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What is QOL in children and adolescents with physical disabilities? A thematic synthesis of pediatric QOL literature. Qual Life Res 2021; 30:1233-1248. [PMID: 33550543 DOI: 10.1007/s11136-021-02769-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE Many neuromotor conditions affect children from a young age through to adulthood, impacting their quality of life (QOL). For QOL to be accurately measured in these children, pediatric QOL must first be conceptualized. Some theoretical models and definitions have been proposed to understand QOL, but they were not developed for the pediatric population. The purpose of this review is to build on existing frameworks of QOL and develop a framework and definition of pediatric QOL for measurement purposes, by integrating the findings of multiple qualitative studies involving children and adolescents with physical disabilities. METHODS A systematic search was conducted on four databases. Inclusion criteria were qualitative studies with participants with common neurological and neuromuscular conditions. The content of studies had to involve the lived experiences of children and adolescents with disabilities. Thematic synthesis was conducted. RESULTS 48 studies were included. Results generated a schema of the causes and the mitigators of QOL. This consisted of casual indicators of QOL, mitigators, and components of QOL. Themes under QOL included thoughts and feelings, fitting in, self-image, about the future, and independence. A new framework and definition of pediatric QOL were proposed. CONCLUSIONS In conclusion, pediatric QOL for children with disabilities is formed by their thoughts and feelings, being accepted by society, being able to forge an identity that is beyond their disability, having autonomy, and having a hope for the future. The resulting QOL framework proposed here can also aid future development of QOL measures in children with physical disabilities.
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Karlov VA, Kozhokaru AB, Vlasov PN, Pushkar TN, Orlova AS. [Dynamics of epileptiform activity, efficacy and tolerability of valproic acid in adults and adolescents with newly-diagnosed epilepsy]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:35-43. [PMID: 32790974 DOI: 10.17116/jnevro202012007135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the changes of epileptiform activity index (EAI) as a measure of the efficacy and tolerability of treatment with valproic acid (VA) in patients with newly-diagnosed generalized and focal epilepsy. MATERIAL AND METHODS The study included 93 patients (55 men and 38 women): 27 with focal epilepsy (FE) and 66 with idiopathic generalized epilepsy (IGE). Patients with idiopathic and age-dependent FE were not included in the study. At each visit, video-EEG monitoring with the analysis of focal, diffuse and generalized epileptiform activity during wakefulness before sleep, during sleep, after sleep and during partial awakenings with quantitative EAI assessment at baseline, after 1, 3, 6 and 12 months of therapy was performed. Therapeutic drug monitoring was performed during dose titration 1 month after the start of treatment or in case of treatment change. Treatment efficacy was assessed based on the absence of seizures, decrease of seizure episodes by more than 50% (responders) and <50% (insufficient efficacy). Adverse effects (AE) were assessed using the Assessing SIDe effects in AED treatment scale (SIDAED). RESULTS Maximal EAI was observed at baseline both in FE and IGE groups. In patients with IGE, the total EAI (52.8±7.8) was significantly higher compared to FE group (27.1±5.5 (p=0,027)). During wakefulness before sleep and during sleep EAI was significantly lower in the IGE group compared to FE patients (3.4±0. vs. 10.5±5.5 (p=0.003) and 4.3±0.8 vs. 8.9±3.7 (p=0.046), respectively). VA demonstrated the high efficacy and good tolerability in IGE and FE patients: after 12 months of treatment remission was achieved in 69 (74.2%) patients, the decrease of seizure frequency by more than 50% was observed in 22 (23,7%) patients, insufficient efficacy only in 2 (2.1%). AEs were registered only sporadically. CONCLUSIONS VA remains one of the drugs of choice in IGE and FE. EAI may become an additional objective test in cases of difficult differential diagnosis in IGE and FE, using total EAI, EAI before sleep, during sleep, during partial awakenings in the first months of treatment (1-3 months). EAI objectively reflects the dynamics of VA treatment efficacy.
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Affiliation(s)
- V A Karlov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A B Kozhokaru
- State Research Center - Burnasyan Federal Medical Biophysical Center, Moscow, Russia
| | - P N Vlasov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - T N Pushkar
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A S Orlova
- Sechenov First Moscow State Medical Univesity, Moscow, Russia
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Bhatti SFM, De Risio L, Muñana K, Penderis J, Stein VM, Tipold A, Berendt M, Farquhar RG, Fischer A, Long S, Löscher W, Mandigers PJJ, Matiasek K, Pakozdy A, Patterson EE, Platt S, Podell M, Potschka H, Rusbridge C, Volk HA. International Veterinary Epilepsy Task Force consensus proposal: medical treatment of canine epilepsy in Europe. BMC Vet Res 2015; 11:176. [PMID: 26316233 PMCID: PMC4552371 DOI: 10.1186/s12917-015-0464-z] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 06/29/2015] [Indexed: 12/14/2022] Open
Abstract
In Europe, the number of antiepileptic drugs (AEDs) licensed for dogs has grown considerably over the last years. Nevertheless, the same questions remain, which include, 1) when to start treatment, 2) which drug is best used initially, 3) which adjunctive AED can be advised if treatment with the initial drug is unsatisfactory, and 4) when treatment changes should be considered. In this consensus proposal, an overview is given on the aim of AED treatment, when to start long-term treatment in canine epilepsy and which veterinary AEDs are currently in use for dogs. The consensus proposal for drug treatment protocols, 1) is based on current published evidence-based literature, 2) considers the current legal framework of the cascade regulation for the prescription of veterinary drugs in Europe, and 3) reflects the authors' experience. With this paper it is aimed to provide a consensus for the management of canine idiopathic epilepsy. Furthermore, for the management of structural epilepsy AEDs are inevitable in addition to treating the underlying cause, if possible.
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Affiliation(s)
- Sofie F M Bhatti
- Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, 9820, Belgium.
| | - Luisa De Risio
- Animal Health Trust, Lanwades Park, Kentford, Newmarket, CB8 7UU, Suffolk, United Kingdom.
| | - Karen Muñana
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1052 William Moore Drive, Raleigh, NC, 27607, USA.
| | - Jacques Penderis
- Vet Extra Neurology, Broadleys Veterinary Hospital, Craig Leith Road, Stirling, FK7 7LE, Stirlingshire, United Kingdom.
| | - Veronika M Stein
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany.
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany.
| | - Mette Berendt
- Department of Veterinary and Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg C, Denmark.
| | - Robyn G Farquhar
- Fernside Veterinary Centre, 205 Shenley Road, Borehamwood, SG9 0TH, Hertfordshire, United Kingdom.
| | - Andrea Fischer
- Clinical Veterinary Medicine, Ludwig-Maximillians-University, Veterinärstr. 13, 80539, Munich, Germany.
| | - Sam Long
- University of Melbourne, 250 Princes Highway, Weibee, 3015, VIC, Australia.
| | - Wolfgang Löscher
- Department of Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine Hannover, Bünteweg 17, 30559, Hannover, Germany.
| | - Paul J J Mandigers
- Department of Clinical Sciences of Companion Animals, Utrecht University, Yalelaan 108, 3583 CM, Utrecht, The Netherlands.
| | - Kaspar Matiasek
- Section of Clinical & Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University, Veterinärstr. 13, 80539, Munich, Germany.
| | - Akos Pakozdy
- Clinical Unit of Internal Medicine Small Animals, University of Veterinary Medicine, Veterinärplatz 1, 1210, Vienna, Austria.
| | - Edward E Patterson
- University of Minnesota College of Veterinary Medicine, D426 Veterinary Medical Center, 1352 Boyd Avenue, St. Paul, MN, 55108, USA.
| | - Simon Platt
- College of Veterinary Medicine, University of Georgia, 501 DW Brooks Drive, Athens, GA, 30602, USA.
| | - Michael Podell
- Chicago Veterinary Neurology and Neurosurgery, 3123 N. Clybourn Avenue, Chicago, IL, 60618, USA.
| | - Heidrun Potschka
- Department of Pharmacology, Toxicology and Pharmacy, Ludwig-Maximillians-University, Königinstr. 16, 80539, Munich, Germany.
| | - Clare Rusbridge
- Fitzpatrick Referrals, Halfway Lane, Eashing, Godalming, GU7 2QQ, Surrey, United Kingdom.
- School of Veterinary Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, GU2 7TE, Surrey, United Kingdom.
| | - Holger A Volk
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, AL9 7TA, Hertfordshire, UK.
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Suarez RO, Taimouri V, Boyer K, Vega C, Rotenberg A, Madsen JR, Loddenkemper T, Duffy FH, Prabhu SP, Warfield SK. Passive fMRI mapping of language function for pediatric epilepsy surgical planning: validation using Wada, ECS, and FMAER. Epilepsy Res 2014; 108:1874-88. [PMID: 25445239 DOI: 10.1016/j.eplepsyres.2014.09.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 09/07/2014] [Accepted: 09/13/2014] [Indexed: 11/25/2022]
Abstract
In this study we validate passive language fMRI protocols designed for clinical application in pediatric epilepsy surgical planning as they do not require overt participation from patients. We introduced a set of quality checks that assess reliability of noninvasive fMRI mappings utilized for clinical purposes. We initially compared two fMRI language mapping paradigms, one active in nature (requiring participation from the patient) and the other passive in nature (requiring no participation from the patient). Group-level analysis in a healthy control cohort demonstrated similar activation of the putative language centers of the brain in the inferior frontal (IFG) and temporoparietal (TPG) regions. Additionally, we showed that passive language fMRI produced more left-lateralized activation in TPG (LI=+0.45) compared to the active task; with similarly robust left-lateralized IFG (LI=+0.24) activations using the passive task. We validated our recommended fMRI mapping protocols in a cohort of 15 pediatric epilepsy patients by direct comparison against the invasive clinical gold-standards. We found that language-specific TPG activation by fMRI agreed to within 9.2mm to subdural localizations by invasive functional mapping in the same patients, and language dominance by fMRI agreed with Wada test results at 80% congruency in TPG and 73% congruency in IFG. Lastly, we tested the recommended passive language fMRI protocols in a cohort of very young patients and confirmed reliable language-specific activation patterns in that challenging cohort. We concluded that language activation maps can be reliably achieved using the passive language fMRI protocols we proposed even in very young (average 7.5 years old) or sedated pediatric epilepsy patients.
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Affiliation(s)
- Ralph O Suarez
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Vahid Taimouri
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Katrina Boyer
- Department of Psychology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Clemente Vega
- Department of Psychology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander Rotenberg
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph R Madsen
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tobias Loddenkemper
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Frank H Duffy
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sanjay P Prabhu
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Simon K Warfield
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Berg AT, Levy SR, Testa FM, Blumenfeld H. Long-term seizure remission in childhood absence epilepsy: might initial treatment matter? Epilepsia 2014; 55:551-7. [PMID: 24512528 DOI: 10.1111/epi.12551] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Examine the possible association between long-term seizure outcome in childhood absence epilepsy (CAE) and the initial treatment choice. METHODS Children with CAE were prospectively recruited at initial diagnosis and followed in a community-based cohort study. Children presenting with convulsive seizures, significant imaging abnormalities, or who were followed <5 years were excluded. Early outcomes included success of initial medication, early remission, and pharmacoresistance. The primary long-term outcome was complete remission: ≥5 years both seizure free and medication free. Survival methods were used for analyses. RESULTS The first medication was ethosuximde (ESM) in 41 (69%) and valproic acid (VPA) in 18 (31%). Initial success rates were 59% (ESM) and 56% (VPA). Early remission and pharmacoresistance were similar in each group. Apart from atypical electroencephalography (EEG) features (61% [VPA], 17% [ESM]), no clinical features varied substantially between the treatment groups. Complete remission occurred in 31 children (76%) treated with ESM and 7 (39%) who received VPA (p = 0.007). Children with versus without atypical EEG features were less likely to enter complete remission (50% vs. 71%, p = 0.03). In a Cox regression, ESM was associated with a higher rate of complete remission than VPA (hazards ratio [HR] 2.5, 95% confidence interval [CI] 1.1-6.0; p = 0.03). Atypical EEG features did not independently predict outcome (p = 0.15). Five-year and 10-year remission, regardless of continued treatment, occurred more often in children initially treated with ESM versus VPA. SIGNIFICANCE These findings are congruent with results of studies in genetic absence models in rats and provide preliminary evidence motivating a hypothesis regarding potential disease-modifying effects of ESM in CAE. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.
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Affiliation(s)
- Anne T Berg
- Department of Pediatrics, Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A; the Northwestern Memorial Feinberg School of Medicine, Chicago, Illinois, U.S.A
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