by depressive symptoms. CONCLUSIONS Neuroticism is the third most important factor for HRQoL of persons with epilepsy, following depressive symptoms and anxiety. Both neuroticism and extraversion indirectly affect HRQoL through depressive symptoms.
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Burket L, Parling T, Jansson-Fröjmark M, Reuterskiöld L, Ahlqvist J, Shanavazh S, Reinebo G, Vinnars B, Beckman M, Bohman B, Rozenthal A, Larsson C, Lindgren A, Linde J, Bonnert M, Lundgren T. Development and preliminary evaluation of the psychometric properties of the psychological flexibility in epilepsy questionnaire (PFEQ). Epilepsy Behav 2021; 115:107685. [PMID: 33360177 DOI: 10.1016/j.yebeh.2020.107685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/23/2020] [Accepted: 11/29/2020] [Indexed: 10/22/2022]
Abstract
The present study describes the development and preliminary psychometric evaluation of the Psychological Flexibility in Epilepsy Questionnaire (PFEQ), which was developed to measure the construct referred to as Psychological Flexibility (PF) in epilepsy. Results from 81 participants with epilepsy support a one-factor solution, consisting of 12 items, indicating a satisfactory structure and reliability with an alpha coefficient of 0.92. Criterion validity of the instrument was supported by moderate correlations with outcomes predicting quality of life, PF in the general population, depressive symptoms, and anxiety symptoms. Number of seizures in the past three and 12 months was positively correlated with scores on the PFEQ. These findings are consistent with the instrument's underlying theory. Further development and investigation of the PFEQ is recommended, as the preliminary results of the questionnaire suggest that the scale has the potential to be a valuable contribution to the future exploration of the role of PF in epilepsy.
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Affiliation(s)
- Liis Burket
- Radboud University, Montessorilaan 3, 6525 HR Nijmegen, The Netherlands
| | - Thomas Parling
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, The Centre for Psychotherapy, Education & Research, Liljeholmstorget 7, SE-117 63 Stockholm, Sweden
| | - Markus Jansson-Fröjmark
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, The Centre for Psychotherapy, Education & Research, Liljeholmstorget 7, SE-117 63 Stockholm, Sweden
| | - Lotta Reuterskiöld
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, The Centre for Psychotherapy, Education & Research, Liljeholmstorget 7, SE-117 63 Stockholm, Sweden
| | - Josefin Ahlqvist
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, The Centre for Psychotherapy, Education & Research, Liljeholmstorget 7, SE-117 63 Stockholm, Sweden
| | - Shervin Shanavazh
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, The Centre for Psychotherapy, Education & Research, Liljeholmstorget 7, SE-117 63 Stockholm, Sweden
| | - Gustaf Reinebo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, The Centre for Psychotherapy, Education & Research, Liljeholmstorget 7, SE-117 63 Stockholm, Sweden
| | - Bo Vinnars
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, The Centre for Psychotherapy, Education & Research, Liljeholmstorget 7, SE-117 63 Stockholm, Sweden
| | - Maria Beckman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, The Centre for Psychotherapy, Education & Research, Liljeholmstorget 7, SE-117 63 Stockholm, Sweden
| | - Benjamin Bohman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, The Centre for Psychotherapy, Education & Research, Liljeholmstorget 7, SE-117 63 Stockholm, Sweden
| | - Alexander Rozenthal
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, The Centre for Psychotherapy, Education & Research, Liljeholmstorget 7, SE-117 63 Stockholm, Sweden
| | - Cornelia Larsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, The Centre for Psychotherapy, Education & Research, Liljeholmstorget 7, SE-117 63 Stockholm, Sweden
| | - Annika Lindgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, The Centre for Psychotherapy, Education & Research, Liljeholmstorget 7, SE-117 63 Stockholm, Sweden
| | - Johanna Linde
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, The Centre for Psychotherapy, Education & Research, Liljeholmstorget 7, SE-117 63 Stockholm, Sweden
| | - Marianne Bonnert
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, The Centre for Psychotherapy, Education & Research, Liljeholmstorget 7, SE-117 63 Stockholm, Sweden
| | - Tobias Lundgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, The Centre for Psychotherapy, Education & Research, Liljeholmstorget 7, SE-117 63 Stockholm, Sweden.
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Smith AW, Gutierrez-Colina AM, Roemisch E, Hater B, Combs A, Shoulberg AM, Modi AC. Modifiable factors related to transition readiness in adolescents and young adults with epilepsy. Epilepsy Behav 2021; 115:107718. [PMID: 33440273 DOI: 10.1016/j.yebeh.2020.107718] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/25/2020] [Accepted: 12/14/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To characterize transition readiness in adolescents and young adults (AYAs) with epilepsy and validate the social-ecological model of AYA readiness to transition (SMART) in a sample of AYAs with epilepsy. METHODS This cross-sectional study included typically developing youth with epilepsy 13-25 years old seen in a comprehensive epilepsy center. Adolescents and young adults completed measures of transition readiness (Transition Readiness Assessment Questionnaire; TRAQ), epilepsy knowledge, epilepsy self-management, developmental factors, and emotional and behavioral functioning. Adolescents and young adults also completed a measure of their relationship quality with healthcare providers. Caregiver report was included when available. RESULTS Participants included 82 AYAs (Mage = 17.3 ± 2.8; 86.6% White Non-Hispanic, 53.7% females) with epilepsy. Transition Readiness Assessment Questionnaire scores (M = 3.33, SD = 0.86) were correlated with modifiable and non-modifiable factors: age (r = 0.66, p < 0.001), income (r = -0.23, p = 0.04), AYA cognitive problems (r = 0.24, p = 0.03), AYA knowledge (r = 0.31, p = 0.005), AYA expectations (r = 0.26, p ≤ 02), AYA inattention (r = -0.24, p = 0.03), AYA executive dysfunction (r = 0.25, p = 0.02), caregiver-reported AYA odd behaviors (r = -0.25, p = 0.036), and caregiver-reported AYA communication problems (r = 0.25, p = 0.04). Transition Readiness Assessment Questionnaire scores were higher in AYAs who had seen adult providers for general healthcare issues (e.g., primary care), but were not related to other demographic (e.g., minority status, insurance), medical (years since diagnosis, type of epilepsy, polytherapy, seizure frequency), developmental (e.g., adaptive skills, cognitive functioning) or emotional/behavioral factors (e.g., skills, relationship with the provider, psychosocial functioning). Linear regression including variables significantly correlated with the outcome of transition readiness (F (7, 59) = 9.70, p < 0.001) explained 54% of the variance. Specifically, age was the only significant model predictor. SIGNIFICANCE Transition readiness in AYAs with epilepsy was predicted by non-modifiable (e.g., age) and correlated with modifiable factors (e.g., knowledge, psychosocial/cognitive functioning). Providers must better prepare patients prior to transfer, and future research should use an epilepsy-specific measure of transition readiness to identify targets for intervention.
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Affiliation(s)
| | | | | | | | | | | | - Avani C Modi
- Cincinnati Children's Hospital Medical Center, United States
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Honari B, Homam SM, Nabipour M, Mostafavian Z, Farajpour A, Sahbaie N. Epilepsy and quality of life in Iranian epileptic patients. J Patient Rep Outcomes 2021; 5:16. [PMID: 33511464 PMCID: PMC7843789 DOI: 10.1186/s41687-021-00292-3] [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: 05/24/2020] [Accepted: 01/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background Epilepsy is one of the most common neurological disorders with physical, emotional, and social consequences. Previous studies indicate that epilepsy symptoms can highly affect the epileptic patients’ satisfaction in life. The aim of the present study is to investigate the QOL of People with Epilepsy (PWE) in Khorasan Razavi province, Iran. Methods In this study, 100 patients were randomly selected. After confirmation of the diagnosis of epilepsy by neurologists and fulfilling the entrance criteria, patients completed the Quality of Life in Epilepsy-31 inventory (QOLIE-31) questionnaire. Finally, data was analyzed statistically by SPSS software. Results The study sample comprised 100 PWE, aged 18–74 years (34 ± 13), of whom 58 (58%) were females. Tonic-colonic seizure was the most common (60%) type of seizure. The obtained score of each subscale and the range of the QOLIE-31 total score was 16.40–79.18 with the mean of 50 (SD = 16). The energy-fatigue subscale score was significantly higher in patients younger than 35 (p = 0.018). The data analysis showed that the seizure worry subscale was significantly higher in single patients (p = 0.04). Duration of epilepsy had a positive correlation with QOLIE-31 total score (p = 0.038), and a negative relationship with energy-fatigue subscale (p = 0.018). In contrast with previous studies, which reported the frequency of the epileptic episodes as the most important predictor of QOL, our results showed no significant correlation between the number of the episodes and overall QOL score (p = 0.063). However, the number of episodes was significantly correlated with emotional well-being and cognition subscales. Furthermore, the results indicated that poor QOL score is correlated with depressed mood. Conclusion In fact, the ultimate and preferred outcome of all treatments and care interventions is the patient’s QOL. Thus, improvement of the QOL by means of obtaining more information about its contributing factors, in PWE should be one of the main goals in the patients’ treatment.
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Affiliation(s)
- Bahareh Honari
- Faculty of Psychology and Educational Sciences, Semnan University, Semnan, Iran
| | - Seyed Mehran Homam
- Department of Neurology, Mashhad Branch, Islamic Azad University, Mashhad, Iran.
| | - Maryam Nabipour
- Faculty of Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Zahra Mostafavian
- Department of Community Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Arezou Farajpour
- Department of Education Development Center, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Nyusha Sahbaie
- Faculty of Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran
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Tombini M, Assenza G, Quintiliani L, Ricci L, Lanzone J, Di Lazzaro V. Epilepsy and quality of life: what does really matter? Neurol Sci 2021; 42:3757-3765. [PMID: 33449244 DOI: 10.1007/s10072-020-04990-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/11/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE To assess quality of life (QoL) in adult people with epilepsy (PWE) and identify the main factors affecting it. METHODS We enrolled consecutively 122 PWE. They were interviewed for a careful collection of demographic and clinical data. Patients completed dedicated questionnaires for the assessment of the quality of life (Quality of Life in Epilepsy Scale-31) (Q31) as well as psychosocial features: depressive symptoms (DS) (Beck Depression Inventory-II/BDI-II), difficulties of emotion regulation (Difficulties of Emotion Regulation Scale/DERS), and stigma related to epilepsy (Stigma Scale of Epilepsy/SSE and Jacoby's Stigma Scale/JSS). The results of Q31 and their subscales were correlated with clinical details of PWE, as well as the other scores. A stepwise multiple regression analysis was applied to identify the main factors affecting QoL. RESULTS Quality of life is inversely correlated mostly with psychosocial features, as DS, emotion dysregulation, and stigma perception, as well as with epilepsy-related factors, as the seizure frequency and number of antiseizure medications (ASMs). The combination of DS, perceived stigma, and number of ASMs best explained the QoL. Worse features of QoL were detected in females and in patients with age of epilepsy onset in adulthood. CONCLUSION Quality of life in adult PWE is predominantly affected by psychosocial factors more than epilepsy-related ones. These findings suggest that effective epilepsy management requires more than seizure control, and early detection of psychological dysfunction and tailored interventions to improve the QoL should be considered.
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Affiliation(s)
- Mario Tombini
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128, Rome, Italy.
| | - Giovanni Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128, Rome, Italy
| | - Livia Quintiliani
- Psicologia Clinica, Università Campus Bio-Medico, via Álvaro del Portillo 21, 00128, Rome, Italy
| | - Lorenzo Ricci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128, Rome, Italy
| | - Jacopo Lanzone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128, Rome, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128, Rome, Italy
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Campos-Fernández D, Fonseca E, Olivé-Gadea M, Quintana M, Abraira L, Seijo-Raposo I, Santamarina E, Toledo M. The mediating role of epileptic seizures, irritability, and depression on quality of life in people with epilepsy. Epilepsy Behav 2020; 113:107511. [PMID: 33129044 DOI: 10.1016/j.yebeh.2020.107511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/16/2020] [Accepted: 09/20/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Psychiatric comorbidity is common in epilepsy and has a considerable impact on patient quality of life (QoL). This study aimed to analyze the relationship between seizure frequency, irritability, and depression and describe how they mediate each other's effect on QoL in epilepsy. METHODS This is a cross-sectional study of consecutive adults seen at an outpatient epilepsy clinic of a tertiary hospital in Barcelona, Spain. All the patients were evaluated for psychiatric comorbidity and administered the State-Trait Anger Expression Inventory-2 (STAXI-2), the Hospital Anxiety and Depression Scale (HADS), and the Quality Of Life in Epilepsy Inventory-10 (QOLIE-10). Mediation analysis with multiple linear regression followed by the Sobel test was performed. RESULTS We studied 157 patients. Seizure frequency (R = -0.193, P = .053), irritability (R = 0.216, P = .039), and depression (R = -0.598, P < .001) had all a negative effect on QoL. In the adjusted linear regression model, depression was the only independent predictor of impaired QoL (B = -2.453 [95% confidence interval (CI): -3.161, -1.744], P < .001). The Sobel test showed that depression exerted a significant mediating effect on seizure frequency (Z = -1.984; P = .047) and irritability (Z = -3.669; P < .001) in their influence on QoL. CONCLUSION Depression is an independent predictor of worse QoL and significantly mediated the effects of irritability and poor seizure control on QoL impairment in patients with epilepsy.
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Affiliation(s)
- Daniel Campos-Fernández
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Elena Fonseca
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain.
| | - Marta Olivé-Gadea
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Laura Abraira
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Iván Seijo-Raposo
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
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Alexithymia and emotion dysregulation in adult patients with epilepsy. Epilepsy Behav 2020; 113:107537. [PMID: 33242774 DOI: 10.1016/j.yebeh.2020.107537] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The concept of alexithymia refers to difficulty perceiving, identifying, and describing emotions. We aimed at evaluating the prevalence of alexithymia in a sample of adult people with epilepsy (PWE) with and without psychogenic nonepileptic seizures (PNES) and healthy control subjects (HC) and identifying major factors able to affect it. MATERIALS AND METHODS We enrolled consecutively 91 PWE (12 of which with PNES in addition to seizures) and 146 HC age- and gender-matched. Both groups' subjects completed the following questionnaires: TAS-20, Beck Depression Inventory-II (BDI-II), Difficulties in Emotion Regulation Scale (DERS) and the Italian translation of Stigma Scale of Epilepsy (SSE), able to evaluate stigma related to epilepsy both in epileptic and nonepileptic subjects. Moreover, PWE completed the well-known Jacoby's Stigma Scale (JSS), dedicated to the evaluation of stigma only by patients with epilepsy and QOLIE-31 (Q31) for evaluating the quality of life. We analyzed correlations between alexithymia and several epilepsy-related (seizure frequency, antiseizure medications-ASMs) and psychosocial factors. Finally, a stepwise multiple regression analysis was performed to identify major factor affecting alexithymia in both groups. RESULTS Alexithymia was prevalent in PWE compared to controls (17.6% of alexithymic subjects in PWE vs 11% in HC), without discriminating epileptic subjects with and without PNES. This predominance disappeared when depressive symptoms (DS) were controlled for. The difficulties of identifying feelings and emotions resulted to be clearly higher in PWE, even when DS are controlled for, and significantly correlated with stigma perception. Alexithymia in PWE was also strongly associated with lower quality of life and education and greater number of ASMs and difficulties in emotion regulation (ER), that turned out to be the main factor affecting alexithymia in both groups (PWE and HC). CONCLUSIONS Alexithymia is prevalent in PWE, mostly influenced by DS and significantly associated with worse quality of life and higher emotion dysregulation and stigma perception. The latter finding could be explained by difficulty identifying emotions (DIE) that selectively characterizes PWE.
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O'Dwyer R. Epilepsy: Workup and Management in Adults. Semin Neurol 2020; 40:624-637. [PMID: 33176373 DOI: 10.1055/s-0040-1719069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
When managing epilepsy, there is a temptation to focus care with respect to the last and the next seizure. However, epilepsy is a multifaceted chronic condition and should be treated as such. Epilepsy comes with many physical risks, psychological effects, and socioeconomic ramifications, demanding a long-term commitment from the treating physician. Patients with epilepsy, compared to other chronically ill patient populations, have a worse quality of life, family function, and less social support. The majority of patients are well controlled on antiseizure drugs. However, approximately one-third will continue to have seizures despite optimized medical management. The primary aim of this article is to explore the long-term management of chronic epilepsy, and to address some of the particular needs of patients with chronic epilepsy.
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Affiliation(s)
- Rebecca O'Dwyer
- Department of Neurological Science, Rush University Medical Center, Chicago, Illinois
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42
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Lee SA, Kim SJ. Self-efficacy in seizure management differentially correlated with quality of life in persons with epilepsy depending on seizure recurrence and felt stigma. Seizure 2020; 81:91-95. [DOI: 10.1016/j.seizure.2020.07.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 01/06/2023] Open
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Yang L, Yan M, Du L, Hu S, Zhang Z. Comparative efficacy and safety of different drugs for bipolar disorder complicated with anxiety disorder: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2020; 99:e22280. [PMID: 32957382 PMCID: PMC7505332 DOI: 10.1097/md.0000000000022280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Nowadays, there are some randomized controlled trials (RCTs) to explore the effectiveness of drug therapy for bipolar disorder with anxiety disorders. However, due to lack of sufficient data, there are currently no good treatment recommendations. The purpose of this network meta-analysis is to compare the efficacy and safety of different drugs for bipolar disorder complicated with anxiety disorders to provide evidence to support clinical practice and guidelines development. METHODS A systematic literature search will be performed in the Cochrane Library, PubMed, EMBASE, and Web of Science from inception to July 2020. RCTs that compared the efficacy and safety of different drugs for bipolar disorder complicated with anxiety disorders will be included. Two reviewers will independently search and select the studies, extract the data, and assess the risk of bias. We will assess the risk of bias of included RCTs using the Cochrane risk of bias tool. The WinBUGS 1.4.3 software will be used to perform the network meta-analysis, and the result figures will be generated by STATA 15.0 software. In addition, we will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess the quality of evidence. RESULTS This study will systematically compare the efficacy and safety of different drugs for bipolar disorder complicated with anxiety disorders. The results of this network meta-analysis will be submitted to a peer-reviewed journal for publication. CONCLUSION Our study will provide evidence for the drug therapy of patients with bipolar disorder complicated with anxiety disorders, and provide suggestions for clinical practice or guidelines. INPLASY REGISTRATION NUMBER INPLASY202070132.
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Affiliation(s)
- Li Yang
- Intensive-Care Unit, The First People's Hospital of Lanzhou City, Lanzhou, China
| | - Meili Yan
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Li Du
- Psychiatry Department, The Third People's Hospital of Lanzhou City, Lanzhou, China
| | - Shasha Hu
- Gynecology Department, The First Hospital of Lanzhou University, Lanzhou, China
| | - Zhigang Zhang
- Intensive-Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
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Abstract
This article reviews common and clinically important neuropsychiatric aspects of epilepsy. Comorbidities are common, underdiagnosed, and powerfully impact clinical outcomes. Biological, psychological, and social factors contribute to the associations between epilepsy and neuropsychiatric disorders. Epidemiologic studies point to a bidirectional relationships between epilepsy and neuropsychiatric disorders. People with epilepsy are more likely to develop certain neuropsychiatric disorders, and those with these disorders are more likely to develop epilepsy. This relationship suggests the possibility of shared underlying pathophysiologies. We review the neuropsychiatric impact of antiseizure medications and therapeutic options for treatment. Diagnosis and treatment involve close collaboration among a multidisciplinary team.
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Affiliation(s)
- Benjamin Tolchin
- Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, 15 York Street, New Haven, CT 06510, USA; Epilepsy Center of Excellence, VA Connecticut Healthcare System, West Haven, CT, USA.
| | - Lawrence J Hirsch
- Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, 15 York Street, New Haven, CT 06510, USA
| | - William Curt LaFrance
- Brown University, Rhode Island Hospital, Potter 3, 593 Eddy Street, Providence, RI 02903, USA
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Johnson EK, Fraser RT, Lashley S, Barber J, Brandling-Bennett EM, Vossler DG, Miller JW, Caylor L, Warheit-Niemi T. Program of Active Consumer Engagement in Self-Management in Epilepsy: Replication and extension of a self-management randomized controlled trial. Epilepsia 2020; 61:1129-1141. [PMID: 32401339 DOI: 10.1111/epi.16530] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The Program of Active Consumer Engagement in Self-Management in Epilepsy (PACES) is an evidenced-based self-management intervention for adults with epilepsy. Prior randomized controlled trial (RCT) data show that PACES reduces depression and improves self-management, self-efficacy, and quality of life for 6 months postprogram. The objective of this study was to replicate a PACES RCT with key extensions: more diverse patient pool from community-based epilepsy centers; option for telephone-based participation; and longer follow-up (12 months with booster support for intervention group), to examine duration of impact and inform dissemination and implementation. METHODS Participants were adults with chronic epilepsy (n = 101) without serious mental illness or substantive intellectual impairment, recruited from three epilepsy centers. Participants were randomly assigned to intervention or waitlist control groups. Outcomes included the Epilepsy Self-Management Scale (ESMS), Epilepsy Self-Efficacy Scale (ESES), Quality of Life in Epilepsy-31, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7, administered at baseline, postintervention (8 weeks), and 6 and 12 months postintervention. Intervention was an 8-week group of five to eight adults co-led by a psychologist and trained peer with epilepsy that met once per week by teleconference or in person at a hospital for 60-75 minutes. Topics included medical, psychosocial, cognitive, and self-management aspects of epilepsy, as well as community integration and epilepsy-related communication. Treatment group provided program evaluation. RESULTS PACES participants (n = 49) improved relative to controls (n = 52) on the ESES (P < .022) and overall distress composite (P = .008). At 6 months, PACES participants remained improved on the ESES (P = .008) and composite (P = .001), and were improved on the ESMS (P = .005). At 12 months, PACES participants remained improved on the ESMS (P = .006) and were improved on an overall distress composite of combined measures (P = .018). Attrition was low (<6% in each group), and all program satisfaction ratings exceeded 4.0/5.0. SIGNIFICANCE A consumer-generated epilepsy self-management program with broad psychosocial and medical emphasis can be effectively delivered by telephone or in person and facilitates long-term epilepsy self-management, adjustment, and coping up to 1 year after treatment.
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Affiliation(s)
- Erica K Johnson
- Health Promotion Research Center, University of Washington, Seattle, Washington, USA.,Neurology Vocational Services Unit, University of Washington, Seattle, Washington, USA
| | - Robert T Fraser
- Health Promotion Research Center, University of Washington, Seattle, Washington, USA.,Neurology Vocational Services Unit, University of Washington, Seattle, Washington, USA.,Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.,Department of Neurology, University of Washington, Seattle, Washington, USA.,Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Steven Lashley
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | | | - David G Vossler
- Department of Neurology, University of Washington, Seattle, Washington, USA.,UW Medicine, Valley Medical Center, Renton, Washington, USA
| | - John W Miller
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Lisa Caylor
- Swedish Neuroscience Institute, Seattle, Washington, USA
| | - Tessala Warheit-Niemi
- Neurology Vocational Services Unit, University of Washington, Seattle, Washington, USA
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Leal STF, Santos MV, Thomé U, Machado HR, Escorsi-Rosset S, Dos Santos AC, Wichert-Ana L, Leite JP, Fernandes RMF, Sakamoto AC, Hamad APA. Impact of epilepsy surgery on quality of life and burden of caregivers in children and adolescents. Epilepsy Behav 2020; 106:106961. [PMID: 32199346 DOI: 10.1016/j.yebeh.2020.106961] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/31/2020] [Accepted: 02/01/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this study was to analyze the impact of pediatric epilepsy surgery on the quality of life (QOL), determining whether patients improve, worsen, or maintain their preoperative patterns, as it relates to the burden of caregivers, as well as evaluating potential related factors, from both the children and caregivers perspectives. MATERIAL AND METHODS This is a retrospective study of children and adolescents who underwent epilepsy surgery and were evaluated through clinical data, videoelectroencephalogram (V-EEG), neuroimaging findings, neuropsychological testing, and aspects of QOL. These assessments were performed prior to surgery and after six months and two years of follow-up. Quality of life was assessed with epilepsy-specialized questionnaires, namely Questionnaire health-related quality of life for children with epilepsy (QVCE-50), Autoquestionnaire Qualité de Vie Enfant Image Scale (AUQUEI), Quality of life in epilepsy inventory for adolescents (QOLEI-AD-48); and burden of caregivers with Burden Interview - ZARIT scale. Postoperative changes in QVCE-50 were quantified using measures of the analysis of variance (ANOVA MR) for comparison of the difference between the three times of the scale and domains. RESULTS Fifty patients were enrolled. Of these, 27 (54%) were male, with a mean age at surgery of 8.2 years (range: 1-18 years). Thirty-five patients (70%) were Engel I and one was Engel II (2%) at six months of follow-up, whereas 28 (56%) were Engel I and 32 (64%) were Engel I or II at two years of follow-up. Preoperatively, 21 (42%) presented with moderate or severe intellectual disability. Postoperative cognitive evaluations at the two-year follow-up showed 18 (36%) maintained similar deficits. The QVCE-50 showed postoperative improvement in the two-year follow-up period, but not at six months after surgery. Postoperative improvements were associated mainly with better seizure outcome. Autoperception evaluations were limited because of the clinical and cognitive severity of patients. The burden of caregivers was quoted as mild to moderate and remained unchanged postoperatively. CONCLUSIONS Children and adolescents with surgically treated epilepsy reach a good seizure outcome, stabilize in intellectual and adaptive functions, and have an increase in QOL, from the caregiver's perspective. Nevertheless, their burden remains unchanged. Seizure outcome is the main factor for improvement in the QOL. The upgrading of structured questionnaires and QOL instruments specific to pediatric epilepsy can be helpful to assess patient- and caregiver-reported surgical outcomes, allowing for better planning of therapeutic approaches.
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Affiliation(s)
- Suenia Timotheo Figueiredo Leal
- Department of Neurosciences and Behavioural Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Marcelo Volpon Santos
- Center for Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Division of Pediatric Neurosurgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Ursula Thomé
- Center for Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Helio Rubens Machado
- Center for Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Division of Pediatric Neurosurgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Sara Escorsi-Rosset
- Center for Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Radiology Division-Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Antônio Carlos Dos Santos
- Center for Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Radiology Division-Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Lauro Wichert-Ana
- Center for Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Section of Nuclear Medicine, Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - João Pereira Leite
- Department of Neurosciences and Behavioural Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Regina Maria França Fernandes
- Department of Neurosciences and Behavioural Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Ameriko Ceiki Sakamoto
- Department of Neurosciences and Behavioural Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Center for Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Ana Paula Andrada Hamad
- Department of Neurosciences and Behavioural Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Center for Epilepsy Surgery (CIREP), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
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Gonzalez LM, Wrennall JA. A neuropsychological model for the pre-surgical evaluation of children with focal-onset epilepsy: An integrated approach. Seizure 2020; 77:29-39. [DOI: 10.1016/j.seizure.2018.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/28/2018] [Accepted: 12/17/2018] [Indexed: 12/20/2022] Open
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48
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Englot DJ, Morgan VL, Chang C. Impaired vigilance networks in temporal lobe epilepsy: Mechanisms and clinical implications. Epilepsia 2020; 61:189-202. [PMID: 31901182 DOI: 10.1111/epi.16423] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 12/19/2022]
Abstract
Mesial temporal lobe epilepsy (mTLE) is a neurological disorder in which patients suffer from frequent consciousness-impairing seizures, broad neurocognitive deficits, and diminished quality of life. Although seizures in mTLE originate focally in the hippocampus or amygdala, mTLE patients demonstrate cognitive deficits that extend beyond temporal lobe function-such as decline in executive function, cognitive processing speed, and attention-as well as diffuse decreases in neocortical metabolism and functional connectivity. Given prior observations that mTLE patients exhibit impairments in vigilance, and that seizures may disrupt the activity and long-range connectivity of subcortical brain structures involved in vigilance regulation, we propose that subcortical activating networks underlying vigilance play a critical role in mediating the widespread neural and cognitive effects of focal mTLE. Here, we review evidence for impaired vigilance in mTLE, examine clinical implications and potential network underpinnings, and suggest neuroimaging strategies for determining the relationship between vigilance, brain connectivity, and neurocognition in patients and healthy controls.
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Affiliation(s)
- Dario J Englot
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee.,Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Victoria L Morgan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Catie Chang
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee.,Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
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Comparison of psychiatric comorbidities and impact on quality of life in patients with epilepsy or psychogenic nonepileptic spells. Epilepsy Behav 2020; 102:106649. [PMID: 31759316 DOI: 10.1016/j.yebeh.2019.106649] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/29/2019] [Accepted: 10/02/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Psychiatric comorbidity is common in people with epilepsy (PWE) and psychogenic nonepileptic spells (PNES). These comorbidities can be detrimental to quality of life (QOL) and are often underdiagnosed and undertreated. Some types of epilepsy, such as focal temporal lobe epilepsy (TLE), have been associated with higher rates of psychiatric comorbidity. This study examined the impact of psychiatric comorbidity on QOL in patients admitted to two level 4 epilepsy monitoring units (EMUs). METHODS In this prospective observational study, 200 patients admitted to two level 4 EMUs completed standardized surveys including the Quality of Life in Epilepsy (QOLIE-31-P), Generalized Anxiety Disorder 7-item (GAD-7), Patient Health Questionnaire (PHQ-9), and Beck Depression Inventory-II (BDI-II). Hierarchal multiple regression was performed to assess impact on QOL. RESULTS Of the 200 participants, 113 had a diagnosis of epilepsy, 36 had a diagnosis of PNES, and 51 were excluded for nondiagnostic evaluation or dual diagnosis. Of those with epilepsy, 65 had TLE, 28 had focal extratemporal lobe epilepsy (ETLE), and 20 had nonfocal epilepsy. Patients with PNES had higher self-reported anxiety and depression levels (GAD-7: p = 0.04, PHQ-9: p < 0.01; BDI-II: p < 0.01) but similar QOL to PWE (p = 0.78). Using hierarchal multiple regression, symptoms of anxiety and depression were significant predictors of lower QOL in PWE but not in patients with PNES. There was no difference in QOL in those with ETLE and TLE. CONCLUSIONS Our findings suggest that self-reported anxiety and depression symptoms are common in patients admitted to level 4 EMUs regardless of diagnosis and play an important role in predicting QOL in PWE. Our findings emphasize the importance of routinely screening all EMU patients for psychiatric comorbidity.
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Abstract
PURPOSE OF REVIEW This article reviews the management of patients with medically responsive epilepsy, including discussion of factors that may lead to transient breakthrough seizures and patient and physician strategies to maintain freedom from seizures. RECENT FINDINGS Imperfect adherence, unanticipated changes in ongoing medical therapy, inadvertent use of proconvulsants or concurrent medications that alter epilepsy medication kinetics, and a variety of seizure precipitants such as stress or sleep deprivation may alter long-term seizure control. SUMMARY The majority of patients with epilepsy are medically responsive. Many potential factors may lead to breakthrough seizures in these patients. Identification of these factors, patient education, and use of self-management techniques including mindfulness therapy and cognitive-behavioral therapy may play a role in protecting patients with epilepsy against breakthrough seizures.
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