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Ghaith AK, El-Hajj VG, Sanchez-Garavito JE, Zamanian C, Ghanem M, Bon-Nieves A, Chen B, Drees CN, Miller D, Parker JJ, Almeida JP, Elmi-Terander A, Tatum W, Middlebrooks EH, Bydon M, Van-Gompel JJ, Lundstrom BN, Grewal SS. Trends in the Utilization of Surgical Modalities for the Treatment of Drug-Resistant Epilepsy: A Comprehensive 10-Year Analysis Using the National Inpatient Sample. Neurosurgery 2024:00006123-990000000-01011. [PMID: 38189460 DOI: 10.1227/neu.0000000000002811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/10/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Epilepsy is considered one of the most prevalent and severe chronic neurological disorders worldwide. Our study aims to analyze the national trends in different treatment modalities for individuals with drug-resistant epilepsy and investigate the outcomes associated with these procedural trends in the United States. METHODS Using the National Inpatient Sample database from 2010 to 2020, patients with drug-resistant focal epilepsy who underwent laser interstitial thermal therapy (LITT), open surgical resection, vagus nerve stimulation (VNS), or responsive neurostimulation (RNS) were identified. Trend analysis was performed using piecewise joinpoint regression. Propensity score matching was used to compare outcomes between 10 years prepandemic before 2020 and the first peak of the COVID-19 pandemic. RESULTS This study analyzed a total of 33 969 patients with a diagnosis of drug-resistant epilepsy, with 3343 patients receiving surgical resection (78%), VNS (8.21%), RNS (8%), and LITT (6%). Between 2010 and 2020, there was an increase in the use of invasive electroencephalography monitoring for seizure zone localization (P = .003). There was an increase in the use of LITT and RNS (P < .001), while the use of surgical resection and VNS decreased over time (P < .001). Most of these patients (89%) were treated during the pre-COVID pandemic era (2010-2019), while a minority (11%) underwent treatment during the COVID pandemic (2020). After propensity score matching, the rate of pulmonary complications, postprocedural hematoma formation, and mortality were slightly higher during the pandemic compared with the prepandemic period (P = .045, P = .033, and P = .026, respectively). CONCLUSION This study indicates a relative decrease in the use of surgical resections, as a treatment for drug-resistant focal epilepsy. By contrast, newer, minimally invasive surgical approaches including LITT and RNS showed gradual increases in usage.
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Affiliation(s)
- Abdul Karim Ghaith
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Victor Gabriel El-Hajj
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Cameron Zamanian
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Marc Ghanem
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Antonio Bon-Nieves
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Baibing Chen
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - David Miller
- Department of Diagnostic Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jonathon J Parker
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Joao Paulo Almeida
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | | | - William Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jamie J Van-Gompel
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Sanjeet S Grewal
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
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Mutarelli A, Nogueira A, Felix N, Godoi A, Dagostin CS, Castro LHM, Mota Telles JP. Modified Atkins diet for drug-resistant epilepsy: A systematic review and meta-analysis of randomized controlled trials. Seizure 2023; 112:77-83. [PMID: 37769548 DOI: 10.1016/j.seizure.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/21/2023] [Accepted: 09/11/2023] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVE To evaluate the effectiveness and side-effect profile of the modified Atkins diet (MAD) compared to the usual diet (UD) in reducing seizure frequency among patients with drug-resistant epilepsy (DRE). METHODS In February 2023, we conducted an extensive search in PubMed, EMBASE, and Cochrane databases to find randomized controlled trials (RCTs) comparing MAD to UD in patients with drug-resistant epilepsy (DRE) on standard anti-seizure medication (ASM). We used random-effects meta-analyses and the Risk of Bias 2 tool to evaluate treatment effects and assess the quality of the included RCTs, respectively. RESULTS Six studies were evaluated in the meta-analysis, including 575 patients, of whom 288 (50.1 %) were randomized to the MAD. Average follow-up period was 12 weeks. MAD plus standard drug therapy was associated with a higher rate of 50 % or greater reduction in seizure frequency compared to UD plus drug therapy (RR 6.28; 95 % CI 3.52-10.50; p<0.001), both in children (RR 6.28; 95 % CI 3.43-11.49; p<0.001) and adults with DRE (RR 6.14; 95 % CI 1.15-32.66; p = 0.033). MAD was also associated with a higher seizure freedom rate compared to UD (RR 5.94; 95 % CI 1.93-18.31; p = 0.002). Five studies reported adverse events with MAD; constipation was reported in 17 % of patients (95 % CI 5-44 %), lethargy in 11 % (95 % CI 4-25 %), and anorexia in 12 % (95 % CI 8-19 %). Due to limited information about the ASM regimens, we were unable to further analyze the interaction between MAD and ASM. SIGNIFICANCE This meta-analysis, comprising 575 patients from 6 RCTs, revealed that MAD led to higher rates of seizure freedom and underscored its role in seizure frequency reduction by 50 % or more in both adults and children, with no significant adverse events concerns.
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Affiliation(s)
- Antonio Mutarelli
- Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil
| | - Alleh Nogueira
- Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Nicole Felix
- Federal University of Campina Grande, Campina Grande, Brazil
| | - Amanda Godoi
- Cardiff University School of Medicine, Wales, United Kingdom
| | | | | | - João Paulo Mota Telles
- Department of Neurology, University of São Paulo, Av Dr Arnaldo, 455, São Paulo, São Paulo, Brazil.
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Shawahna R, Jaber M. Development of Consensus-Based Recommendations to Prevent/Minimize Medication Errors in the Perioperative Care of Patients with Epilepsy: A Mixed-Method. World Neurosurg 2022; 166:e632-e644. [PMID: 35872130 DOI: 10.1016/j.wneu.2022.07.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study explored medication errors in the perioperative care of patients with epilepsy and developed consensus-based recommendations to prevent/minimize these errors. METHODS A mixed method was used in this study. Medication error situations were explored in semi-structured in-depth interviews with nurses (n = 12), anesthesiologists (n = 5), anesthesia technicians (n = 5), surgeons (n = 4), neurologists (n = 4), and patients with epilepsy (n = 10). The qualitative data were analyzed using the qualitative interpretive description approach. A two-round Delphi technique was used among nurses (n = 22), anesthesiologists (n = 9), anesthesia technicians (n = 7), surgeons (n = 7), and neurologists (n = 5). RESULTS A total of 1400 minutes of interview time was analyzed in this study. Of the panelists, 39 (78.0%) agreed that patients with epilepsy present unique challenges to providers of perioperative care that make them prone to medication errors. The interviewees in this study described 32 different medication error situations that occurred while providing perioperative care services to patients with epilepsy. In this study, 35 consensus-based recommendations to prevent/minimize medication errors in the perioperative care of patients with epilepsy were developed. CONCLUSIONS The findings of this study are informative to decision-makers in health care facilities and other stakeholders in health regulatory authorities who need to design measures to prevent/minimize medication errors and improve perioperative outcomes of patients with epilepsy. Studies are needed to investigate if these recommendations can be effective in preventing/reducing medication errors in the perioperative care of patients with epilepsy.
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Affiliation(s)
- Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine; An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University, Nablus, Palestine
| | - Mohammad Jaber
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine; An-Najah National University Hospital, An-Najah National University, Nablus, Palestine.
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4
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Apantaku GO, McDonald PJ, Aguiar M, Cabrera LY, Chiong W, Connolly MB, Hrincu V, Ibrahim GM, Kaal KJ, Lawson A, Naftel R, Racine E, Safari A, Harrison M, Illes J. Clinician preferences for neurotechnologies in pediatric drug-resistant epilepsy: A discrete choice experiment. Epilepsia 2022; 63:2338-2349. [PMID: 35699675 PMCID: PMC9796345 DOI: 10.1111/epi.17328] [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: 03/09/2022] [Revised: 06/10/2022] [Accepted: 06/10/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Novel and minimally invasive neurotechnologies offer the potential to reduce the burden of epilepsy while avoiding the risks of conventional resective surgery. Few neurotechnologies have been tested in randomized controlled trials with pediatric populations, leaving clinicians to face decisions about whether to recommend these treatments with insufficient evidence about the relevant risks and benefits. This study specifically explores the preferences of clinicians for treating pediatric drug-resistant epilepsy (DRE) with novel neurotechnologies. METHODS A discrete-choice experiment (DCE) was designed to elicit the preferences of clinicians with experience in treating children with DRE using novel neurotechnological interventions. The preferences for six key attributes used when making treatment decisions (chances of clinically significant improvement in seizures, major and minor risks from intervention, availability of evidence, financial burden for the family, and access to the intervention) were estimated using a conditional logit model. The estimates from this model were then used to predict the adoption of existing novel neurotechnological interventions. RESULTS Sixty-eight clinicians completed the survey: 33 neurosurgeons, 28 neurologists, and 7 other clinicians. Most clinicians were working in the United States (74%), and the remainder (26%) in Canada. All attributes, apart from the nearest location with access to the intervention, influenced preferences significantly. The chance of clinically significant improvement in seizures was the most positive influence on clinician preferences, but low-quality evidence and a higher risk of major complications could offset these preferences. Of the existing neurotechnological interventions, vagus nerve stimulation was predicted to have the highest likelihood of adoption; deep brain stimulation had the lowest likelihood of adoption. SIGNIFICANCE The preferences of clinicians are drive primarily by the likelihood of achieving seizure freedom for their patients, but preferences for an intervention are largely eradicated if only low quality of evidence supporting the intervention is available. Until better evidence supporting the use of potentially effective, novel neurotechnologies becomes available, clinicians are likely to prefer more established treatments.
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Affiliation(s)
- Glory O. Apantaku
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Patrick J. McDonald
- Neuroethics Canada, Division of Neurology, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada,Division of Neurosurgery, Department of Surgery, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada,Section of Neurosurgery, Department of SurgeryUniversity of ManitobaWinnipegManitobaCanada
| | - Magda Aguiar
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Laura Y. Cabrera
- Department of Science and Mechanics, Center for Neural EngineeringPennsylvania State UniversityUniversity ParkPennsylvaniaUSA,Rock Ethics InstitutePennsylvania State UniversityUniversity ParkPennsylvaniaUSA
| | - Winston Chiong
- Department of Neurology, Memory and Aging Center, Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Mary B. Connolly
- Division of Neurology, Department of PediatricsUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Viorica Hrincu
- Neuroethics Canada, Division of Neurology, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - George M. Ibrahim
- Division of Neurosurgery, Department of Surgery, Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | - K. Julia Kaal
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Ashley Lawson
- Neuroethics Canada, Division of Neurology, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Robert Naftel
- Department of NeurosurgeryVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Eric Racine
- Pragmatic Health Ethics Research UnitInstitut de recherches cliniques de MontréalMontréalQuébecCanada,Department of Preventive and Social Medicine, Faculty of MedicineUniversité de MontréalMontréalQuébecCanada,Department of Neurology and Neurosurgery, Faculty of Medicine and Health SciencesMcGill UniversityMontréalQuébecCanada
| | - Abdollah Safari
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Mark Harrison
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada,Centre for Health Evaluation and Outcome SciencesSt. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Judy Illes
- Neuroethics Canada, Division of Neurology, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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5
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Khoo A, de Tisi J, Foong J, Bindman D, O'Keeffe AG, Sander JW, Miserocchi A, McEvoy AW, Duncan JS. Long-term seizure, psychiatric and socioeconomic outcomes after frontal lobe epilepsy surgery. Epilepsy Res 2022; 186:106998. [PMID: 35985250 DOI: 10.1016/j.eplepsyres.2022.106998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 07/17/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Resective surgery for selected individuals with frontal lobe epilepsy can be effective, although multimodal outcomes are less established than in temporal lobe epilepsy. We describe long-term seizure remission and relapse patterns, psychiatric comorbidity, and socioeconomic outcomes following frontal lobe epilepsy surgery. METHODS We reviewed individual data on frontal lobe epilepsy procedures at our center between 1990 and 2020. This included the presurgical evaluation, operative details and annual postoperative seizure and psychiatric outcomes, prospectively recorded in an epilepsy surgery database. Outcome predictors were subjected to multivariable analysis, and rates of seizure freedom were analyzed using Kaplan-Meier methods. We used longitudinal assessment of the Index of Multiple Deprivation to assess change in socioeconomic status over time. RESULTS A total of 122 individuals with a median follow-up of seven years were included. Of these, 33 (27 %) had complete seizure freedom following surgery, with a further 13 (11 %) having only auras. Focal MRI abnormality, histopathology (focal cortical dysplasia, cavernoma or dysembryoplastic neuronal epithelial tumor) and fewer anti-seizure medications at the time of surgery were predictive of a favorable outcome; 67 % of those seizure-free for the first 12 months after surgery never experienced a seizure relapse. Thirty-one of 50 who had preoperative psychiatric pathology noticed improved psychiatric symptomatology by two years postoperatively. New psychiatric comorbidity was diagnosed in 15 (13 %). Persistent motor complications occurred in 5 % and dysphasia in 2 %. No significant change in socioeconomic deciles of deprivation was observed after surgery. SIGNIFICANCE Favorable long-term seizure, psychiatric and socioeconomic outcomes can be seen following frontal lobe epilepsy surgery. This is a safe and effective treatment that should be offered to suitable individuals early.
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Affiliation(s)
- Anthony Khoo
- Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; College of Medicine and Public Health, Flinders University, Bedford Park SA 5042, Australia.
| | - Jane de Tisi
- Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Jacqueline Foong
- Department of Neuropsychiatry, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Dorothea Bindman
- Department of Neuropsychiatry, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Aidan G O'Keeffe
- School of Mathematical Sciences, University of Nottingham, Nottingham NG7 2RD, UK
| | - Josemir W Sander
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, Heemstede 2103SW, Netherlands; Department of Neurology, West China Hospital, & Institute of Brain Science & Brain-inspired Technology, Sichuan University, Chengdu 610041, China
| | - Anna Miserocchi
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Andrew W McEvoy
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - John S Duncan
- Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK
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6
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You C, Yao L, Yao P, Li L, Ding P, Liang S, Liu C, Xue N. An iEEG Recording and Adjustable Shunt-Current Conduction Platform for Epilepsy Treatment. BIOSENSORS 2022; 12:bios12040247. [PMID: 35448307 PMCID: PMC9032513 DOI: 10.3390/bios12040247] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 05/05/2023]
Abstract
This paper proposes a compact bioelectronics sensing platform, including a multi-channel electrode, intracranial electroencephalogram (iEEG) recorder, adjustable galvanometer, and shunt-current conduction circuit pathway. The developed implantable electrode made of polyurethane-insulated stainless-steel materials is capable of recording iEEG signals and shunt-current conduction. The electrochemical impedance of the conduction, ground/reference, and working electrode were characterized in phosphate buffer saline solution, revealing in vitro results of 517.2 Ω@1 kHz (length of 0.1 mm, diameter of 0.8 mm), 1.374 kΩ@1 kHz (length of 0.3 mm, diameter of 0.1 mm), and 3.188 kΩ@1 kHz (length of 0.1 mm, diameter of 0.1 mm), respectively. On-bench measurement of the system revealed that the input noise of the system is less than 2 μVrms, the signal frequency bandwidth range is 1 Hz~10 kHz, and the shunt-current detection range is 0.1~3000 μA with an accuracy of above 99.985%. The electrode was implanted in the CA1 region of the right hippocampus of rats for the in vivo experiments. Kainic acid (KA)-induced seizures were detected through iEEG monitoring, and the induced shunt-current was successfully measured and conducted out of the brain through the designed circuit-body path, which verifies the potential of current conduction for the treatment of epilepsy.
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Affiliation(s)
- Changhua You
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute (AIR), Chinese Academy of Sciences, Beijing 100190, China; (C.Y.); (P.Y.); (C.L.)
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Lei Yao
- School of Microelectronics, Shanghai University, Shanghai 200444, China;
| | - Pan Yao
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute (AIR), Chinese Academy of Sciences, Beijing 100190, China; (C.Y.); (P.Y.); (C.L.)
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Li Li
- SPF Biotechnology Co., Ltd., Beijing 102100, China;
| | - Ping Ding
- Functional Neurosurgery Department, Beijing Children’s Hospital, Capital Medical University, Beijing 100045, China; (P.D.); (S.L.)
| | - Shuli Liang
- Functional Neurosurgery Department, Beijing Children’s Hospital, Capital Medical University, Beijing 100045, China; (P.D.); (S.L.)
| | - Chunxiu Liu
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute (AIR), Chinese Academy of Sciences, Beijing 100190, China; (C.Y.); (P.Y.); (C.L.)
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
- Personalized Management of Chronic Respiratory Disease, Chinese Academy of Medical Sciences, Beijing 100190, China
| | - Ning Xue
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute (AIR), Chinese Academy of Sciences, Beijing 100190, China; (C.Y.); (P.Y.); (C.L.)
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
- Personalized Management of Chronic Respiratory Disease, Chinese Academy of Medical Sciences, Beijing 100190, China
- Correspondence:
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7
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Bonilla L, Esteruelas G, Ettcheto M, Espina M, García ML, Camins A, Souto EB, Cano A, Sánchez-López E. Biodegradable nanoparticles for the treatment of epilepsy: From current advances to future challenges. Epilepsia Open 2021; 7 Suppl 1:S121-S132. [PMID: 34862851 PMCID: PMC9340299 DOI: 10.1002/epi4.12567] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 11/04/2021] [Accepted: 11/30/2021] [Indexed: 12/15/2022] Open
Abstract
Epilepsy is the second most prevalent neurological disease worldwide. It is mainly characterized by an electrical abnormal activity in different brain regions. The massive entrance of Ca2+ into neurons is the main neurotoxic process that lead to cell death and finally to neurodegeneration. Although there are a huge number of antiseizure medications, there are many patients who do not respond to the treatments and present refractory epilepsy. In this context, nanomedicine constitutes a promising alternative to enhance the central nervous system bioavailability of antiseizure medications. The encapsulation of different chemical compounds at once in a variety of controlled drug delivery systems gives rise to an enhanced drug effectiveness mainly due to their targeting and penetration into the deepest brain region and the protection of the drug chemical structure. Thus, in this review we will explore the recent advances in the development of drugs associated with polymeric and lipid-based nanocarriers as novel tools for the management of epilepsy disorders.
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Affiliation(s)
- Lorena Bonilla
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain.,Institute of Nanoscience and Nanotechnology (IN2UB), University of Barcelona, Barcelona, Spain
| | - Gerard Esteruelas
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain.,Institute of Nanoscience and Nanotechnology (IN2UB), University of Barcelona, Barcelona, Spain
| | - Miren Ettcheto
- Centre for Biomedical Research in Neurodegenerative Diseases Network (CIBERNED), Carlos III Health Institute, Madrid, Spain.,Department of Pharmacology, Toxicology and Therapeutic Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain.,Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Marta Espina
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain.,Institute of Nanoscience and Nanotechnology (IN2UB), University of Barcelona, Barcelona, Spain
| | - María Luisa García
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain.,Institute of Nanoscience and Nanotechnology (IN2UB), University of Barcelona, Barcelona, Spain.,Centre for Biomedical Research in Neurodegenerative Diseases Network (CIBERNED), Carlos III Health Institute, Madrid, Spain
| | - Antoni Camins
- Centre for Biomedical Research in Neurodegenerative Diseases Network (CIBERNED), Carlos III Health Institute, Madrid, Spain.,Department of Pharmacology, Toxicology and Therapeutic Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain.,Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Eliana B Souto
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.,CEB - Centre of Biological Engineering, University of Minho, Braga, Portugal
| | - Amanda Cano
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain.,Institute of Nanoscience and Nanotechnology (IN2UB), University of Barcelona, Barcelona, Spain.,Centre for Biomedical Research in Neurodegenerative Diseases Network (CIBERNED), Carlos III Health Institute, Madrid, Spain.,Ace Alzheimer Center Barcelona - Universitat Internacional de Catalunya, Barcelona, Spain
| | - Elena Sánchez-López
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain.,Institute of Nanoscience and Nanotechnology (IN2UB), University of Barcelona, Barcelona, Spain.,Centre for Biomedical Research in Neurodegenerative Diseases Network (CIBERNED), Carlos III Health Institute, Madrid, Spain
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8
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Amoudi M, Nairat Q, Shawahna R. Knowledge, attitudes, and practices of physiotherapists with regard to epilepsy and patients with epilepsy: A systematic scoping review. Epilepsy Behav 2021; 124:108367. [PMID: 34717245 DOI: 10.1016/j.yebeh.2021.108367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/21/2021] [Accepted: 09/25/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND In today's healthcare systems, physiotherapists are one of the most important providers of care services to patients with disabilities including those with epilepsy. The aims of this systematic scoping review were to identify, summarize, and present narrative synthesis of qualitative evidence on knowledge, attitudes, and practices of physiotherapists toward epilepsy and patients with epilepsy. METHODS Primary studies were searched in Medline/PubMed, Embase, Science Direct, SpringerLink, CInAHL/EBSCO, Cochrane library, and Scopus as late as July 02, 2021. Appraisal of the methodological quality was conducted for the studies included in this systematic scoping review. Due to the heterogenous nature of the collected data, results of this study are presented as narrative synthesis. RESULTS A total of 11 were finally included in the qualitative synthesis. The selected studies were published in the period between 2016 and 2020. The studies included in this review had acceptable methodological quality in many of the 11 domains of the quality assessment tool. Contents of the included studies were grouped into the 11 themes and 8 subthemes. The major themes were related education/access to information, interaction with patients, witnessing seizures, barriers and promoters of adequate knowledge and attitudes, and interventions to improve knowledge and attitudes. CONCLUSION Currently, high-quality interventional studies are needed to improve knowledge, attitudes, and practices of physiotherapists with regard to epilepsy and patients with epilepsy. Future studies are still needed to investigate if improving knowledge, attitudes, and practices of physiotherapists with regard to epilepsy and patients with epilepsy can improve health-related outcomes of the patients.
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Affiliation(s)
- Mosab Amoudi
- Health Sciences Department, Arab American University, Palestine
| | - Qais Nairat
- Department of Physical Education, Faculty of Educational Sciences and Teachers' Training, An-Najah National University, Nablus, Palestine
| | - Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine; An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University, Nablus, Palestine.
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9
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Jaber M, Shawahna R, Abu-Issa M, Radwan F, Dweik M. Anesthesia considerations for patients with epilepsy: Findings of a qualitative study in the Palestinian practice. Epilepsy Behav 2021; 123:108278. [PMID: 34492543 DOI: 10.1016/j.yebeh.2021.108278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/11/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This qualitative exploratory study was conducted to explore how anesthesiologists in Palestine provide perioperative care for patients with epilepsy and how they account for the unique challenges relevant to epilepsy while planning perioperative care for patients with epilepsy. METHODS This study was conducted in an explorative qualitative design. Purposive and snowball sampling approaches were used to recruit the study participants. Qualitative semi-structured in-depth interviews were conducted with anesthesiologists (n = 10) and a neurologist (n = 1). The qualitative data collected in this study were thematically analyzed using the interpretive description methodology to generate themes, subthemes, and patterns. RESULTS Three major themes emerged from the collected qualitative data with a total of 18 subthemes. The 3 themes were: 1) considerations/challenges while assessing patients, 2) anesthetic considerations, and 3) recovery considerations. Lack of epilepsy-specific assessment and anesthesia protocols, underuse of neurology referral services, and lack of neuromonitoring were identified. CONCLUSION Findings of this study highlighted the need to develop specific anesthesia protocols for patients with epilepsy. Anesthesiologists and planners of perioperative care should improve collection of patient information and assessment methods, ensure control over seizures, reduce triggers of seizures, and improve patient monitoring approaches. Findings of this study might be used to inform anesthesiologists and decision makers in professional groups, patient advocacy groups, and healthcare authorities to benchmark and improve anesthesia care and services offered to patients with epilepsy. More studies are still needed to quantitatively assess the quality of anesthesia care and services provided to patients with epilepsy.
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Affiliation(s)
- Mohammad Jaber
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine; An-Najah National University Hospital, An-Najah National University, Nablus, Palestine.
| | - Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine; An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University, Nablus, Palestine
| | - Majd Abu-Issa
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Faris Radwan
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Mohammad Dweik
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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