1
|
Georgis-Yap Z, Popovic MR, Khan SS. Supervised and Unsupervised Deep Learning Approaches for EEG Seizure Prediction. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2024; 8:286-312. [PMID: 38681760 PMCID: PMC11052752 DOI: 10.1007/s41666-024-00160-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 01/04/2024] [Accepted: 01/18/2024] [Indexed: 05/01/2024]
Abstract
Epilepsy affects more than 50 million people worldwide, making it one of the world's most prevalent neurological diseases. The main symptom of epilepsy is seizures, which occur abruptly and can cause serious injury or death. The ability to predict the occurrence of an epileptic seizure could alleviate many risks and stresses people with epilepsy face. We formulate the problem of detecting preictal (or pre-seizure) with reference to normal EEG as a precursor to incoming seizure. To this end, we developed several supervised deep learning approaches model to identify preictal EEG from normal EEG. We further develop novel unsupervised deep learning approaches to train the models on only normal EEG, and detecting pre-seizure EEG as an anomalous event. These deep learning models were trained and evaluated on two large EEG seizure datasets in a person-specific manner. We found that both supervised and unsupervised approaches are feasible; however, their performance varies depending on the patient, approach and architecture. This new line of research has the potential to develop therapeutic interventions and save human lives.
Collapse
Affiliation(s)
- Zakary Georgis-Yap
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 550, University Avenue, Toronto, M5G 2A2 Ontario Canada
- Institute of Biomedical Engineering, University of Toronto, 64 College St., Toronto, M5S 3G9 Ontario Canada
| | - Milos R. Popovic
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 550, University Avenue, Toronto, M5G 2A2 Ontario Canada
- Institute of Biomedical Engineering, University of Toronto, 64 College St., Toronto, M5S 3G9 Ontario Canada
| | - Shehroz S. Khan
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 550, University Avenue, Toronto, M5G 2A2 Ontario Canada
- Institute of Biomedical Engineering, University of Toronto, 64 College St., Toronto, M5S 3G9 Ontario Canada
| |
Collapse
|
2
|
Li H, Liao J, Wang H, Zhan CA, Yang F. EEG power spectra parameterization and adaptive channel selection towards semi-supervised seizure prediction. Comput Biol Med 2024; 175:108510. [PMID: 38691913 DOI: 10.1016/j.compbiomed.2024.108510] [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: 10/24/2023] [Revised: 03/27/2024] [Accepted: 04/21/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND The seizure prediction algorithms have demonstrated their potential in mitigating epilepsy risks by detecting the pre-ictal state using ongoing electroencephalogram (EEG) signals. However, most of them require high-density EEG, which is burdensome to the patients for daily monitoring. Moreover, prevailing seizure models require extensive training with significant labeled data which is very time-consuming and demanding for the epileptologists. METHOD To address these challenges, here we propose an adaptive channel selection strategy and a semi-supervised deep learning model respectively to reduce the number of EEG channels and to limit the amount of labeled data required for accurate seizure prediction. Our channel selection module is centered on features from EEG power spectra parameterization that precisely characterize the epileptic activities to identify the seizure-associated channels for each patient. The semi-supervised model integrates generative adversarial networks and bidirectional long short-term memory networks to enhance seizure prediction. RESULTS Our approach is evaluated on the CHB-MIT and Siena epilepsy datasets. With utilizing only 4 channels, the method demonstrates outstanding performance with an AUC of 93.15% on the CHB-MIT dataset and an AUC of 88.98% on the Siena dataset. Experimental results also demonstrate that our selection approach reduces the model parameters and training time. CONCLUSIONS Adaptive channel selection coupled with semi-supervised learning can offer the possible bases for a light weight and computationally efficient seizure prediction system, making the daily monitoring practical to improve patients' quality of life.
Collapse
Affiliation(s)
- Hanyi Li
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China; Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China
| | - Jiahui Liao
- School of Electronics and Information Engineering, Harbin Institute of Technology at Shenzhen, Shenzhen, 518055, China
| | - Hongxiao Wang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Chang'an A Zhan
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China; Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China; Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China.
| | - Feng Yang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China; Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China.
| |
Collapse
|
3
|
Liu Q, Tan B, Zhang J, Jin Y, Lei P, Wang X, Li M, Jia X, Zhang Q. Premature mortality risk in individuals with convulsive epilepsy: Results from a longitudinal, prospective, population-based study. Epilepsy Res 2023; 197:107243. [PMID: 37839339 DOI: 10.1016/j.eplepsyres.2023.107243] [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: 04/03/2023] [Revised: 09/02/2023] [Accepted: 10/08/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE To assess premature mortality and identify associated risk factors among individuals with convulsive epilepsy in resource-poor settings using a longitudinal, prospective, population-based approach. METHOD The study recruited people with convulsive epilepsy who underwent assessment and management of epilepsy at primary healthcare centers in rural Northwest China, including newly diagnosed individuals and previously identified prevalent cases. All participants were confirmed to have epilepsy by neurologists according to strict criteria and were followed up monthly by primary care physicians. Demographic data and cause of death (COD) were obtained from death certificates or verbal autopsies conducted by neurologists, following the International Classification of Diseases, 10th Edition. The standardized mortality ratio (SMR) and proportionate mortality ratio (PMR) for each cause of death were estimated using the Cause-Of-Death Surveillance Dataset of China (2020). Survival analysis was used to identify risk factors associated with all-cause mortality and death directly due to epilepsy. RESULTS During 5.9 years of follow-up with 40,947 person-years, there were 781 (11.2%) deaths among 6967 participants. The risk of premature death in people with convulsive epilepsy was 2.7-fold higher than that in the general population. Young participants had a significantly higher risk (standardized mortality ratio 26.5-52.5) of premature death. The proportionate mortality ratio was higher for cerebrovascular disease (15%), sudden unexpected death in epilepsy (SUDEP) (13.4%), cardiovascular disease (11.7%), status epilepsy (SE) (11.3%), and epilepsy-related accidents (14.0%) than other premature mortality cause of deaths. Additionally, the highest standardized proportional mortality ratio (SPMR) was observed from drowning in all cause of death (10.4, 95% confidence interval [CI]: 7.6-13.8), followed by burning (9.0, 95% CI: 3.7-18.9). Factors that increased the risk of all-cause mortality included male sex, late age of onset, short disease duration, high body mass index, monotherapy, and the frequency of generalized tonic-clonic seizures (GTCS). High frequency of generalized tonic-clonic seizures (> 3 attacks in the last year) was an independent risk factor for premature death directly due to epilepsy (including sudden unexpected death in epilepsy, status epilepsy, and epilepsy-related accidents), while early age of onset (≤ 14 years) and long duration of epilepsy (> 20 years) were independent risk factors for sudden unexpected death in epilepsy. In addition, short duration of epilepsy (≤ 20 years) was an independent risk factor for status epilepsy. CONCLUSIONS This study demonstrated that individuals with poorly controlled seizures are more likely to experience premature death, with most deaths being epilepsy-related and preventable. These findings underline the importance of effective seizure treatment and the potential impact on reducing premature mortality among people with convulsive epilepsy.
Collapse
Affiliation(s)
- Qiang Liu
- Department of Neurology, General Hospital of Ningxia Medical University, Ningxia Key Laboratory of Cerebrocranial Diseases, Incubation Base of National Key Laboratory, Yinchuan 750004, Ningxia Province, China; Graduate College of Ningxia Medical University, Yinchuan 750004, Ningxia Province, China
| | - Bofei Tan
- Graduate College of Ningxia Medical University, Yinchuan 750004, Ningxia Province, China
| | - Jie Zhang
- Graduate College of Ningxia Medical University, Yinchuan 750004, Ningxia Province, China
| | - Yanzi Jin
- Department of Neurology, General Hospital of Ningxia Medical University, Ningxia Key Laboratory of Cerebrocranial Diseases, Incubation Base of National Key Laboratory, Yinchuan 750004, Ningxia Province, China
| | - Pingping Lei
- Ningxia Center for Disease Prevention and Control, Yinchuan 750004, Ningxia Province, China
| | - Xu Wang
- Department of Neurology, General Hospital of Ningxia Medical University, Ningxia Key Laboratory of Cerebrocranial Diseases, Incubation Base of National Key Laboratory, Yinchuan 750004, Ningxia Province, China
| | - Mengyun Li
- Graduate College of Ningxia Medical University, Yinchuan 750004, Ningxia Province, China
| | - Xiaodan Jia
- Graduate College of Ningxia Medical University, Yinchuan 750004, Ningxia Province, China
| | - Qing Zhang
- Department of Neurology, General Hospital of Ningxia Medical University, Ningxia Key Laboratory of Cerebrocranial Diseases, Incubation Base of National Key Laboratory, Yinchuan 750004, Ningxia Province, China.
| |
Collapse
|
4
|
Kang W. Factor Structure of the GHQ-12 and Their Applicability to Epilepsy Patients for Screening Mental Health Problems. Healthcare (Basel) 2023; 11:2209. [PMID: 37570449 PMCID: PMC10418596 DOI: 10.3390/healthcare11152209] [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: 07/06/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
Epilepsy, a severe neurological disorder impacting approximately 50 million individuals worldwide, is associated with a high prevalence of mental health issues. However, existing research has predominantly examined the relationship between epilepsy and depression or anxiety, neglecting other dimensions of mental health as assessed by factor scores from the general health survey (GHQ), such as the GHQ-12. This study aimed to explore how epilepsy affects both general mental health and specific dimensions of mental health. By employing a factor analysis and a predictive normative modeling approach, the study examined 426 epilepsy patients and 39,171 individuals without epilepsy. The findings revealed that epilepsy patients experienced poorer general mental health and specific aspects of mental health. Consequently, this study highlights the validity of GHQ-12 as a measure of mental health problems in epilepsy patients and emphasizes the importance of considering the impact of epilepsy on various dimensions of mental health, rather than focusing solely on depression or anxiety. Clinicians should incorporate these study results into the development of interventions aimed at enhancing mental well-being in epilepsy patients, ultimately leading to improved outcomes.
Collapse
Affiliation(s)
- Weixi Kang
- Department of Brain Sciences, Imperial College London, London W12 0BZ, UK
| |
Collapse
|
5
|
Schnier C, Chin RF. Mortality in children with epilepsy: Cohort study using the clinical practice research datalink. Seizure 2023; 109:77-82. [PMID: 37269743 DOI: 10.1016/j.seizure.2023.05.020] [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: 03/07/2023] [Revised: 05/22/2023] [Accepted: 05/30/2023] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVE To estimate Mortality Rate (MR) in UK children with epilepsy (CWE) compared to children without epilepsy (CWOE), describe causes of death, determine Mortality Rate Ratios (MRRs) for cause-specific mortality, and to analyse the contribution of co-morbidities (respiratory disease, neoplasm, and congenital disorders) to mortality rate. METHOD Retrospective cohort study of children born between 1998 and 2017, using linked data from the Clinical Practice Research Datalink Gold (Set 18). Epilepsy diagnoses were identified using previously validated codes. Causes of death were defined as natural or non-natural. Epilepsy-related deaths in CWE were those where underlying or contributing cause of death was epilepsy, status epilepticus, seizures, ill-defined/unknown cause or sudden death. We used Cox proportional hazard analysis to investigate associations of epilepsy and mortality. RESULTS There were 1,191,304 children followed for 13,994,916 person-years (median: 12) if which 9665 (0.8%) had epilepsy. Amongst CWE, 3.4% died. MR of CWE was 4.1 (95%CI 3.7-4.6)/1,000 person-years. CWE had an increased adjusted all-cause mortality (MRR 50.9,95%CI 44.8-57.7) compared to CWOE. Amongst the 330 deaths in CWE, 323 (98%) were natural, 7 (2%) non-natural, 80 (24%) epilepsy-related. MRR of non-natural deaths was 2.09 (95%CI 0.92,4.74, p = 0.08). SIGNIFICANCE Amongst CWE, 3.4% died during the study period. All-cause mortality rate in CWE was 4/1,000 person-years representing a fifty-fold increased mortality risk, after taking into account sex and socioeconomic status, compared to similarly aged children who did not have epilepsy. Causes of death mostly were not seizure-related. Non-natural death in CWE was uncommon.
Collapse
Affiliation(s)
- Christian Schnier
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, Edinburgh
| | - Richard F Chin
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, Edinburgh; Royal Hospital for Children and Young People, Edinburgh.
| |
Collapse
|
6
|
Belete D, Jacobs BM, Simonet C, Bestwick JP, Waters S, Marshall CR, Dobson R, Noyce AJ. Association Between Antiepileptic Drugs and Incident Parkinson Disease. JAMA Neurol 2023; 80:183-187. [PMID: 36574240 PMCID: PMC9857018 DOI: 10.1001/jamaneurol.2022.4699] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/18/2022] [Indexed: 12/28/2022]
Abstract
Importance Recent studies have highlighted an association between epilepsy and Parkinson disease (PD). The role of antiepileptic drugs (AEDs) has not been explored. Objective To investigate the association between AEDs and incident PD. Design, Setting, and Participants This nested case-control study started collecting data from the UK Biobank (UKB) in 2006, and data were extracted on June 30, 2021. Individuals with linked primary care prescription data were included. Cases were defined as individuals with a Hospital Episode Statistics (HES)-coded diagnosis of PD. Controls were matched 6:1 for age, sex, race and ethnicity, and socioeconomic status. Prescription records were searched for AEDs prescribed prior to diagnosis of PD. The UKB is a longitudinal cohort study with more than 500 000 participants; 45% of individuals in the UKB have linked primary care prescription data. Participants living in the UK aged between 40 and 69 years were recruited to the UKB between 2006 and 2010. All participants with UKB-linked primary care prescription data (n = 222 106) were eligible for enrollment in the study. Individuals with only a self-reported PD diagnosis or missing data for the matching variables were excluded. In total, 1477 individuals were excluded; 49 were excluded due to having only self-reported PD, and 1428 were excluded due to missing data. Exposures Exposure to AEDs (carbamazepine, lamotrigine, levetiracetam, and sodium valproate) was defined using routinely collected prescription data derived from primary care. Main Outcomes and Measures Odds ratios and 95% CIs were calculated using adjusted logistic regression models for individuals prescribed AEDs before the first date of HES-coded diagnosis of PD. Results In this case-control study, there were 1433 individuals with an HES-coded PD diagnosis (cases) and 8598 controls in the analysis. Of the 1433 individuals, 873 (60.9%) were male, 1397 (97.5%) had their race and ethnicity recorded as White, and their median age was 71 years (IQR, 65-75 years). An association was found between AED prescriptions and incident PD (odds ratio, 1.80; 95% CI, 1.35-2.40). There was a trend for a greater number of prescription issues and multiple AEDs being associated with a greater risk of PD. Conclusions and Relevance This study, the first to systematically look at PD risk in individuals prescribed the most common AEDs, to our knowledge, found evidence of an association between AEDs and incident PD. With the recent literature demonstrating an association between epilepsy and PD, this study provides further insights.
Collapse
Affiliation(s)
- Daniel Belete
- Preventive Neurology Unit, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Benjamin M. Jacobs
- Preventive Neurology Unit, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Cristina Simonet
- Preventive Neurology Unit, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Jonathan P. Bestwick
- Preventive Neurology Unit, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Sheena Waters
- Preventive Neurology Unit, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Charles R. Marshall
- Preventive Neurology Unit, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Ruth Dobson
- Preventive Neurology Unit, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Alastair J. Noyce
- Preventive Neurology Unit, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| |
Collapse
|
7
|
Serrand C, Rheims S, Faucanié M, Crespel A, Dinkelacker V, Szurhaj W, Biraben A, Bartolomei F, de Grissac N, Landré E, Denuelle M, Vercueil L, Marchal C, Maillard L, Derambure P, Dupont S, Navarro V, Mura T, Jaussent A, Macioce V, Ryvlin P, Picot MC. Stratifying sudden death risk in adults with drug-resistant focal epilepsy: The SUDEP-CARE score. Eur J Neurol 2023; 30:22-31. [PMID: 36094672 PMCID: PMC10087018 DOI: 10.1111/ene.15566] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/22/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE A clinical risk score for sudden unexpected death in epilepsy (SUDEP) in patients with drug-resistant focal epilepsy could help improve prevention. METHODS A case-control study was conducted including (i) definite or probable SUDEP cases collected by the French National Sentinel Mortality Epilepsy Network and (ii) control patients from the French national research database of epilepsy monitoring units. Patients with drug-resistant focal epilepsy were eligible. Multiple logistic regressions were performed. After sensitivity analysis and internal validation, a simplified risk score was developed from the selected variables. RESULTS Sixty-two SUDEP cases and 620 controls were included. Of 21 potential predictors explored, seven were ultimately selected, including generalized seizure frequency (>1/month vs. <1/year: adjusted odds ratio [AOR] 2.6, 95% confidence interval [CI] 1.25-5.41), nocturnal or sleep-related seizures (AOR 4.49, 95% CI 2.68-7.53), current or past depression (AOR 2.0, 95% CI 1.19-3.34) or the ability to alert someone of an oncoming seizure (AOR 0.57, 95% CI 0.33-0.98). After internal validation, a clinically usable score ranging from -1 to 8 was developed, with high discrimination capabilities (area under the receiver operating curve 0.85, 95% CI 0.80-0.90). The threshold of 3 has good sensitivity (82.3%, 95% CI 72.7-91.8), whilst keeping a good specificity (82.7%, 95% CI 79.8-85.7). CONCLUSIONS These results outline the importance of generalized and nocturnal seizures on the occurrence of SUDEP, and show a protective role in the ability to alert someone of an oncoming seizure. The SUDEP-CARE score is promising and will need external validation. Further work, including paraclinical explorations, could improve this risk score.
Collapse
Affiliation(s)
- Chris Serrand
- University Hospital of Montpellier, Montpellier, France
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and University of Lyon, Lyon, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sophie Dupont
- AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Vincent Navarro
- AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, Paris, France.,Paris Brain Institute, ICM, INSERM, CNRS, Paris, France
| | | | | | | | | | | |
Collapse
|
8
|
Ioannou P, Foster DL, Sander JW, Dupont S, Gil-Nagel A, Drogon O'Flaherty E, Alvarez-Baron E, Medjedovic J. The burden of epilepsy and unmet need in people with focal seizures. Brain Behav 2022; 12:e2589. [PMID: 36017757 PMCID: PMC9480957 DOI: 10.1002/brb3.2589] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/24/2022] [Accepted: 02/12/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Epilepsy is one of the most common neurological conditions worldwide. As a chronic condition, epilepsy imposes a significant burden on people with epilepsy and society. We aimed to assess the burden and unmet need of individuals with epilepsy and their caregivers, focusing on focal seizures, the main type of seizure in adults and children. METHODS A targeted evidence review of the burden of epilepsy, focusing on focal seizures, was conducted to identify articles reporting: epidemiology, mortality, morbidity, quality of life (QoL), and costs. RESULTS Focal seizures affect up to ∼61% of people with epilepsy. They are associated with an increased risk of injury and premature death than the general population. People with epilepsy also have high comorbidity, particularly depression, anxiety, and cognitive impairments. Higher seizure frequency, adverse treatment events, and employment concerns reduce QoL. A reduction in caregivers' QoL is also often reported. Epilepsy requires long-term treatment accounting for high individual costs. Hospitalizations and antiseizure medications (ASMs) are the leading cost drivers of inpatient management and indirect costs with high unemployment rates, particularly in drug-resistant populations. Despite the advent of new treatments, a high unmet need remains unaddressed; approximately 40% of people with epilepsy are drug-resistant, further increasing the risks associated with epilepsy. CONCLUSIONS Our findings highlight a substantial burden of illness and unmet needs in individuals with focal seizures, especially those with drug-resistant epilepsy. Suboptimal treatment options negatively impact QoL and, consequently, a sizeable economic burden indicating the need for new treatments and prioritizing this condition.
Collapse
Affiliation(s)
| | | | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont St Peter, UK.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | | | - Antonio Gil-Nagel
- Department of Neurology, Hospital Ruber Internacional, Madrid, Spain
| | | | | | | |
Collapse
|
9
|
Liang CY, Chiang KL, Hsieh LP, Chien LN. Prescription patterns and dosages of antiepileptic drugs in prevalent patients with epilepsy in Taiwan: A nationwide retrospective cross-sectional study. Epilepsy Behav 2022; 126:108450. [PMID: 34864625 DOI: 10.1016/j.yebeh.2021.108450] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate the prescription patterns and prescribed daily dose (PDD)/defined daily dose (DDD) ratios of antiepileptic drugs (AEDs) in prevalent patients with epilepsy in Taiwan. MATERIALS AND METHODS A nationwide retrospective cross-sectional study was conducted for prevalent patients with epilepsy in 2016 using the Taiwanese National Health Insurance Research Database. The prescription records of AEDs of all prevalent patients with epilepsy were retrieved. The mean PDDs and PDD/DDD ratios of AEDs in adult patients were obtained to evaluate dosing adequacy. A chi-square test and two-sample t test were used to analyze the differences in AED prescription patterns and dosages, respectively, among patients with different ages, sexes, comorbidities, and therapeutic approaches. RESULTS A total of 118,937 prevalent patients with epilepsy were enrolled. The predominant therapeutic approach was monotherapy, especially in the elder adults, accounting for 82.9% of elder adult patients with epilepsy. The proportion of AED monotherapy was higher in patients with dementia (78.9%) and stroke (80.6%). The top three antiepileptic monotherapies were valproic acid (28.7%), levetiracetam (19.1%), and phenytoin (16.9%); however, oxcarbazepine (22.8%) was substituted for carbamazepine (3.9%) as monotherapy for patients aged 0-17 years. Among adult patients with epilepsy, the PDD/DDD ratio of each AED in monotherapy was less than 1.00. The mean PDD of each AED was higher in polytherapy than in monotherapy (p < 0.01), except for lacosamide. The mean PDDs of all evaluated AEDs in monotherapy were lower in elder adult patients than in younger adult patients, most of which reached statistical significance (p < 0.001). CONCLUSIONS In Taiwan, valproic acid was the most prescribed AED for prevalent patients with epilepsy. The mean PDDs of most AEDs were lower than the DDDs developed by the World Health Organization.
Collapse
Affiliation(s)
- Chun-Yu Liang
- Department of Neurology, Yumin Medical Corporation Yumin Hospital, No. 200, Sec. 1, Taiping Rd., Caotun Township, Nantou County 542007, Taiwan; Department of Neurology, Changhua Christian Hospital, No. 135, Nanxiao St., Changhua City, Changhua County 500209, Taiwan.
| | - Kuo-Liang Chiang
- Department of Pediatric Neurology, Kuang-Tien General Hospital, No. 117, Shatian Rd., Shalu Dist., Taichung City 433401, Taiwan
| | - Liang-Po Hsieh
- Department of Neurology, Cheng-Ching Hospital, No. 966, Sec. 4, Taiwan Blvd., Xitun Dist., Taichung City 407211, Taiwan.
| | - Li-Nien Chien
- School of Health Care Administration, College of Management, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei 110301, Taiwan.
| |
Collapse
|
10
|
Chou IJ, Chung TT, Liu YH, Hung PC, Lin JJ, Chiou MJ, See LC, Lin KL, Wang HS. Secular Trends in the Incidence, Prevalence, and Medications for Epilepsy from 2007 to 2015 in Taiwan: A Nationwide Population-Based Study. Neuroepidemiology 2021; 55:484-494. [PMID: 34781294 DOI: 10.1159/000519544] [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: 08/24/2021] [Accepted: 09/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with epilepsy have a higher mortality rate than the general population. Up-to-date estimates of epilepsy incidence, prevalence, and medication use are critical to assist policymaking. METHODS Using the National Taiwan Insurance Research Database, the standardized incidence and prevalence of epilepsy were estimated in each calendar year from 2007 to 2015. We used the incident cases of epilepsy to analyze the change in prescribing patterns from 2007 to 2015. Joinpoint regression was used to estimate secular trends. RESULTS From 2007 to 2015, the age- and sex-standardized incidence decreased from 0.72 (95% confidence interval [CI] 0.70-0.73) to 0.54 (95% CI 0.53-0.55) per 1,000 person-years, giving an annual percentage change (APC) of -2.73 (p < 0.05). Among patients younger than 20 years, the incidence did not change significantly. The age- and sex-standardized prevalence decreased from 6.94 (95% CI 6.90-6.98) to 6.86 (95% CI, 6.82-6.89) per 1,000 people, giving an APC of -0.31 (p < 0.05). However, the prevalence increased in the 35- to 49- and 50- to 64-year age-groups. The most common first-line anticonvulsant was phenytoin in 2007 and valproate in 2015. The use of levetiracetam, clobazam, and valproate increased during the study period, with APCs of 25.48% (95% CI 19.97-31.24), 6.41 (3.09-9.85), and 2.83 (1.51-4.16), respectively. The use of carbamazepine, phenytoin, and topiramate decreased; the APCs were -23.86% (95% CI -25.25 to -22.44), -6.61 (-8.40 to -4.79), and -4.29% (-7.87 to -0.57), respectively. CONCLUSIONS The overall prevalence and incidence of epilepsy decreased slightly from 2007 to 2015. The prescribed first-line anticonvulsant also changed over time.
Collapse
Affiliation(s)
- I-Jun Chou
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine at Linkou, Taoyuan, Taiwan,
| | - Ting-Ting Chung
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yi-Hsuan Liu
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine at Linkou, Taoyuan, Taiwan
| | - Po-Cheng Hung
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine at Linkou, Taoyuan, Taiwan
| | - Jainn-Jim Lin
- Division of Pediatric Critical Care and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital and Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Meng-Jiun Chiou
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Lai-Chu See
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan.,Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuang-Lin Lin
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine at Linkou, Taoyuan, Taiwan
| | - Huei-Shyong Wang
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine at Linkou, Taoyuan, Taiwan
| |
Collapse
|
11
|
Wojewodka G, Gulliford MC, Ashworth M, Richardson MP, Ridsdale L. Epilepsy and mortality: a retrospective cohort analysis with a nested case-control study identifying causes and risk factors from primary care and linkage-derived data. BMJ Open 2021; 11:e052841. [PMID: 34697121 PMCID: PMC8547505 DOI: 10.1136/bmjopen-2021-052841] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES People with epilepsy (PWE) have a higher mortality rate than the general population. Epilepsy-related deaths have increased despite all-cause mortality decreasing in the general population pre-COVID-19. We hypothesised that clinical and lifestyle factors may identify people more at risk. DESIGN We used a retrospective cohort study to explore cause of death and a nested case-control study to identify risk factors. SETTING We explored factors associated with mortality using primary care population data from 1 April 2004 to 31 March 2014. Data were obtained from the Clinical Practice Research Datalink which compiles anonymised patient data from primary care in the UK. Cause of death data was supplemented from the Office of National Statistics when available. PARTICIPANTS The analysis included 70 431 PWE, with 11 241 registered deaths. RESULTS The number of deaths within the database increased by 69% between the first and last year of the study. Epilepsy was considered as a contributing cause in approximately 45% of deaths of PWE under 35. Factors associated with increased risk of death included attendance at emergency departments and/or emergency admissions (OR 3.48, 95% CI 3.19 to 3.80), antiepileptic drug (AED) polytherapy (2 AEDs: OR 1.60, 95% CI 1.51 to 1.71; 3 AEDs: OR 2.06, 95% CI 1.86 to 2.29; 4+AEDs: OR 2.62, 95% CI 2.23 to 3.08), status epilepticus (OR 2.78, 95% CI 1.64 to 4.71), depression (OR 1.67, 95% CI 1.57 to 1.76) and injuries (OR 1.54, 95% CI 1.43 to 1.67). No seizures in the prior year (OR 0.52, 95% CI 0.41 to 0.65). CONCLUSION Our results add to existing evidence that deaths in epilepsy are increasing. Future studies could focus on identifying PWE at high risk and addressing them with clinical interventions or better self-management. Identifying specific risk factors for younger people should be a priority as epilepsy may be a factor in close to half of deaths of PWE under 35 years of age.
Collapse
Affiliation(s)
- Gabriella Wojewodka
- Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Martin C Gulliford
- School of Population Health and Environmental Sciences, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Mark Ashworth
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Mark P Richardson
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Leone Ridsdale
- Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| |
Collapse
|
12
|
Wang X, Zhang G, Wang Y, Yang L, Liang Z, Cong F. One-Dimensional Convolutional Neural Networks Combined with Channel Selection Strategy for Seizure Prediction Using Long-Term Intracranial EEG. Int J Neural Syst 2021; 32:2150048. [PMID: 34635034 DOI: 10.1142/s0129065721500489] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Seizure prediction using intracranial electroencephalogram (iEEG) has attracted an increasing attention during recent years. iEEG signals are commonly recorded in the form of multiple channels. Many previous studies generally used the iEEG signals of all channels to predict seizures, ignoring the consideration of channel selection. In this study, a method of one-dimensional convolutional neural networks (1D-CNN) combined with channel selection strategy was proposed for seizure prediction. First, we used 30-s sliding windows to segment the raw iEEG signals. Then, the 30-s iEEG segments, which were in three channel forms (single channel, channels only from seizure onset or free zone and all channels from seizure onset and free zones), were used as the inputs of 1D-CNN for classification, and the patient-specific model was trained. Finally, the channel form with the best classification was selected for each patient. The proposed method was evaluated on the Freiburg Hospital iEEG dataset. In the situation of seizure occurrence period (SOP) of 30[Formula: see text]min and seizure prediction horizon (SPH) of 5[Formula: see text]min, 98.60[Formula: see text] accuracy, 98.85[Formula: see text] sensitivity and 0.01/h false prediction rate (FPR) were achieved. In the situation of SOP of 60[Formula: see text]min and SPH of 5[Formula: see text]min, 98.32[Formula: see text] accuracy, 98.48[Formula: see text] sensitivity and 0.01/h FPR were attained. Compared with the many existing methods using the same iEEG dataset, our method showed a better performance.
Collapse
Affiliation(s)
- Xiaoshuang Wang
- School of Biomedical Engineering, Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian 116024, P. R. China.,Faculty of Information Technology, University of Jyväskylä, Jyväskylä 40014, Finland
| | - Guanghui Zhang
- School of Biomedical Engineering, Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian 116024, P. R. China.,Faculty of Information Technology, University of Jyväskylä, Jyväskylä 40014, Finland
| | - Ying Wang
- Department of Neurology and Psychiatry, First Affiliated Hospital, DaLian Medical University, Dalian, P. R. China
| | - Lin Yang
- Department of Neurology and Psychiatry, First Affiliated Hospital, DaLian Medical University, Dalian, P. R. China
| | - Zhanhua Liang
- Department of Neurology and Psychiatry, First Affiliated Hospital, DaLian Medical University, Dalian, P. R. China
| | - Fengyu Cong
- School of Biomedical Engineering, Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian 116024, P. R. China.,Faculty of Information Technology, University of Jyväskylä, Jyväskylä 40014, Finland.,School of Artificial Intelligence, Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian 116024, P. R. China.,Key Laboratory of Integrated Circuit and Biomedical Electronic System, Liaoning Province Dalian University of Technology, Dalian, P. R. China
| |
Collapse
|
13
|
Nei M, Pickard A. The role of convulsive seizures in SUDEP. Auton Neurosci 2021; 235:102856. [PMID: 34343824 DOI: 10.1016/j.autneu.2021.102856] [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: 03/17/2021] [Revised: 06/01/2021] [Accepted: 07/19/2021] [Indexed: 11/19/2022]
Abstract
Convulsive seizures are the most consistently reported risk factor for SUDEP. However, the precise mechanisms by which convulsive seizures trigger fatal cardiopulmonary changes are still unclear. Additionally, it is not clear why some seizures cause death when most do not. This article reviews the physiologic changes that occur during and after convulsive seizures and how these may contribute to SUDEP. Seizures activate specific cortical and subcortical regions that can cause potentially lethal cardiorespiratory changes. Clinical factors, including sleep state, medication treatment and withdrawal, positioning and posturing during seizures, and underlying structural or genetic conditions may also affect specific aspects of seizures that may contribute to SUDEP. While seizure control, either through medication or surgical treatment, is the primary intervention that reduces SUDEP risk, unfortunately, seizures cannot be fully controlled despite maximal treatment in a significant proportion of people with epilepsy. Thus specific interventions to prevent adverse seizure-related cardiopulmonary consequences are needed. The potential roles of repositioning/stimulation after seizures, oxygen supplementation, cardiopulmonary resuscitation and clinical treatment options in reducing SUDEP risk are explored. Ultimately, understanding of these factors may lead to interventions that could reduce or prevent SUDEP.
Collapse
Affiliation(s)
- Maromi Nei
- Sidney Kimmel Medical College at Thomas Jefferson University, Jefferson Comprehensive Epilepsy Center, Department of Neurology, 901 Walnut Street, Suite 400, Philadelphia, PA 19107, United States of America.
| | - Allyson Pickard
- Sidney Kimmel Medical College at Thomas Jefferson University, Jefferson Comprehensive Epilepsy Center, Department of Neurology, 901 Walnut Street, Suite 400, Philadelphia, PA 19107, United States of America
| |
Collapse
|
14
|
Thorpe J, Ashby S, Hallab A, Ding D, Andraus M, Dugan P, Perucca P, Costello D, French JA, O'Brien TJ, Depondt C, Andrade DM, Sengupta R, Delanty N, Jette N, Newton CR, Brodie MJ, Devinsky O, Helen Cross J, Sander JW, Hanna J, Sen A. Evaluating risk to people with epilepsy during the COVID-19 pandemic: Preliminary findings from the COV-E study. Epilepsy Behav 2021; 115:107658. [PMID: 33341393 PMCID: PMC7698680 DOI: 10.1016/j.yebeh.2020.107658] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/22/2020] [Accepted: 11/22/2020] [Indexed: 01/21/2023]
Abstract
The COVID-19 pandemic has caused global anguish unparalleled in recent times. As cases rise, increased pressure on health services, combined with severe disruption to people's everyday lives, can adversely affect individuals living with chronic illnesses, including people with epilepsy. Stressors related to disruption to healthcare, finances, mental well-being, relationships, schooling, physical activity, and increased isolation could increase seizures and impair epilepsy self-management. We aim to understand the impact that COVID-19 has had on the health and well-being of people with epilepsy focusing on exposure to increased risk of seizures, associated comorbidity, and mortality. We designed two online surveys with one addressing people with epilepsy directly and the second for caregivers to report on behalf of a person with epilepsy. The survey is ongoing and has yielded 463 UK-based responses by the end of September 2020. Forty percent of respondents reported health changes during the pandemic (n = 185). Respondents cited a change in seizures (19%, n = 88), mental health difficulties (34%, n = 161), and sleep disruption (26%, n = 121) as the main reasons. Thirteen percent found it difficult to take medication on time. A third had difficulty accessing medical services (n = 154), with 8% having had an appointment canceled (n = 39). Only a small proportion reported having had discussions about epilepsy-related risks, such as safety precautions (16%, n = 74); mental health (29%, n = 134); sleep (30%, n = 140); and Sudden Unexpected Death in Epilepsy (SUDEP; 15%, n = 69) in the previous 12 months. These findings suggest that people with epilepsy are currently experiencing health changes, coupled with inadequate access to services. Also, there seems to be a history of poor risk communication in the months preceding the pandemic. As the UK witnesses a second COVID-19 wave, those involved in healthcare delivery must ensure optimal care is provided for people with chronic conditions, such as epilepsy, to ensure that avoidable morbidity and mortality is prevented during the pandemic, and beyond.
Collapse
Affiliation(s)
- Jennifer Thorpe
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX3 9DU, UK,SUDEP Action, 18 Newbury Street, Wantage, Oxfordshire OX12 8DA. UK
| | - Samantha Ashby
- SUDEP Action, 18 Newbury Street, Wantage, Oxfordshire OX12 8DA. UK
| | - Asma Hallab
- Department of Nuclear Medicine, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Ding Ding
- Institute of Neurology, Fudan University Huashan Hospital, Shanghai, China
| | - Maria Andraus
- Department of Internal Medicine, Neurology Service, Epilepsy Program, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Patricia Dugan
- Department of Neurology, NYU Grossman School of Medicine, USA
| | - Piero Perucca
- Department of Neuroscience, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Australia & Departments of Medicine and Neurology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - Daniel Costello
- Epilepsy Service, Cork University Hospital & College of Medicine and Health, University College Cork, Ireland
| | | | - Terence J. O'Brien
- Department of Neuroscience, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Australia & Departments of Medicine and Neurology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - Chantal Depondt
- Department of Neurology, Hôpital Erasme – Université Libre de Bruxelles, Brussels, Belgium
| | - Danielle M. Andrade
- Adult Epilepsy Genetics Program, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | | | - Norman Delanty
- Beaumont Hospital, and School of Pharmacy and Biomolecular Sciences, FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nathalie Jette
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Charles R. Newton
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX3 9DU, UK,University Department of Psychiatry, University of Oxford, UK
| | - Martin J. Brodie
- Epilepsy Unit, West Glasgow Ambulatory Care Hospital-Yorkhill, Glasgow, UK
| | - Orrin Devinsky
- Department of Neurology, NYU Grossman School of Medicine, USA
| | - J. Helen Cross
- UCL NIHR BRC Great Ormond Street Institute of Child Health, London, UK,Young Epilepsy, St Pier's Lane, Dormansland, Lingfield RH7 6P, UK
| | - Josemir W. Sander
- UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands
| | - Jane Hanna
- SUDEP Action, 18 Newbury Street, Wantage, Oxfordshire OX12 8DA. UK
| | - Arjune Sen
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX3 9DU, UK.
| | | |
Collapse
|
15
|
Gorton HC, Webb RT, Parisi R, Carr MJ, DelPozo-Banos M, Moriarty KJ, Pickrell WO, John A, Ashcroft DM. Alcohol-Specific Mortality in People With Epilepsy: Cohort Studies in Two Independent Population-Based Datasets. Front Neurol 2021; 11:623139. [PMID: 33551978 PMCID: PMC7859425 DOI: 10.3389/fneur.2020.623139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives: The risk of dying by alcohol-specific causes in people with epilepsy has seldom been reported from population-based studies. We aimed to estimate the relative risk of alcohol-specific mortality in people with epilepsy, and the extent to which problematic alcohol use was previously identified in the patients' medical records. Method: We delineated cohort studies in two population-based datasets, the Clinical Practice Research Datalink (CPRD GOLD) in England (January 01, 2001–December 31, 2014) and the Secure Anonymised Information Linkage (SAIL) Databank in Wales (January 01, 2001–December 31, 2014), linked to hospitalization and mortality records. People with epilepsy were matched to up to 20 persons without epilepsy on gender, age (±2 years) and registered general practice. We identified alcohol-specific death from Office for National Statistics (ONS) records using specified ICD-10 codes. We further identified prescriptions, interventions and hospitalisations related to alcohol use. Results: In the CPRD GOLD, we identified 9,871 individuals in the incident epilepsy cohort and 185,800 in the comparison cohort and, in the SAIL Databank, these numbers were 5,569 and 110,021, respectively. We identified a five-fold increased risk of alcohol-specific mortality in people with epilepsy vs. those without the condition in our pooled estimate across the two datasets (deprivation-adjusted HR 4.85, 95%CI 3.46–6.79). Conclusions: People with epilepsy are at increased risk of dying by an alcohol-specific cause than those without the disorder. It is plausible that serious alcohol misuse could either contribute to the development of epilepsy or it could commence subsequent to epilepsy being diagnosed. Regardless of the direction of the association, it is important that the risk of dying as a consequence of alcohol misuse is accurately quantified in people affected by epilepsy. Systematically-applied, sensitive assessment of alcohol consumption by healthcare professionals, at opportunistic, clinical contacts, with rapid access to quality treatment services, should be mandatory and play a key role in reduction of health harms and mortality.
Collapse
Affiliation(s)
- Hayley C Gorton
- School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Roger T Webb
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, United Kingdom.,Division of Psychology & Mental Health, Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre (MAHSC), Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Rosa Parisi
- Division of Informatics, Imaging & Data Sciences, Manchester Academic Health Sciences Centre (MAHSC), Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Matthew J Carr
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, United Kingdom.,Centre for Pharmacoepidemiology and Drug Safety, Manchester Academic Health Sciences Centre (MAHSC), Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | | | | | - W Owen Pickrell
- Neurology and Molecular Neuroscience Research Group, Swansea University Medical School, Swansea University, Swansea, United Kingdom.,Neurology Department, Morriston Hospital, Swansea Bay University Health Board, Swansea, United Kingdom
| | - Ann John
- Farr Institute, Swansea University Medical School, Swansea, United Kingdom
| | - Darren M Ashcroft
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, United Kingdom.,Centre for Pharmacoepidemiology and Drug Safety, Manchester Academic Health Sciences Centre (MAHSC), Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| |
Collapse
|
16
|
Nashef L, Rugg-Gunn F. Reducing the risk of SUDEP. Neurology 2020; 95:807-808. [DOI: 10.1212/wnl.0000000000010916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
17
|
Noble A, Nevitt S, Holmes E, Ridsdale L, Morgan M, Tudur-Smith C, Hughes D, Goodacre S, Marson T, Snape D. Seizure first aid training for people with epilepsy attending emergency departments and their significant others: the SAFE intervention and feasibility RCT. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
No seizure first aid training intervention exists for people with epilepsy who regularly attend emergency departments and their significant others, despite such an intervention’s potential to reduce clinically unnecessary and costly visits.
Objectives
The objectives were to (1) develop Seizure first Aid training For Epilepsy (SAFE) by adapting a broader intervention and (2) determine the feasibility and optimal design of a definitive randomised controlled trial to test SAFE’s efficacy.
Design
The study involved (1) the development of an intervention informed by a co-design approach with qualitative feedback and (2) a pilot randomised controlled trial with follow-ups at 3, 6 and 12 months and assessments of treatment fidelity and the cost of SAFE’s delivery.
Setting
The setting was (1) third-sector patient support groups and professional health-care organisations and (2) three NHS emergency departments in England.
Participants
Participants were (1) people with epilepsy who had visited emergency departments in the prior 2 years, their significant others and emergency department, paramedic, general practice, commissioning, neurology and nursing representatives and (2) people with epilepsy aged ≥ 16 years who had been diagnosed for ≥ 1 year and who had made two or more emergency department visits in the prior 12 months, and one of their significant others. Emergency departments identified ostensibly eligible people with epilepsy from attendance records and patients confirmed their eligibility.
Interventions
Participants in the pilot randomised controlled trial were randomly allocated 1 : 1 to SAFE plus treatment as usual or to treatment as usual only.
Main outcome measures
Consent rate and availability of routine data on emergency department use at 12 months were the main outcome measures. Other measures of interest included eligibility rate, ease with which people with epilepsy could be identified and routine data secured, availability of self-reported emergency department data, self-reported emergency department data’s comparability with routine data, SAFE’s effect on emergency department use, and emergency department use in the treatment as usual arm, which could be used in sample size calculations.
Results
(1) Nine health-care professionals and 23 service users provided feedback that generated an intervention considered to be NHS feasible and well positioned to achieve its purpose. (2) The consent rate was 12.5%, with 53 people with epilepsy and 38 significant others recruited. The eligibility rate was 10.6%. Identifying people with epilepsy from attendance records was resource intensive for emergency department staff. Those recruited felt more stigmatised because of epilepsy than the wider epilepsy population. Routine data on emergency department use at 12 months were secured for 94.1% of people with epilepsy, but the application process took 8.5 months. Self-reported emergency department data were available for 66.7% of people with epilepsy, and people with epilepsy self-reported more emergency department visits than were captured in routine data. Most participants (76.9%) randomised to SAFE received the intervention. The intervention was delivered with high fidelity. No related serious adverse events occurred. Emergency department use at 12 months was lower in the SAFE plus treatment as usual arm than in the treatment as usual only arm, but not significantly so. Calculations indicated that a definitive trial would need ≈ 674 people with epilepsy and ≈ 39 emergency department sites.
Limitations
Contrary to patient statements on recruitment, routine data secured at the pilot trial’s end indicated that ≈ 40% may not have satisfied the inclusion criterion of two or more emergency department visits.
Conclusions
An intervention was successfully developed, a pilot randomised controlled trial conducted and outcome data secured for most participants. The consent rate did not satisfy a predetermined ‘stop/go’ level of ≥ 20%. The time that emergency department staff needed to identify eligible people with epilepsy is unlikely to be replicable. A definitive trial is currently not feasible.
Future work
Research to more easily identify and recruit people from the target population is required.
Trial registration
Current Controlled Trials ISRCTN13871327.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 39. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Adam Noble
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Sarah Nevitt
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Emily Holmes
- Centre for Health Economics and Medicine Evaluation, Bangor University, Bangor, UK
| | - Leone Ridsdale
- Department of Basic and Clinical Neuroscience, King’s College London, London, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King’s College London, London, UK
| | | | - Dyfrig Hughes
- Centre for Health Economics and Medicine Evaluation, Bangor University, Bangor, UK
| | - Steve Goodacre
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Tony Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Darlene Snape
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| |
Collapse
|
18
|
Suller Marti A, Aldosari M, Mirsattari SM. The role of the epilepsy monitoring unit in the investigation of patients with epilepsy and intellectual disabilities. Epilepsy Behav 2020; 111:107195. [PMID: 32554231 DOI: 10.1016/j.yebeh.2020.107195] [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: 01/29/2020] [Revised: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND A significant proportion of the people with intellectual disabilities (ID) has epilepsy and lives in institutions. These patients tend to have atypical presentations of epileptic seizures with an increased risk of misdiagnoses. They often have drug-resistant epilepsy (DRE) requiring polypharmacy with increased risk of morbidity. The aim of this study was to determine the usefulness of Epilepsy Monitoring Unit (EMU) in the diagnosis and management of these patients. METHODS This is a retrospective observational study of people with epilepsy and ID living in institutions that were admitted to the EMU at London Health Sciences Center (LHSC), from January 2014 to December 2016. RESULTS Out of 1121 patients admitted to the EMU at the LHSC, 1.96% (N = 22) fulfilled the inclusion criteria for this study. The mean age was 34.5 years (interquartile range [IQR]: 28.8-53); 50%(N = 11) were female. Fourteen (63.6%) had generalized epilepsy. Six (27.3%) had a history of status epilepticus. The mean number of antiseizure medications (ASMs) in those patients was three (IQR: 2-4). Eight (36.4%) patients had severely impaired or no language skills and seven (31.8%) required wheelchair. Eleven (50%) had a mood disorder and seven (31.8%) of them were taking antipsychotic medications. The mean duration of admission duration was 6.6 days (IQR: 3.5-8.5). There was a clinical-electrographic correlation between the behavioral events and epileptic seizures in nineteen (86.4%) of the patients. CONCLUSIONS Admission to the EMU provided an accurate characterization of transient events in people with ID and epilepsy with improvement in their medical management.
Collapse
Affiliation(s)
- A Suller Marti
- Epilepsy Program, Schulich School of Medicine, Western University, 339 Windermere Rd, London, Ontario N6A 5A5, Canada.
| | - M Aldosari
- Epilepsy Program, King Fahad Medical City, As Sulimaniyah, Riyadh 12231, Saudi Arabia
| | - S M Mirsattari
- Epilepsy Program, Schulich School of Medicine, Western University, 339 Windermere Rd, London, Ontario N6A 5A5, Canada
| |
Collapse
|
19
|
Yang J, Sawan M. From Seizure Detection to Smart and Fully Embedded Seizure Prediction Engine: A Review. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2020; 14:1008-1023. [PMID: 32822304 DOI: 10.1109/tbcas.2020.3018465] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Recent review papers have investigated seizure prediction, creating the possibility of preempting epileptic seizures. Correct seizure prediction can significantly improve the standard of living for the majority of epileptic patients, as the unpredictability of seizures is a major concern for them. Today, the development of algorithms, particularly in the field of machine learning, enables reliable and accurate seizure prediction using desktop computers. However, despite extensive research effort being devoted to developing seizure detection integrated circuits (ICs), dedicated seizure prediction ICs have not been developed yet. We believe that interdisciplinary study of system architecture, analog and digital ICs, and machine learning algorithms can promote the translation of scientific theory to a more realistic intelligent, integrated, and low-power system that can truly improve the standard of living for epileptic patients. This review explores topics ranging from signal acquisition analog circuits to classification algorithms and dedicated digital signal processing circuits for detection and prediction purposes, to provide a comprehensive and useful guideline for the construction, implementation and optimization of wearable and integrated smart seizure prediction systems.
Collapse
|
20
|
Sveinsson O, Andersson T, Mattsson P, Carlsson S, Tomson T. Pharmacologic treatment and SUDEP risk: A nationwide, population-based, case-control study. Neurology 2020; 95:e2509-e2518. [PMID: 32967928 PMCID: PMC7682832 DOI: 10.1212/wnl.0000000000010874] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 06/18/2020] [Indexed: 12/31/2022] Open
Abstract
Objective We conducted a nationwide case–control study in Sweden to test the hypothesis that antiepileptic drugs (AEDs) mono- or polytherapy, adherence, antidepressants, neuroleptics, β-blockers, and statins are associated with sudden unexpected death in epilepsy (SUDEP) risk. Methods Included were 255 SUDEP cases and 1,148 matched controls. Information on clinical factors and medications came from medical records and the National Patient and Prescription Registers. The association between SUDEP and medications was assessed by odds ratios (ORs) with 95% confidence intervals (CIs) adjusted for potential risk factors including type of epilepsy, living conditions, comorbidity, and frequency of generalized tonic-clonic seizures (GTCS). Results Polytherapy, especially taking 3 or more AEDs, was associated with a substantially reduced risk of SUDEP (OR 0.31, 95% CI 0.14–0.67). Combinations including lamotrigine (OR 0.55, 95% CI 0.31–0.97), valproic acid (OR 0.53, 95% CI 0.29–0.98), and levetiracetam (OR 0.49, 95% CI 0.27–0.90) were associated with reduced risk. No specific AED was associated with increased risk. Regarding monotherapy, although numbers were limited, the lowest SUDEP risk was seen in users of levetiracetam (0.10, 95% CI 0.02–0.61). Having nonadherence mentioned in the medical record was associated with an OR of 2.75 (95% CI 1.58–4.78). Statin use was associated with a reduced SUDEP risk (OR 0.34, 95% CI 0.11–0.99) but selective serotonin reuptake inhibitor use was not. Conclusion These results provide support for the importance of medication adherence and intensified AED treatment for patients with poorly controlled GTCS in the effort to reduce SUDEP risk and suggest that comedication with statins may reduce risk.
Collapse
Affiliation(s)
- Olafur Sveinsson
- From the Department of Neurology (O.S., T.T.), Karolinska University Hospital; Department of Clinical Neuroscience (O.S., T.T.) and Institute of Environmental Medicine (T.A., S.C.), Karolinska Institutet, Stockholm; Center for Occupational and Environmental Medicine (T.A.), Stockholm County Council; and Department of Neuroscience (P.M.), University of Uppsala, Sweden.
| | - Tomas Andersson
- From the Department of Neurology (O.S., T.T.), Karolinska University Hospital; Department of Clinical Neuroscience (O.S., T.T.) and Institute of Environmental Medicine (T.A., S.C.), Karolinska Institutet, Stockholm; Center for Occupational and Environmental Medicine (T.A.), Stockholm County Council; and Department of Neuroscience (P.M.), University of Uppsala, Sweden
| | - Peter Mattsson
- From the Department of Neurology (O.S., T.T.), Karolinska University Hospital; Department of Clinical Neuroscience (O.S., T.T.) and Institute of Environmental Medicine (T.A., S.C.), Karolinska Institutet, Stockholm; Center for Occupational and Environmental Medicine (T.A.), Stockholm County Council; and Department of Neuroscience (P.M.), University of Uppsala, Sweden
| | - Sofia Carlsson
- From the Department of Neurology (O.S., T.T.), Karolinska University Hospital; Department of Clinical Neuroscience (O.S., T.T.) and Institute of Environmental Medicine (T.A., S.C.), Karolinska Institutet, Stockholm; Center for Occupational and Environmental Medicine (T.A.), Stockholm County Council; and Department of Neuroscience (P.M.), University of Uppsala, Sweden
| | - Torbjörn Tomson
- From the Department of Neurology (O.S., T.T.), Karolinska University Hospital; Department of Clinical Neuroscience (O.S., T.T.) and Institute of Environmental Medicine (T.A., S.C.), Karolinska Institutet, Stockholm; Center for Occupational and Environmental Medicine (T.A.), Stockholm County Council; and Department of Neuroscience (P.M.), University of Uppsala, Sweden
| |
Collapse
|
21
|
Lhatoo SD, Bernasconi N, Blumcke I, Braun K, Buchhalter J, Denaxas S, Galanopoulou A, Josephson C, Kobow K, Lowenstein D, Ryvlin P, Schulze-Bonhage A, Sahoo SS, Thom M, Thurman D, Worrell G, Zhang GQ, Wiebe S. Big data in epilepsy: Clinical and research considerations. Report from the Epilepsy Big Data Task Force of the International League Against Epilepsy. Epilepsia 2020; 61:1869-1883. [PMID: 32767763 DOI: 10.1111/epi.16633] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/25/2022]
Abstract
Epilepsy is a heterogeneous condition with disparate etiologies and phenotypic and genotypic characteristics. Clinical and research aspects are accordingly varied, ranging from epidemiological to molecular, spanning clinical trials and outcomes, gene and drug discovery, imaging, electroencephalography, pathology, epilepsy surgery, digital technologies, and numerous others. Epilepsy data are collected in the terabytes and petabytes, pushing the limits of current capabilities. Modern computing firepower and advances in machine and deep learning, pioneered in other diseases, open up exciting possibilities for epilepsy too. However, without carefully designed approaches to acquiring, standardizing, curating, and making available such data, there is a risk of failure. Thus, careful construction of relevant ontologies, with intimate stakeholder inputs, provides the requisite scaffolding for more ambitious big data undertakings, such as an epilepsy data commons. In this review, we assess the clinical and research epilepsy landscapes in the big data arena, current challenges, and future directions, and make the case for a systematic approach to epilepsy big data.
Collapse
Affiliation(s)
- Samden D Lhatoo
- University of Texas Health Sciences Center at Houston, Houston, Texas
| | - Neda Bernasconi
- Neuroimaging of Epilepsy Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Ingmar Blumcke
- Friedrich-Alexander University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Kees Braun
- Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jeffrey Buchhalter
- Department of Neurology, St Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
| | - Aristea Galanopoulou
- Saul Korey Department of Neurology, Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, New York
| | - Colin Josephson
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Katja Kobow
- Friedrich-Alexander University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Daniel Lowenstein
- Department of Neurology, University of California, San Francisco, San Francisco, California
| | - Philippe Ryvlin
- Department of Neurosciences, University of Lausanne, Lausanne, Switzerland
| | | | - Satya S Sahoo
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Maria Thom
- Institute of Neurology, University College London, London, UK
| | | | - Greg Worrell
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Guo-Qiang Zhang
- University of Texas Health Sciences Center at Houston, Houston, Texas
| | - Samuel Wiebe
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| |
Collapse
|
22
|
McKinlay A, Morgan M, Noble A, Ridsdale L. Patient views on use of emergency and alternative care services for adult epilepsy: A qualitative study. Seizure 2020; 80:56-62. [PMID: 32540637 PMCID: PMC7443693 DOI: 10.1016/j.seizure.2020.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/18/2020] [Accepted: 04/22/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Emergency Department (ED) visits are costly to the health service and alternative care pathways may address this whilst improving outcomes. We aimed to describe decision-making and preferences of people with epilepsy (PWE) during emergency service use, and views of ED alternatives, including use of an Urgent Treatment Centre and telephone-based support from an epilepsy nurse specialist. METHODS We conducted a community-based interview study in South East England, informed by a qualitative framework approach. 25 adults with epilepsy and 5 of their carers took part. RESULTS Participants' choice to attend ED generally corresponded with guidelines, including continuing seizures and injury. Nevertheless, over half reported unwanted or unnecessary ED attendance, mainly due to lack of access to individual patient history, a carer, or seizures occurring in a public place. Participants used proactive strategies to communicate their care needs to others, including 24 -h alarm devices and care plans. Some suggested preventative strategies including referral after ED. Participants highlighted the importance of ambulance staff in providing fast and efficient care that gives reassurance. CONCLUSION Improving communication and access to preventative, proactive services may facilitate better outcomes within existing care pathways. PWE felt ED alternatives were helpful in some circumstances, but Urgent Treatment Centres or epilepsy nurse specialists were not viewed as an ED replacement.
Collapse
Affiliation(s)
- Alison McKinlay
- King's College London, Department of Basic and Clinical Neuroscience, London, UK.
| | - Myfanwy Morgan
- King's College London, Institute of Pharmaceutical Science, London, UK.
| | - Adam Noble
- University of Liverpool, Department of Health Services Research, UK.
| | - Leone Ridsdale
- King's College London, Department of Basic and Clinical Neuroscience, London, UK.
| |
Collapse
|
23
|
Noble AJ, Snape D, Nevitt S, Holmes EA, Morgan M, Tudur-Smith C, Hughes DA, Buchanan M, McVicar J, MacCallum E, Goodacre S, Ridsdale L, Marson AG. Seizure First Aid Training For people with Epilepsy (SAFE) frequently attending emergency departments and their significant others: results of a UK multi-centre randomised controlled pilot trial. BMJ Open 2020; 10:e035516. [PMID: 32303515 PMCID: PMC7201300 DOI: 10.1136/bmjopen-2019-035516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To determine the feasibility and optimal design of a randomised controlled trial (RCT) of Seizure First Aid Training For Epilepsy (SAFE). DESIGN Pilot RCT with embedded microcosting. SETTING Three English hospital emergency departments (EDs). PARTICIPANTS Patients aged ≥16 with established epilepsy reporting ≥2 ED visits in the prior 12 months and their significant others (SOs). INTERVENTIONS Patients (and their SOs) were randomly allocated (1:1) to SAFE plus treatment-as-usual (TAU) or TAU alone. SAFE is a 4-hour group course. MAIN OUTCOME MEASURES Two criteria evaluated a definitive RCT's feasibility: (1) ≥20% of eligible patients needed to be consented into the pilot trial; (2) routine data on use of ED over the 12 months postrandomisation needed securing for ≥75%. Other measures included eligibility, ease of obtaining routine data, availability of self-report ED data and comparability, SAFE's effect and intervention cost. RESULTS Of ED attendees with a suspected seizure, 424 (10.6%) patients were eligible; 53 (12.5%) patients and 38 SOs consented. Fifty-one patients (and 37 SOs) were randomised. Routine data on ED use at 12 months were secured for 94.1% patients. Self-report ED data were available for 66.7% patients. Patients reported more visits compared with routine data. Most (76.9%) patients randomised to SAFE received it and no related serious adverse events occurred. ED use at 12 months was lower in the SAFE+TAU arm compared with TAU alone, but not significantly (rate ratio=0.62, 95% CI 0.33 to 1.17). A definitive trial would need ~674 patient participants and ~39 recruitment sites. Obtaining routine data was challenging, taking ~8.5 months. CONCLUSIONS In satisfying only one predetermined 'stop/go' criterion, a definitive RCT is not feasible. The low consent rate in the pilot trial raises concerns about a definitive trial's finding's external validity and means it would be expensive to conduct. Research is required into how to optimise recruitment from the target population. TRIAL REGISTRATION NUMBER ISRCTN13871327.
Collapse
Affiliation(s)
- Adam J Noble
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Dee Snape
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Sarah Nevitt
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Emily A Holmes
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, London, UK
| | | | - Dyfrig A Hughes
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - Mark Buchanan
- Emergency Department, Arrowe Park Hospital, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - Jane McVicar
- MacKinnon Memorial Hospital / Broadford Hospital, NHS Highland, Broadford, Isle of Skye, UK
| | - Elizabeth MacCallum
- Emergency Department, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Steve Goodacre
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Leone Ridsdale
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Anthony G Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| |
Collapse
|
24
|
Banks J, Varley J, Fitzsimons M, Doherty CP. Self-reported antiepilepsy medication adherence and its connection to perception of medication error. Epilepsy Behav 2020; 104:106896. [PMID: 31986441 DOI: 10.1016/j.yebeh.2019.106896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/20/2019] [Accepted: 12/29/2019] [Indexed: 11/25/2022]
Abstract
Although 70% of people with epilepsy (PWE) achieve seizure freedom following an appropriate antiepileptic drug (AED) regime, evidence suggests that adherence to AEDs by PWE is suboptimal. Nonadherence to AEDs is associated with increased morbidity, mortality, emergency department visits, and hospitalizations, with reduced adherence also correlating to a lower quality of life, decreased productivity, and loss of employment. Furthermore, research indicates that medication errors which are widespread in chronic disease are less well studied in epilepsy but are likely also to contribute to avoidable disease morbidity and mortality. The goals of this project were to determine rates of medication adherence by self-reported questionnaire and its links to perceived medication error in a cohort of PWE attending a general epilepsy outpatient clinic. Following a plan-do-study-act cycle, it was found that the most appropriate methodology for conducting was in the form of a bespoke 9-item self-administered questionnaire. One hundred eighty-six PWE completed a nine-question questionnaire asking patients about their own medication adherence habits and their perception that they were previously exposed to medication error. This study found that 41% of respondents reported suboptimal adherence to AED therapy, while 28.5% of respondents self-reported that they unintentionally do not take their AED medication on an occasional, regular, or frequent basis. A 5.9% of respondents self-reported that they intentionally do not take their medication as prescribed. A 6% of respondents self-reported that they are both unintentionally and intentionally nonadherent to their AED therapy. No significant associations were demonstrated between age, sex, perceived effectiveness of medication, feelings of stigma/embarrassment, adverse effects or additional neurological comorbidities, and unintentional or intentional nonadherence. A 28.5% of respondents to the questionnaire reported that they perceived themselves to have been subjected to medication error. Prescribing errors were the most common form of perceived medication error, followed by dispensing errors, then administration errors. Significant associations were found between ineffective medication and feelings of stigma or embarrassment about epilepsy with perceived prescribing errors. Intentional nonadherence to medication was significantly associated with perceived dispensing errors.
Collapse
Affiliation(s)
- Jack Banks
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland; FutureNeuro SFI Research Centre, The Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland.
| | - Jarlath Varley
- School of Nursing and Midwifery, Trinity College, Dublin 2, Ireland
| | - Mary Fitzsimons
- FutureNeuro SFI Research Centre, The Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland
| | - Colin P Doherty
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland; FutureNeuro SFI Research Centre, The Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland; Department of Neurology, St. James's Hospital, James's Street, Dublin 8, Ireland
| |
Collapse
|
25
|
Morrish P, Duncan S, Cock H. Epilepsy deaths: Learning from health service delivery and trying to reduce risk. Epilepsy Behav 2020; 103:106473. [PMID: 31668578 DOI: 10.1016/j.yebeh.2019.106473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 11/25/2022]
Abstract
Two recent UK reports have highlighted data of concern in relation to potentially preventable epilepsy deaths. Public Health England, an executive agency of the Government Department of Health, using National Health Service data from 2001 to 2014 reported a rise in direct age-standardised mortality for epilepsy-associated deaths, in contrast to a reduction in all-cause deaths over the same period. Premature death was seen in people aged below 50 years, especially in men, and where epilepsy was a contributory cause rather than an association. The Scottish Epilepsy Deaths Study, analysing deaths between 2009 and 2016, similarly found death in those with epilepsy was significantly higher than the matched population below the age of 54, especially between the ages of 16 and 24 (6 times higher). Sudden unexpected death in epilepsy accounted for 38% of epilepsy-related deaths under the age of 45. Both studies found a strong relationship between risk of death and deprivation; we discuss the implications of these and other data for planning service delivery and improving epilepsy care. This paper is for the Special Issue: Prevent 21: SUDEP Summit - Time to Listen.
Collapse
Affiliation(s)
| | - Susan Duncan
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh EH4 2XU, UK; Muir Maxwell Epilepsy Centre, University of Edinburgh EH9 1UW, UK
| | - Hannah Cock
- St George's, University of London SW17 0RE, UK; Atkinson Morley Regional Epilepsy Network, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK.
| |
Collapse
|
26
|
Shankar R, Ashby S, McLean B, Newman C. Bridging the gap of risk communication and management using the SUDEP and Seizure Safety Checklist. Epilepsy Behav 2020; 103:106419. [PMID: 31648927 DOI: 10.1016/j.yebeh.2019.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 07/05/2019] [Indexed: 01/17/2023]
Abstract
Sudden unexpected death in epilepsy (SUDEP) is a tragic condition and, despite varied risk levels among the population with epilepsy, is the cause of significant premature mortality. In the last 20 years, though awareness of SUDEP has increased among epilepsy professionals, little has changed with regard to the death rates per se, in rates of informing people with epilepsy (PWE) of their person-centered SUDEP risks, or in the awareness levels of nonepilepsy clinicians, such as, primary care practitioners and hospital doctors. The challenges to make aware and inform PWE have been multifold, in particular, 'when', 'what', and 'how' to tell about SUDEP. Current guidance recognizes that to improve SUDEP rates, it is important to engage proactively with PWE. There is a need to bring shared responsibility between clinicians and PWE to help mitigate the risk of SUDEP. To enable this, a meaningful evidence-based person-centered conversation is essential. The SUDEP and Seizure Safety Checklist ("Checklist") was created to facilitate this. This paper showcases the background, concept, development, implementation, feasibility and validity studies undertaken, challenges, barriers, and limitations of the eight-year Checklist project, which has moved from a single clinic to an international presence. It outlines the need to further reform SUDEP risk communication recognizing the differences between a basic risk message at time of diagnosis as advocated by current good practice guidance and the need for a more person-centered discussion on a regular basis for which the Checklist can be a key catalyst. This article is part of the Special Issue "Prevent 21: SUDEP Summit - Time to Listen".
Collapse
Affiliation(s)
- Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Threemilestone Industrial Estate, Truro TR4 9LD, UK; Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro TR1 3HD, UK.
| | | | | | - Craig Newman
- Plymouth University, Peninsula Schools of Medicine and Dentistry, Plymouth PL4 8AA, UK
| |
Collapse
|
27
|
Noble AJ, Mathieson A, Ridsdale L, Holmes EA, Morgan M, McKinlay A, Dickson JM, Jackson M, Hughes DA, Goodacre S, Marson AG. Developing patient-centred, feasible alternative care for adult emergency department users with epilepsy: protocol for the mixed-methods observational 'Collaborate' project. BMJ Open 2019; 9:e031696. [PMID: 31678950 PMCID: PMC6830638 DOI: 10.1136/bmjopen-2019-031696] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Emergency department (ED) visits for epilepsy are common, costly, often clinically unnecessary and typically lead to little benefit for epilepsy management. An 'Alternative Care Pathway' (ACP) for epilepsy, which diverts people with epilepsy (PWE) away from ED when '999' is called and leads to care elsewhere, might generate savings and facilitate improved ambulatory care. It is unknown though what features it should incorporate to make it acceptable to persons from this particularly vulnerable target population. It also needs to be National Health Service (NHS) feasible. This project seeks to identify the optimal ACP configuration. METHODS AND ANALYSIS Mixed-methods project comprising three-linked stages. In Stage 1, NHS bodies will be surveyed on ACPs they are considering and semi-structured interviews with PWE and their carers will explore attributes of care important to them and their concerns and expectations regarding ACPs. In Stage 2, Discrete Choice Experiments (DCE) will be completed with PWE and carers to identify the relative importance placed on different care attributes under common seizure scenarios and the trade-offs people are willing to make. The uptake of different ACP configurations will be estimated. In Stage 3, two Knowledge Exchange workshops using a nominal group technique will be run. NHS managers, health professionals, commissioners and patient and carer representatives will discuss DCE results and form a consensus on which ACP configuration best meets users' needs and is NHS feasible. ETHICS AND DISSEMINATION Ethical approval: NRES Committee (19/WM/0012) and King's College London ethics Committee (LRS-18/19-10353). Primary output will be identification of optimal ACP configuration which should be prioritised for implementation and evaluation. A pro-active dissemination strategy will make those considering developing or supporting an epilepsy ACP aware of the project and opportunities to take part in it. It will also ensure they are informed of its findings. PROJECT REGISTRATION NUMBER Researchregistry4723.
Collapse
Affiliation(s)
- Adam J Noble
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Amy Mathieson
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Leone Ridsdale
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - E A Holmes
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Alison McKinlay
- Basic & Clinical Neuroscience, King's College London, London, UK
| | - Jon Mark Dickson
- Academic Unit of Primary Medical Care, The University of Sheffield, Sheffield, UK
| | - Mike Jackson
- North West Ambulance Service NHS Trust, Bolton, UK
| | - Dyfrig A Hughes
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Steve Goodacre
- Medical Care Research Unit, University of Sheffield, Sheffield, UK
| | - Anthony G Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| |
Collapse
|
28
|
Gorton HC, Webb RT, Carr MJ, DelPozo-Banos M, John A, Ashcroft DM. Risk of Unnatural Mortality in People With Epilepsy. JAMA Neurol 2019; 75:929-938. [PMID: 29630689 DOI: 10.1001/jamaneurol.2018.0333] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance People with epilepsy are at increased risk of mortality, but, to date, the cause-specific risks of all unnatural causes have not been reported. Objective To estimate cause-specific unnatural mortality risks in people with epilepsy and to identify the medication types involved in poisoning deaths. Design, Setting, and Participants This population-based cohort study used 2 electronic primary care data sets linked to hospitalization and mortality records, the Clinical Practice Research Datalink (CPRD) in England (from January 1, 1998, to March 31, 2014) and the Secure Anonymised Information Linkage (SAIL) Databank in Wales (from January 1, 2001, to December 31, 2014). Each person with epilepsy was matched on age (within 2 years), sex, and general practice with up to 20 individuals without epilepsy. Unnatural mortality was determined using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes V01 through Y98 in the Office for National Statistics mortality records. Hazard ratios (HRs) were estimated in each data set using a stratified Cox proportional hazards model, and meta-analyses were conducted using DerSimonian and Laird random-effects models. The analysis was performed from January 5, 2016, to November 16, 2017. Exposures People with epilepsy were identified using primary care epilepsy diagnoses and associated antiepileptic drug prescriptions. Main Outcomes and Measures Hazard ratios (HRs) for unnatural mortality and the frequency of each involved medication type estimated as a percentage of all medication poisoning deaths. Results In total, 44 678 individuals in the CPRD and 14 051 individuals in the SAIL Databank were identified in the prevalent epilepsy cohorts, and 891 429 (CPRD) and 279 365 (SAIL) individuals were identified in the comparison cohorts. In both data sets, 51% of the epilepsy and comparison cohorts were male, and the median age at entry was 40 years (interquartile range, 25-60 years) in the CPRD cohorts and 43 years (interquartile range, 24-64 years) in the SAIL cohorts. People with epilepsy were significantly more likely to die of any unnatural cause (HR, 2.77; 95% CI, 2.43-3.16), unintentional injury or poisoning (HR, 2.97; 95% CI, 2.54-3.48) or suicide (HR, 2.15; 95% CI, 1.51-3.07) than people in the comparison cohort. Particularly large risk increases were observed in the epilepsy cohorts for unintentional medication poisoning (HR, 4.99; 95% CI, 3.22-7.74) and intentional self-poisoning with medication (HR, 3.55; 95% CI, 1.01-12.53). Opioids (56.5% [95% CI, 43.3%-69.0%]) and psychotropic medication (32.3% [95% CI, 20.9%-45.3%)] were more commonly involved than antiepileptic drugs (9.7% [95% CI, 3.6%-19.9%]) in poisoning deaths in people with epilepsy. Conclusions and Relevance Compared with people without epilepsy, people with epilepsy are at increased risk of unnatural death and thus should be adequately advised about unintentional injury prevention and monitored for suicidal ideation, thoughts, and behaviors. The suitability and toxicity of concomitant medication should be considered when prescribing for comorbid conditions.
Collapse
Affiliation(s)
- Hayley C Gorton
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, MAHSC (Manchester Academic Health Sciences Centre), Manchester, United Kingdom.,National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, MAHSC, Manchester, United Kingdom
| | - Roger T Webb
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, MAHSC, Manchester, United Kingdom.,Centre for Mental Health and Safety, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, MAHSC, Manchester, United Kingdom
| | - Matthew J Carr
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, MAHSC, Manchester, United Kingdom.,Centre for Mental Health and Safety, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, MAHSC, Manchester, United Kingdom
| | | | - Ann John
- Farr Institute, Swansea University Medical School, Swansea, United Kingdom
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, MAHSC (Manchester Academic Health Sciences Centre), Manchester, United Kingdom.,National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, MAHSC, Manchester, United Kingdom
| |
Collapse
|
29
|
Ritchie HE, Oakes D, Farrell E, Ababneh D, Howe A. Fetal hypoxia and hyperglycemia in the formation of phenytoin-induced cleft lip and maxillary hypoplasia. Epilepsia Open 2019; 4:443-451. [PMID: 31440725 PMCID: PMC6698684 DOI: 10.1002/epi4.12352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Phenytoin exposure during the first trimester of pregnancy increases the risk of maxillary hypoplasia and cleft lip. The etiology of phenytoin embryopathy is unknown. Interestingly, phenytoin is also known to induce hyperglycemia in humans as well as rats. This study uses a rat model of fetal phenytoin syndrome to examine the role of hyperoxia, hyperglycemia, and arachidonic acid deficiency in the development of cleft lip and maxillary hypoplasia. METHODS Pregnant rats were dosed with phenytoin during the critical period of lip development (day 11 of pregnancy) with or without supplemental oxygen, insulin, or arachidonic acid. The fetuses from all studies were examined at term. RESULTS The frequency of cleft lip and maxillary hypoplasia was reduced by treating dams at the time of phenytoin exposure with either increased oxygen or insulin. However, in fetuses from phenytoin-treated dams dosed with arachidonic acid, the incidence of severe lip deformities remained the same although there was an increase in normal and mildly affected fetuses. Interestingly, this occurred in embryos from hyperglycemic dams. SIGNIFICANCE Together, the results from these experiments suggest phenytoin-induced malformations may be a multifactorial process as malformations were not solely linked to a hyperglycemic state of the dam.
Collapse
Affiliation(s)
- Helen E. Ritchie
- School of Medical Sciences, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Diana Oakes
- School of Medical Sciences, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Emma Farrell
- School of Medical Sciences, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Deena Ababneh
- Department of Basic Engineering Sciences, College of EngineeringImam Abdulrahman bin Faisal UniversityDammamSaudi Arabia
| | - Andrew Howe
- School of Medical Sciences, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| |
Collapse
|
30
|
Kuhlmann L, Lehnertz K, Richardson MP, Schelter B, Zaveri HP. Seizure prediction - ready for a new era. Nat Rev Neurol 2019; 14:618-630. [PMID: 30131521 DOI: 10.1038/s41582-018-0055-2] [Citation(s) in RCA: 191] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Epilepsy is a common disorder characterized by recurrent seizures. An overwhelming majority of people with epilepsy regard the unpredictability of seizures as a major issue. More than 30 years of international effort have been devoted to the prediction of seizures, aiming to remove the burden of unpredictability and to couple novel, time-specific treatment to seizure prediction technology. A highly influential review published in 2007 concluded that insufficient evidence indicated that seizures could be predicted. Since then, several advances have been made, including successful prospective seizure prediction using intracranial EEG in a small number of people in a trial of a real-time seizure prediction device. In this Review, we examine advances in the field, including EEG databases, seizure prediction competitions, the prospective trial mentioned and advances in our understanding of the mechanisms of seizures. We argue that these advances, together with statistical evaluations, set the stage for a resurgence in efforts towards the development of seizure prediction methodologies. We propose new avenues of investigation involving a synergy between mechanisms, models, data, devices and algorithms and refine the existing guidelines for the development of seizure prediction technology to instigate development of a solution that removes the burden of the unpredictability of seizures.
Collapse
Affiliation(s)
- Levin Kuhlmann
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia.,Department of Medicine - St. Vincent's, The University of Melbourne, Parkville, Victoria, Australia.,Department of Biomedical Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Klaus Lehnertz
- Department of Epileptology, University of Bonn, Bonn, Germany. .,Interdisciplinary Center for Complex Systems, University of Bonn, Bonn, Germany.
| | - Mark P Richardson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Björn Schelter
- Institute for Complex Systems and Mathematical Biology, University of Aberdeen, Aberdeen, UK
| | - Hitten P Zaveri
- Department of Neurology, Yale University, New Haven, CT, USA
| |
Collapse
|
31
|
Andersen KM, Petersen LV, Vestergaard M, Pedersen CB, Christensen J. Premature mortality in persons with epilepsy and schizophrenia: A population-based nationwide cohort study. Epilepsia 2019; 60:1200-1208. [PMID: 31077351 DOI: 10.1111/epi.15158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 04/12/2019] [Accepted: 04/15/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine the mortality for persons with epilepsy and schizophrenia by absolute and relative measures. METHODS This is a population-based nationwide cohort study of persons born in Denmark from 1960 to 1987 who were alive and residing in Denmark on their 25th birthday. We identified persons diagnosed with epilepsy and schizophrenia prior to their 25th birthday and followed them to death, emigration, or December 31, 2012, whichever came first. The primary outcome was overall mortality. Data were analyzed using Cox regressions. RESULTS Persons were followed for 24 167 573 person years; the median was 15 years. The mortality rate ratio was 4.4 (95% confidence interval [CI] = 4.1-4.7) for persons with epilepsy, 6.6 (95% CI = 6.1-7.1) for persons with schizophrenia, and 12.8 (95% CI = 9.1-18.1) for persons with both disorders, compared with persons without these disorders. The estimated cumulative mortality at the age of 50 years was 3.1% (95% CI = 3.0-3.1) for persons without epilepsy and schizophrenia, 10.7% (95% CI = 9.7-11.8) for persons with epilepsy, 17.4% (95% CI = 16.0-18.8) for persons with schizophrenia, and 27.2% (95% CI = 15.7-40.1) for persons with both disorders. SIGNIFICANCE Persons with epilepsy and schizophrenia have very high mortality; more than one in four persons with both disorders died between the age of 25 and 50 years, indicating that these patients need special clinical attention.
Collapse
Affiliation(s)
| | | | - Mogens Vestergaard
- Research Unit and Section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Carsten B Pedersen
- National Center for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Jakob Christensen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.,National Center for Register-Based Research, Aarhus University, Aarhus, Denmark
| |
Collapse
|
32
|
Ridsdale L, McKinlay A, Wojewodka G, Robinson EJ, Mosweu I, Feehan SJ, Noble AJ, Morgan M, Taylor SJ, McCrone P, Landau S, Richardson M, Baker G, Goldstein LH. Self-Management education for adults with poorly controlled epILEpsy [SMILE (UK)]: a randomised controlled trial. Health Technol Assess 2019; 22:1-142. [PMID: 29717699 DOI: 10.3310/hta22210] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Epilepsy is a common neurological condition resulting in recurrent seizures. Research evidence in long-term conditions suggests that patients benefit from self-management education and that this may improve quality of life (QoL). Epilepsy self-management education has yet to be tested in a UK setting. OBJECTIVES To determine the effectiveness and cost-effectiveness of Self-Management education for people with poorly controlled epILEpsy [SMILE (UK)]. DESIGN A parallel pragmatic randomised controlled trial. SETTING Participants were recruited from eight hospitals in London and south-east England. PARTICIPANTS Adults aged ≥ 16 years with epilepsy and two or more epileptic seizures in the past year, who were currently being prescribed antiepileptic drugs. INTERVENTION A 2-day group self-management course alongside treatment as usual (TAU). The control group received TAU. MAIN OUTCOME MEASURES The primary outcome is QoL in people with epilepsy at 12-month follow-up using the Quality Of Life In Epilepsy 31-P (QOLIE-31-P) scale. Other outcomes were seizure control, impact of epilepsy, medication adverse effects, psychological distress, perceived stigma, self-mastery and medication adherence. Cost-effectiveness analyses and a process evaluation were undertaken. RANDOMISATION A 1 : 1 ratio between trial arms using fixed block sizes of two. BLINDING Participants were not blinded to their group allocation because of the nature of the study. Researchers involved in data collection and analysis remained blinded throughout. RESULTS The trial completed successfully. A total of 404 participants were enrolled in the study [SMILE (UK), n = 205; TAU, n = 199] with 331 completing the final follow-up at 12 months [SMILE (UK), n = 163; TAU, n = 168]. In the intervention group, 61.5% completed all sessions of the course. No adverse events were found to be related to the intervention. At baseline, participants had a mean age of 41.7 years [standard deviation (SD) 14.1 years], and had epilepsy for a median of 18 years. The mean QOLIE-31-P score for the whole group at baseline was 66.0 out of 100.0 (SD 14.2). Clinically relevant levels of anxiety symptoms were reported in 53.6% of the group and depression symptoms in 28.0%. The results following an intention-to-treat analysis showed no change in any measures at the 12-month follow-up [QOLIE-31-P: SMILE (UK) mean: 67.4, SD 13.5; TAU mean: 69.5, SD 14.8]. The cost-effectiveness study showed that SMILE (UK) was possibly cost-effective but was also associated with lower QoL. The process evaluation with 20 participants revealed that a group course increased confidence by sharing with others and improved self-management behaviours. CONCLUSIONS For people with epilepsy and persistent seizures, a 2-day self-management education course is cost-saving, but does not improve QoL after 12-months or reduce anxiety or depression symptoms. A psychological intervention may help with anxiety and depression. Interviewed participants reported attending a group course increased their confidence and helped them improve their self-management. FUTURE WORK More research is needed on self-management courses, with psychological components and integration with routine monitoring. TRIAL REGISTRATION Current Controlled Trials ISRCTN57937389. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 21. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Leone Ridsdale
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alison McKinlay
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gabriella Wojewodka
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emily J Robinson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Iris Mosweu
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sarah J Feehan
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adam J Noble
- Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Stephanie Jc Taylor
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Centre for Primary Care and Public Health, London, UK
| | - Paul McCrone
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mark Richardson
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gus Baker
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
33
|
McKinlay AR, Ridsdale LL. Views of People With Epilepsy About Web-Based Self-Presentation: A Qualitative Study. Interact J Med Res 2018; 7:e10349. [PMID: 30578229 PMCID: PMC6320425 DOI: 10.2196/10349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 12/15/2022] Open
Abstract
Background Web-based media, particularly social networking sites (SNSs), are a source of support for people with long-term conditions, like epilepsy. Living with epilepsy can reduce opportunities for accessing information and social support owing to transportation difficulties and stigma leading to self-isolation. However, some people with epilepsy (PWE) overcome these barriers using SNSs and other Web-based media. At present, little is known about Web-based identity and self-presentation of PWE; this study aims to address this gap. Objective This study aims to describe how the use of digital technologies, such as SNSs, impacts sense of identity in PWE. Methods We used qualitative research methods to examine Web-based media use and self-presentation in a group of 14 PWE (age range: 33-73 years; 7 men and 7 women). The median diagnosis duration was 25 years. Semistructured interviews ranged from 40 to 120 minutes, held at participants’ homes or in a public place of their choice, in the United Kingdom. QSR Nvivo 11 software was used to perform an inductive thematic analysis. Results In this study, 9 participants used Web-based media to “silently” learn from other PWE by reading user posts on SNSs and epilepsy-related forums. When asked about self-presentation, 7 participants described feeling cautious about disclosing their epilepsy to others online. Six participants presented themselves in the same manner irrespective of the situation and described their identity as being presented in the same way both online and offline. Conclusions PWE can deploy SNSs and Web-based media to manage aspects of their condition by learning from others and obtaining social support that may otherwise be difficult to access. Some PWE share openly, whereas others silently observe, without posting. Both benefit from the shared experiences of others. Privacy concerns and stigma can act as a barrier to sharing using Web-based media and SNSs. For some, Web-based media offers a chance to experiment with identity and change self-presentation, leading to gradually “coming out” and feeling more comfortable discussing epilepsy with others.
Collapse
Affiliation(s)
- Alison Ruth McKinlay
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Leone Lorna Ridsdale
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| |
Collapse
|
34
|
Chou IJ, Kuo CF, Tanasescu R, Tench CR, Tiley CG, Constantinescu CS, Whitehouse WP. Epilepsy and associated mortality in patients with multiple sclerosis. Eur J Neurol 2018; 26:342-e23. [PMID: 30312502 DOI: 10.1111/ene.13821] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/04/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to determine the prevalence of epilepsy in patients with multiple sclerosis (MS) at diagnosis, the risk of developing epilepsy after the diagnosis of MS and the relative risk of mortality associated with epilepsy. METHODS We used the UK Clinical Practice Research Data-link to identify 2526 patients with incident MS and 9980 age-, sex- and index year-matched non-MS controls from 1997 to 2006. Logistic regression was used to estimate odds ratios [95% confidence interval (CI)] for epilepsy and Cox regression was used to estimate hazard ratios (HRs) (95% CI) for epilepsy and mortality. RESULTS Patients with incident MS were on average 45 years old and 70.9% were female. At diagnosis, the prevalence of epilepsy in patients with MS was 1.30% compared with 0.57% in non-MS controls. At diagnosis, MS was associated with an adjusted odds ratio (95% CI) of 2.11 (1.36-3.27) for pre-existing epilepsy. Among epilepsy-free patients, the cumulative probabilities of developing epilepsy, first recorded within 10 years of the index date, were 2.77% for patients with MS and 0.90% for controls. MS was associated with an adjusted HR (95% CI) of 6.01 (2.94-12.29) for epilepsy. Among patients with MS, epilepsy was associated with an HR (95% CI) of 2.23 (1.02-4.84) for all-cause mortality. CONCLUSIONS This population-based study found an increased prevalence of epilepsy in patients with MS at diagnosis when compared with non-MS controls and the risk of developing epilepsy was also higher following the MS diagnosis. Patients with MS with epilepsy had a higher risk of mortality compared with those without.
Collapse
Affiliation(s)
- I J Chou
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham.,Division of Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Paediatric Neurology, Chang Gung Memorial Hospital, Taoyuan
| | - C F Kuo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham
| | - R Tanasescu
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham
| | - C R Tench
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham
| | - C G Tiley
- Mevagissey Surgery, Mevagissey, Cornwall.,Lander Medical Practice, Truro, UK
| | - C S Constantinescu
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham
| | - W P Whitehouse
- Division of Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
35
|
Meritam P, Ryvlin P, Beniczky S. User-based evaluation of applicability and usability of a wearable accelerometer device for detecting bilateral tonic-clonic seizures: A field study. Epilepsia 2018; 59 Suppl 1:48-52. [DOI: 10.1111/epi.14051] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Pirgit Meritam
- Department of Clinical Neurophysiology; Danish Epilepsy Center; Dianalund Denmark
| | - Philippe Ryvlin
- Department of Clinical Neurosciences; Vaud University Hospital Center; Lausanne Switzerland
- European Epilepsy Monitoring Association; Lyon France
| | - Sándor Beniczky
- Department of Clinical Neurophysiology; Danish Epilepsy Center; Dianalund Denmark
- Department of Clinical Neurophysiology; Aarhus University Hospital; Aarhus Denmark
| |
Collapse
|
36
|
Ridsdale L, Wojewodka G, Robinson EJ, Noble AJ, Morgan M, Taylor SJC, McCrone P, Richardson MP, Baker G, Landau S, Goldstein LH. The effectiveness of a group self-management education course for adults with poorly controlled epilepsy, SMILE (UK): A randomized controlled trial. Epilepsia 2018; 59:1048-1061. [PMID: 29658989 PMCID: PMC5969309 DOI: 10.1111/epi.14073] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Epilepsy is one of the most common neurological conditions affecting about 1% of adults. Up to 40% of people with epilepsy (PWE) report recurring seizures while on medication. And optimal functioning requires good self-management. Our objective was to evaluate a group self-management education courses for people with epilepsy and drug-resistant seizures by means of a multicenter, pragmatic, parallel group, randomized controlled trial. METHODS We recruited adults with epilepsy, having ≥2 seizures in the prior 12 months, from specialist clinics. Consenting participants were randomized 1:1 to a group course or treatment as usual. The primary outcome measure was quality of life 12 months after randomization using Quality of Life 31-P (QOLIE-31-P). Secondary outcome measures were seizure frequency and recency, psychological distress, impact and stigma of epilepsy, self-mastery, medication adherence, and adverse effects. Analysis of outcomes followed the intention-to-treat principle using mixed-effects regression models. RESULTS We enrolled 404 participants (intervention: n = 205, control: n = 199) with 331 (82%) completing 12-month follow-up (intervention: n = 163, control: n = 168). Mean age was 41.7 years, ranging from 16 to 85, 54% were female and 75% were white. From the intervention arm, 73.7% attended all or some of the course. At 12-month follow-up, there were no statistically significant differences between trial arms in QOLIE-31-P (intervention mean: 67.4, standard deviation [SD]: 13.5; control mean: 69.5, SD 14.8) or in secondary outcome measures. SIGNIFICANCE This is the first pragmatic trial of group education for people with poorly controlled epilepsy. Recruitment, course attendance, and follow-up rates were higher than expected. The results show that the primary outcome and quality of life did not differ between the trial arms after 12 months. We found a high prevalence of felt-stigma and psychological distress in this group of people with drug-resistant seizures. To address this, social and psychological interventions require evaluation, and may be necessary before or alongside self-management-education courses.
Collapse
Affiliation(s)
- Leone Ridsdale
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology, and Neuroscience, Academic Neuroscience Centre, King's College London, London, UK
| | - Gabriella Wojewodka
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology, and Neuroscience, Academic Neuroscience Centre, King's College London, London, UK
| | - Emily J Robinson
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Adam J Noble
- Department of Psychological Sciences, Institute of Psychology, Health, and Society, University of Liverpool, Liverpool, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, Waterloo Campus, King's College London, London, UK
| | - Stephanie J C Taylor
- Centre for Primary Care and Public Health, Blizard Institute, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Paul McCrone
- King's Health Economics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Mark P Richardson
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology, and Neuroscience, Academic Neuroscience Centre, King's College London, London, UK
| | - Gus Baker
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Sabine Landau
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| |
Collapse
|
37
|
Watkins L, Shankar R, Sander JW. Identifying and mitigating Sudden Unexpected Death in Epilepsy (SUDEP) risk factors. Expert Rev Neurother 2018; 18:265-274. [PMID: 29425076 DOI: 10.1080/14737175.2018.1439738] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Sudden Unexpected Death in Epilepsy (SUDEP) is a significant cause of death for people with chronic epilepsy. Good practice guidance in the UK and the USA expect SUDEP to be discussed with the individual. The event rarity, methodological variance and lack of robust research into the pathological mechanisms, associated risk factors, and management strategies have created a challenge on how and what to discuss. There are some significant associations which allows for risk assessment and mitigation. Areas covered: The current understanding of static and modifiable risk factors for SUDEP and how to manage these more effectively are reviewed. Longitudinal risk may be assessed using standardised risk assessment tools which help in communicating risk. Technological advancement allows measurement of physiological parameters associated with seizures and risk of SUDEP using small wearable devices. Further evidence is needed to demonstrate such technologies are efficacious and safe. Expert commentary: Risk reduction should be an important part of epilepsy management and we suggest a Gold Standard of Care which healthcare professionals and services should aim for when approaching SUDEP risk management. A Minimum Standard of Care is also proposed that is practical to implement, that all people with epilepsy should expect to receive.
Collapse
Affiliation(s)
- Lance Watkins
- a Neath Port Talbot CLDT, Mental Health & Learning Disability Delivery Unit , Abertawe Bro Morgannwyg University Health Board , Morriston , Swansea
| | - Rohit Shankar
- b Department of Intellectual Disability Neuropsychiatry , Cornwall Partnership NHS Foundation Trust , Truro , UK.,c Exeter Medical School, Knowledge Spa , Royal Cornwall Hospital Truro , Cornwall , UK
| | - Josemir W Sander
- d UCL Institute of Neurology , NIHR University College London Hospitals Biomedical Research Centre , London , UK.,e Chalfont Centre for Epilepsy , Buckinghamshire , UK.,f Stichting Epilepsie Instellingen Nederland (SEIN) , Heemstede , Netherlands
| |
Collapse
|
38
|
Zhu X, He Z, Luo C, Qiu X, He S, Peng A, Zhang L, Chen L. Altered spontaneous brain activity in MRI-negative refractory temporal lobe epilepsy patients with major depressive disorder: A resting-state fMRI study. J Neurol Sci 2018; 386:29-35. [PMID: 29406962 DOI: 10.1016/j.jns.2018.01.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/31/2017] [Accepted: 01/09/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate alterations in spontaneous brain activity in MRI-negative refractory temporal lobe epilepsy patients with major depressive disorder using resting-state functional magnetic resonance imaging (RS-fMRI). METHODS Eighteen MRI-negative refractory temporal lobe epilepsy patients with major depressive disorder (PDD), 17 MRI-negative refractory temporal lobe epilepsy patients without major depressive disorder (nPDD), and 21 matched healthy controls (HC) were recruited from West China Hospital of SiChuan University from April 2016 to June 2017. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and 17-item Hamilton Depression Rating Scale were employed to confirm the diagnosis of major depressive disorder and assess the severity of depression. All participants underwent RS-fMRI scans using a 3.0T MRI system. MRI data were compared and analyzed using the amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) to measure spontaneous brain activity. These two methods were both used to evaluate spontaneous cerebral activity. RESULTS The PDD group showed significantly altered spontaneous brain activity in the bilateral mesial prefrontal cortex, precuneus, angular gyrus, right parahippocampal gyrus, and right temporal pole. Meanwhile, compared with HC, the nPDD group demonstrated altered spontaneous brain activity in the temporal neocortex but no changes in mesial temporal structures. CONCLUSION The PDD group showed regional brain activity alterations in the prefrontal-limbic system and dysfunction of the default mode network. The underlying pathophysiology of PDD may be provided for further studies.
Collapse
Affiliation(s)
- Xi Zhu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zhongqiong He
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Cheng Luo
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Xiangmiao Qiu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Shixu He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Anjiao Peng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lin Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lei Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China.
| |
Collapse
|
39
|
Depression and Epilepsy: Comorbidity, Pathogenetic Similarity, and Principles of Treatment. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s11055-017-0534-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
40
|
Abstract
People with epilepsy have increased risk of premature death, and their life expectancy may reduce by 2-10 yr. Population- and hospital-based studies have shown that the excess mortality in epilepsy is not entirely explained by deaths directly attributable to epilepsy such as accidents and drowning during a seizure. It is also significantly contributed by deaths from other causes such as cardiac deaths, deaths due to malignancies and other causes. It had recently been recognized that sudden unexpected deaths in epilepsy (SUDEP) contributed to a small yet important proportion of mortality in epilepsy. SUDEPs are deaths (witnessed or unwitnessed) unrelated to trauma, drowning or status epilepticus and not attributable to any specific medical conditions. Several factors related to epilepsy and drug therapy have been found to be associated with higher risk of SUDEP.
Collapse
Affiliation(s)
- Shishir Nagesh Duble
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, India
| | - Sanjeev V Thomas
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, India
| |
Collapse
|
41
|
Ridsdale L, Philpott SJ, Krooupa AM, Morgan M. People with epilepsy obtain added value from education in groups: results of a qualitative study. Eur J Neurol 2017; 24:609-616. [PMID: 28181344 PMCID: PMC5396134 DOI: 10.1111/ene.13253] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 01/04/2017] [Indexed: 12/13/2022]
Abstract
Background and purpose Having epilepsy requires individuals to learn about self‐management. So far, trials of self‐management courses have not included in‐depth qualitative evaluations of how the learning method influences participants’ perceptions and behaviour. We aimed to interview participants who had attended a course, as part of a randomized controlled trial, to examine: (i) their perceptions of what they valued and negative aspects of the intervention, and (ii) whether and in what ways they continued to make use of the training. Methods Twenty participants were selected within 6 months of undertaking a course from the larger randomized controlled trial conducted in England. Semi‐structured interviews were based on a topic guide. Results Participants’ characteristics were representative of the clinical and demographic characteristics of the trial group. Their mean age was 44 years, half were male, and three‐quarters had had epilepsy for over 10 years and had experienced one or more seizures in the previous month. Participants valued the opportunity to meet ‘people like them’. Structured learning methods encouraged them to share and compare feelings and experience. Specific benefits included: overcoming the sense of ‘being alone’ and improving self‐acceptance through meeting people with similar experience. Over half reported that this, and comparison of attitudes and experience, helped them to improve their confidence to talk openly, and make changes in health behaviours. Conclusions People feel socially isolated in long‐term poorly controlled epilepsy. They gain confidence and self‐acceptance from interactive groups. Expert‐facilitated courses that encourage experiential learning can help people learn from each other, and this may enhance self‐efficacy and behaviour change.
Collapse
Affiliation(s)
- L Ridsdale
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - S J Philpott
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - A-M Krooupa
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - M Morgan
- King's College London, Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, London, UK
| |
Collapse
|
42
|
Rider FK, Danilenko OA, Grishkina MN, Kustov GV, Akzhigitov RG, Lebedeva AV, Guekht AB. [Depression and epilepsy: comorbidities, pathogenesis, principles of therapy]. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:19-24. [PMID: 28005042 DOI: 10.17116/jnevro20161169219-24] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Numerous trials of last years confirm the bilateral link between depression and epilepsy with mutual complication of both diseases. Depression increases the risk of the first unprovoked paroxysm, worsens the compliance of epileptic patients, leads to decrease of the response both to therapeutic and surgical treatment and to increase of side effects of antiepileptic drugs. Depression is associated with high risk of suicidal behavior and reduces the quality of life level. Depression in epileptic patients is characterized by atypical clinical course in most cases what makes its diagnostics difficult and becomes the reason of the absence of the necessary pharmacologic and psychotherapeutic treatment. All of the above creates significant economical burden for the community because the epileptic patient with comorbid depression visits the physicians 2-4 times more often.
Collapse
Affiliation(s)
- F K Rider
- Soloviev Moscow Research and Clinical for Neuropsychiatry, Moscow, Russia
| | - O A Danilenko
- Soloviev Moscow Research and Clinical for Neuropsychiatry, Moscow, Russia
| | - M N Grishkina
- Soloviev Moscow Research and Clinical for Neuropsychiatry, Moscow, Russia
| | - G V Kustov
- Soloviev Moscow Research and Clinical for Neuropsychiatry, Moscow, Russia
| | - R G Akzhigitov
- Soloviev Moscow Research and Clinical for Neuropsychiatry, Moscow, Russia
| | - A V Lebedeva
- Soloviev Moscow Research and Clinical for Neuropsychiatry, Moscow, Russia; Pirogov Russian Natural Research Medical Univercity, Moscow, Russia
| | - A B Guekht
- Soloviev Moscow Research and Clinical for Neuropsychiatry, Moscow, Russia; Pirogov Russian Natural Research Medical Univercity, Moscow, Russia
| |
Collapse
|
43
|
|
44
|
Thurman DJ, Logroscino G, Beghi E, Hauser WA, Hesdorffer DC, Newton CR, Scorza FA, Sander JW, Tomson T. The burden of premature mortality of epilepsy in high-income countries: A systematic review from the Mortality Task Force of the International League Against Epilepsy. Epilepsia 2016; 58:17-26. [PMID: 27888514 DOI: 10.1111/epi.13604] [Citation(s) in RCA: 202] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 11/27/2022]
Abstract
Since previous reviews of epidemiologic studies of premature mortality among people with epilepsy were completed several years ago, a large body of new evidence about this subject has been published. We aim to update prior reviews of mortality in epilepsy and to reevaluate and quantify the risks, potential risk factors, and causes of these deaths. We systematically searched the Medline and Embase databases to identify published reports describing mortality risks in cohorts and populations of people with epilepsy. We reviewed relevant reports and applied criteria to identify those studies likely to accurately quantify these risks in representative populations. From these we extracted and summarized the reported data. All population-based studies reported an increased risk of premature mortality among people with epilepsy compared to general populations. Standard mortality ratios are especially high among people with epilepsy aged <50 years, among those whose epilepsy is categorized as structural/metabolic, those whose seizures do not fully remit under treatment, and those with convulsive seizures. Among deaths directly attributable to epilepsy or seizures, important immediate causes include sudden unexpected death in epilepsy (SUDEP), status epilepticus, unintentional injuries, and suicide. Epilepsy-associated premature mortality imposes a significant public health burden, and many of the specific causes of death are potentially preventable. These require increased attention from healthcare providers, researchers, and public health professionals.
Collapse
Affiliation(s)
- David J Thurman
- Department of Neurology, School of Medicine, Emory University, Atlanta, Georgia, U.S.A
| | - Giancarlo Logroscino
- Department of Clinical Research in Neurology, University of Bari "Aldo Moro,", Pia Fondazione Cardinale G. Panico, Lecce, Italy.,Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro,", Bari, Italy
| | | | - W Allen Hauser
- Sergievsky Center and Mailman School of Public Health, Columbia University, New York City, New York, U.S.A
| | - Dale C Hesdorffer
- Sergievsky Center and Mailman School of Public Health, Columbia University, New York City, New York, U.S.A
| | - Charles R Newton
- Department of Neurosciences, Institute of Child Health, University College London, London, United Kingdom.,Department of Paediatrics, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Fulvio Alexandre Scorza
- Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, United Kingdom.,Epilepsy Institute of The Netherlands Foundation (SEIN), Heemstede, The Netherlands
| | - Torbjörn Tomson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | | |
Collapse
|
45
|
Newman C, Shankar R, Hanna J, McLean B, Osland A, Milligan C, Ball A, Jory C, Walker M. Developing an Evidence-Based Epilepsy Risk Assessment eHealth Solution: From Concept to Market. JMIR Res Protoc 2016; 5:e82. [PMID: 27269382 PMCID: PMC4916330 DOI: 10.2196/resprot.5389] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 02/01/2016] [Accepted: 02/20/2016] [Indexed: 11/13/2022] Open
Abstract
Introduction Sudden unexpected death in epilepsy (SUDEP) is possibly the most common cause of death as a result of complications from epilepsy. The need to educate and regularly review risk for all patients with epilepsy is paramount, but rarely delivered in actual clinical practice. Evidence suggests that education around SUDEP and modifiable risk variables translate into better self-management of epilepsy. Objective We aimed to develop and implement an eHealth solution to support education and self-management of risks, in epilepsy. Methods We undertook an innovation pathways approach, including problem identification, feasibility assessment, design, implementation, and marketing. People with epilepsy were provided a smartphone-based app (Epilepsy Self-Monitor, EpSMon), which translates the clinical risk assessment tool into an educational and self-monitoring platform, for the self-management of epilepsy. Results Results include the success of the marketing campaign, and in what areas, with an estimated reach of approximately 38 million people. EpSMon has proved a success in academic and clinical circles, attracting awards and nominations for awards. The number of users of EpSMon, after 3 months, turned out to be lower than expected (N=221). A 4-month trial of the app in use in the United Kingdom, and the success of the marketing strategy, point to necessary changes to the model of delivery and marketing, summarized in this paper. These include the marketing message, user cost model, and need for the availability of an Android version. Conclusions EpSMon has proven a success in respect to its reception by academics, clinicians, stakeholder groups, and the patients who use it. There is work needed to promote the model and increase its acceptability/attractiveness, including broadening the marketing message, increasing its availability, and reducing its cost. Future development and promotion of the tool will hopefully inform iterative design of its core features for a receptive audience and lead to increased uptake as it is launched worldwide in 2016.
Collapse
Affiliation(s)
- Craig Newman
- Neuro-Cognitive Research Group (NeuroCoRe), Plymouth University Peninsular School of Medicine and Dentistry (PUPSMD), Plymouth, United Kingdom.
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Tomson T, Surges R, Delamont R, Haywood S, Hesdorffer DC. Who to target in sudden unexpected death in epilepsy prevention and how? Risk factors, biomarkers, and intervention study designs. Epilepsia 2016; 57 Suppl 1:4-16. [PMID: 26749012 DOI: 10.1111/epi.13234] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2015] [Indexed: 11/28/2022]
Abstract
The risk of dying suddenly and unexpectedly is increased 24- to 28-fold among young people with epilepsy compared to the general population, but the incidence of sudden unexpected death in epilepsy (SUDEP) varies markedly depending on the epilepsy population. This article first reviews risk factors and biomarkers for SUDEP with the overall aim of enabling identification of epilepsy populations with different risk levels as a background for a discussion of possible intervention strategies. The by far most important clinical risk factor is frequency of generalized tonic-clonic seizures (GTCS), but nocturnal seizures, early age at onset, and long duration of epilepsy have been identified as additional risk factors. Lack of antiepileptic drug (AED) treatment or, in the context of clinical trials, adjunctive placebo versus active treatment is associated with increased risks. Despite considerable research, reliable electrophysiologic (electrocardiography [ECG] or electroencephalography [EEG]) biomarkers of SUDEP risk remain to be established. This is an important limitation for prevention strategies and intervention studies. There is a lack of biomarkers for SUDEP, and until validated biomarkers are found, the endpoint of interventions to prevent SUDEP must be SUDEP itself. These interventions, be they pharmacologic, seizure-detection devices, or nocturnal supervision, require large numbers. Possible methods for assessing prevention measures include public health community interventions, self-management, and more traditional (and much more expensive) randomized clinical trials.
Collapse
Affiliation(s)
- Torbjörn Tomson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Robert Delamont
- Department of Clinical Neurophysiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Dale C Hesdorffer
- GH Sergievsky Center and Department of Epidemiology, Columbia University, New York, New York, U.S.A
| |
Collapse
|
47
|
Si Y, Chen D, Tian L, Mu J, Chen T, Liu L, Deng Y, He J, Li Y, He L, Zhou D. Update on causes of premature death in people with convulsive epilepsy in rural West China. Epilepsia 2016; 57:e117-20. [PMID: 27145533 DOI: 10.1111/epi.13395] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Yang Si
- Department of Neurology; West China Hospital; Sichuan University; Chengdu China
| | - Deng Chen
- Department of Neurology; West China Hospital; Sichuan University; Chengdu China
| | - Linyu Tian
- Department of Neurology; West China Hospital; Sichuan University; Chengdu China
| | - Jie Mu
- Department of Neurology; West China Hospital; Sichuan University; Chengdu China
| | - Tao Chen
- Department of Neurology; West China Hospital; Sichuan University; Chengdu China
| | - Ling Liu
- Department of Neurology; West China Hospital; Sichuan University; Chengdu China
| | - Ying Deng
- Sichuan Center of Disease Control and Prevention; Chengdu Sichuan China
| | - Jun He
- Sichuan Center of Disease Control and Prevention; Chengdu Sichuan China
| | - You Li
- Sichuan Center of Disease Control and Prevention; Chengdu Sichuan China
| | - Li He
- Department of Neurology; West China Hospital; Sichuan University; Chengdu China
| | - Dong Zhou
- Department of Neurology; West China Hospital; Sichuan University; Chengdu China
| |
Collapse
|
48
|
Noble AJ, Marson AG, Tudur-Smith C, Morgan M, Hughes DA, Goodacre S, Ridsdale L. 'Seizure First Aid Training' for people with epilepsy who attend emergency departments, and their family and friends: study protocol for intervention development and a pilot randomised controlled trial. BMJ Open 2015; 5:e009040. [PMID: 26209121 PMCID: PMC4521519 DOI: 10.1136/bmjopen-2015-009040] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 06/30/2015] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION People with chronic epilepsy (PWE) often make costly but clinically unnecessary emergency department (ED) visits. Offering them and their carers a self-management intervention that improves confidence and ability to manage seizures may lead to fewer visits. As no such intervention currently exists, we describe a project to develop and pilot one. METHODS AND ANALYSIS To develop the intervention, an existing group-based seizure management course that has been offered by the Epilepsy Society within the voluntary sector to a broader audience will be adapted. Feedback from PWE, carers and representatives from the main groups caring for PWE will help refine the course so that it addresses the needs of ED attendees. Its behaviour change potential will also be optimised. A pilot randomised controlled trial will then be completed. 80 PWE aged ≥16 who have visited the ED in the prior 12 months on ≥2 occasions, along with one of their family members or friends, will be recruited from three NHS EDs. Dyads will be randomised to receive the intervention or treatment as usual alone. The proposed primary outcome is ED use in the 12 months following randomisation. For the pilot, this will be measured using routine hospital data. Secondary outcomes will be measured by patients and carers completing questionnaires 3, 6 and 12 months postrandomisation. Rates of recruitment, retention and unblinding will be calculated, along with the ED event rate in the control group and an estimate of the intervention's effect on the outcome measures. ETHICS AND DISSEMINATION Ethical approval: NRES Committee North West-Liverpool East (Reference number 15/NW/0225). The project's findings will provide robust evidence on the acceptability of seizure management training and on the optimal design of a future definitive trial. The findings will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER ISRCTN13 871 327.
Collapse
Affiliation(s)
- A J Noble
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - A G Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - C Tudur-Smith
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - M Morgan
- Institute of Pharmaceutical Science, King's College London, Liverpool, UK
| | - D A Hughes
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - S Goodacre
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - L Ridsdale
- Department of Basic and Clinical Neuroscience, King's College London, London, UK
| |
Collapse
|
49
|
Magill N, Ridsdale L, Goldstein LH, McCrone P, Morgan M, Noble AJ, Baker G, Richardson M, Taylor S, Landau S. Self-management education for adults with poorly controlled epilepsy (SMILE (UK)): statistical, economic and qualitative analysis plan for a randomised controlled trial. Trials 2015; 16:269. [PMID: 26068449 PMCID: PMC4488108 DOI: 10.1186/s13063-015-0788-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 05/29/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is a need to test the effectiveness of new educational interventions for people with poorly controlled epilepsy. The SMILE (self-management education for adults with poorly controlled epilepsy) trial evaluates a complex service intervention that involves a 2-day self-management course with the aim of improving quality of life and clinical outcomes. This article describes the statistical, economic, and qualitative analysis plan for the trial. METHODS AND DESIGN SMILE is a pragmatic, parallel design, two-arm, multi-centre randomised controlled superiority trial of a group-based interactive course compared with treatment as usual for people who have experienced two or more seizures in the past 12 months. RESULTS A summary of the objectives and design of the trial are reported as well as the manner in which the data will be summarised and inferentially analysed. This includes the type of modelling that will be employed for each of the primary and secondary outcomes and the methods by which the assumptions of these models will be checked. Strategies are described for handling clustering of outcome data, missing observations, and treatment non-compliance. CONCLUSION This update to the previously published trial protocol provides a description of the trial analysis which is transparent and specified before any outcome data are available. It also provides guidance to those planning the analysis of similar trials. TRIAL REGISTRATION Current Controlled Trials ISRCTN57937389; date assigned: 27 March 2013.
Collapse
Affiliation(s)
- Nicholas Magill
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO 20, , Denmark Hill Campus, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Leone Ridsdale
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO 43, , Denmark Hill Campus, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO 77, , Denmark Hill Campus, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Paul McCrone
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO 24, , Denmark Hill Campus, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Myfanwy Morgan
- Division of Health and Social Care Research, School of Medicine, King's College London, 7th Floor Capital House, 42 Weston Street, London, SE1 3QD, UK.
| | - Adam J Noble
- Department of Psychological Sciences, Institute of Psychology, Health and Society, The Whelan Building, University of Liverpool, Brownlow Hill, Liverpool, L69 3GB, UK.
| | - Gus Baker
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Ashton Street, Liverpool, L69 3GE, UK.
| | - Mark Richardson
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO 43, , Denmark Hill Campus, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Stephanie Taylor
- Barts & The London School of Medicine and Dentistry, Centre for Primary Care and Public Health, Blizard Institute, Abernethy Building, 2 Newark Street, London, E1 2AT, UK.
| | - Sabine Landau
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO 20, , Denmark Hill Campus, 16 De Crespigny Park, London, SE5 8AF, UK.
| |
Collapse
|
50
|
Shankar R, Newman C, Hanna J, Ashton J, Jory C, McLean B, Anderson T, Walker M, Cox D, Ewins L. Keeping patients with epilepsy safe: a surmountable challenge? BMJ QUALITY IMPROVEMENT REPORTS 2015; 4:bmjquality_uu208167.w3252. [PMID: 26734336 PMCID: PMC4645845 DOI: 10.1136/bmjquality.u208167.w3252] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 03/04/2015] [Indexed: 11/04/2022]
Abstract
This quality improvement project was inspired as an answer to a problem that intellectual disability teams have been struggling to manage whilst caring for people with epilepsy (PWE). The issue was that despite guidance to discuss the possibility of sudden unexpected death in epilepsy (SUDEP) be discussed with a newly diagnosed PWE this is rarely done. Additionally when, how, and what to discuss about SUDEP and reduce its risk is arbitrary, non-person centred, and with no structured evidence. Prior to initiating changes a discussion of SUDEP was recorded in just 10% of PWE. We introduced a check-list to help identify risk factors for SUDEP. We then modified the check-list, and then used it via telehealth, a way of contacting patients and their carers over the phone using the check-list approach. Following interventions, discussions of SUDEP are now recorded in 80% of PWE. Feedback from patients, carers and primary and secondary care professionals has been positive. We are now developing an app so that patients and carers can monitor their own risk factors, thus empowering them and increasing their knowledge and awareness of SUDEP.
Collapse
Affiliation(s)
| | | | - Jane Hanna
- Cornwall Partnership NHS Foundation Trust
| | | | - Caryn Jory
- Cornwall Partnership NHS Foundation Trust
| | | | | | | | - David Cox
- Cornwall Partnership NHS Foundation Trust
| | - Liz Ewins
- Cornwall Partnership NHS Foundation Trust
| |
Collapse
|