1
|
Reyes A, Prabhakaran D, Banegas MP, Shih JJ, Iragui-Madoz VJ, Almane DN, Ferguson L, Jones JE, Busch RM, Hermann BP, McDonald CR. Individual- and community-level social determinants of health are associated with cognition in older adults with focal epilepsy. Epilepsy Behav 2024; 158:109927. [PMID: 38970893 DOI: 10.1016/j.yebeh.2024.109927] [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: 05/15/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/08/2024]
Abstract
OBJECTIVE Epilepsy is associated with significant health disparities, including access to specialized care and adverse outcomes that have been associated with several social determinants of health (SDOH). We sought to examine the relationship between individual- and community-level SDOH and cognitive outcomes in older adults with epilepsy. MATERIALS AND METHODS We collected clinical, SDOH, and neuropsychological data in 57 older adults with epilepsy. Individual-level SDOH included patient factors (quality of education, income, insurance, marital status) and early-life environmental factors (parental education and occupation, childhood employment). Neighborhood deprivation was measured with the Area Deprivation Index (ADI). Stepwise regressions were conducted to examine the independent contribution of individual-level SDOH to cognitive performance, and Spearman rho correlations were conducted to examine the relationship between ADI and cognitive performance. The SDOH profiles of patients who met the criteria for cognitive impairment were examined. RESULTS After controlling for clinical variables, patient factors (public health insurance, poorer quality of education) and early-life environmental factors (lower mother's education, lower father's and mother's occupational complexity, history of childhood employment) were significant predictors of lower performance on measures of global cognition, verbal learning and memory, processing speed, and executive function. Higher ADI values (greater disadvantage) were associated with lower scores on global cognitive measures, verbal learning and memory, and executive function. Patients who met criteria for cognitive impairment had, on average, a greater number of adverse SDOH, including lower household incomes and father's education, and higher ADI values compared to those who were cognitively intact. CONCLUSION We provide new evidence of the role of individual- and community-level SDOH on cognitive outcomes in older adults with epilepsy. This emerging literature highlights the need to examine SDOH beyond epilepsy-related clinical factors. These data could inform the development of interventions focused on increasing access to epilepsy care, education, and resources and promoting brain and cognitive health within the most at-risk communities.
Collapse
Affiliation(s)
- Anny Reyes
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, San Diego, CA, USA.
| | - Divya Prabhakaran
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, San Diego, CA, USA
| | - Matthew P Banegas
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, San Diego, CA, USA
| | - Jerry J Shih
- Department of Neuroscience, University of California, San Diego, San Diego, CA, USA
| | | | - Dace N Almane
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, USA
| | - Lisa Ferguson
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jana E Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, USA
| | - Robyn M Busch
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, USA
| | - Carrie R McDonald
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| |
Collapse
|
2
|
Mazzone PP, Weir CJ, Stephen J, Bhattacharya S, Chin RFM. Socioeconomic status in adulthood of children with and without a history of seizures: A retrospective cohort study. Epilepsy Behav 2024; 153:109705. [PMID: 38428172 DOI: 10.1016/j.yebeh.2024.109705] [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: 11/14/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Compare adulthood socioeconomic status for children with and without a history of seizures. METHODS Retrospective cohort study using Aberdeen Children of the Nineteen Fifties (ACONF) data comprising children born 1950-1956 attending primary school 1962-1964, with follow-up data collected in 2001. Adulthood socioeconomic status was based on registrar general measure of occupational social class and categorised as high or low. We adjusted for potentially confounding variables including childhood socioeconomic status, behavioural issues (Rutter A/B scores), biological sex, school test scores, educational attainment, parental engagement with education, peer-status in school, and alcohol use in adulthood. A multivariate binary logistic regression was performed to estimate the adjusted association between children with a history of seizures of any type (for example febrile seizures, or provoked seizures of any other etiology or seizures in the context of epilepsy) or severity and adult socioeconomic status. Multiple imputation using the Monte-Carlo-Markov-Chain method accounted for missing data. RESULTS Pooled estimates (N = 2,208) comparing children with a history of seizures (n = 81) and children without a history of seizures (n = 2,127) found no differences between these cohorts in terms of adulthood socioeconomic status in both unadjusted (Odds Ratio (OR) 1.45 [95 % CI 0.71-2.96], p = 0.31) and adjusted (1.02 [0.46, 2.24], p = 0.96) analyses. Compared to males, females were at increased odds of having a lower socioeconomic status in adulthood (1.56 [1.13-2.17], p = 0.01).Compared to those with low educational attainment, those with moderate (0.32 [0.21, 0.48], p < 0.001) and high (0.12 [0.07, 0.20], p < 0.001) educational attainment were at reduced odds of having a lower socioeconomic status in adulthood. CONCLUSION Cognitive problems in childhood (using educational attainment and scores on primary school tests proxy markers for cognition) rather than a history of seizures per se, were associated with lower SES in a population of adults born 1950-56 in Aberdeen. This relationship may be different depending on the time in history and nation/region of study. Given the changes in health, education and social support in the management of children with seizures over time, it would be of interest to investigate outcomes in a contemporary cohort. Such studies should ideally have validated diagnoses of seizures, details on seizure characteristics such as seizure type and severity, and a large sample size using national data.
Collapse
Affiliation(s)
- Paolo P Mazzone
- Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, United Kingdom; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; Child Life and Health, Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom.
| | - Christopher J Weir
- Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Jacqueline Stephen
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Sohinee Bhattacharya
- Formerly of Aberdeen Centre for Women's Health Research, The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Richard F M Chin
- Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, United Kingdom; Royal Hospital for Children and Young People, Edinburgh, United Kingdom; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; Child Life and Health, Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
3
|
Deng L, Macartney K, Gill D, Fathima P, Wood N, Gidding H. Status epilepticus outcomes among vaccinated and unvaccinated children: A population-based study. Epilepsy Behav 2022; 126:108482. [PMID: 34920348 DOI: 10.1016/j.yebeh.2021.108482] [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: 09/06/2021] [Revised: 11/27/2021] [Accepted: 11/28/2021] [Indexed: 11/16/2022]
Abstract
AIM To determine the proportion of first status epilepticus (SE) cases that are vaccine-proximate (VP-) and compare clinical outcomes to non-vaccine-proximate (NVP-) cases. METHODS Birth records for 1,440,807 Australian children born in 1998-2012, were probabilistically linked to hospitalizations, deaths, and vaccination history available to 2013. First SE coded hospitalizations were categorized as VP-SE or NVP-SE; clinical severity and post-SE vaccination coverage were compared. SE rates were calculated. RESULTS Of 867 first SE cases (7.9 per 100,000 person-years), 31 (3.6%) were VP-SE; 16 followed dose-1 measles vaccine (1.2 SE per 100,000 doses). Compared with NVP-SE, VP-SE cases were younger (1.0 vs 2.6 years, P < 0.0001) and had longer hospitalizations (4 vs 3 days, P = 0.005). There was no difference in the proportion of VP-SE cases with a coinfection diagnosis compared to NVP-SE (25.8% vs 19.9%, P = 0.42). Controlling for age and history of hospitalization for a neurological condition, intensive care unit (ICU) admission had a stronger association with coinfection (aOR 2.52 (95%CI 1.78-3.57)) than having VP-SE (aOR 1.41 (0.66-3.01)). Groups had similar SE recurrence rates at 12-months (12.9% VP vs 16.9% NVP, P = 0.56) and reduced vaccine uptake following initial SE (from 93.5% to 56.3%). CONCLUSION Proportionally few first SE cases were VP-SE, with higher ICU admission rates mostly explained by younger age and higher coinfection rates. Vaccination plans are needed to improve vaccine uptake following SE.
Collapse
Affiliation(s)
- Lucy Deng
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia; The University of Sydney Children's Hospital Westmead Clinical School, NSW, Australia.
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia; The University of Sydney Children's Hospital Westmead Clinical School, NSW, Australia
| | - Deepak Gill
- T.Y. Nelson Department of Neurology, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Parveen Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia; Epidemiology Branch, Western Australia Department of Health, Perth, WA, Australia
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia; The University of Sydney Children's Hospital Westmead Clinical School, NSW, Australia
| | - Heather Gidding
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia; Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia; The University of Sydney Northern Clinical School, NSW, Australia
| |
Collapse
|
4
|
Iio K, Hagiwara Y, Saito O, Ishida Y, Horikoshi Y. Seizure in children with severe acute respiratory syndrome coronavirus 2 Omicron variant infection. Pediatr Int 2022; 64:e15255. [PMID: 35972066 PMCID: PMC9537988 DOI: 10.1111/ped.15255] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/18/2022] [Accepted: 05/24/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Kazuki Iio
- Division of Pediatric Emergency Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.,Department of Pediatrics, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Yusuke Hagiwara
- Division of Pediatric Emergency Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Osamu Saito
- Department of Critical Care, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yu Ishida
- Department of Pediatrics, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Yuho Horikoshi
- Division of Infectious Diseases, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| |
Collapse
|
5
|
Caramaschi D, Hatcher C, Mulder RH, Felix JF, Cecil CAM, Relton CL, Walton E. Epigenome-wide association study of seizures in childhood and adolescence. Clin Epigenetics 2020; 12:8. [PMID: 31915053 PMCID: PMC6950851 DOI: 10.1186/s13148-019-0793-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/02/2019] [Indexed: 12/31/2022] Open
Abstract
The occurrence of seizures in childhood is often associated with neurodevelopmental impairments and school underachievement. Common genetic variants associated with epilepsy have been identified and epigenetic mechanisms have also been suggested to play a role. In this study, we analyzed the association of genome-wide blood DNA methylation with the occurrence of seizures in ~ 800 children from the Avon Longitudinal Study of Parents and Children, UK, at birth (cord blood), during childhood, and adolescence (peripheral blood). We also analyzed the association between the lifetime occurrence of any seizures before age 13 with blood DNA methylation levels. We sought replication of the findings in the Generation R Study and explored causality using Mendelian randomization, i.e., using genetic variants as proxies. The results showed five CpG sites which were associated cross-sectionally with seizures either in childhood or adolescence (1-5% absolute methylation difference at pFDR < 0.05), although the evidence of replication in an independent study was weak. One of these sites was located in the BDNF gene, which is highly expressed in the brain, and showed high correspondence with brain methylation levels. The Mendelian randomization analyses suggested that seizures might be causal for changes in methylation rather than vice-versa. In conclusion, we show a suggestive link between seizures and blood DNA methylation while at the same time exploring the limitations of conducting such study.
Collapse
Affiliation(s)
- Doretta Caramaschi
- Bristol Medical School, Population Health Sciences, University of Bristol, 5 Tyndall Avenue, Bristol, BS8 1UD, UK. .,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
| | - Charlie Hatcher
- Bristol Medical School, Population Health Sciences, University of Bristol, 5 Tyndall Avenue, Bristol, BS8 1UD, UK.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Rosa H Mulder
- Institute of Education and Child Studies, Leiden University, Pieter de la Court building, Wassenaarseweg 52, 2333, AK, Leiden, The Netherlands.,Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Janine F Felix
- Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Charlotte A M Cecil
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Caroline L Relton
- Bristol Medical School, Population Health Sciences, University of Bristol, 5 Tyndall Avenue, Bristol, BS8 1UD, UK.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Esther Walton
- Bristol Medical School, Population Health Sciences, University of Bristol, 5 Tyndall Avenue, Bristol, BS8 1UD, UK.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.,Department of Psychology, University of Bath, Bath, BA2 7AY, UK
| |
Collapse
|
6
|
Yeung Gregerson CH, Bakian AV, Wilkes J, Knighton AJ, Nkoy F, Sweney M, Filloux FM, Bonkowsky JL. Disparities in Pediatric Epilepsy Remission Are Associated With Race and Ethnicity. J Child Neurol 2019; 34:928-936. [PMID: 31502509 PMCID: PMC6842107 DOI: 10.1177/0883073819866623] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of our study was to assess whether race/ethnicity was associated with seizure remission in pediatric epilepsy. METHODS This was a retrospective population-based cohort study of children who were evaluated for new-onset epilepsy in the clinic, emergency department, and/or hospital by a pediatric neurologist in an integrated health care delivery system. Children were between ages 6 months and 15 years at their initial presentation of epilepsy. The cohort, identified through an electronic database, was assembled over 6 years, with no less than 5 years of follow-up. All children were evaluated for race, ethnicity, insurance type, and socioeconomic background. Patient outcome was determined at the conclusion of the study period and categorized according to their epilepsy control as either drug resistant (pharmacoresistant and intractable) or drug responsive (controlled, probable remission, and terminal remission). RESULTS In the final cohort of 776 patients, 63% were drug responsive (control or seizure remission). After controlling for confounding socioeconomic and demographic factors, children of Hispanic ethnicity experienced reduced likelihood (hazard) of drug-responsive epilepsy (hazard ratio 0.6, P < .001), and had longer median time to remission (8 years; 95% CI 5.9-9.6 years) compared to white non-Hispanic patients (5.6 years; 95% CI 4.9-6.1 years). Among Hispanic patients, higher health care costs were associated with reduced likelihood of drug responsiveness. SIGNIFICANCE We found that Hispanic ethnicity is associated with a reduced likelihood of achieving seizure control and remission. This study suggests that factors associated with the race/ethnicity of patients contributes to their likelihood of achieving seizure freedom.
Collapse
Affiliation(s)
| | - Amanda V. Bakian
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah
| | | | | | - Flory Nkoy
- Division of Inpatient Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Matthew Sweney
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah,Brain and Spine Center, Primary Children’s Hospital, Salt Lake City, Utah
| | - Francis M. Filloux
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Joshua L. Bonkowsky
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah,Brain and Spine Center, Primary Children’s Hospital, Salt Lake City, Utah,Corresponding Author: Joshua L. Bonkowsky, Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way/Williams Building, Salt Lake City, Utah 84108, , Phone: 801-581-6756, Fax: 801-581-4233
| |
Collapse
|
7
|
Bergin PS, Brockington A, Jayabal J, Scott S, Litchfield R, Roberts L, Timog J, Beilharz E, Dalziel SR, Jones P, Yates K, Thornton V, Walker EB, Davis S, Te Ao B, Parmar P, Beghi E, Rossetti AO, Feigin V. Status epilepticus in Auckland, New Zealand: Incidence, etiology, and outcomes. Epilepsia 2019; 60:1552-1564. [PMID: 31260104 DOI: 10.1111/epi.16277] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/18/2019] [Accepted: 06/12/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To determine the incidence, etiology, and outcome of status epilepticus (SE) in Auckland, New Zealand, using the latest International League Against Epilepsy (ILAE) SE semiological classification. METHODS We prospectively identified patients presenting to the public or major private hospitals in Auckland (population = 1.61 million) between April 6, 2015 and April 5, 2016 with a seizure lasting 10 minutes or longer, with retrospective review to confirm completeness of data capture. Information was recorded in the EpiNet database. RESULTS A total of 477 episodes of SE occurred in 367 patients. Fifty-one percent of patients were aged <15 years. SE with prominent motor symptoms comprised 81% of episodes (387/477). Eighty-four episodes (18%) were nonconvulsive SE. Four hundred fifty episodes occurred in 345 patients who were resident in Auckland. The age-adjusted incidence of 10-minute SE episodes and patients was 29.25 (95% confidence interval [CI] = 27.34-31.27) and 22.22 (95% CI = 20.57-23.99)/100 000/year, respectively. SE lasted 30 minutes or longer in 250 (56%) episodes; age-adjusted incidence was 15.95 (95% CI = 14.56-17.45) SE episodes/100 000/year and 12.92 (95% CI = 11.67-14.27) patients/100 000/year. Age-adjusted incidence (10-minute SE) was 25.54 (95% CI = 23.06-28.24) patients/100 000/year for males and 19.07 (95% CI = 16.91-21.46) patients/100 000/year for females. The age-adjusted incidence of 10-minute SE was higher in Māori (29.31 [95% CI = 23.52-37.14]/100 000/year) and Pacific Islanders (26.55 [95% CI = 22.05-31.99]/100 000/year) than in patients of European (19.13 [95% CI = 17.09-21.37]/100 000/year) or Asian/other descent (17.76 [95% CI = 14.73-21.38]/100 000/year). Seventeen of 367 patients in the study died within 30 days of the episode of SE; 30-day mortality was 4.6%. SIGNIFICANCE In this population-based study, incidence and mortality of SE in Auckland lie in the lower range when compared to North America and Europe. For pragmatic reasons, we only included convulsive SE if episodes lasted 10 minutes or longer, although the 2015 ILAE SE classification was otherwise practical and easy to use.
Collapse
Affiliation(s)
- Peter S Bergin
- Auckland District Health Board, Grafton, Auckland, New Zealand.,Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Alice Brockington
- Auckland District Health Board, Grafton, Auckland, New Zealand.,Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - Jayaganth Jayabal
- Auckland District Health Board, Grafton, Auckland, New Zealand.,Pantai-Gleneagles Hospital, Penang and Sungai Petani, Malaysia
| | - Shona Scott
- Auckland District Health Board, Grafton, Auckland, New Zealand.,Western General Hospital, Edinburgh, UK
| | | | - Lynair Roberts
- Auckland District Health Board, Grafton, Auckland, New Zealand
| | - Jerelyn Timog
- Auckland District Health Board, Grafton, Auckland, New Zealand
| | - Erica Beilharz
- Auckland District Health Board, Grafton, Auckland, New Zealand
| | - Stuart R Dalziel
- Auckland District Health Board, Grafton, Auckland, New Zealand.,Department of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Peter Jones
- Auckland District Health Board, Grafton, Auckland, New Zealand
| | - Kim Yates
- Waitematā District Health Board, Auckland, New Zealand
| | | | | | - Suzanne Davis
- Auckland District Health Board, Grafton, Auckland, New Zealand
| | - Braden Te Ao
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Priya Parmar
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Ettore Beghi
- Mario Negri Institute of Pharmacological Research, Scientific Institute for Research and Health Care, Milan, Italy
| | - Andrea O Rossetti
- Department of Clinical Neurosciences, Vaud University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| |
Collapse
|
8
|
Adherence to antiepileptic drugs among diverse older Americans on Part D Medicare. Epilepsy Behav 2017; 66:68-73. [PMID: 28038389 PMCID: PMC5297256 DOI: 10.1016/j.yebeh.2016.10.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 10/13/2016] [Accepted: 10/14/2016] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Older minority groups are more likely to have poor AED adherence. We describe adherence to antiepileptic drugs (AEDs) among older Americans with epilepsy. METHODS In retrospective analyses of 2008-2010 Medicare claims for a 5% random sample of beneficiaries augmented by minority representation, epilepsy cases in 2009 were those with ≥1 claim with ICD-9345.x or ≥2 with 780.3x, and ≥1 AED. New-onset cases had no such claims or AEDs in the year before the 2009 index event. We calculated the Proportion of Days Covered (PDC) (days with ≥1 AED over total follow-up days) and used logistic regression to estimate associations of non-adherence (PDC <0.8) with minority group adjusting for covariates. RESULTS Of 36,912 epilepsy cases (19.2% White, 62.5% African American (AA), 11.3% Hispanic, 5.0% Asian and 2% American Indian/Alaskan Native), 31.8% were non-adherent (range: 24.1% Whites to 34.3% AAs). Of 3706 new-onset cases, 37% were non-adherent (range: 28.7% Whites to 40.5% AAs). In adjusted analyses, associations with minority group were significant among prevalent cases, and for AA and Asians vs. Whites among new cases. Among other findings, beneficiaries from high-poverty ZIP codes were more likely to be non-adherent than their counterparts, and those in cost-sharing drug benefit phases were less likely to be non-adherent than those in deductible phases. CONCLUSION About a third of older adults with epilepsy have poor AED adherence; minorities are more likely than Whites. Investigations of reasons for non-adherence, and interventions to promote adherence, are needed with particular attention to the effect of cost-sharing and poverty.
Collapse
|
9
|
Camfield C, Camfield P, Smith B. Poor versus rich children with epilepsy have the same clinical course and remission rates but a less favorable social outcome: A population-based study with 25 years of follow-up. Epilepsia 2016; 57:1826-1833. [PMID: 27813062 DOI: 10.1111/epi.13576] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore the influence of several estimates of family socioeconomic status on the long-term clinical course and social outcomes of children with epilepsy. METHODS The Nova Scotia childhood epilepsy cohort is population based and includes all children in this Canadian province who developed epilepsy between 1977 and 1985. Eligible patients had ≥10 years of follow-up. Children with childhood absence epilepsy were excluded. Total family income at seizure onset was assessed at seizure onset and classified as "poor" (first quintile), "adequate" (second to third quintiles), and "well-off" (fourth to fifth quintiles). We also assessed parental education and home ownership. Social outcome was assessed in those with normal intelligence who were ≥18 years of age at the end of follow-up using a semistructured interview that explored eight adverse effects. RESULTS Of 584 patients, 421 (72%) were included. Average follow-up was 26 ± 5.6 years. Overall 137 families (33%) had "poor" income, 159 (38%) had "adequate income," and 125 (30%) were "well-off." Terminal remission of epilepsy occurred in 65% of the poor, 61% of the adequate, and 61% of the well-off (p = ns). Intractable epilepsy, status epilepticus, number of antiepileptic drugs (AEDs) used, and the number of generalized tonic-clonic or focal with secondary generalization seizures through the clinical course was the same in all groups. Home ownership did not predict remission. Neither paternal nor maternal education was associated with remission. Poor children had significantly more adverse social outcomes including failure to graduate from high school, unemployment, personal poverty, inadvertent pregnancy, and psychiatric diagnoses. SIGNIFICANCE In Nova Scotia with universal health care, coming from a poor or more affluent family does not seem to affect the clinical course or long-term seizure outcome of childhood epilepsy. Unfortunately children from poor families are less likely to have a good social outcome.
Collapse
Affiliation(s)
- Carol Camfield
- Department of Pediatrics, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Peter Camfield
- Department of Pediatrics, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Bruce Smith
- Department of Mathematics and Statistics, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
10
|
Hayakawa I, Miyama S, Inoue N, Sakakibara H, Hataya H, Terakawa T. Epidemiology of Pediatric Convulsive Status Epilepticus With Fever in the Emergency Department: A Cohort Study of 381 Consecutive Cases. J Child Neurol 2016; 31:1257-64. [PMID: 27280723 DOI: 10.1177/0883073816652234] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/27/2016] [Indexed: 11/16/2022]
Abstract
Pediatric convulsive status epilepticus with fever is common in the emergency setting but leads to severe neurological sequelae in some patients. To explore the epidemiology of convulsive status epilepticus with fever, a retrospective cohort covering all convulsive status epilepticus cases with fever seen in the emergency department of a tertiary care children's hospital were consecutively collected. Of the 381 consecutive cases gathered, 81.6% were due to prolonged febrile seizure, 6.6% to encephalopathy/encephalitis, 0.8% to meningitis, and 7.6% to epilepsy. In addition, seizures were significantly longer in encephalopathy/encephalitis cases than in prolonged febrile seizure cases (log rank test, P < .001). These results provide for the first time the pretest probability of final diagnoses in children with convulsive status epilepticus with fever in the emergency setting, and will help optimize the management of pediatric patients presenting to the emergency department with convulsive status epilepticus with fever.
Collapse
Affiliation(s)
- Itaru Hayakawa
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Sahoko Miyama
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan Department of Neurology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Nobuaki Inoue
- Division of Pediatric Emergency Medicine, Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hiroshi Sakakibara
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hiroshi Hataya
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Toshiro Terakawa
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| |
Collapse
|
11
|
Nishiyama M, Nagase H, Tanaka T, Fujita K, Maruyama A, Toyoshima D, Nakagawa T, Taniguchi-Ikeda M, Morioka I, Morisada N, Takada S, Iijima K. Demographics and outcomes of patients with pediatric febrile convulsive status epilepticus. Pediatr Neurol 2015; 52:499-503. [PMID: 25769239 DOI: 10.1016/j.pediatrneurol.2015.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 02/02/2015] [Accepted: 02/04/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Convulsive status epilepticus with fever is common and may be related to neurological sequela in children. However, there are limited data on the demographics and risk factors of this phenomenon. Thus, we aimed to describe the demographics and risk factors of neurological sequela among children with convulsive status epilepticus with fever. METHODS We reviewed convulsive status epilepticus with fever cases in the pediatric intensive care unit at Kobe Children's Hospital between 2002 and 2013. We included patients with intrinsic neurological disease, and excluded those with obvious central nervous system infection. Cases of neurological worsening were categorized as poor outcome using the pediatric cerebral performance category scale. Possible risk factors for poor outcome included age, sex, neurological medical history, seizure duration, body temperature, and level of consciousness. RESULTS A total of 253 patients (128 males), aged 1 month to 15 years (mean 45 ± 40 months), were enrolled. Three patients (1.2%) died during hospitalization, and 32 (12.6%) patients had a poor outcome. A univariate analysis identified male sex, absence of epilepsy history, body temperature above 40°C on admission, seizure duration longer than 120 minutes, impaired consciousness at 12 hours after onset, and presence of nonconvulsive seizure as potential predictors of poor outcome. A multivariate analysis, revealed that an absence of epilepsy history (odds ratio = 11.18), body temperature above 40°C on admission (odds ratio = 3.39), or impaired consciousness at 12 hours after onset (odds ratio = 41.85) was associated with poor outcome. CONCLUSIONS Our study indicated that absence of epilepsy history, high temperature, and/or prolonged impaired consciousness were associated with brain injury.
Collapse
Affiliation(s)
- Masahiro Nishiyama
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan; Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan.
| | - Hiroaki Nagase
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Tsukasa Tanaka
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Kyoko Fujita
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Azusa Maruyama
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Daisaku Toyoshima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Taku Nakagawa
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Ichiro Morioka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoya Morisada
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoshi Takada
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
12
|
Carson J, Weir A, Chin RF, McLellan A. Socioeconomic deprivation is an independent risk factor for behavioral problems in children with epilepsy. Epilepsy Behav 2015; 45:105-9. [PMID: 25843344 DOI: 10.1016/j.yebeh.2015.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 02/25/2015] [Accepted: 03/08/2015] [Indexed: 10/23/2022]
Abstract
AIM The aim of this study was to examine whether socioeconomic deprivation in children with epilepsy (CWE) increases risk for behavioral problems independent of seizure factors. METHODS A cross-sectional study was done in which parents of children attending a specialist epilepsy clinic were invited to complete a child behavior checklist (CBCL) questionnaire about their child. Medical and sociodemographic data on CWE were obtained through their pediatric neurologists. Home postal code was used to obtain quintiles of Scottish Index of Multiple Deprivation 2012 (SIMD2012) scores for individuals. Lower (1-3) quintiles correspond to higher socioeconomic deprivation. Regression analysis was used to investigate whether a lower quintile was an independent risk factor for scores >63 (significant behavioral problem). RESULTS Parents of 87 children (42 male, mean age of 10.5years) were enrolled. Fifty-nine percent had total scores >63. A higher proportion of children from quintiles 1-3 compared to those from quintiles 4-5 had externalizing (49% vs. 25%, p=0.02) and total (54% vs. 30%, p=0.02) scores >63. Adjusted OR of quintiles 1-3 vs. 4-5 for scores >63=14.8, 95% CI=3.0, 68.0. Fewer children with scores >63 and from quintiles 1-3 were known to the child and adolescent mental health service (CAMHS) compared to those in quintiles 4-5 (p=0.01). INTERPRETATION Socioeconomic deprivation was an independent risk factor for behavioral problems in CWE. Children with epilepsy and behavioral problems who lived in socioeconomically deprived areas received less help.
Collapse
Affiliation(s)
| | | | - Richard F Chin
- The University of Edinburgh, UK; Muir Maxwell Epilepsy Centre, UK; Royal Hospital for Sick Children, Edinburgh, UK.
| | | |
Collapse
|
13
|
Abstract
PURPOSE OF REVIEW There is a long-standing hypothesis that febrile status epilepticus (FSE) can cause brain injury, particularly to the hippocampus. This review will evaluate recent evidence on the relationships between FSE and later epilepsy and cognitive impairments. Potential strategies for minimizing adverse outcomes will be discussed. RECENT FINDINGS There are two major longitudinal studies evaluating the outcomes for FSE. These studies provide evidence of acute hippocampal edema that evolves to mesial temporal sclerosis in a small number of children (∼7%). However, none of these children have developed temporal lobe epilepsy. There is also evidence of more global white matter injury. Development is affected, with a loss of about 10 developmental quotient points and there is evidence for accelerated forgetting. These findings do not correlate with MRI parameters. Therefore, FSE can cause a wide spectrum of injury, but the relationship between this and clinically relevant adverse outcomes remains uncertain. SUMMARY Although there is accumulating evidence that FSE can cause brain injury, the strategies to minimize the impact remain uncertain. Imaging requires sedation, with inherent risks, and may not be appropriate for all children with FSE, given the small number with significant hippocampal edema that could be a biomarker. The alternative of treating all children requires a very safe drug which currently does not exist.
Collapse
|
14
|
Steer S, Pickrell WO, Kerr MP, Thomas RH. Epilepsy prevalence and socioeconomic deprivation in England. Epilepsia 2014; 55:1634-41. [DOI: 10.1111/epi.12763] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Samuel Steer
- Morriston Hospital; Heol Maes Eglwys; Morriston Swansea United Kingdom
| | - William O. Pickrell
- Neurology and Molecular Neuroscience Research Group; Institute of Life Science; College of Medicine; Swansea University; Swansea United Kingdom
- Wales Epilepsy Research Network (WERN); College of Medicine; Swansea University; Swansea United Kingdom
| | - Michael P. Kerr
- Wales Epilepsy Research Network (WERN); College of Medicine; Swansea University; Swansea United Kingdom
- Psychiatric Medicine & Clinical Neurosciences; Cardiff University; Cardiff United Kingdom
| | - Rhys H. Thomas
- Wales Epilepsy Research Network (WERN); College of Medicine; Swansea University; Swansea United Kingdom
- MRC Centre for Neuropsychiatric Genetics and Genomics; Cardiff University; Cardiff United Kingdom
- Epilepsy Research Centre; University of Melbourne; Austin Health Heidelberg Victoria Australia
| |
Collapse
|
15
|
Neighborhood, family, and childhood and adolescent epilepsy: A nationwide epidemiological study from Sweden. Seizure 2014; 23:62-8. [DOI: 10.1016/j.seizure.2013.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 09/24/2013] [Accepted: 09/24/2013] [Indexed: 12/31/2022] Open
|
16
|
Widjaja E, Smith ML, Jette N, Payne E. Patient and hospital characteristics are associated with cost of hospitalizations in children with epilepsy. Epilepsy Behav 2013; 28:335-42. [PMID: 23816520 DOI: 10.1016/j.yebeh.2013.05.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 05/06/2013] [Accepted: 05/24/2013] [Indexed: 11/18/2022]
Abstract
We assessed patient and hospital characteristics and cost of hospitalizations in children with epilepsy, using the United States (U.S.) Kids' Inpatient Database (KID2009). There were 114,256 pediatric admissions for epilepsy in 2009. Admission rate was highest in those with the lowest household income. Private, urban teaching, and nonchildren's hospitals and hospitals in the Southern U.S. admitted the most patients. The average length of hospitalization was 5.4days, and adjusted cost was $6656/day of admission. The cost of hospitalizations was higher in those with the highest household income versus in those with lower income, private versus Medicare/Medicaid insurance, admissions to private versus public hospitals, urban teaching versus nonteaching or rural hospitals, and children's versus nonchildren's hospitals. Epilepsy comorbidities did not increase the cost of hospitalization. We found that the number and cost of hospitalizations in children with epilepsy vary by patient and hospital characteristics. Such findings are essential for informing future health plans and policy decisions on resource allocation.
Collapse
Affiliation(s)
- Elysa Widjaja
- Diagnostic Imaging, University of Toronto, Toronto, Canada.
| | | | | | | |
Collapse
|
17
|
Abstract
Healthy children are high transmitters of influenza and can experience poor influenza outcomes. Many questions remain about the efficacy and impect of preventive measures because most existing studies report imprecise proxies of influenza incidence, do not follow subjects throughout the entire influenza season and across multiple influenza seasons, or do not control for important factors such as timing of implementation and social contact patterns. Modeling and simulation are key methodologies to answer questions regarding influenza prevention. While vaccination may be the most efficacious existing intervention, variations in circulating strains and children's immune systems keep current vaccines from being fully protective, necessitating further clinical and economic studies and technology improvements. Hand hygiene appears to be an important adjunct but improving compliance, standardizing regimens and quantifying its impact remain challenging. Future studies should help better define the specific indications and circumstances for antiviral use and the role of nutritional supplements and nonpharmaceutical interventions.
Collapse
Affiliation(s)
- Bruce Y Lee
- Public Health Computational and Operations Research, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh, PA, USA.
| | | |
Collapse
|
18
|
Abstract
OBJECTIVE To determine sociodemographics, patterns of comorbidity, and function of US children with reported epilepsy/seizure disorder. METHODS Bivariate and multivariable cross-sectional analysis of data from the National Survey of Children's Health (2007) on 91 605 children ages birth to 17 years, including 977 children reported by their parents to have been diagnosed with epilepsy/seizure disorder. RESULTS Estimated lifetime prevalence of epilepsy/seizure disorder was 10.2/1000 (95% confidence interval [CI]: 8.7-11.8) or 1%, and of current reported epilepsy/seizure disorder was 6.3/1000 (95% CI: 4.9-7.8). Epilepsy/seizure disorder prevalence was higher in lower-income families and in older, male children. Children with current reported epilepsy/seizure disorder were significantly more likely than those never diagnosed to experience depression (8% vs 2%), anxiety (17% vs 3%), attention-deficit/hyperactivity disorder (23% vs 6%), conduct problems (16% vs 3%), developmental delay (51% vs 3%), autism/autism spectrum disorder (16% vs 1%), and headaches (14% vs 5%) (all P < .05). They had greater risk of limitation in ability to do things (relative risk: 9.22; 95% CI: 7.56-11.24), repeating a school grade (relative risk: 2.59; CI: 1.52-4.40), poorer social competence and greater parent aggravation, and were at increased risk of having unmet medical and mental health needs. Children with prior but not current seizures largely had intermediate risk. CONCLUSIONS In a nationally representative sample, children with seizures were at increased risk for mental health, developmental, and physical comorbidities, increasing needs for care coordination and specialized services. Children with reported prior but not current seizures need further study to establish reasons for their higher than expected levels of reported functional limitations.
Collapse
Affiliation(s)
- Shirley A Russ
- Department of Academic Primary Care Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | | | | |
Collapse
|
19
|
Pujar SS, Neville BGR, Scott RC, Chin RFM. Death within 8 years after childhood convulsive status epilepticus: a population-based study. Brain 2011; 134:2819-27. [PMID: 21914715 DOI: 10.1093/brain/awr239] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The risk of long-term mortality and its predictors following convulsive status epilepticus in childhood are uncertain. We report mortality within 8 years after an episode of convulsive status epilepticus, and investigate its predictors from a paediatric, prospective, population-based study from north London, UK. In the current study, we followed-up a cohort previously ascertained during a surveillance study of convulsive status epilepticus in childhood. After determining the survival status of the cohort members, we defined cause of death as that listed on their death certificates. We estimated a standardized mortality ratio to compare mortality in our cohort with that expected in the reference population. Multivariable Cox regression analysis was used to investigate any association between the clinical and demographic factors at the time of status epilepticus and subsequent risk of death. The overall case fatality was 11% (95% confidence interval 7.5-16.2%); seven children died within 30 days of their episode of convulsive status epilepticus and 16 during follow-up. The overall mortality in our cohort was 46 times greater than expected in the reference population, and was predominantly due to higher mortality in children who had pre-existing clinically significant neurological impairments when they had their acute episode of convulsive status epilepticus. Children without prior neurological impairment who survived their acute episode of convulsive status epilepticus were not at a significantly increased risk of death during follow-up. There were no deaths in children following prolonged febrile convulsions and idiopathic convulsive status epilepticus. A quarter of deaths during follow-up were associated with intractable seizures/convulsive status epilepticus, and the rest died as a complication of their underlying medical condition. On regression analysis, presence of clinically significant neurological impairments prior to convulsive status epilepticus was the only independent risk factor for mortality. In conclusion, there is a high risk of death within 8 years following childhood convulsive status epilepticus but most deaths are not seizure related. Presence of pre-existing clinically significant neurological impairments at the time of convulsive status epilepticus is the main risk factor for mortality within 8 years after the acute episode. The attributable role of convulsive status epilepticus on mortality remains uncertain, but appears less than is generally perceived.
Collapse
Affiliation(s)
- Suresh S Pujar
- Neurosciences Unit, Institute of Child Health, University College London and Great Ormond Street Hospital for Children NHS Trust, London WC1N 3LU, UK
| | | | | | | | | |
Collapse
|
20
|
Nishiyama I, Ohtsuka Y, Tsuda T, Kobayashi K, Inoue H, Narahara K, Shiraga H, Kimura T, Ogawa M, Terasaki T, Ono H, Takata T. An epidemiological study of children with status epilepticus in Okayama, Japan: Incidence, etiologies, and outcomes. Epilepsy Res 2011; 96:89-95. [DOI: 10.1016/j.eplepsyres.2011.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 03/30/2011] [Accepted: 05/08/2011] [Indexed: 11/15/2022]
|
21
|
Zeber JE, Copeland LA, Pugh MJV. Variation in antiepileptic drug adherence among older patients with new-onset epilepsy. Ann Pharmacother 2010; 44:1896-904. [PMID: 21045168 DOI: 10.1345/aph.1p385] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Medication adherence among patients with epilepsy remains a significant challenge, even for patients prescribed newer antiepileptic drugs (AEDs), leading to increased risks of seizures, hospitalizations, and higher treatment costs. Despite substantial research identifying numerous risk factors, the role of specific medications has been neglected. OBJECTIVE To analyze adherence to 9 different AEDs in a national clinical sample of elderly patients with new-onset epilepsy. METHODS Patients over age 66 receiving care in the Veterans Health Administration were eligible if they met criteria for new-onset epilepsy with AED monotherapy of at least 3 months. A cross-sectional study design was used to assess adherence as defined by the medication possession ratio (MPR) and a 90-day or longer medication gap. Multivariable logistic regression modeled each dichotomous adherence outcome as a function of clinical and demographic measures. RESULTS The sample (N = 6373) was primarily male (98%), white (79%), and exempt from medication copayments due to disability status; nearly 40% had a prior psychiatric or dementia diagnosis. Nearly half of the patients were poorly adherent, with rates ranging from 42% to 63% across AEDs. In multivariable models, patients on phenobarbital, valproate, and gabapentin were significantly less likely to be adherent on both outcomes, while lamotrigine and levetiracetam were positively associated with adherence per the MPR. CONCLUSIONS Adherence difficulty in this elderly cohort is attributable to several factors, yet specific AEDs substantially increased this risk. Drugs that produce adverse effects such as cognitive difficulty or weight gain may prove detrimental to maintaining appropriate adherence early in the treatment course. Given comparable efficacy among AEDs, providers should be aware that certain medications impart differential risks of poor adherence in older patients with epilepsy.
Collapse
Affiliation(s)
- John E Zeber
- Central Texas Veterans Health Care System, Temple, TX, USA
| | | | | |
Collapse
|
22
|
Chivu CM, Reidpath DD. Social deprivation and exposure to health promotion. A study of the distribution of health promotion resources to schools in England. BMC Public Health 2010; 10:473. [PMID: 20698980 PMCID: PMC2924293 DOI: 10.1186/1471-2458-10-473] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 08/10/2010] [Indexed: 12/01/2022] Open
Abstract
Background Area deprivation is a known determinant of health. It is also known that area deprivation is associated with lower impact health promotion. It is less well known, however, whether deprived areas are less responsive to health promotion, or whether they are less exposed. Using data from a national, school-based campaign to promote vaccination against the human papilloma virus (HPV), the relationship between area deprivation and exposure was examined. Methods Taking advantage of a health promotion campaign to provide information to schools about HPV vaccination, a cross sectional study was conducted to examine the relationship between area level, social deprivation, and take-up of (i.e., exposure to) available health promotion material. The sample was 4,750 schools across England, including government maintained and independent schools. The relationship between area deprivation and exposure was examined using bi- and multivariate logistic regression. Results It was found that schools in the least deprived quintile had 1.32 times the odds of requesting health promotion materials than schools in the most deprived areas (p = .01). This effect was independent of the school size, the type of school, and the geographic region. Conclusion The relationship between area deprivation and the impact of health promotion may be due, at least in part, to differential levels of exposure. The study was limited in scope, pointing to the need for more research, but also points to potentially important policy implications.
Collapse
Affiliation(s)
- Corina M Chivu
- Centre for Public Health Research Brunel University Uxbridge, Middlesex, UB83PH UK.
| | | |
Collapse
|