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Batchelor R, Taylor MD. Experiences and perspectives of peer support among young adults with epilepsy. Epilepsy Behav Rep 2023; 21:100590. [PMID: 36818645 PMCID: PMC9929678 DOI: 10.1016/j.ebr.2023.100590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/14/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Young adulthood is a critical developmental period which having epilepsy tends to complicate, suggesting support could be useful. This study aimed to examine the experiences and perspectives of peer support among young adults with epilepsy (YAWE). An online survey was completed by 144 YAWE. Most YAWE reported not having access to peer support but perceived several potential benefits which could support their mental health including mutual understanding, fostering friendships and reducing loneliness, and promoting self-management and coping strategies. Reported barriers to accessing peer support included practical barriers such as travel and time constraints, emotional barriers (e.g., anxiety), and peers not feeling confident or skilled enough to support others. The need for epilepsy peer support groups specifically designed for young adults, university students, and individuals with co-occurring conditions such as autism and attention deficit hyperactivity disorder were also recognised as well as online delivery to address some of the identified barriers. Appropriate training for facilitators and group moderation were noted as important. Overall, these preliminary findings support the acceptability of peer support among YAWE, indicating peer support could be a worthy focus of policy and care pathway development. However, future research is needed to evaluate the effectiveness of peer support for epilepsy populations.
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Affiliation(s)
- Rachel Batchelor
- Department of Psychology, Royal Holloway, University of London, Surrey, UK
- Corresponding author at: Department of Psychology, Royal Holloway, University of London, Egham, Surrey TW20 0EX, UK.
| | - Michelle D. Taylor
- Department of Psychology, Royal Holloway, University of London, Surrey, UK
- Health Psychology Research Limited (HPR Ltd.), 188 High Street, Egham, Surrey, UK
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Bensken WP, Navale SM, Andrew AS, Jobst BC, Sajatovic M, Koroukian SM. Markers of Quality Care for Newly Diagnosed People With Epilepsy on Medicaid. Med Care 2021; 59:588-596. [PMID: 33797505 PMCID: PMC8187271 DOI: 10.1097/mlr.0000000000001541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND For newly diagnosed people with epilepsy (PWE), proper treatment is important to improve outcomes, yet limited data exist on markers of quality care. OBJECTIVE Examine markers of quality care for newly diagnosed PWE. METHODS Using Medicaid claims data (2010-2014) for 15 states we identified adults 18-64 years of age diagnosed with incident epilepsy in 2012 or 2013. We built 5 sequential logistic regression models to evaluate: (1) seeing a neurologist; (2) diagnostic evaluation; (3) antiepileptic medication adherence; (4) serum drug levels checked; and (5) being in the top quartile of number of negative health events (NHEs). We adjusted for demographics, comorbidities, county-level factors, and the outcomes from all prior models. RESULTS Of 25,663 PWE, 37.3% saw a neurologist, with decreased odds for those of older age, those residing in counties with low-density of neurologists, and certain race/ethnicities; about 57% of PWE received at least 1 diagnostic test; and nearly 62% of PWE were adherent to their medication. The most common comorbidities were hypertension (37.1%) and psychoses (26.9%). PWE with comorbidities had higher odds of seeing a neurologist and to have NHEs. Substance use disorders were negatively associated with medication adherence and positively associated with high NHEs. CONCLUSIONS There are notable differences in demographics among people with incident epilepsy who do or do not see a neurologist. Differences in NHEs persist, even after controlling for neurologist care and diagnostic evaluation. Continued attention to these disparities and comorbidities is needed in the evaluation of newly diagnosed PWE.
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Affiliation(s)
- Wyatt P Bensken
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Suparna M Navale
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Angeline S Andrew
- Department of Neurology, Geisel School of Medicine and Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Barbara C Jobst
- Department of Neurology, Geisel School of Medicine and Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Martha Sajatovic
- Departments of Neurology and Psychiatry, University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Siran M Koroukian
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH
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Hew A, Lloyd M, Rayner G, Matson A, Rychkova M, Ali R, Winton-Brown T, Perucca P, Kwan P, O'Brien TJ, Velakoulis D, Malpas CB, Loi SM. Psychiatric and cognitive characteristics of older adults admitted to a Video-EEG monitoring (VEM) unit. Epilepsy Behav 2021; 120:107987. [PMID: 33979768 DOI: 10.1016/j.yebeh.2021.107987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 03/20/2021] [Accepted: 04/07/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare the clinical, psychiatric, and cognitive characteristics of older with younger patients presenting to a video-EEG monitoring (VEM) unit. METHOD This was a retrospective case-control study involving patients admitted for VEM over a two-year period (from April 2018 to April 2020) at two comprehensive epilepsy units. Patients were categorized into an older (≥60 years) and a younger (<60 years) group. Younger patients were individually matched to older adults to form a matched younger group. Diagnosis was determined by a consensus opinion of epileptologists, neurologists, and neuropsychiatrists. The main diagnostic categories were epilepsy, psychogenic nonepileptic seizures (PNES), and 'other' diagnosis (non-diagnostic and other nonepileptic diagnoses). Clinical psychiatric diagnoses were obtained from neuropsychiatric reports. Objective cognitive function was measured with the Neuropsychiatry Unit Cognitive Assessment Tool (NUCOG). Subjective cognitive function was assessed using the Quality of Life in Epilepsy Inventory-89 (QOLIE-89) cognitive subscales. RESULTS Five-hundred and thirty three patients (71 older, 462 younger) aged 16-91 years were admitted to the VEM unit during the study period. There was a diagnosis of focal epilepsy in 55% of the older group and 48% of the younger group, generalized epilepsy in 3% of the older group and 10% of the younger group, and 'other' in 32% of the older group and 19% of the younger group. Ten percent (2 males and 5 females) of the older group were diagnosed with PNES compared to 22% of the younger group (p = 0.016). A depressive disorder was diagnosed in 34% of the older group and 24% of the younger group (p = 0.20). An anxiety disorder was diagnosed in 15% of the older group and 25% of the younger group (p = 0.15). Mild neurocognitive disorder was more common in the older group (34%) compared to the matched younger group (34% vs 3%, p < 0.001). The older group had lower mean NUCOG scores compared to the matched younger group (79.49 vs 87.73, p = <0.001). There was no evidence for a relationship between mean NUCOG score and overall subjective cognitive difficulties for the older group (r = 0.03, p = 0.83). Among older adults, those diagnosed with PNES had more experiences of childhood trauma. Measures of dissociation, depression, or general anxiety did not differ between PNES and non-PNES diagnoses in the older group. CONCLUSION Psychiatric comorbidities are common among older adults admitted for VEM. The psychological impact of epilepsy and risk factors for PNES seen in younger patients are also applicable in the older group. The older group demonstrated more cognitive impairments than the younger group, although these were usually unrecognized by individuals. Older adults admitted to VEM will benefit from psychiatric and neuropsychological input to ensure a comprehensive care approach to evaluation and management.
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Affiliation(s)
- Anthony Hew
- Department of Neuropsychiatry, The Royal Melbourne Hospital, Parkville, Australia.
| | - Michael Lloyd
- Department of Psychiatry, Alfred Health, Prahran, Australia
| | - Genevieve Rayner
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia; Department of Neurosciences, Alfred Health, Australia; Department of Medicine, Austin Hospital, The University of Melbourne
| | - Alice Matson
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Maria Rychkova
- Department of Medicine (RMH), The University of Melbourne, Australia; Department of Neurosciences, Monash University, Australia; Department of Neurology, Alfred Health, Prahran, Australia
| | - Rashida Ali
- Department of Medicine (RMH), The University of Melbourne, Australia; Department of Neurosciences, Monash University, Australia; Department of Neurology, Alfred Health, Prahran, Australia
| | | | - Piero Perucca
- Department of Medicine (RMH), The University of Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Australia; Department of Neurosciences, Monash University, Australia; Department of Neurology, Alfred Health, Prahran, Australia
| | - Patrick Kwan
- Department of Medicine (RMH), The University of Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Australia; Department of Neurosciences, Monash University, Australia; Department of Neurology, Alfred Health, Prahran, Australia
| | - Terence J O'Brien
- Department of Medicine (RMH), The University of Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Australia; Department of Neurosciences, Monash University, Australia; Department of Neurology, Alfred Health, Prahran, Australia
| | - Dennis Velakoulis
- Department of Neuropsychiatry, The Royal Melbourne Hospital, Parkville, Australia; Melbourne Neuropsychiatry Centre, University of Melbourne and NorthWestern Mental Health, Melbourne, VIC, Australia; Department of Psychiatry, University of Melbourne, Australia
| | - Charles B Malpas
- Department of Medicine (RMH), The University of Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Samantha M Loi
- Department of Medicine (RMH), The University of Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Australia
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Sajatovic M, Wilson B, Shegog R, B S Briggs F, Escoffery C, Jobst BC, Johnson EK, Fraser RT, Quarells RC, Spruill TM. The Managing Epilepsy Well (MEW) network database: Lessons learned in refining and implementing an integrated data tool in service of a national U.S. Research Collaborative. Epilepsy Behav 2021; 115:107650. [PMID: 33421855 DOI: 10.1016/j.yebeh.2020.107650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 11/17/2020] [Indexed: 12/19/2022]
Abstract
Epilepsy self-management (ESM) is the summative set of behaviors that people with epilepsy use to cope with seizures and optimize health. This report describes the implementation and evolution of the Managing Epilepsy Well Network Database (MEW DB), an integrated data resource intended to advance knowledge on ESM. The MEW DB utilizes a three-tiered (Tier 1-3) system of data organization, with tiers of data generally increasing in ascending complexity or collection burden. A MEW DB Steering Committee (SC) establishes consensus on planned analyses using a standardized new analysis request template. The data management structure facilitates harmonization and integration of additional data, or to update the database as new data become available. The current MEW DB comprises 1,563 people with epilepsy. Mean age was 39.9 years, 64.9% women (N = 1006), 12.8% African American (N = 170), 22.2% Hispanic (N = 306). On average, individuals have lived with epilepsy since their early 20s and are prescribed between 1 and 2 antiepileptic drugs. The MEW DB spans multiple socio-ecological levels to provide a robust multi-tiered framework for studying ESM. A total of 41 common data elements have been identified through iterative consensus. This integrated database takes advantage of an extensive collective background of archival evidence in ESM and brings together engaged investigators to build a dataset that represents diverse types of individuals with epilepsy, targets health domains important to ESM, and facilitates analyses that would not be possible with sites operating independently. Overall, the MEW DB serves the greater mission of this research collaborative and has potential to advance ESM research.
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Affiliation(s)
- Martha Sajatovic
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Department of Neurology Case, Western Reserve University School of Medicine, Cleveland, OH, United States; Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.
| | - Betsy Wilson
- Department of Neurology Case, Western Reserve University School of Medicine, Cleveland, OH, United States; Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Ross Shegog
- University of Texas Health Science Center, Houston School of Public Health, Houston, TX, United States
| | - Farren B S Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Cam Escoffery
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Barbara C Jobst
- Department of Neurology, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | - Erica K Johnson
- Health Promotion Research Center, University of Washington, Seattle, WA, United States
| | - Robert T Fraser
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Rakale C Quarells
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, United States
| | - Tanya M Spruill
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
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