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Watkins L, Henning O, Bassett P, Ashby S, Tromans S, Shankar R. Epilepsy professionals' views on sudden unexpected death in epilepsy counselling: A tale of two countries. Eur J Neurol 2024; 31:e16375. [PMID: 38837829 PMCID: PMC11295158 DOI: 10.1111/ene.16375] [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: 02/16/2024] [Revised: 03/30/2024] [Accepted: 05/16/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND AND PURPOSE Sudden unexpected death in epilepsy (SUDEP) is a leading cause of epilepsy mortality. All international guidance strongly advocates for clinicians working with people with epilepsy (PWE) to discuss SUDEP. Clinician views working with PWE in the UK and Norway on SUDEP counselling are compared. METHODS A cross-sectional online mixed methodology survey of 17 Likert and free-text response questions using validated themes was circulated via International League against Epilepsy/Epilepsy Specialist Nurses Association in the UK and International League against Epilepsy/Epilepsinet in Norway using a non-discriminatory exponential snowballing technique leading to non-probability sampling. Quantitative data were analysed using descriptive statistics and Mann-Whitney, Kruskal-Wallis, chi-squared and Fisher's exact tests. Significance was accepted at p < 0.05. Thematic analysis was conducted on free-text responses. RESULTS Of 309 (UK 197, Norway 112) responses, UK clinicians were more likely to have experienced an SUDEP (p < 0.001), put greater importance on SUDEP communication (p < 0.001), discuss SUDEP with all PWE particularly new patients (p < 0.001), have access and refer to bereavement support (p < 0.001) and were less likely to never discuss SUDEP (p < 0.001). Significant differences existed between both countries' neurologists and nurses in SUDEP counselling with UK clinicians generally being more supportive. UK responders were more likely to be able to identify bereavement support (p < 0.001). Thematic analysis highlighted four shared themes and two specific to Norwegians. DISCUSSION Despite all international guidelines stating the need/importance to discuss SUDEP with all PWE there remain hesitation, avoidance and subjectivity in clinicians having SUDEP-related conversations, more so in Norway than the UK. Training and education are required to improve communication, engagement and decision making.
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Affiliation(s)
- Lance Watkins
- University of South WalesPontypriddUK
- Swansea Bay University Health BoardPort TalbotUK
- Cornwall Intellectual Disability Equitable Research (CIDER)University of Plymouth Peninsula School of MedicineTruroUK
| | - Oliver Henning
- National Epilepsy CenterOslo University HospitalOsloNorway
| | | | | | - Samuel Tromans
- SAPPHIRE Group, Department of Population Health SciencesUniversity of LeicesterLeicesterUK
- Adult Learning Disability ServiceLeicestershire Partnership NHS TrustLeicesterUK
| | - Rohit Shankar
- Cornwall Intellectual Disability Equitable Research (CIDER)University of Plymouth Peninsula School of MedicineTruroUK
- Cornwall Intellectual Disability Equitable Research (CIDER)Cornwall Partnership NHS Foundation TrustTruroUK
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Penovich P, Glauser T, Becker D, Patel AD, Sirven J, Long L, Stern J, Dixon-Salazar T, Carrazana E, Rabinowicz AL. Recommendations for development of acute seizure action plans (ASAPs) from an expert panel. Epilepsy Behav 2021; 123:108264. [PMID: 34482230 DOI: 10.1016/j.yebeh.2021.108264] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Disease-related treatment action plans for acute exacerbations providing information that may be helpful for self-management for patients and caregivers are commonly used for chronic conditions such as asthma and diabetes. However, among patients with epilepsy, a review of the literature suggested that the majority did not have an action plan in place for acute seizure treatment. RECENT FINDINGS Currently, there is a lack of unified guidance on seizure action plans (SAPs) in the literature. In the authors' opinion, available formats have limitations for practical use and may not be easily customizable to individual patients, and they are not often designed to provide simple-to-follow steps for rapid immediate steps to determine and initiate appropriate treatment of seizure emergencies. Our group reviewed current examples of SAPs and provided guidance on the development of acute seizure action plans (ASAPs) designed to facilitate rapid, appropriate acute care in the community and to be as useful as possible for a wide range of care partners, including those with limited experience. SUMMARY This paper provides agreed upon expert opinion recommendations and considerations for goals, development process, types of content, and format for an ASAP.
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Affiliation(s)
| | - Tracy Glauser
- Comprehensive Epilepsy Center, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Danielle Becker
- Case Western Reserve University School of Medicine and MetroHealth System, Cleveland, OH, USA
| | - Anup D Patel
- Neurology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Joseph Sirven
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Lucretia Long
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - John Stern
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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3
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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.
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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
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4
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Kuchenbuch M, D'Onofrio G, Wirrell E, Jiang Y, Dupont S, Grinspan ZM, Auvin S, Wilmshurst JM, Arzimanoglou A, Cross JH, Specchio N, Nabbout R. An accelerated shift in the use of remote systems in epilepsy due to the COVID-19 pandemic. Epilepsy Behav 2020; 112:107376. [PMID: 32882627 PMCID: PMC7457939 DOI: 10.1016/j.yebeh.2020.107376] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE The purpose of the study was to describe epileptologists' opinion on the increased use of remote systems implemented during the COVID-19 pandemic across clinics, education, and scientific meetings activities. METHODS Between April and May 2020, we conducted a cross-sectional, electronic survey on remote systems use before and during the COVID-19 pandemic through the European reference center for rare and complex epilepsies (EpiCARE) network, the International and the French Leagues Against Epilepsy, and the International and the French Child Neurology Associations. After descriptive statistical analysis, we compared the results of France, China, and Italy. RESULTS One hundred and seventy-two respondents from 35 countries completed the survey. Prior to the COVID-19 pandemic, 63.4% had experienced remote systems for clinical care. During the pandemic, the use of remote clinics, either institutional or personal, significantly increased (p < 10-4). Eighty-three percent used remote systems with video, either institutional (75%) or personal (25%). During the pandemic, 84.6% of respondents involved in academic activities transformed their courses to online teaching. From February to July 2020, few scientific meetings relevant to epileptologists and routinely attended was adapted to virtual meeting (median: 1 [25th-75th percentile: 0-2]). Responders were quite satisfied with remote systems in all three activity domains. Interestingly, before the COVID-19 pandemic, remote systems were significantly more frequently used in China for clinical activity compared with France or Italy. This difference became less marked during the pandemic. CONCLUSION The COVID-19 pandemic has dramatically altered how academic epileptologists carry out their core missions of clinical care, medical education, and scientific discovery and dissemination. Close attention to the impact of these changes is merited.
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Affiliation(s)
- Mathieu Kuchenbuch
- APHP, Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France,Laboratory of Translational Research for Neurological Disorders, INSERM UMR 1163, Imagine institute, Université de Paris, France
| | - Gianluca D'Onofrio
- APHP, Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France,Pediatric Residency Program, Department of Women and Child Health, University of Padua, Italy
| | - Elaine Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Yuwu Jiang
- Departments of Pediatrics and Pediatric Epilepsy Center, Peking, University First Hospital, Beijing, China
| | - Sophie Dupont
- Epilepsy Unit and Rehabilitation Unit, Hôpital de la Pitié-Salpêtrière, AP-HP; Centre de recherche de l'Institut du cerveau et de la moelle épinière (ICM), UMPC-UMR 7225 CNRS-UMRS 975 Inserm, Paris, France,Université Paris Sorbonne, Paris, France
| | - Zachary M. Grinspan
- Departments of Population Health Sciences and Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Stephane Auvin
- APHP, Department of Pediatric Neurology, Hôpital Robert-Debré, Paris, France
| | - Jo M. Wilmshurst
- Paediatric Neurology Department, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, South Africa
| | - Alexis Arzimanoglou
- Department of Paediatric Epilepsy, Sleep Disorders and Functional Neurology, University Hospitals of Lyon, Member of the ERN EpiCARE, Lyon, France,Epilepsy Unit, San Juan de Dios Children's Hospital, Universitat de Barcelona, Member of the ERN EpiCARE, Barcelona, Spain
| | - J. Helen Cross
- UCL NIHR BRC Great Ormond Street Institute of Child Health, London WC1N 1EH, United Kingdom of Great Britain and Northern Ireland
| | - Nicola Specchio
- Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino Gesu’ Children's Hospital, IRCCS, Member of European Reference Network EpiCARE, Rome, Italy
| | - Rima Nabbout
- APHP, Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France; Laboratory of Translational Research for Neurological Disorders, INSERM UMR 1163, Imagine institute, Université de Paris, France.
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Abstract
Sudden unexpected death in epilepsy (SUDEP) remains an important cause of epilepsy-related mortality, especially in patients with refractory epilepsy. The exact cause is not known, but postictal cardiac, respiratory, and brainstem dysfunctions are implicated. SUDEP prevention remains a big challenge. Except for low-quality evidence of preventive effect of nocturnal supervision for SUDEP, no other evidence-based preventive modality is available. Other potential preventive strategies for SUDEP include reducing the occurrence of generalized tonic-clonic seizures using seizure detection devices, detecting cardiorespiratory distress through respiratory and heart rate monitoring devices, preventing airway obstruction (safety pillows), and reducing central hypoventilation using selective serotonin reuptake inhibitors and adenosine and opiate antagonists. However, none of the above-mentioned modalities has been proven to prevent SUDEP. The present review intends to provide insight into the available SUDEP prevention modalities.
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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".
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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
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7
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Newman C, Ashby S, McLean B, Shankar R. Improving epilepsy management with EpSMon: A Templar to highlight the multifaceted challenges of incorporating digital technologies into routine clinical practice. Epilepsy Behav 2020; 103:106514. [PMID: 31526645 DOI: 10.1016/j.yebeh.2019.106514] [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: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 11/25/2022]
Abstract
The digital epilepsy self-monitor (EpSMon) app was developed to address the challenge of improving risk education and management in the UK. The tool, which has emerged out of quality improvement methodology, demonstrates efficacy and has been met with peer-reviewed support and international awards. The focus of this paper is about the development and integration into care of a digital self-assessment epilepsy risk empowerment tool into the UK health system. This paper provides detail into the specific challenges of incorporating a digital epilepsy intervention into routine clinical practice. Despite a strong narrative and evidence, the engagement of commissioners, clinicians, and people with epilepsy is slow. A breakdown of the strategies used, the current governance landscape, and emerging opportunities to develop an informed implementation strategy is provided to support others who seek to create impact with digital solutions for people with epilepsy. This paper is for the Special Issue: Prevent 21: SUDEP Summit - Time to Listen".
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Affiliation(s)
- Craig Newman
- Plymouth University, Peninsula Schools of Medicine and Dentistry, Plymouth PL4 8AA, UK
| | - Samantha Ashby
- SUDEP Action, 18 Newbury Street, Wantage, Oxon OX12 8DA, UK
| | | | - 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.
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Young C, Shankar R, Henley W, Rose A, Cheatle K, Sander JW. SUDEP and seizure safety communication: Assessing if people hear and act. Epilepsy Behav 2018; 86:200-203. [PMID: 30007785 DOI: 10.1016/j.yebeh.2018.06.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/16/2018] [Accepted: 06/20/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sudden unexpected death in epilepsy (SUDEP) is a leading cause of death among people with chronic epilepsy. People with intellectual disability (ID) are overrepresented in this population. The SUDEP and Seizure Safety Checklist ("Checklist") is a tool to discuss risk factors influencing seizures and the risk of SUDEP. It includes questions about the availability of nocturnal monitoring. In Cornwall UK, people with epilepsy and ID and their relatives and carers are routinely advised to consider nocturnal surveillance to reduce harm from potential nocturnal seizures. We assessed the retention of advice provided on nocturnal monitoring and if there were differences between those in residential care and those living with their families. METHODS A postal questionnaire was sent to carers of all people with epilepsy and ID in Cornwall followed by the adult specialist ID epilepsy service. All those who were contacted had received the same advice on SUDEP and nocturnal monitoring at least once in the past year. Each person was categorized into living in a residential setting or with their family group. Intergroup differences were compared using Fisher's exact test. RESULTS Carers for 170 people were contacted and 121 responded (71%). The family group had statistically more nocturnal seizures than the residential group. While there was no difference in the awareness of SUDEP, the groups differed in their recollection of the person-centered discussion of risk with carers in residential setting being less aware. Where nocturnal monitoring advice was given, it was followed, and previously unknown seizures were identified in 75%. CONCLUSIONS Carers in residential settings are less likely to recall specific person-centered discussion of risks to the individual they support as compared with those living with families although general awareness of SUDEP and implementing advice such as nocturnal monitoring is present equally in both groups. In improving detection of nocturnal seizures, audio monitoring may be a useful strategy to reduce risk of harm for people with ID.
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Affiliation(s)
- Charlotte Young
- Cornwall Partnership NHS Foundation Trust, Threemilestone Industrial Estate, Truro TR4 9LD, UK
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Threemilestone Industrial Estate, Truro TR4 9LD, UK; Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.
| | - William Henley
- Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK
| | - Adam Rose
- Cornwall Partnership NHS Foundation Trust, Threemilestone Industrial Estate, Truro TR4 9LD, UK
| | - Katie Cheatle
- Cornwall Partnership NHS Foundation Trust, Threemilestone Industrial Estate, Truro TR4 9LD, UK
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire SL9 0RJ, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103 SW Heemstede, the Netherlands
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9
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Watkins L, Shankar R. Reducing the Risk of Sudden Unexpected Death in Epilepsy (SUDEP). Curr Treat Options Neurol 2018; 20:40. [DOI: 10.1007/s11940-018-0527-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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10
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Shankar R, Henley W, Boland C, Laugharne R, McLean BN, Newman C, Hanna J, Ashby S, Walker MC, Sander JW. Decreasing the risk of sudden unexpected death in epilepsy: structured communication of risk factors for premature mortality in people with epilepsy. Eur J Neurol 2018; 25:1121-1127. [PMID: 29611888 DOI: 10.1111/ene.13651] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/27/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Good practice guidelines highlight the importance of making people with epilepsy aware of the risk of premature mortality in epilepsy particularly due to sudden unexpected death in epilepsy (SUDEP). The SUDEP and Seizure Safety Checklist ('Checklist') is a structured risk communication tool used in UK clinics. It is not known if sharing structured information on risk factors allows individuals to reduce SUDEP and premature mortality risks. The aim of this study was to ascertain if the introduction of the Checklist in epilepsy clinics led to individual risk reduction. METHODS The Checklist was administered to 130 consecutive people with epilepsy attending a specialized epilepsy neurology clinic and 129 attending an epilepsy intellectual disability (ID) clinic within a 4-month period. At baseline, no attendees at the neurology clinic had received formal risk advice, whereas all those attending the ID clinic had received formal risk advice on multiple occasions for 6 years. The Checklist was readministered 1 year later to each group and scores were compared with baseline and between groups. RESULTS Of 12 risk factors considered, there was an overall reduction in mean risk score for the general (P = 0.0049) but not for the ID (P = 0.322) population. Subanalysis of the 25% of people at most risk in both populations showed that both sets had a significant reduction in risk scores (P < 0.001). CONCLUSION Structured discussion results in behavioural change that reduces individual risk factors. This impact seems to be higher in those who are at current higher risk. It is important that clinicians share risk information with individuals as a matter of public health and health promotion.
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Affiliation(s)
- R Shankar
- Cornwall Partnership NHS Foundation Trust, Truro, UK.,Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, UK
| | - W Henley
- Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, UK
| | - C Boland
- Cornwall Partnership NHS Foundation Trust, Truro, UK
| | - R Laugharne
- Cornwall Partnership NHS Foundation Trust, Truro, UK.,Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, UK
| | | | - C Newman
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | | | | | - M C Walker
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, UK
| | - J W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, UK.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands
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11
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Shankar R, Newman C, Gales A, McLean BN, Hanna J, Ashby S, Walker MC, Sander JW. Has the Time Come to Stratify and Score SUDEP Risk to Inform People With Epilepsy of Their Changes in Safety? Front Neurol 2018; 9:281. [PMID: 29755403 PMCID: PMC5934492 DOI: 10.3389/fneur.2018.00281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 04/10/2018] [Indexed: 11/24/2022] Open
Abstract
Recent publication of the American Academy of Neurology SUDEP guidance highlighted the importance to American clinicians of making people with epilepsy aware of SUDEP risk. It is the first guideline to do this in the United States. It follows precedent set out in the UK by National Institute of Clinical Excellence in 2004. While a significant achievement, the lack of clarity of how to deliver this guidance in an enduring and person-centered manner, raises concerns on how its long-term effectiveness in risk mitigation. Shared decision-making with an emphasis on delivering person-centered communication to foster self-management strategies is increasingly recognized as the ideal model of patient–clinician communication in chronic diseases such as epilepsy. The tension between delivering evidence-based risk information, yet, tailoring it to the individual is complex. It needs to incorporate the potential for change not only in seizure factors but also other health and social factors. Safety advice needs to be dynamic and situation sensitive as opposed to a “one off” discussion. As a significant minority of people with epilepsy have drug-resistant seizures, the importance of keeping the advice contextual at different intervals of the person’s life cannot be overstated as many of them are managed in primary care. We present some exploratory work, which identifies the need to improve communication at a primary care level and to review risks regularly. Regular reviews using a structured risk factor checklist as a screening tool could identify, sooner, people who’s health issues are worsening and justify referrals to specialists.
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Affiliation(s)
- Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Truro, United Kingdom.,Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, United Kingdom
| | - Craig Newman
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, United Kingdom
| | | | | | | | | | - Matthew C Walker
- NIHR University College London, Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, United Kingdom
| | - Josemir W Sander
- NIHR University College London, Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, United Kingdom.,Chalfont Centre for Epilepsy, Buckinghamshire, United Kingdom.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands
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12
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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.
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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
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Mclean B, Shankar R, Hanna J, Jory C, Newman C. Sudden unexpected death in epilepsy: measures to reduce risk. Pract Neurol 2016; 17:13-20. [DOI: 10.1136/practneurol-2016-001392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2016] [Indexed: 11/04/2022]
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Shankar R, Walker M, McLean B, Laugharne R, Ferrand F, Hanna J, Newman C. Steps to prevent SUDEP: the validity of risk factors in the SUDEP and seizure safety checklist: a case control study. J Neurol 2016; 263:1840-6. [DOI: 10.1007/s00415-016-8203-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 05/24/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
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Jory C, Shankar R, Coker D, McLean B, Hanna J, Newman C. Safe and sound? A systematic literature review of seizure detection methods for personal use. Seizure 2016; 36:4-15. [PMID: 26859097 DOI: 10.1016/j.seizure.2016.01.013] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 01/18/2016] [Accepted: 01/19/2016] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The study aims to review systematically the quality of evidence supporting seizure detection devices. The unpredictable nature of seizures is distressing and disabling for sufferers and carers. If a seizure can be reliably detected then the patient or carer could be alerted. It could help prevent injury and death. METHODS A literature search was completed. Forty three of 120 studies found using relevant search terms were suitable for systematic review which was done applying pre-agreed criteria using PRISMA guidelines. The papers identified and reviewed were those that could have potential for everyday use of patients in a domestic setting. Studies involving long term use of scalp electrodes to record EEG were excluded on the grounds of unacceptable restriction of daily activities. RESULTS Most of the devices focused on changes in movement and/or physiological signs and were dependent on an algorithm to determine cut off points. No device was able to detect all seizures and there was an issue with both false positives and missed seizures. Many of the studies involved relatively small numbers of cases or report on only a few seizures. Reports of seizure alert dogs are also considered. CONCLUSION Seizure detection devices are at a relatively early stage of development and as yet there are no large scale studies or studies that compare the effectiveness of one device against others. The issue of false positive detection rates is important as they are disruptive for both the patient and the carer. Nevertheless, the development of seizure detection devices offers great potential in the management of epilepsy.
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Affiliation(s)
- Caryn Jory
- Cornwall Partnership NHS Foundation Trust Chy Govenek, Threemilestone Industrial Estate Truro TR4 9LD
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust Chy Govenek, Threemilestone Industrial Estate Truro TR4 9LD; Exeter Medical School.
| | | | | | | | - Craig Newman
- Plymouth Hospitals NHS Trust; Plymouth University
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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.
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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
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