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Pellinen J, Foster EC, Wilmshurst JM, Zuberi SM, French J. Improving epilepsy diagnosis across the lifespan: approaches and innovations. Lancet Neurol 2024; 23:511-521. [PMID: 38631767 DOI: 10.1016/s1474-4422(24)00079-6] [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: 10/30/2023] [Revised: 02/11/2024] [Accepted: 02/16/2024] [Indexed: 04/19/2024]
Abstract
Epilepsy diagnosis is often delayed or inaccurate, exposing people to ongoing seizures and their substantial consequences until effective treatment is initiated. Important factors contributing to this problem include delayed recognition of seizure symptoms by patients and eyewitnesses; cultural, geographical, and financial barriers to seeking health care; and missed or delayed diagnosis by health-care providers. Epilepsy diagnosis involves several steps. The first step is recognition of epileptic seizures; next is classification of epilepsy type and whether an epilepsy syndrome is present; finally, the underlying epilepsy-associated comorbidities and potential causes must be identified, which differ across the lifespan. Clinical history, elicited from patients and eyewitnesses, is a fundamental component of the diagnostic pathway. Recent technological advances, including smartphone videography and genetic testing, are increasingly used in routine practice. Innovations in technology, such as artificial intelligence, could provide new possibilities for directly and indirectly detecting epilepsy and might make valuable contributions to diagnostic algorithms in the future.
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Affiliation(s)
- Jacob Pellinen
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Emma C Foster
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jo M Wilmshurst
- Red Cross War Memorial Children's Hospital and University of Cape Town Neuroscience Institute, Cape Town, South Africa
| | - Sameer M Zuberi
- Royal Hospital for Children and University of Glasgow School of Health & Wellbeing, Glasgow, UK
| | - Jacqueline French
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, NY, USA
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Yan L, Chen J, Xie L, Li T, Hu Y, Hong S, Jiang L. Mediating effects of sleep quality between clinical characteristics and quality of life in children with epilepsy: A cross-sectional study from Southwest China. Epilepsy Behav 2024; 154:109738. [PMID: 38513572 DOI: 10.1016/j.yebeh.2024.109738] [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: 12/01/2023] [Revised: 03/08/2024] [Accepted: 03/10/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Although sleep quality (SQ) reportedly affects the health-related quality of life (QOL) of patients with epilepsy, little is known about the potential association between SQ and QOL, particularly in children with epilepsy (CWE). Our study aimed to investigate the mediating effect of SQ on the QOL of CWE to obtain more information for the prevention and treatment of epilepsy in children. METHODS We collected general demographic and clinical data of 212 CWE and 79 controls (children who visited the Health Examination Department), and their guardians were instructed to answer the Children's Sleep Habits Questionnaire (CSHQ) and the optimized Quality of Life in Childhood Epilepsy Questionnaire-16 (QOLCE-16). The t-test, analysis of variance, chi-square test, and Fisher's exact test were used for between group comparisons. The Pearson correlation was used to analyze the correlation between variables. The direct, indirect, and total effects of predictors on the QOL of CWE were estimated based on an adjusted mediation model. RESULTS CWE had significantly smaller long-term urban residence rates, less educated guardians, higher total CSHQ score, higher incidence of poor SQ, higher bedtime resistance, more sleep anxiety, worse sleep-disordered breathing, increased parasomnia, more daytime sleepiness, more frequent night waking, and greater sleep onset delay than controls (P < 0.05 for all). The univariable analysis showed significant differences in total CSHQ scores between CWE with different seizure frequency in the last month, whether or not drug-resistant epilepsy (DRE), and with different video electroencephalogram (VEEG) findings (P < 0.05 for all). Differences in QOLCE-16 scores between CWE with different guardian's employment status, age at diagnosis, number of anti-seizure medication (ASM) types, seizure frequency in the last month, DRE status, seizure type, VEEG findings, neuropsychological evaluation findings, magnetic resonance imaging (MRI) findings, and etiology were statistically significant (P < 0.05 for all). The correlation study indicated that the total CSHQ score was negatively correlated with the QOLCE-16 score (P < 0.05). The mediation analysis showed that DRE and VEEG abnormalities had a standardized direct effect on the QOL. Seizure frequency in the last month, DRE, and VEEG abnormalities had an indirect effect on the QOL through SQ, and their mediating effect values of SQ were 31.61 %, 13.45 %, and 14.35 %, respectively. CONCLUSION Our findings uncovered the relationship of some clinical characteristics with SQ and QOL and characterized the nature of factors affecting the QOL of CWE. SQ could be a key factor in the prognosis of CWE experiencing epileptic seizures, and more attention should be paid on the management of SQ in interventions for epilepsy.
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Affiliation(s)
- Lisi Yan
- Department of Neurology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China.
| | - Jin Chen
- Department of Neurology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China.
| | - Lingling Xie
- Department of Neurology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China.
| | - Tianyi Li
- Department of Neurology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China.
| | - Yue Hu
- Department of Neurology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China.
| | - Siqi Hong
- Department of Neurology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China.
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China.
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Wei W, Dong L, Ye J, Xiao Z. Current status and influencing factors of family resilience in families of children with epilepsy: a cross-sectional study. Front Psychiatry 2024; 15:1354380. [PMID: 38516257 PMCID: PMC10954834 DOI: 10.3389/fpsyt.2024.1354380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/21/2024] [Indexed: 03/23/2024] Open
Abstract
Purpose The study was designed to describe the level of family resilience and identify the protective factors and vulnerability factors of family resilience in families of children with epilepsy. So as to provide theoretical guidance for implementing intervention programs to promote family resilience. Methods From November 2020 to July 2021, 258 parents of children with epilepsy were investigated using a convenience sampling method. The questionnaire included demographic data, Chinese-Family Resilience Assessment Scale, Social Support Rating Scale, and the Beck Depression Inventory. SPSS25.0 was used for descriptive statistical analysis, univariate analysis, and multivariate linear regression analysis. Results In this study, two hundred and fifty-eight primary caregivers completed the paper questionnaires. The total score of family resilience was (134.97 ± 16.57), which was above the medium level. Multiple linear regression analysis revealed that subjective support (β=0.327, P<0.001), comorbidity (β=0.181, P<0.05), objective support (β=0.117, P<0.05), and parental depression (β=-0.158, P<0.05) were significantly related to family resilience. These variables contribute 31.7% of the variance in family resilience (F=18.07, P< 0.001). Conclusion The families of children with epilepsy presented appropriate resilience after the children were diagnosed with epilepsy. Family resilience was correlated with multiple factors, subjective and objective support could be protective factors, comorbidity and parental depression could be vulnerability factors of family resilience. Therefore, future psychosocial interventions could focus on enhancing subjective support and objective support, reducing parental depression, and screening for epilepsy comorbidity to promote the family resilience of children with epilepsy.
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Affiliation(s)
- Wenjing Wei
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lianlian Dong
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jinghua Ye
- Department of Neurology, China Medical University Shenzhen Children’s Hospital, Shenzhen, China
| | - Zhitian Xiao
- Department of Neurology, China Medical University Shenzhen Children’s Hospital, Shenzhen, China
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Huntsman RJ, Elliott J, Lewis E, Moore-Hepburn C, Alcorn J, Mansell H, Appendino JP, Bélanger RE, Corley S, Crooks B, Denny AM, Finkelstein Y, Finley A, Fung R, Gilpin A, Litalien C, Jacobs J, Oberlander TF, Palm A, Palm J, Polewicz M, Quinn D, Rassekh SR, Repetski A, Rieder MJ, Robson-McKay A, Seifert B, Shackelford A, Siden H, Szafron M, ‘t Jong G, Vaillancourt R, Kelly LE. Removing barriers to accessing medical cannabis for paediatric patients. Paediatr Child Health 2024; 29:12-16. [PMID: 38332979 PMCID: PMC10848115 DOI: 10.1093/pch/pxac129] [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: 07/04/2022] [Accepted: 12/05/2022] [Indexed: 02/10/2024] Open
Abstract
Medical cannabis (MC) may offer therapeutic benefits for children with complex neurological conditions and chronic diseases. In Canada, parents, and caregivers frequently report encountering barriers when accessing MC for their children. These include negative preconceived notions about risks and benefits, challenges connecting with a knowledgeable healthcare provider (HCP), the high cost of MC products, and navigating MC product shortages. In this manuscript, we explore several of these barriers and provide recommendations to decision-makers to enable a family-centered and evidence-based approach to MC medicine and research for children.
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Affiliation(s)
- Richard J Huntsman
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jesse Elliott
- Independent Researcher, Canadian Collaborative for Childhood Cannabinoid Therapeutics, Winnipeg, Manitoba, Canada
| | - Evan Lewis
- Neurology Center of Toronto and Division of Pediatric Neurology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Jane Alcorn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Holly Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Juan P Appendino
- Division of Pediatric Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Richard E Bélanger
- Départment de Pédiatrie, Faculté de medicine, Université de Laval, Québec, Québec, Canada
| | - Scott Corley
- Cannabinoid Research Initiative of Saskatchewan, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Bruce Crooks
- Division of Paediatric Hematology/Oncology, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - AnneMarie M Denny
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Yaron Finkelstein
- Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Allen Finley
- Departments of Anesthesia and Psychology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ryan Fung
- Department of Pediatric Pharmacy, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Andrea Gilpin
- The Rosalind and Morris Goodman Family Pediatrics Formulation Centre of the CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Catherine Litalien
- Département de Pédiatrie, Faculté de Médecine, Université de Montréal, and The Rosalind and Morris Goodman Family Pediatric Formulation Centre of the CHU Sainte Justine, Montréal, Québec, Canada
| | - Julia Jacobs
- Division of Pediatric Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Timothy F Oberlander
- Department of Pediatrics and School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ashley Palm
- Parent Advocate, Canadian Collaborative for Childhood Cannabinoid Therapeutics, Winnipeg, Manitoba, Canada
| | - Jacob Palm
- Parent Advocate, Canadian Collaborative for Childhood Cannabinoid Therapeutics, Winnipeg, Manitoba, Canada
| | - Monika Polewicz
- Division of Pediatric Research, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Declan Quinn
- Division of Pediatric Psychiatry, Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - S Rod Rassekh
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Repetski
- Parent Advocate, Canadian Collaborative for Childhood Cannabinoid Therapeutics, Winnipeg, Manitoba, Canada
| | - Michael J Rieder
- Division of Pediatric Pharmacology, Department of Pediatrics, University of Western Ontario, London, Ontario, Canada
| | - Amy Robson-McKay
- Division of Pediatric Psychiatry, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Blair Seifert
- Department of Pediatric Pharmacy, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | | | - Hal Siden
- Division of Palliative Care, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Szafron
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Geert ‘t Jong
- Departments of Pediatrics and Pharmacology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Régis Vaillancourt
- Department of Pediatric Pharmacy, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Lauren E Kelly
- George and Fay Yee Centre for Health Care Innovation and Children’s Hospital Research Institute of Manitoba, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
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Kamada Y, Imanishi A, Chiu SW, Yamaguchi T. Burden of narcolepsy in Japan: A health claims database study evaluating direct medical costs and comorbidities. Sleep Med 2024; 114:119-127. [PMID: 38181583 DOI: 10.1016/j.sleep.2023.12.020] [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: 05/24/2023] [Revised: 11/28/2023] [Accepted: 12/21/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE This study aimed to determine the burden of narcolepsy in terms of direct medical costs and comorbidities and compare it with the respective burden of schizophrenia, epilepsy, and ulcerative colitis as controls. METHODS Patients diagnosed with narcolepsy (at least once based on the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, code G47.4) between April 2017 and March 2022 were identified on the health insurance claims database compiled by JMDC Inc. Patients with schizophrenia (F20), epilepsy (G40), and ulcerative colitis (K51) were matched as controls. Direct medical costs (including inpatient, outpatient, and medication costs) and comorbidities were analyzed. RESULTS We identified 4,594 patients with narcolepsy (≥18 years), 18,376 with schizophrenia, 18,376 with epilepsy, and 4,594 with ulcerative colitis. The total annual direct medical cost per person with narcolepsy was 349,188 JPY. The cost for narcolepsy was less than that for schizophrenia, epilepsy, and ulcerative colitis. Several comorbidities, such as sleep apnea, attention deficit hyperactivity disorder (ADHD), and obesity were more prevalent in the narcolepsy group. CONCLUSIONS The total direct cost for narcolepsy was approximately three times higher than the national medical expense for people aged 15-44 years (122,000 JPY in 2020), but lower than the total cost for all control diseases. The patients with narcolepsy were also likely to have comorbidities that affected their burden. These findings can contribute to future discussions on medical expense assistance programs for patients with narcolepsy.
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Affiliation(s)
- Yuta Kamada
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Miyagi, Japan; Eisai Co., Ltd., Tokyo, Japan.
| | - Aya Imanishi
- Department of Neuropsychiatry, Akita University School of Medicine, Akita, Japan.
| | - Shih-Wei Chiu
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Miyagi, Japan.
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Miyagi, Japan.
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Wang J, Chen W, Lai Y. Comprehensive nursing program for children with epilepsy: A randomized controlled trial. Niger J Clin Pract 2023; 26:1498-1504. [PMID: 37929526 DOI: 10.4103/njcp.njcp_93_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Background Epilepsy is a relatively common childhood neurological disease. Children with epilepsy need to take precautions to minimize seizure damage in order to adapt to seizures and manage them. Aim The current study aimed to evaluate the feasibility and effects of a comprehensive nursing program for children with epilepsy to reduce children's symptoms of epilepsy. Subject and Methods Participants were children suffering from epilepsy between 2019 and 2021 at Ningbo Women and Children's Hospital. Seventy children were included in a randomized controlled trial with a comprehensive nursing group (CNG) and an active control group (ACG). Measurements were assessed pre- and post-intervention and at a one- and three-month follow-ups. Children in the CNG learned and practiced the strategies related to the comprehensive nursing intervention. The outcomes were anxiety and depression. Results The results showed that anxiety and depression scores were significantly lower in the CNG than the ACG at 1 and 3 months after intervention (P < 0.05). According to the feasibility results, whereas most participants believed that the program was informative and meaningful, a minority reported that it was time-consuming. Conclusion The intervention has the potential to support children with epilepsy. The program is easily accessible, cost-effective and could be implemented in epilepsy care rehabilitation.
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Affiliation(s)
- J Wang
- Department of Pediatrics, Ningbo Women and Children's Hospital, Ningbo, PR China
| | - W Chen
- Department of Urology, Ningbo Urologic and Nephrotic Hospital, Ningbo, PR China
| | - Y Lai
- Department of Pediatrics, Ningbo Women and Children's Hospital, Ningbo, PR China
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Yorulmaz DS, Sezer HK, Kucukoglu S. The development of The Epileptic Seizure Parental Burden Scale: A validity and reliability study. J Pediatr Nurs 2023; 72:153-160. [PMID: 36463015 DOI: 10.1016/j.pedn.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/24/2022] [Accepted: 11/17/2022] [Indexed: 12/02/2022]
Abstract
OBJECTIVE It is common for parents to shoulder the burden of care for their children with chronic diseases. However, there are no robust scales to measure the burden of care of parents of children with epilepsy. This study aimed to develop the "Epileptic Seizure Parental Burden Scale (ESPBS)" and evaluate its psychometric properties. MATERIALS AND METHODS This was a methodological study. The sample consisted of 333 voluntary parents of children with epilepsy. Data were analyzed using the Statistical Package for Social Sciences (SPSS v. 25) at a significance level of p < .05. Content validity, item-total correlation, explanatory factor analysis (EFA), confirmatory factor analysis (CFA), the "upper- and lower-27 percent rule," Cronbach's alpha coefficient, and the split-half reliability method were used for psychometric analysis. RESULTS The scale consisted of 15 items and two subscales. The Kaiser-Meyer-Olkin (KMO) was 0. 961, for which Bartlett's test of sphericity was significant (X2 = 5079.527, p < .001), indicating sampling adequacy and correlation between the items for factor analysis. The scale had item-total item correlations of 0.311 to 0.741. The Explanatory Factor Analysis (EFA) revealed a two-factor structure. According to the confirmatory factor analysis, x2/df, GFI, AGFI, CFI, and RMSEA were 2.012, 0.93, 0.91, 0.97, and 0.055, respectively. These values were very close to a good fit. The items had factor loadings of 0.508 to 0.890. The total scale explained 60.432% of the total variance. The scale had a Cronbach's alpha of 0.93. The split-half reliability indicated a significant (p < .001) and high (r = 0.890) correlation. CONCLUSION The Epileptic Seizure Parental Burden Scale (ESPBS) has high psychometric properties. It is a valid and reliable instrument that can measure the epileptic seizure burden of parents of children with epilepsy.
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Affiliation(s)
- Deniz Sumeyye Yorulmaz
- Artvin University, Faculty of Health Sciences, Çayağzı, Lif Levha Sokak No:11E, 08000 Merkez Artvin, Turkey.
| | - Hilal Kurt Sezer
- Nigde Omer Halisdemir University, Zubeyde Hanim Faculty of Health Sciences, Derbent Yerleşkesi, Atatürk Blv., 51200 Niğde Merkez, Turkey
| | - Sibel Kucukoglu
- Selçuk University, Nursing Faculty, Ardıçlı, 42250 Selçuklu, Konya, Turkey
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Tinelli M M, Roddy A, Knapp M, Arango C, Mendez MA, Cusack J, Murphy D, Canitano R, Oakley B, Quoidbach V. Economic Evaluation of anti-epileptic Medicines for Autistic Children with Epilepsy. J Autism Dev Disord 2023:10.1007/s10803-023-05941-8. [PMID: 37142904 DOI: 10.1007/s10803-023-05941-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 05/06/2023]
Abstract
We examine the cost-effectiveness of treating epilepsy with anti-epileptic medicines in autistic children, looking at impacts on healthcare providers (in England, Ireland, Italy and Spain) and children's families (in Ireland). We find carbamazepine to be the most cost-effective drug to try first in children with newly diagnosed focal seizures. For England and Spain, oxcarbazepine is the most cost-effective treatment when taken as additional treatment for those children whose response to monotherapy is suboptimal. In Ireland and Italy, gabapentin is the most cost-effective option. Our additional scenario analysis presents the aggregate cost to families with autistic children who are being treated for epilepsy: this cost is considerably higher than healthcare provider expenditure.
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Affiliation(s)
- Michela Tinelli M
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK.
| | - Aine Roddy
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
- Atlantic Technological University, Sligo, Ireland
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, School of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, CIBERSAM, IiSGM, Madrid, Spain
| | - Maria Andreina Mendez
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, School of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, CIBERSAM, IiSGM, Madrid, Spain
| | | | | | - Roberto Canitano
- azienda - Azienda ospedaliero-universitaria Senese, Siena, Italy
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Bakri AH, Hassan MH, Ahmed AEA, Alotaibi G, Halim PR, Abdallah AAM, Rashwan NI. Serum Levels of Growth-Associated Protein-43 and Neurotrophin-3 in Childhood Epilepsy and Their Relation to Zinc Levels. Biol Trace Elem Res 2023; 201:689-697. [PMID: 35349008 PMCID: PMC9849170 DOI: 10.1007/s12011-022-03213-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/19/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Epilepsy is one of the most common neurological disorders, and it places a significant economic strain on the healthcare system around the world. Although the exact mechanism of epilepsy has yet to be illustrated, various pathogenic cascades involving neurotransmitters and trace elements have been reported. We aimed to investigate the serum levels of growth-associated protein-43 (GAP-43) and neurotrophin-3 (NT-3) among cohort of Egyptian children with epilepsy and correlate these biomarkers with their zinc levels. METHODS This case-control study included 50 pediatric patients with epilepsy who were comparable with 50 controls. Neurological assessment and electroencephalogram (EEG) were done to all included children. Biochemical measurements of serum GAP-43 and NT-3 using enzyme linked immunosorbent assays (ELISA), and total antioxidant capacity (TAC) and zinc using colorimetric assays, were performed to all participants. RESULTS There was significantly frequent positive parental consanguinity among cases with significantly frequent generalized onset seizures (94%) than simple partial seizure (6%). There were significantly lower serum GAP-43 and zinc levels with significantly higher TAC among cases vs. the controls, p˂0.05 for all. There was no significant difference in the serum levels of NT-3 among epileptic children vs. the controls, p = 0.269. Serum Zn was positively correlated with GAP-43 level among epileptic children (r = 0.381, p = 0.006). Serum GAP-43 in diagnosing childhood epilepsy at cut-off point ≤ 0.6 ng/mL showed 78% sensitivity, 62% specificity, positive predictive value (PPV) = 50.6%, negative predictive value (NPP) = 84.9% with AUC = 0.574. CONCLUSION GAP-43 can be considered a sensitive good negative biomarker in childhood epilepsy which correlated positively with the zinc status.
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Affiliation(s)
- Ali Helmi Bakri
- Department of Pediatrics, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Mohammed H Hassan
- Department of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena, 83523, Egypt.
| | - Ahmed El-Abd Ahmed
- Department of Pediatrics, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Ghallab Alotaibi
- Department of Pharmaceutical Sciences, College of Pharmacy, Shaqra University, Al-Dawadmi Campus, Shaqra, Saudi Arabia
| | - Pola Rafat Halim
- Department of Pediatrics, Faculty of Medicine, South Valley University, Qena, Egypt
| | | | - Nagwan I Rashwan
- Department of Pediatrics, Faculty of Medicine, South Valley University, Qena, Egypt
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10
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Almojuela A, Xu Q, O'Carroll A, Ritchie L, Serletis D. Paediatric epilepsy surgery: Techniques and outcomes. J Paediatr Child Health 2022; 58:1952-1957. [PMID: 36197046 DOI: 10.1111/jpc.16236] [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: 01/02/2022] [Revised: 07/23/2022] [Accepted: 09/21/2022] [Indexed: 11/28/2022]
Abstract
Epilepsy is a neurological condition characterised by recurrent and persistent seizures. For paediatric patients, achieving early seizure freedom can have positive impacts on cognition, development, social integration and mental health, leading to improved quality of life. In general, one third of patients with epilepsy are refractory to medication; for these patients, epilepsy surgery may offer the only chance for improved seizure control. Epilepsy surgery as a therapeutic intervention has become increasingly accepted in the past few decades, with more diverse options available (including neuromodulatory and minimally invasive techniques). In this context, we discuss here the pre-operative workup for paediatric patients with medically refractory epilepsy and provide an updated review on current and emerging surgical therapies for this condition. We also discuss the clinical, neuropsychological, quality of life and economic impacts of epilepsy surgery.
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Affiliation(s)
- Alysa Almojuela
- Section of Neurosurgery, Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Qi Xu
- Section of Pediatric Neurology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Aoife O'Carroll
- Section of Pediatric Neurology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Lesley Ritchie
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
| | - Demitre Serletis
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, United States.,Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland, Ohio, United States
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11
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Baliunas D, Voci S, de Oliveira C, Selby P, Kurdyak P, Rosella L, Zawertailo L, Fu L, Sutradhar R. Association Between Smoking Cessation Treatment and Healthcare Costs in a Single-Payer Public Healthcare System. Nicotine Tob Res 2022; 25:86-93. [PMID: 35792868 PMCID: PMC9717383 DOI: 10.1093/ntr/ntac166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/02/2022] [Accepted: 07/04/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION There has been little investigation of whether the clinical effectiveness of smoking cessation treatments translates into differences in healthcare costs, using real-world cost data, to determine whether anticipated benefits of smoking cessation treatment are being realized. AIMS AND METHODS We sought to determine the association between smoking cessation treatment and healthcare costs using linked administrative healthcare data. In total, 4752 patients who accessed a smoking cessation program in Ontario, Canada between July 2011 and December 2012 (treatment cohort) were each matched to a smoker who did not access these services (control cohort). The primary outcome was total healthcare costs in Canadian dollars, and secondary outcomes were sector-specific costs, from one year prior to the index date until December 31, 2017, or death. Costs were partitioned into four phases: pretreatment, treatment, posttreatment, and end-of-life for those who died. RESULTS Among females, total healthcare costs were similar between cohorts in pretreatment and posttreatment phases, but higher for the treatment cohort during the treatment phase ($4,554 vs. $3,237, p < .001). Among males, total healthcare costs were higher in the treatment cohort during pretreatment ($3,911 vs. $2,784, p < .001), treatment ($4,533 vs. $3,105, p < .001) and posttreatment ($5,065 vs. $3,922, p = .001) phases. End-of-life costs did not differ. Healthcare sector-specific costs followed a similar pattern. CONCLUSIONS Five-year healthcare costs were similar between females who participated in a treatment program versus those that did not, with a transient increase during the treatment phase only. Among males, treatment was associated with persistently higher healthcare costs. Further study is needed to address the implications with respect to long-term costs. IMPLICATIONS The clinical effectiveness of pharmacological and behavioral smoking cessation treatments is well established, but whether such treatments are associated with healthcare costs, using real-world data, has received limited attention. Our findings suggest that the use of a smoking cessation treatment offered by their health system is associated with persistent higher healthcare costs among males but a transient increase among females. Given increasing access to evidence-based smoking cessation treatments is an important component in national tobacco control strategies, these data highlight the need for further exploration of the relations between smoking cessation treatment engagement and healthcare costs.
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Affiliation(s)
- Dolly Baliunas
- Corresponding Author: Dolly Baliunas, PhD, School of Public Health, Level 3, Public Health Building, 288 Herston Rd, The University of Queensland, Herston, QLD 4006, Australia, Telephone: 61 7 3346 5106; Fax: 61 (7) 3365 5442; E-mail:
| | - Sabrina Voci
- Nicotine Dependence Service, Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Claire de Oliveira
- Centre for Health Economics and Hull York Medical School, University of York, Heslington, York, UK,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada,ICES, Toronto, ON, Canada
| | - Peter Selby
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Nicotine Dependence Service, Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada,ICES, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Laura Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,ICES, Toronto, ON, Canada
| | - Laurie Zawertailo
- Nicotine Dependence Service, Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | | | - Rinku Sutradhar
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada,ICES, Toronto, ON, Canada,Division of Biostatistics, University of Toronto, Toronto, ON, Canada
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12
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Widjaja E, Demoe L, Yossofzai O, Guttmann A, Tomlinson G, Rutka J, Snead OC, Sander B. Health Care System Costs Associated With Surgery and Medical Therapy for Children With Drug-Resistant Epilepsy in Ontario. Neurology 2022; 98:e1204-e1215. [PMID: 35169008 DOI: 10.1212/wnl.0000000000200026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 01/03/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Improvement in seizure control after epilepsy surgery could lead to lower health care resource use and costs, but it is uncertain whether this could offset the high costs related to surgery. This study aimed to evaluate phase-specific and cumulative long-term health care costs of surgery compared to medical therapy in children with drug-resistant epilepsy from the health care payer perspective. METHODS Children who were evaluated for epilepsy surgery and treated with surgery or medical therapy from 2003 to 2018 at the Hospital for Sick Children in Toronto were identified from chart review and linked to their health administrative databases in Ontario, Canada. Inverse probability of treatment weighting with stabilized weights was used to balance the baseline covariates between the 2 groups. Patients were assigned to presurgery, surgery, short-term (first 2 years), intermediate-term (2-5 years), and long-term (>5 years) postsurgery care phases on the basis of treatment trajectory. Phase-specific and cumulative long-term health care costs were evaluated. Costs were converted from Canadian to US dollars year 2018 value. RESULTS There were 372 surgical and 258 medical patients. Costs were higher in surgical than medical patients for presurgery (3 and 39 weeks), surgery, and short-term care phase, and the attributable costs of surgery per 7 patient-days were $1,602 (95% CI $1,438-$1,785), $172 (95% CI $147-$185), $19,819 (95% CI $18,822-$20,932), and $28 (95% CI $22-$32), respectively. Costs were lower in surgical patients for intermediate- and long-term care phase, and the attributable costs were -$72 (95% CI -$124 to -$35) and -$94 (95% CI -$129 to -$63), respectively. In surgical patients, costs were highest for surgery followed by presurgery care phase, with hospitalizations accounting for the highest cost component. In medical patients, costs increased gradually from presurgery to long-term care phase. Cumulative costs were higher for surgical than medical patients in the first 7 years after surgery, but from 8 years on, costs were lower for surgical patients. DISCUSSION This study demonstrated the long-term economic benefits of epilepsy surgery compared to medical therapy for the health care system with the use of real-world data, which would justify the high costs of surgery. The results will support future economic evaluation comparing minimally invasive treatment such as laser therapy to surgery.
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Affiliation(s)
- Elysa Widjaja
- From the Institute of Health Policy, Management and Evaluation (E.W., A.G., G.T., B.H.S.) and Leong Centre for Healthy Children (A.G.), University of Toronto; Diagnostic Imaging (E.W.), Division of Neurology (E.W., O.C.S.), Neurosciences and Mental Health (L.D., O.Y.), Division of Pediatric Medicine (A.G.), and Department of Neurosurgery (J.R.), Hospital for Sick Children; ICES (E.W., A.G., B.H.S.); Toronto Health Economics and Technology Assessment (THETA) Collaborative (G.T., B.H.S.), University Health Network; and Public Health Ontario (B.H.S.), Toronto, Ontario, Canada.
| | - Lindsay Demoe
- From the Institute of Health Policy, Management and Evaluation (E.W., A.G., G.T., B.H.S.) and Leong Centre for Healthy Children (A.G.), University of Toronto; Diagnostic Imaging (E.W.), Division of Neurology (E.W., O.C.S.), Neurosciences and Mental Health (L.D., O.Y.), Division of Pediatric Medicine (A.G.), and Department of Neurosurgery (J.R.), Hospital for Sick Children; ICES (E.W., A.G., B.H.S.); Toronto Health Economics and Technology Assessment (THETA) Collaborative (G.T., B.H.S.), University Health Network; and Public Health Ontario (B.H.S.), Toronto, Ontario, Canada
| | - Omar Yossofzai
- From the Institute of Health Policy, Management and Evaluation (E.W., A.G., G.T., B.H.S.) and Leong Centre for Healthy Children (A.G.), University of Toronto; Diagnostic Imaging (E.W.), Division of Neurology (E.W., O.C.S.), Neurosciences and Mental Health (L.D., O.Y.), Division of Pediatric Medicine (A.G.), and Department of Neurosurgery (J.R.), Hospital for Sick Children; ICES (E.W., A.G., B.H.S.); Toronto Health Economics and Technology Assessment (THETA) Collaborative (G.T., B.H.S.), University Health Network; and Public Health Ontario (B.H.S.), Toronto, Ontario, Canada
| | - Astrid Guttmann
- From the Institute of Health Policy, Management and Evaluation (E.W., A.G., G.T., B.H.S.) and Leong Centre for Healthy Children (A.G.), University of Toronto; Diagnostic Imaging (E.W.), Division of Neurology (E.W., O.C.S.), Neurosciences and Mental Health (L.D., O.Y.), Division of Pediatric Medicine (A.G.), and Department of Neurosurgery (J.R.), Hospital for Sick Children; ICES (E.W., A.G., B.H.S.); Toronto Health Economics and Technology Assessment (THETA) Collaborative (G.T., B.H.S.), University Health Network; and Public Health Ontario (B.H.S.), Toronto, Ontario, Canada
| | - George Tomlinson
- From the Institute of Health Policy, Management and Evaluation (E.W., A.G., G.T., B.H.S.) and Leong Centre for Healthy Children (A.G.), University of Toronto; Diagnostic Imaging (E.W.), Division of Neurology (E.W., O.C.S.), Neurosciences and Mental Health (L.D., O.Y.), Division of Pediatric Medicine (A.G.), and Department of Neurosurgery (J.R.), Hospital for Sick Children; ICES (E.W., A.G., B.H.S.); Toronto Health Economics and Technology Assessment (THETA) Collaborative (G.T., B.H.S.), University Health Network; and Public Health Ontario (B.H.S.), Toronto, Ontario, Canada
| | - James Rutka
- From the Institute of Health Policy, Management and Evaluation (E.W., A.G., G.T., B.H.S.) and Leong Centre for Healthy Children (A.G.), University of Toronto; Diagnostic Imaging (E.W.), Division of Neurology (E.W., O.C.S.), Neurosciences and Mental Health (L.D., O.Y.), Division of Pediatric Medicine (A.G.), and Department of Neurosurgery (J.R.), Hospital for Sick Children; ICES (E.W., A.G., B.H.S.); Toronto Health Economics and Technology Assessment (THETA) Collaborative (G.T., B.H.S.), University Health Network; and Public Health Ontario (B.H.S.), Toronto, Ontario, Canada
| | - O Carter Snead
- From the Institute of Health Policy, Management and Evaluation (E.W., A.G., G.T., B.H.S.) and Leong Centre for Healthy Children (A.G.), University of Toronto; Diagnostic Imaging (E.W.), Division of Neurology (E.W., O.C.S.), Neurosciences and Mental Health (L.D., O.Y.), Division of Pediatric Medicine (A.G.), and Department of Neurosurgery (J.R.), Hospital for Sick Children; ICES (E.W., A.G., B.H.S.); Toronto Health Economics and Technology Assessment (THETA) Collaborative (G.T., B.H.S.), University Health Network; and Public Health Ontario (B.H.S.), Toronto, Ontario, Canada
| | - Beate Sander
- From the Institute of Health Policy, Management and Evaluation (E.W., A.G., G.T., B.H.S.) and Leong Centre for Healthy Children (A.G.), University of Toronto; Diagnostic Imaging (E.W.), Division of Neurology (E.W., O.C.S.), Neurosciences and Mental Health (L.D., O.Y.), Division of Pediatric Medicine (A.G.), and Department of Neurosurgery (J.R.), Hospital for Sick Children; ICES (E.W., A.G., B.H.S.); Toronto Health Economics and Technology Assessment (THETA) Collaborative (G.T., B.H.S.), University Health Network; and Public Health Ontario (B.H.S.), Toronto, Ontario, Canada
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13
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Wei W, Yang R, Zhang J, Chen H, Ye J, Su Q, Liao J, Xiao Z. The Mediating Roles of Family Resilience and Social Support in the Relationship Between Illness Severity and Depressive Symptoms Among Primary Caregivers of Children With Epilepsy in China. Front Neurol 2022; 13:831899. [PMID: 35265030 PMCID: PMC8899194 DOI: 10.3389/fneur.2022.831899] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/31/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE This study was designed to assess the effects of epilepsy severity, family resilience, and social support on depression in primary caregivers of children with epilepsy (CWE), and to test the mediating roles of family resilience and social support in this relationship. METHOD Two hundred fifty-two caregivers of children with epilepsy were recruited from October 2020 to May 2021. The questionnaire contained sociodemographic characteristics, Epilepsy Severity, Chinese-Family Resilience Assessment Scale (C-FRAS), Social Support Rating Scale (SSRS), Beck Depression Inventory (BDI). Structural equation models were used to evaluate whether family resilience and social support as mediators between epilepsy severity and depression. RESULTS In this study, the prevalence of depressive symptoms among primary caregivers of CWE in China was 69.84%. Epilepsy severity was positively associated with depression. Family resilience and social support were negatively correlated with depressive symptoms (both p < 0.01). Furthermore, the fitness indices of structural models were satisfactory. The direct effect of epilepsy severity on depression was 0.266 (95% CI 0.064-0.458), this pathway explained 62.88% variance of depression. The indirect effect of family resilience and then social support was 0.069 (95% CI 0.025-0.176), indicating that the serial multiple mediation was significant. The serial mediation pathway explained 16.31% variance of depression. CONCLUSIONS The high incidence of depression among primary carers of CWE deserves more attention. They should be screened routinely, especially those parents of children with severe epilepsy. Family resilience and social support could be protective factors for caregivers' mental adjustment. Therefore, future psychosocial interventions for enhancing family resilience and social support should be implemented, in order to reduce their depression.
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Affiliation(s)
- Wenjing Wei
- China Medical University, Shenzhen Children's Hospital, Shenzhen, China
| | - Rongrong Yang
- China Medical University, Shenzhen Children's Hospital, Shenzhen, China
| | - Jie Zhang
- China Medical University, Shenzhen Children's Hospital, Shenzhen, China
| | - Haili Chen
- China Medical University, Shenzhen Children's Hospital, Shenzhen, China
| | - Jinghua Ye
- Department of Neurology, Shenzhen Children's Hospital, China Medical University, Shenzhen, China
| | - Qiru Su
- Department of Clinical Research, Shenzhen Children's Hospital, China Medical University, Shenzhen, China
| | - Jianxiang Liao
- Department of Neurology, Shenzhen Children's Hospital, China Medical University, Shenzhen, China
- *Correspondence: Jianxiang Liao
| | - Zhitian Xiao
- Department of Neurology, Shenzhen Children's Hospital, China Medical University, Shenzhen, China
- Zhitian Xiao
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14
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Pellinen J, French J, Knupp KG. Diagnostic Delay in Epilepsy: the Scope of the Problem. Curr Neurol Neurosci Rep 2021; 21:71. [PMID: 34817723 DOI: 10.1007/s11910-021-01161-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Diagnostic delay is an increasingly recognized issue in epilepsy. At the same time, there is a clear disparity between public awareness of epilepsy and that of other public health issues. A contributing factor for this seems to be a lack of studies testing interventions designed to improve seizure recognition. In this review, we summarize the main findings from recent studies investigating diagnostic delay in epilepsy, highlighting causes, consequences, and potential interventions in future research that may improve quality of care in this population. RECENT FINDINGS Building on prior evidence, diagnostic delay in patients with new-onset focal epilepsy has been identified as an important problem for patients with epilepsy. Such delay in diagnosis can lead to delayed treatment and potentially preventable morbidity and mortality including motor vehicle accidents. Nonmotor seizure semiology appears to be a major contributor for delay; such seizures are largely unrecognized when patients present to emergency departments for care. Improving recognition and diagnosis of recurrent nonmotor seizures in emergency departments represents a significant opportunity for improving time to diagnosis, particularly when patients present following a first lifetime motor seizure and meet diagnostic criteria for epilepsy. Diagnostic delay in epilepsy is a significant public health issue and recent studies have highlighted potential areas for intervention.
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Affiliation(s)
- Jacob Pellinen
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Jaqueline French
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, NY, USA
| | - Kelly G Knupp
- Departments of Pediatrics and Neurology, University of Colorado School of Medicine, Aurora, CO, USA
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