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Marquina C, Foster E, Chen Z, Vaughan DN, Abbott DF, Tailby C, Jackson GD, Kwan P, Ademi Z. Work productivity, quality of life, and care needs: An unfolding epilepsy burden revealed in the Australian Epilepsy Project pilot study. Epilepsia Open 2024; 9:739-749. [PMID: 38358341 PMCID: PMC10984321 DOI: 10.1002/epi4.12919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/14/2023] [Accepted: 01/23/2024] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE Epilepsy is a common and serious neurological disorder. This cross-sectional analysis addresses the burden of epilepsy at different stages of the disease. METHODS This pilot study is embedded within the Australian Epilepsy Project (AEP), aiming to provide epilepsy support through a national network of dedicated sites. For this analysis, adults aged 18-65 years with first unprovoked seizure (FUS), newly diagnosed epilepsy (NDE), or drug-resistant epilepsy (DRE) were recruited between February-August 2022. Baseline clinicodemographic data were collected from the participants who completed questionnaires to assess their quality of life (QOLIE-31, EQ-5D-5L), work productivity (Work Productivity and Activity Impairment [WPAI]), and care needs. Univariate analysis and multivariate regression was performed. RESULTS 172 participants formed the study cohort (median age 34, interquartile range [IQR]: 26-45), comprising FUS (n = 44), NDE (n = 53), and DRE (n = 75). Mean QOLIE-31 score was 56 (standard deviation [SD] ± 18) and median EQ-5D-5L score was 0.77 (IQR: 0.56-0.92). QOLIE-31 but not EQ-5D-5L scores were significantly lower in the DRE group compared to FUS and NDE groups (p < 0.001). Overall, 64.5% of participants participated in paid work, with fewer DRE (52.0%) compared with FUS (76.7%) and NDE (72.5%) (p < 0.001). Compared to those not in paid employment, those in paid employment had significantly higher quality of life scores (p < 0.001). Almost 5.8% of participants required formal care (median 20 h/week, IQR: 12-55) and 17.7% required informal care (median 16 h/week, IQR: 7-101). SIGNIFICANCE Epilepsy is associated with a large burden in terms of quality of life, productivity and care needs. PLAIN LANGUAGE SUMMARY This is a pilot study from the Australian Epilepsy Project (AEP). It reports health economic data for adults of working age who live with epilepsy. It found that people with focal drug-resistant epilepsy had lower quality of life scores and were less likely to participate in paid employment compared to people with new diagnosis epilepsy. This study provides important local data regarding the burden of epilepsy and will help researchers in the future to measure the impact of the AEP on important personal and societal health economic outcomes.
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Affiliation(s)
- Clara Marquina
- Health Economics and Policy Evaluation Research (HEPER) Group, Centre for Medicine Use and SafetyMonash UniversityMelbourneVictoriaAustralia
| | - Emma Foster
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Zhibin Chen
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - David N. Vaughan
- Florey Institute of Neuroscience and Mental HealthHeidelbergVictoriaAustralia
- Department of NeurologyAustin HealthMelbourneVictoriaAustralia
- Florey Department of Neuroscience and Mental HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - David F. Abbott
- Florey Institute of Neuroscience and Mental HealthHeidelbergVictoriaAustralia
- Florey Department of Neuroscience and Mental HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Chris Tailby
- Florey Institute of Neuroscience and Mental HealthHeidelbergVictoriaAustralia
- Florey Department of Neuroscience and Mental HealthUniversity of MelbourneMelbourneVictoriaAustralia
- Department of NeuropsychologyAustin HealthMelbourneVictoriaAustralia
| | - Graeme D. Jackson
- Florey Institute of Neuroscience and Mental HealthHeidelbergVictoriaAustralia
- Department of NeurologyAustin HealthMelbourneVictoriaAustralia
- Florey Department of Neuroscience and Mental HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Patrick Kwan
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Zanfina Ademi
- Health Economics and Policy Evaluation Research (HEPER) Group, Centre for Medicine Use and SafetyMonash UniversityMelbourneVictoriaAustralia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
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Chang RSK, Nguyen S, Chen Z, Foster E, Kwan P. Role of machine learning in the management of epilepsy: a systematic review protocol. BMJ Open 2024; 14:e079785. [PMID: 38272549 PMCID: PMC10823996 DOI: 10.1136/bmjopen-2023-079785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/05/2024] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Machine learning is a rapidly expanding field and is already incorporated into many aspects of medicine including diagnostics, prognostication and clinical decision-support tools. Epilepsy is a common and disabling neurological disorder, however, management remains challenging in many cases, despite expanding therapeutic options. We present a systematic review protocol to explore the role of machine learning in the management of epilepsy. METHODS AND ANALYSIS This protocol has been drafted with reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for Protocols. A literature search will be conducted in databases including MEDLINE, Embase, Scopus and Web of Science. A PRISMA flow chart will be constructed to summarise the study workflow. As the scope of this review is the clinical application of machine learning, the selection of papers will be focused on studies directly related to clinical decision-making in management of epilepsy, specifically the prediction of response to antiseizure medications, development of drug-resistant epilepsy, and epilepsy surgery and neuromodulation outcomes. Data will be extracted following the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies checklist. Prediction model Risk Of Bias ASsessment Tool will be used for the quality assessment of the included studies. Syntheses of quantitative data will be presented in narrative format. ETHICS AND DISSEMINATION As this study is a systematic review which does not involve patients or animals, ethics approval is not required. The results of the systematic review will be submitted to peer-review journals for publication and presented in academic conferences. PROSPERO REGISTRATION NUMBER CRD42023442156.
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Affiliation(s)
- Richard Shek-Kwan Chang
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Shani Nguyen
- Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Emma Foster
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Hunter B, Nicorescu I, Foster E, McDonald D, Hulme G, Fuller A, Thomson A, Goldsborough T, Hilkens CMU, Majo J, Milross L, Fisher A, Bankhead P, Wills J, Rees P, Filby A, Merces G. OPTIMAL: An OPTimized Imaging Mass cytometry AnaLysis framework for benchmarking segmentation and data exploration. Cytometry A 2024; 105:36-53. [PMID: 37750225 PMCID: PMC10952805 DOI: 10.1002/cyto.a.24803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 09/27/2023]
Abstract
Analysis of imaging mass cytometry (IMC) data and other low-resolution multiplexed tissue imaging technologies is often confounded by poor single-cell segmentation and suboptimal approaches for data visualization and exploration. This can lead to inaccurate identification of cell phenotypes, states, or spatial relationships compared to reference data from single-cell suspension technologies. To this end we have developed the "OPTimized Imaging Mass cytometry AnaLysis (OPTIMAL)" framework to benchmark any approaches for cell segmentation, parameter transformation, batch effect correction, data visualization/clustering, and spatial neighborhood analysis. Using a panel of 27 metal-tagged antibodies recognizing well-characterized phenotypic and functional markers to stain the same Formalin-Fixed Paraffin Embedded (FFPE) human tonsil sample tissue microarray over 12 temporally distinct batches we tested several cell segmentation models, a range of different arcsinh cofactor parameter transformation values, 5 different dimensionality reduction algorithms, and 2 clustering methods. Finally, we assessed the optimal approach for performing neighborhood analysis. We found that single-cell segmentation was improved by the use of an Ilastik-derived probability map but that issues with poor segmentation were only really evident after clustering and cell type/state identification and not always evident when using "classical" bivariate data display techniques. The optimal arcsinh cofactor for parameter transformation was 1 as it maximized the statistical separation between negative and positive signal distributions and a simple Z-score normalization step after arcsinh transformation eliminated batch effects. Of the five different dimensionality reduction approaches tested, PacMap gave the best data structure with FLOWSOM clustering out-performing phenograph in terms of cell type identification. We also found that neighborhood analysis was influenced by the method used for finding neighboring cells with a "disc" pixel expansion outperforming a "bounding box" approach combined with the need for filtering objects based on size and image-edge location. Importantly, OPTIMAL can be used to assess and integrate with any existing approach to IMC data analysis and, as it creates .FCS files from the segmentation output and allows for single-cell exploration to be conducted using a wide variety of accessible software and algorithms familiar to conventional flow cytometrists.
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Affiliation(s)
- Bethany Hunter
- Flow Cytometry Core Facility, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
- Biosciences Institute, Innovation, Methodology and Application (IMA) Research Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Ioana Nicorescu
- Translational and Clinical Research Institute, Immunity and Inflammation Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Emma Foster
- Image Analysis Unit, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - David McDonald
- Flow Cytometry Core Facility, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
- Biosciences Institute, Innovation, Methodology and Application (IMA) Research Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Gillian Hulme
- Flow Cytometry Core Facility, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
- Biosciences Institute, Innovation, Methodology and Application (IMA) Research Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Andrew Fuller
- Flow Cytometry Core Facility, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
- Biosciences Institute, Innovation, Methodology and Application (IMA) Research Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Amanda Thomson
- Flow Cytometry Core Facility, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
- Translational and Clinical Research Institute, Immunity and Inflammation Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | | | - Catharien M. U. Hilkens
- Translational and Clinical Research Institute, Immunity and Inflammation Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Joaquim Majo
- Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Luke Milross
- Transplantation and Regenerative Medicine, Newcastle University Translational and Clinical Research Institute, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Andrew Fisher
- Transplantation and Regenerative Medicine, Newcastle University Translational and Clinical Research Institute, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Peter Bankhead
- Centre for Genomic and Experimental Medicine, CRUK Scotland Centre, and Edinburgh PathologyUniversity of EdinburghEdinburghUK
| | - John Wills
- Department of Veterinary MedicineCambridge UniversityCambridgeUK
- Department of Biomedical EngineeringSwansea UniversitySwansea, WalesUK
| | - Paul Rees
- Department of Biomedical EngineeringSwansea UniversitySwansea, WalesUK
- Imaging PlatformBroad Institute of MIT and HarvardCambridgeMassachusettsUSA
| | - Andrew Filby
- Flow Cytometry Core Facility, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
- Biosciences Institute, Innovation, Methodology and Application (IMA) Research Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - George Merces
- Biosciences Institute, Innovation, Methodology and Application (IMA) Research Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
- Image Analysis Unit, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
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Foster E, West N, Butterfield S, Rusbridge C, Crawford A. Respiratory compromise in French bulldogs presented with intervertebral disc extrusion. Vet Rec 2023; 193:e3603. [PMID: 37938865 DOI: 10.1002/vetr.3603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/06/2023] [Accepted: 09/29/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND French bulldogs hospitalised for the management of intervertebral disc extrusion (IVDE) are frequently affected by respiratory compromise, typically brachycephalic-associated upper respiratory obstruction and/or aspiration events. We evaluated the occurrence of such respiratory compromise events in French bulldogs presented to two referral hospitals. METHODS Clinical data for French bulldogs diagnosed with IVDE were retrospectively collated, including severity of neurological deficits, neuroanatomical localisation, diagnosis, details of respiratory compromise, treatment and outcome. RESULTS A total of 306 dogs diagnosed with IVDE were included. Sixty dogs (19.6%) experienced respiratory compromise, of which 31 dogs (10.1%) progressed to cyanosis, collapse or respiratory arrest. LIMITATIONS The study was limited by its retrospective nature. Furthermore, the duration of hospitalisation was not evaluated and the decision for euthanasia was often multifactorial. CONCLUSION One in five French bulldogs presented with IVDE experienced respiratory compromise. The detrimental welfare effects of this warrant further discussion.
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Affiliation(s)
- Emma Foster
- Clinical Science and Services, Royal Veterinary College, Hatfield, UK
- The Neighbourhood Vet, London, UK
| | - Natalie West
- North Downs Specialist Referrals, Bletchingley, UK
- Fitzpatrick Referrals Orthopaedics and Neurology, Eashing, UK
| | - Sarah Butterfield
- Clinical Science and Services, Royal Veterinary College, Hatfield, UK
| | - Clare Rusbridge
- Fitzpatrick Referrals Orthopaedics and Neurology, Eashing, UK
- Wear Referrals Veterinary Specialist & Emergency Hospital, Stockton-on-Tees, UK
- School of Veterinary Medicine, University of Surrey, Guildford, UK
| | - Abbe Crawford
- Clinical Science and Services, Royal Veterinary College, Hatfield, UK
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Kim SJ, Wood S, Marquina C, Foster E, Bell JS, Ilomäki J. Shift from older- to newer-generation antiseizure medications in people with acute ischemic stroke in Australia: A population-based study. Epilepsia Open 2023; 8:1413-1424. [PMID: 37574594 PMCID: PMC10690710 DOI: 10.1002/epi4.12809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/11/2023] [Indexed: 08/15/2023] Open
Abstract
OBJECTIVE To investigate the trends in antiseizure medications (ASMs) use following ischemic stroke and to examine factors associated with use of newer- and older-generation ASMs. METHODS A retrospective cohort study was conducted using state-wide linked health datasets. Patients who were hospitalized with a first-ever ischemic stroke between 2013 and 2017 and were dispensed ASM within 12 months from discharge were included. Logistic regression was used to examine the predictors of receiving newer-generation ASMs. Generalized linear modeling was used to identify factors associated with ASM use after ischemic stroke. RESULTS Of 19 601 people hospitalized with a first-ever ischemic stroke, 989 were dispensed an ASM within 12 months from discharge. The most prevalent first ASMs were levetiracetam (38.0%), valproate (25.8%), and carbamazepine (10.3%). Most people were dispensed ASM monotherapy (86.9%). There was a shift toward the use of newer-generation ASMs between 2013 and 2017 (odds ratio [OR] 2.82, 95% confidence interval [CI] 1.92-4.16). Metropolitan residents were more likely to be dispensed newer-generation ASMs as a first-line treatment (OR 1.79, 95% CI 1.31-2.45). People over 85 years (OR 0.38, 95% CI 0.23-0.64), with dementia (OR 0.35, 95% CI 0.19-0.63) and psychotic comorbidities (OR 0.29, 95% CI 0.09-0.96) were less likely to be dispensed newer-generation ASMs. Older age (coefficient [β] 0.23, P = 0.030), history of beta blocker use (β 0.17, P = 0.029), multiple ASMs (β 0.78, P < 0.001), and newer-generation ASM (β 0.23, P = 0.001) were associated with higher defined daily dose (DDD) of ASM whereas female sex and being married were associated with lower DDD. SIGNIFICANCE There has been a shift toward newer-generation ASMs for poststroke seizures and epilepsy. Concerningly, vulnerable patient groups were more likely to be dispensed older-generation ASMs. This may lead to unnecessary exposure to adverse events and drug-drug interactions. Further research is needed to evaluate comparative effectiveness and safety of newer- and older-generation ASMs in poststroke populations.
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Affiliation(s)
| | - Stephen Wood
- Centre for Medicine Use and SafetyMonash UniversityMelbourneVictoriaAustralia
| | - Clara Marquina
- Centre for Medicine Use and SafetyMonash UniversityMelbourneVictoriaAustralia
| | - Emma Foster
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - J. Simon Bell
- Centre for Medicine Use and SafetyMonash UniversityMelbourneVictoriaAustralia
| | - Jenni Ilomäki
- Centre for Medicine Use and SafetyMonash UniversityMelbourneVictoriaAustralia
- School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
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Sgro M, Ray J, Foster E, Mychasiuk R. Making migraine easier to stomach: the role of the gut-brain-immune axis in headache disorders. Eur J Neurol 2023; 30:3605-3621. [PMID: 37329292 DOI: 10.1111/ene.15934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/30/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND AND PURPOSE Headache disorders place a significant burden on the healthcare system, being the leading cause of disability in those under 50 years. Novel studies have interrogated the relationship between headache disorders and gastrointestinal dysfunction, suggesting a link between the gut-brain-immune (GBI) axis and headache pathogenesis. Although the exact mechanisms driving the complex relationship between the GBI axis and headache disorders remain unclear, there is a growing appreciation that a healthy and diverse microbiome is necessary for optimal brain health. METHODS A literature search was performed through multiple reputable databases in search of Q1 journals within the field of headache disorders and gut microbiome research and were critically and appropriately evaluated to investigate and explore the following; the role of the GBI axis in dietary triggers of headache disorders and the evidence indicating that diet can be used to alleviate headache severity and frequency. The relationship between the GBI axis and post-traumatic headache is then synthesized. Finally, the scarcity of literature regarding paediatric headache disorders and the role that the GBI axis plays in mediating the relationship between sex hormones and headache disorders are highlighted. CONCLUSIONS There is potential for novel therapeutic targets for headache disorders if understanding of the GBI axis in their aetiology, pathogenesis and recovery is increased.
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Affiliation(s)
- Marissa Sgro
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jason Ray
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Neurology, Austin Health, Melbourne, Victoria, Australia
| | - Emma Foster
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Cronin W, Kwan P, Foster E. Anxiety and depressive symptoms in adults with new-onset seizures: A scoping review. Epilepsia Open 2023; 8:758-772. [PMID: 37247255 PMCID: PMC10472411 DOI: 10.1002/epi4.12766] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/18/2023] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE Anxiety and depression are common comorbidities in people living with epilepsy. Emerging research suggests that these conditions may even predate epilepsy onset. This review aimed to summarize the prevalence of clinically significant anxiety and depressive symptoms in people with first seizures and newly diagnosed epilepsy, as well as clinicodemographic factors associated with these symptoms. METHODS A scoping literature review was performed. OVID Medline and Embase were searched from January 1, 2000, through May 1, 2022. Articles of interest were selected based on predetermined inclusion and exclusion criteria. RESULTS From 1836 studies identified on screening, 16 met eligibility criteria and were included in the review. Clinically significant anxiety and depressive symptoms, as determined by validated cutoff scores for anxiety and depression screening instruments, were common in people with first seizures (range 13-28%) and newly diagnosed epilepsy (range 11-45%). They were associated with a range of clinicodemographic factors including past psychiatric history and trauma, personality traits, self-esteem, and stigma profiles. SIGNIFICANCE There is substantial evidence that clinically significant anxiety and depressive symptoms are often present at the time and shortly following the first seizure or epilepsy diagnosis. Future research is needed to better understand the complex interactions between these common psychiatric comorbidities, new-onset seizure disorders, and certain clinicodemographic characteristics. This knowledge may inform targeted and holistic treatment approaches.
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Affiliation(s)
- William Cronin
- Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneVictoriaParkvilleAustralia
| | - Patrick Kwan
- Neurology DepartmentAlfred HealthMelbourneVictoriaAustralia
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of Medicine (The Royal Melbourne Hospital)The University of MelbourneParkvilleVictoriaAustralia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Monash Institute for Medical Engineering (MIME)Monash UniversityMelbourneVictoriaAustralia
| | - Emma Foster
- Neurology DepartmentAlfred HealthMelbourneVictoriaAustralia
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
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Cosentino C, Al Maawali S, Wittayacharoenpong T, Tan T, Au Yong HM, Shakhatreh L, Chen Z, Beech P, Foster E, O'Brien TJ, Kwan P, Neal A. Ex-SPECTing Success: predictors of successful SPECT radiotracer injection during pre-surgical video-EEG admissions. Epilepsia Open 2023. [PMID: 37469231 DOI: 10.1002/epi4.12795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 07/17/2023] [Indexed: 07/21/2023] Open
Abstract
OBJECTIVES To determine predictors of successful ictal Single Photon Emission Computed Tomography (SPECT) injections during Epilepsy Monitoring Unit (EMU) admissions for patients undergoing presurgical evaluation for drug resistant focal epilepsy. METHODS In this retrospective study, consecutive EMU admissions were analysed at a single centre between 2019-2021. All seizures that occurred during the admission were reviewed. 'Injectable seizures' occurred during hours when the radiotracer was available. EMU-level data were analysed to identify factors predictive of an EMU admission with a successful SPECT injection (successful admission). Seizure-level data were analysed to identify factors predictive of an 'injectable seizure' receiving a SPECT injection during the ictal phase (successful injection). A multivariate generalised linear model was used to identify predictive variables. RESULTS 125 EMU admissions involving 103 patients (median 37 years, IQR27.0-45.5) were analysed. 38.8% of seizures that were eligible for SPECT (n=134) were successfully injected; this represented 17.4% of all seizures (n=298) that occurred during admission. Unsuccessful admissions were most commonly due to a lack of seizures during EMU-SPECT (19.3%) or no 'injectable seizures' (62.3%). Successful EMU-SPECT was associated with baseline seizure frequency >1 per week (95%CI 2.1-3.0, p <0.001) and focal PET hypometabolism (95%CI 2.0-3.7, p <0.001). On multivariate analysis, the only factor associated with successful injection was patients being able to indicate they were having a seizure to staff (95%CI 1.0-4.4, p=0.038). SIGNIFICANCE Completing a successful ictal SPECT study remains challenging. Baseline seizure frequency of >1 per-week, a PET hypometabolic focus and a patient's ability to indicate seizure onset were identified as predictors of success. These findings may assist EMUs in optimising their SPECT protocols, patient selection, and resource allocation.
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Affiliation(s)
| | - Said Al Maawali
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | | | - Tracie Tan
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Hue Mun Au Yong
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Lubna Shakhatreh
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Paul Beech
- Department of Radiology, Alfred Health, Melbourne, VIC, Australia
| | - Emma Foster
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Terence J O'Brien
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Patrick Kwan
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Andrew Neal
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
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Shakhatreh L, Foster E, Siriratnam P, Neal A, Carney PW, Jackson GD, O'Brien TJ, Kwan P, Chen Z, Ademi Z. Impact of epilepsy surgery on quality of life: Systematic review and meta-analysis. Epilepsia 2023; 64:1709-1721. [PMID: 37157209 DOI: 10.1111/epi.17644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 05/05/2023] [Accepted: 05/05/2023] [Indexed: 05/10/2023]
Abstract
Improved quality of life (QoL) is an important outcome goal following epilepsy surgery. This study aims to quantify change in QoL for adults with drug-resistant epilepsy (DRE) who undergo epilepsy surgery, and to explore clinicodemographic factors associated with these changes. We conducted a systematic review and meta-analysis using Medline, Embase, and Cochrane Central Register of Controlled Trials. All studies reporting pre- and post-epilepsy surgery QoL scores in adults with DRE via validated instruments were included. Meta-analysis assessed the postsurgery change in QoL. Meta-regression assessed the effect of postoperative seizure outcomes on postoperative QoL as well as change in pre- and postoperative QoL scores. A total of 3774 titles and abstracts were reviewed, and ultimately 16 studies, comprising 1182 unique patients, were included. Quality of Life in Epilepsy Inventory-31 item (QOLIE-31) meta-analysis included six studies, and QOLIE-89 meta-analysis included four studies. Postoperative change in raw score was 20.5 for QOLIE-31 (95% confidence interval [CI] = 10.9-30.1, I2 = 95.5) and 12.1 for QOLIE-89 (95% CI = 8.0-16.1, I2 = 55.0%). This corresponds to clinically meaningful QOL improvements. Meta-regression demonstrated a higher postoperative QOLIE-31 score as well as change in pre- and postoperative QOLIE-31 score among studies of cohorts with higher proportions of patients with favorable seizure outcomes. At an individual study level, preoperative absence of mood disorders, better preoperative cognition, fewer trials of antiseizure medications before surgery, high levels of conscientiousness and openness to experience at the baseline, engagement in paid employment before and after surgery, and not being on antidepressants following surgery were associated with improved postoperative QoL. This study demonstrates the potential for epilepsy surgery to provide clinically meaningful improvements in QoL, as well as identifies clinicodemographic factors associated with this outcome. Limitations include substantial heterogeneity between individual studies and high risk of bias.
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Affiliation(s)
- Lubna Shakhatreh
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia
- Neurology Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Emma Foster
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | | | - Andrew Neal
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia
- Neurology Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Patrick W Carney
- Neurology Department, Eastern Health, Box Hill, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Graeme D Jackson
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Terence J O'Brien
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia
- Neurology Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Victoria, Australia
| | - Patrick Kwan
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia
- Neurology Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Victoria, Australia
| | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Faculty of Pharmacy, Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia
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10
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Li R, Millist L, Foster E, Yuan X, Guvenc U, Radfar M, Marendy P, Ni W, O'Brien TJ, Casillas-Espinosa PM. Spike and wave discharges detection in genetic absence epilepsy rat from Strasbourg and patients with genetic generalized epilepsy. Epilepsy Res 2023; 194:107181. [PMID: 37364342 DOI: 10.1016/j.eplepsyres.2023.107181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/02/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Generalised spike and wave discharges (SWDs) are pathognomonic EEG signatures for diagnosing absence seizures in patients with Genetic Generalized Epilepsy (GGE). The Genetic Absence Epilepsy Rats from Strasbourg (GAERS) is one of the best-validated animal models of GGE with absence seizures. METHODS We developed an SWDs detector for both GAERS rodents and GGE patients with absence seizures using a neural network method. We included 192 24-hour EEG sessions recorded from 18 GAERS rats, and 24-hour scalp-EEG data collected from 11 GGE patients. RESULTS The SWDs detection performance on GAERS showed a sensitivity of 98.01% and a false positive (FP) rate of 0.96/hour. The performance on GGE patients showed 100% sensitivity in five patients, while the remaining patients obtained over 98.9% sensitivity. Moderate FP rates were seen in our patients with 2.21/hour average FP. The detector trained within our patient cohort was validated in an independent dataset, TUH EEG Seizure Corpus (TUSZ), that showed 100% sensitivity in 11 of 12 patients and 0.56/hour averaged FP. CONCLUSIONS We developed a robust SWDs detector that showed high sensitivity and specificity for both GAERS rats and GGE patients. SIGNIFICANCE This detector can assist researchers and neurologists with the time-efficient and accurate quantification of SWDs.
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Affiliation(s)
- Rui Li
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria 3004, Australia; Department of Neurology, The Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia
| | - Lyn Millist
- Department of Neurology, The Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia; Department of Neurology, The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia
| | - Emma Foster
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria 3004, Australia; Department of Neurology, The Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia
| | - Xin Yuan
- Department of Cyber-Physical Systems, Data61, CSIRO, Marsfield, New South Wales 2122, Australia
| | - Umut Guvenc
- Department of Microsystems, Data61, CSIRO, Pullenvale, Queensland 4069, Australia
| | - Mohsen Radfar
- Department of Microsystems, Data61, CSIRO, Pullenvale, Queensland 4069, Australia
| | - Peter Marendy
- Department of Microsystems, Data61, CSIRO, Pullenvale, Queensland 4069, Australia
| | - Wei Ni
- Department of Cyber-Physical Systems, Data61, CSIRO, Marsfield, New South Wales 2122, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria 3004, Australia; Department of Neurology, The Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia; Department of Neurology, The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia; Department of Medicine, The University of Melbourne, Parkville 3050, Victoria, Australia
| | - Pablo M Casillas-Espinosa
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria 3004, Australia; Department of Neurology, The Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia; Department of Medicine, The University of Melbourne, Parkville 3050, Victoria, Australia.
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11
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O'Dwyer R, Foster E, Leppik I, Kwan P. Pharmacological treatment for older adults with epilepsy and comorbid neurodegenerative disorders. Curr Opin Neurol 2023; 36:117-123. [PMID: 36762636 DOI: 10.1097/wco.0000000000001143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
PURPOSE OF REVIEW An increased interest in epilepsy in older adults has emerged as the global population ages. The purpose of this article is to review the literature regarding the pharmacological treatment of epilepsy in older adults, highlighting issues specifically pertinent to those living with comorbid neurodegenerative disorders. RECENT FINDINGS Although new original research remains sparse, in the last 5 years, there has been a growing number of studies addressing the relationship between epilepsy and neurodegenerative disorders. Accurate diagnosis is incredibly challenging with electroencephalogram findings often requiring circumspect interpretation. Older individuals are often excluded from or under-represented in clinical trials, and there are sparse guidelines offered on the management of these patients, with even less available in reference to those with neurodegenerative comorbidities. SUMMARY We propose that seizures occurring earlier in the neurodegenerative process should be treated aggressively, with the goal to inhibit neuro-excitotoxicity and the associated neuronal loss. By strategically choosing newer antiseizure medications with less adverse effects and a holistic approach to treatment, a patient's time living independently can be conserved. In addition, we advocate for original, multinational collaborative research efforts.
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Affiliation(s)
- Rebecca O'Dwyer
- Rush Epilepsy Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Emma Foster
- Central Clinical School, Monash University
- Neurology Department, The Alfred, Melbourne, Victoria, Australia
| | - Ilo Leppik
- MINCEP Epilepsy Care, University of Minnesota, Minneapolis, Minnesota, USA
| | - Patrick Kwan
- Central Clinical School, Monash University
- Neurology Department, The Alfred, Melbourne, Victoria, Australia
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12
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Kee NN, Foster E, Marquina C, Tan A, Pang SST, O'Brien TJ, Kwan P, Jackson G, Chen Z, Ademi Z. Systematic Review of Cost-Effectiveness Analysis for Surgical and Neurostimulation Treatments for Drug-Resistant Epilepsy in Adults. Neurology 2023; 100:e1866-e1877. [PMID: 36927880 PMCID: PMC10159768 DOI: 10.1212/wnl.0000000000207137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/18/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Surgical and neurostimulator treatments are effective for reducing seizure burden in selected individuals living with drug resistant epilepsy (DRE). We aimed to determine the presence and key model determinants for cost-effectiveness of these interventions, compared to medical management alone, to assist with decisions about resource allocation. METHODS A systematic literature search was conducted on June 1, 2022, using Medline, Embase, NHS Economic Evaluation Database, and the Cost-Effectiveness Analysis database. Included studies were economic evaluations in adult DRE cohorts; comparing surgical and neurostimulator treatments (vagus nerve stimulation (VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS)) vs medical management alone; and reporting cost-benefit analysis, cost-utility, or cost-effectiveness. Exclusion criteria were studies with pediatric cohorts and those published in a language other than English. Three independent reviewers screened, extracted, and assessed data against the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist, and a fourth reviewer adjudicated discrepancies. RESULTS Ten studies met inclusion criteria. Seven studies evaluated epilepsy surgery, and three evaluated neurostimulation treatments. All relevant studies established that epilepsy surgery is a cost-effective intervention compared to medical management alone, with regards to quality adjusted life years (QALYs), and seizure freedom at 2- and 5 years. All relevant studies found neurostimulator treatments to be potentially cost-effective. The incremental cost-effectiveness ratio (ICER), with lower ICER indicating greater cost-effectiveness, was reported for nine studies, and varied between GBP £3,013 and US $61,333. Cost adaptation revealed ICERs from US $170 to US $121,726. Key model determinants included, but were not limited to, improved surgical outcomes and quality of life, reduced surgical and presurgical evaluation costs, higher rates of surgical eligibility after referral and evaluation, epilepsy subtype, less expensive neurostimulator devices with improved longevity, and cost analysis strategy used in the analysis. DISCUSSION There is consistent evidence that epilepsy surgery is a cost-effective treatment for eligible candidates with DRE. Limited evidence suggests that VNS, RNS, and DBS may be cost-effective therapies for DRE, although more health economic evaluations alongside prospective clinical trials are needed to validate these findings.
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Affiliation(s)
- Nicholas Ngan Kee
- The Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia
| | - Emma Foster
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia.,Department of Neurology, Alfred Health, Commercial Road, Melbourne, VIC 3000, Australia
| | - Clara Marquina
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3000, Australia.,Centre for Medicine Use and Safety, Monash University, Parkville, VIC 3050, Australia
| | - Andy Tan
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3800, Australia
| | - Samantha S T Pang
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3800, Australia
| | - Terence J O'Brien
- Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia
| | - Patrick Kwan
- Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia.,Monash Institute of Medical Engineering, Monash University, Clayton, VIC 3800, Australia
| | - Graeme Jackson
- Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia.,Florey Institute of Neuroscience and Mental Health, Melbourne, VIC 3052, Australia.,Department of Neurology, Austin Hospital, Heidelberg, VIC 3084, Australia
| | - Zhibin Chen
- Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia
| | - Zanfina Ademi
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia .,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3000, Australia.,Centre for Medicine Use and Safety, Monash University, Parkville, VIC 3050, Australia
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13
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Reeder S, Foster E, Vishwanath S, Kwan P. Experience of waiting for seizure freedom and perception of machine learning technologies to support treatment decision: A qualitative study in adults with recent onset epilepsy. Epilepsy Res 2023; 190:107096. [PMID: 36738538 DOI: 10.1016/j.eplepsyres.2023.107096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE With no reliable surrogate biomarkers for treatment response, people with epilepsy currently await the passage of time to determine whether prescribed treatments are effective. Few studies have examined the issues faced by people with epilepsy during this waiting period. We aim to explore the experiences of people with recently diagnosed epilepsy as they wait to achieve seizure freedom. METHODS We purposively sampled adults of working age who had been diagnosed and treated for epilepsy for less than four years. Semi-structured interviews were undertaken between July and September 2021. A thematic analysis using a framework approach was performed. RESULTS We recruited 15 patients. Results revealed four main themes: 1) Impact on mental health, as people with newly diagnosed epilepsy described waiting for seizure freedom as a time of vulnerability, uncertainty, and confusion. 2) Participants described their life as "on hold", prior to achieving effective seizure control 3) Difficulty navigating health systems to find and understand information about epilepsy, tests, and medications, and to find the 'right' health professional to address their needs. 4) Technology systems that support clinician decision making with selecting effective medications early after diagnosis were cautiously welcomed by participants. CONCLUSION Interventions are needed to reduce the negative impacts experienced by people who are newly diagnosed with epilepsy while waiting for effective seizure control. Technology systems that support clinician decision making were acceptable, as people with epilepsy sought accessible and effective solutions to restore a sense of control in their lives.
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Affiliation(s)
- Sandra Reeder
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne 3004, Australia; Department of Neurosciences, Monash University, Central Clinical School, 99 Commercial Road, Melbourne 3004, Australia.
| | - Emma Foster
- Department of Neurosciences, Monash University, Central Clinical School, 99 Commercial Road, Melbourne 3004, Australia; Department of Neurology, The Alfred, 55 Commercial Road, Melbourne 3004, Australia.
| | - Swarna Vishwanath
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne 3004, Australia; Department of Neurosciences, Monash University, Central Clinical School, 99 Commercial Road, Melbourne 3004, Australia.
| | - Patrick Kwan
- Department of Neurosciences, Monash University, Central Clinical School, 99 Commercial Road, Melbourne 3004, Australia; Department of Neurology, The Alfred, 55 Commercial Road, Melbourne 3004, Australia.
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14
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Adamson A, Davies K, Wham C, Kepa M, Foster E, Jones A, Mathers J, Granic A, Teh R, Moyes S, Hayman K, Siervo M, Maxted E, Redwood K, Collerton J, Jagger C, Kirkwood T, Dyall L, Kerse N. Assessment of Dietary Intake in Three Cohorts of Advanced Age in Two Countries: Methodology Challenges. J Nutr Health Aging 2023; 27:59-66. [PMID: 36651487 DOI: 10.1007/s12603-023-1878-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Dietary intake information is key to understanding nutrition-related outcomes. Intake changes with age and some older people are at increased risk of malnutrition. Application, difficulties, and advantages of the 24-hour multiple pass recall (24hr-MPR) dietary assessment method in three cohorts of advanced age in the United Kingdom (UK) and New Zealand (NZ) is described. PARTICIPANTS The Newcastle 85+ study (UK) recruited a single year birth cohort of people aged 85 years during 2006-7. LiLACS NZ recruited a 10-year birth cohort of Māori (indigenous New Zealanders) aged 80-90 years and a single year birth cohort of non-Māori aged 85 years in 2010. MEASUREMENTS Two 24hr-MPR were conducted on non-consecutive days by trained assessors. Pictorial resources and language were adapted for the New Zealand and Māori contexts. Detailed methods are described. RESULTS In the Newcastle 85+ study, 805 (93%) participants consented to the 24-MPR, 95% of whom completed two 24hr-MPR; in LiLACS NZ, 218 (82%) consented and 203 (76%) Māori and 353 (90%) non-Māori completed two 24hr-MPR. Mean time to complete each 24hr-MPR was 22 minutes in the Newcastle 85+ study, and 45 minutes for Māori and 39 minutes for non-Māori in LiLACS NZ. Dietary assessment of participants residing in residential care and those requiring proxy respondents were successfully included in both studies. Most participants (83-94%) felt that data captured by the 24hr-MPR reflected their usual dietary intake. CONCLUSIONS Dietary assessment using 24hr-MPR was successful in capturing detailed dietary data including information on portion size and time of eating for over 1300 octogenarians in the UK and New Zealand (Māori and non- Māori). The 24hr-MPR is an acceptable method of dietary assessment in this age group.
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Affiliation(s)
- A Adamson
- Professor Ngaire Kerse, Department of General Practice and Primary Health Care, University of Auckland, New Zealand,
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15
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Ray JC, Cheema S, Foster E, Gunasekera L, Mehta D, Corcoran SJ, Matharu MS, Hutton EJ. Autonomic symptoms in migraine: Results of a prospective longitudinal study. Front Neurol 2022; 13:1036798. [PMID: 36408496 PMCID: PMC9669069 DOI: 10.3389/fneur.2022.1036798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/13/2022] [Indexed: 10/05/2023] Open
Abstract
Objective To assess the prevalence and burden of autonomic symptoms in migraine, and determine the relationship with migraine frequency. Background Autonomic symptoms in migraine have been theorized to occur in the setting of inter-ictal sympathetic hypoactivity and hyper-sensitivity. There is limited data prospectively assessing cranial and extra-cranial autonomic symptoms with a validated instrument, or longitudinal data on the relationship between migraine disease activity and autonomic symptoms. Methods Patients attending a single tertiary academic center were recruited into a prospective cohort study between September 2020 and June 2022. In addition to standard clinical care, they completed several surveys including the Composite Autonomic Symptom Scale (COMPASS-31) questionnaire, a validated survey of autonomic symptoms. Results A total of 43 patients (66.7% female, median age 42, IQR 17) were included in the final analysis. There was a baseline 20 monthly headache days (MHD) (IQR 21.7), and 65.1% of the population had chronic migraine by ICHD-3 criteria. A significantly elevated weighted COMPASS-31 score was reported in 60.5% of respondents (mean 30.3, SD 13.3) at baseline. After 12 months treatment, significant improvements were reported in migraine frequency (median MHD 20-8.7) and disability (median Migraine Disability Assessment Score 67-48), but not in autonomic symptoms (mean score 30.3, SD 11.2). Conclusion Autonomic symptoms were frequently reported in patients with migraine. However, they did not correlate with headache frequency or reversion to episodic frequency. Further study is required to elucidate specific approaches and treatments for autonomic symptoms, and further evaluate the underlying pathophysiological mechanisms.
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Affiliation(s)
- Jason C. Ray
- Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Austin Health, Heidelberg, VIC, Australia
| | - Sanjay Cheema
- Headache and Facial Pain Group, University College London (UCL) Queen Square Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Emma Foster
- Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | | | - Dwij Mehta
- Headache and Facial Pain Group, University College London (UCL) Queen Square Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Susan J. Corcoran
- Department of Cardiology, Alfred Hospital, Melbourne, VIC, Australia
| | - Manjit S. Matharu
- Headache and Facial Pain Group, University College London (UCL) Queen Square Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Elspeth J. Hutton
- Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
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16
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Lloyd M, Winton-Brown TT, Hew A, Rayner G, Foster E, Rychkova M, Ali R, Velakoulis D, O'Brien TJ, Kwan P, Malpas CB. Multidimensional psychopathological profile differences between patients with psychogenic nonepileptic seizures and epileptic seizure disorders. Epilepsy Behav 2022; 135:108878. [PMID: 35998513 DOI: 10.1016/j.yebeh.2022.108878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/30/2022] [Accepted: 08/04/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Early differential diagnosis of psychogenic nonepileptic seizures (PNES) and epileptic seizures (ES) remains difficult. Self-reported psychopathology is often elevated in patients with PNES, although relatively few studies have examined multiple measures of psychopathology simultaneously. This study aimed to identify differences in multidimensional psychopathology profiles between PNES and ES patient groups. METHOD This was a retrospective case-control study involving patients admitted for video-EEG monitoring (VEM) over a two-year period. Clinicodemographic variables and psychometric measures of depression, anxiety, dissociation, childhood trauma, maladaptive personality traits, and cognition were recorded. Diagnosis of PNES or ES was determined by multidisciplinary assessment and consensus opinion. General linear mixed models (GLMMs) were used to investigate profile differences between diagnostic groups across psychometric measures. A general psychopathology factor was then computed using principal components analysis (PCA) and differences between groups in this 'p' factor were investigated. RESULTS 261 patients (77 % with ES and 23 % with PNES) were included in the study. The PNES group endorsed greater symptomatology with GLMM demonstrating a significant main effect of group (η2p = 0.05) and group by measure interaction (η2p = 0.03). Simple effects analysis indicated that the PNES group had particularly elevated scores for childhood trauma (β = 0.78), dissociation (β = 0.70), and depression (β = 0.60). There was a high correlation between psychopathology measures, with a single p factor generated to explain 60 % variance in the psychometric scores. The p factor was elevated in the PNES group (β = 0.61). ROC curve analysis indicated that these psychometric measures had limited usefulness when considered individually (AUC range = 0.63-0.69). CONCLUSION Multidimensional psychopathological profile differences exist between patients with PNES and ES. Patients with PNES report more psychopathology overall, with particular elevations in childhood trauma, dissociation, and depression. Although not suitable to be used as a standalone screening tool to differentiate PNES and ES, understanding of these profiles at a construct level might help triage patients and guide further psychiatric examination and enquiry.
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Affiliation(s)
- Michael Lloyd
- Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Psychiatry, Alfred Health, Melbourne, Australia.
| | - Toby T Winton-Brown
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Psychiatry, Alfred Health, Melbourne, Australia
| | - Anthony Hew
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Richmond, Victoria, Australia; Department of Neuropsychiatry, The Royal Melbourne Hospital, Parkville, Australia
| | - Genevieve Rayner
- Department of Neurology, Alfred Health, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia
| | - Emma Foster
- Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia
| | - Maria Rychkova
- Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia
| | - Rashida Ali
- Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Dennis Velakoulis
- Department of Neuropsychiatry, The Royal Melbourne Hospital, Parkville, Australia
| | - Terence J O'Brien
- Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia
| | - Patrick Kwan
- Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia
| | - Charles B Malpas
- Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia; Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Clinical Outcomes Research (CORe) Unit, Department of Medicine (RMH), The University of Melbourne, Parkville, Australia
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17
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Fowler PD, Nguyentran S, Quatroche L, Porter ML, Kobbekaduwa V, Tippin S, Miller G, Dinh E, Foster E, Tsao JI. Northward Expansion of Amblyomma americanum (Acari: Ixodidae) into Southwestern Michigan. J Med Entomol 2022; 59:1646-1659. [PMID: 35776508 PMCID: PMC9989843 DOI: 10.1093/jme/tjac082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Indexed: 05/28/2023]
Abstract
Amblyomma americanum (Linnaeus) (Acari: Ixodidae) (lone star tick) is an aggressive, generalist parasite that vectors numerous important human and animal pathogens. In recent decades its geographic range has expanded northwards from endemic regions in the southeastern and southcentral United States. In 2019 five questing A. americanum ticks, comprising two life stages were detected at one site in southwestern Michigan, satisfying one CDC criterium for an established population for the first time in recent history in the state. To better characterize the extent of emerging A. americanum, we conducted active surveillance (i.e., drag sampling) in summer 2020 throughout Michigan's southern counties and detected one adult A. americanum from each of six widespread sites, including where they had been detected in 2019. A larger established population was identified at another site in Berrien County, which yielded 691 A. americanum comprising three life stages, and questing phenologies here were similar to that reported for other endemic regions. Statewide surveillance in 2021 revealed no A. americanum outside of Berrien County, but establishment criteria were met again at the two sites where established populations were first detected respectively in 2019 and 2020. These observations may represent the successful invasion of A. americanum into Michigan. Data from passive (1999-2020) and active surveillance (2004-2021) efforts, including a domestic animal sentinel program (2015-2018), are reported to provide context for this nascent invasion. Continued active surveillance is needed to help inform the public, medical professionals, and public health officials of the health risks associated with this vector.
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Affiliation(s)
| | - S Nguyentran
- Department of Fisheries & Wildlife, Michigan State University, East Lansing, MI 48824, USA
| | - L Quatroche
- Department of Fisheries & Wildlife, Michigan State University, East Lansing, MI 48824, USA
| | - M L Porter
- Comparative Medicine & Integrative Biology, Michigan State University, East Lansing, MI 48824, USA
| | - V Kobbekaduwa
- Comparative Medicine & Integrative Biology, Michigan State University, East Lansing, MI 48824, USA
| | - S Tippin
- Berrien County Health Department, Benton Harbor, MI 49023, USA
| | - Guy Miller
- Berrien County Health Department, Benton Harbor, MI 49023, USA
| | - E Dinh
- Michigan Department of Health and Human Services, Lansing, MI 48933, USA
| | - E Foster
- Current address: Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO 80521, USA
| | - J I Tsao
- Department of Fisheries & Wildlife, Michigan State University, East Lansing, MI 48824, USA
- Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, MI 48824, USA
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18
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Baghoomian W, Dunlap R, Chang A, Foster E, Simpson E. 335 Developing a treatment decision aid for patients with moderate to severe atopic dermatitis. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Ray JC, Pham X, Foster E, Cheema S, Corcoran SJ, Matharu MS, Hutton EJ. The prevalence of headache disorders in Postural Tachycardia Syndrome: A systematic review and meta-analysis of the literature. Cephalalgia 2022; 42:1274-1287. [PMID: 35469447 DOI: 10.1177/03331024221095153] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Headache is a common presentation of postural tachycardia syndrome, yet robust prevalence data is lacking. OBJECTIVES To undertake a systematic review and meta-analysis to estimate the prevalence of headache disorders in postural tachycardia syndrome, and to explore the potential shared pathophysiological mechanisms that underpin these conditions as well as treatment options. METHODS Three databases were searched for publications evaluating prevalence of migraine (primary outcome) and general and orthostatic headache (secondary outcomes) in patients with postural tachycardia syndrome. Two independent reviewers selected studies and extracted data. A random-effects meta-analysis calculated the pooled prevalence of migraine in postural tachycardia syndrome. A narrative literature review explored the pathophysiology and treatment options for concurrent headache disorders and postural tachycardia syndrome. RESULTS Twenty-three articles met inclusion criteria. Estimated pooled prevalence of migraine in postural tachycardia syndrome was 36.8% (95% CI 2.9-70.7%). Various shared pathophysiological pathways for these conditions, as well as proposed treatment strategies, were identified.Limitations: Heterogeneity of study design, populations, and methodology for identifying headache disorders and postural tachycardia syndrome limited the generalisability of results. CONCLUSIONS Migraine is a commonly reported comorbidity in POTS, however the true prevalence cannot be determined from the current literature. Further studies are required to assess this comorbidity and investigate the underlying mechanisms, as well as identify effective treatment strategies.
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Affiliation(s)
- Jason C Ray
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Neuroscience, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
| | - Xiuxian Pham
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Emma Foster
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Sanjay Cheema
- Headache and Facial Pain Group, University College London Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Susan J Corcoran
- Department of Cardiology, Alfred Hospital, Melbourne Victoria, Australia
| | - Manjit S Matharu
- Headache and Facial Pain Group, University College London Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Elspeth J Hutton
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
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20
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Fraser MJ, Leslie SJ, Gorely T, Foster E, Walters R. Barriers and facilitators to participating in cardiac rehabilitation and physical activity: A cross-sectional survey. World J Cardiol 2022; 14:83-95. [PMID: 35316976 PMCID: PMC8900522 DOI: 10.4330/wjc.v14.i2.83] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/15/2021] [Accepted: 01/29/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cardiovascular diseases (CVD) have been shown to be the greatest cause of death worldwide and rates continue to increase. It is recommended that CVD patients attend cardiac rehabilitation (CR) following a cardiac event to reduce mortality, improve recovery and positively influence behaviour around CVD risk factors. Despite the recognised benefits and international recommendations for exercise-based CR, uptake and attendance remain suboptimal. A greater understanding of CR barriers and facilitators is required, not least to inform service development. Through understanding current cardiac patients’ attitudes and opinions around CR and physical activity (PA) could inform patient-led improvements. Moreover, through understanding aspects of CR and PA that participants like/dislike could provide healthcare providers and policy makers with information around what elements to target in the future.
AIM To investigate participants’ attitudes and opinions around CR and PA.
METHODS This study employed a cross-sectional survey design on 567 cardiac patients. Cardiac patients who were referred for standard CR classes at a hospital in the Scottish Highlands, from May 2016 to May 2017 were sampled. As part of a larger survey, the current study analysed the free-text responses to 5 open-ended questions included within the wider survey. Questions were related to the participants’ experience of CR, reasons for non-attendance, ideas to increase attendance and their opinions on PA. Qualitative data were analysed using a 6-step, reflexive thematic analysis.
RESULTS Two main topic areas were explored: “Cardiac rehabilitation experience” and “physical activity”. Self-efficacy was increased as a result of attending CR due to exercising with similar individuals and the safe environment offered. Barriers ranged from age and health to distance and starting times of the classes which increased travel time and costs. Moreover, responses demonstrated a lack of information and communication around the classes. Respondents highlighted that the provision of more classes and classes being held out with working hours, in addition to a greater variety would increase attendance. In terms of PA, respondents viewed this as different to the CR experience. Responses demonstrated increased freedom when conducting PA with regards to the location, time and type of exercise conducted.
CONCLUSION Changes to the structure of CR may prove important in creating long term behaviour change after completing the rehabilitation programme.
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Affiliation(s)
- Matthew James Fraser
- Division of Biomedical Science, University of the Highlands and Islands, Inverness IV2 3JH, United Kingdom
| | - Stephen J Leslie
- Department of Cardiology, NHS Highland, Inverness IV2 3UJ, United Kingdom
| | - Trish Gorely
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness IV2 3JH, United Kingdom
| | - Emma Foster
- Cardiac Unit NHSH, NHS Highland, Inverness IV2 3JH, United Kingdom
| | - Ronie Walters
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness IV2 3JH, United Kingdom
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21
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Siriratnam P, Foster E, Shakhatreh L, Neal A, Carney PW, Jackson GD, O'Brien TJ, Kwan P, Chen Z, Ademi Z. The effect of epilepsy surgery on productivity: A systematic review and meta-analysis. Epilepsia 2022; 63:789-811. [PMID: 35088411 DOI: 10.1111/epi.17172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES An important but understudied benefit of resective epilepsy surgery is improvement in productivity; that is, people's ability to contribute to society through participation in the workforce and in unpaid roles such as carer duties. Here, we aimed to evaluate productivity in adults with drug-resistant epilepsy (DRE) pre- and post-resective epilepsy surgery, and to explore the factors that positively influence productivity outcomes. METHODS We conducted a systematic review and meta-analysis using four electronic databases: Medline (Ovid), EMBASE (Ovid), EBM Reviews - Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Library. All studies over the past 30 years reporting on pre- and post-resective epilepsy surgical outcomes in adults with DRE were eligible for inclusion. Meta-analysis was performed to assess the post-surgery change in employment outcomes. RESULTS A total of 1005 titles and abstracts were reviewed. Seventeen studies, comprising 2056 unique patients, were suitable for the final quantitative synthesis and meta-analysis. Resective epilepsy surgery resulted in a 22% improvement in overall productivity (95% confidence interval [CI]: 1.07-1.40). The factors associated with increased post-surgery employment risk ratios were lower pre-surgical employment in the workforce (relative risk ratio [RRR] =0.34; 95% CI: 0.15-0.74), shorter follow-up duration (RRR = 0.95; 95% CI: 0.90-0.99), and lower mean age at time of surgery (RRR= 0.97; 95% CI: 0.94-0.99). The risk of bias of the included studies was assessed using Risk Of Bias In Non-randomised Studies - of Interventions and was low for most variables except "measurement of exposure." SIGNIFICANCE There is clear evidence that resective surgery in eligible surgical DRE patients results in improved productivity. Future work may include implementing a standardized method for collecting and reporting productivity in epilepsy cohorts and focusing on ways to reprioritize health care resource allocation to allow suitable candidates to access surgery earlier. This will ultimately benefit individuals with DRE, their families, our communities, and the wider health care system.
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Affiliation(s)
- Pakeeran Siriratnam
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia.,Neurology Department, Eastern Health, Box Hill, Victoria, Australia
| | - Emma Foster
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia.,Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Lubna Shakhatreh
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia.,Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Neurology Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Andrew Neal
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia.,Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Neurology Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Patrick W Carney
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Graeme D Jackson
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Terence J O'Brien
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia.,Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Neurology Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Parkville, Victoria, Australia
| | - Patrick Kwan
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia.,Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Neurology Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Parkville, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zhibin Chen
- Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Parkville, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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22
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Honaker A, Kyntchev A, Foster E, Clough K, Hawk G, Asiedu E, Berling K, DeBurger E, Feltner M, Ferguson V, Forrest PT, Jenkins K, Massie L, Mullaguru J, Niang MD, Perry C, Sene Y, Towell A, Curran CP. The behavioral effects of gestational and lactational benzo[a]pyrene exposure vary by sex and genotype in mice with differences at the Ahr and Cyp1a2 loci. Neurotoxicol Teratol 2022; 89:107056. [PMID: 34890772 PMCID: PMC8763354 DOI: 10.1016/j.ntt.2021.107056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/20/2021] [Accepted: 12/03/2021] [Indexed: 01/03/2023]
Abstract
Benzo[a]pyrene (BaP) is a polycyclic aromatic hydrocarbon (PAH) and known carcinogen in the Top 10 on the United States' list of priority pollutants. Humans are exposed through a variety of sources including tobacco smoke, grilled foods and fossil fuel combustion. Recent studies of children exposed to higher levels of PAHs during pregnancy and early life have identified numerous adverse effects on the brain and behavior that persist into school age and adolescence. Our studies were designed to look for genotype and sex differences in susceptibility to gestational and lactational exposure to BaP using a mouse model with allelic differences in the aryl hydrocarbon receptor and the xenobiotic metabolizing enzyme CYP1A2. Pregnant dams were exposed to 10 mg/kg/day of BaP in corn oil-soaked cereal or the corn oil vehicle alone from gestational day 10 until weaning at postnatal day 25. Neurobehavioral testing began at P60 using one male and one female per litter. We found main effects of sex, genotype and treatment as well as significant gene x treatment and sex x treatment interactions. BaP-treated female mice had shorter latencies to fall in the Rotarod test. BaP-treated high-affinity AhrbCyp1a2(-/-) mice had greater impairments in Morris water maze. Interestingly, poor-affinity AhrdCyp1a2(-/-) mice also had deficits in spatial learning and memory regardless of treatment. We believe our findings provide future directions in identifying human populations at highest risk of early life BaP exposure, because our model mimics known human variation in our genes of interest. Our studies also highlight the value of testing both males and females in all neurobehavioral studies.
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Affiliation(s)
- Amanda Honaker
- Department of Biological Sciences, Northern Kentucky University, 100 Nunn Drive, Highland Heights, KY 41099, USA
| | - Angela Kyntchev
- Department of Biological Sciences, Northern Kentucky University, 100 Nunn Drive, Highland Heights, KY 41099, USA
| | - Emma Foster
- Department of Biological Sciences, Northern Kentucky University, 100 Nunn Drive, Highland Heights, KY 41099, USA
| | - Katelyn Clough
- Department of Biological Sciences, Northern Kentucky University, 100 Nunn Drive, Highland Heights, KY 41099, USA
| | - Greg Hawk
- University of Kentucky Applied Statistics Laboratory, Department of Statistics, University of Kentucky, 725 Rose Street, Lexington, KY 40536, USA
| | - Emmanuella Asiedu
- Department of Biological Sciences, Northern Kentucky University, 100 Nunn Drive, Highland Heights, KY 41099, USA
| | - Kevin Berling
- Department of Biological Sciences, Northern Kentucky University, 100 Nunn Drive, Highland Heights, KY 41099, USA
| | - Emma DeBurger
- Department of Biological Sciences, Northern Kentucky University, 100 Nunn Drive, Highland Heights, KY 41099, USA
| | - Mackenzie Feltner
- Department of Biological Sciences, Northern Kentucky University, 100 Nunn Drive, Highland Heights, KY 41099, USA
| | - Victoria Ferguson
- Department of Biological Sciences, Northern Kentucky University, 100 Nunn Drive, Highland Heights, KY 41099, USA
| | - Philip Tyler Forrest
- Department of Biological Sciences, Northern Kentucky University, 100 Nunn Drive, Highland Heights, KY 41099, USA
| | - Kayla Jenkins
- Department of Biological Sciences, Northern Kentucky University, 100 Nunn Drive, Highland Heights, KY 41099, USA
| | - Lisa Massie
- Department of Biological Sciences, Northern Kentucky University, 100 Nunn Drive, Highland Heights, KY 41099, USA
| | - Jayasree Mullaguru
- Department of Biological Sciences, Northern Kentucky University, 100 Nunn Drive, Highland Heights, KY 41099, USA
| | - Mame Diarra Niang
- Department of Biological Sciences, Northern Kentucky University, 100 Nunn Drive, Highland Heights, KY 41099, USA
| | - Connor Perry
- Department of Biological Sciences, Northern Kentucky University, 100 Nunn Drive, Highland Heights, KY 41099, USA
| | - Yvonne Sene
- Department of Biological Sciences, Northern Kentucky University, 100 Nunn Drive, Highland Heights, KY 41099, USA
| | - Aria Towell
- Department of Biological Sciences, Northern Kentucky University, 100 Nunn Drive, Highland Heights, KY 41099, USA
| | - Christine Perdan Curran
- Department of Biological Sciences, Northern Kentucky University, 100 Nunn Drive, Highland Heights, KY 41099, USA.
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23
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Foster E, Chen Z, Vaughan DN, Tailby C, Carney PW, D'Souza W, Au Yong HM, Nicolo JP, Pellinen J, Carrillo de Albornoz S, Liew D, O'Brien TJ, Kwan P, Ademi Z. Prospective multisite cohort study of patient-reported outcomes in adults with new-onset seizures. Epilepsia Open 2021; 7:201-209. [PMID: 34913272 PMCID: PMC8886095 DOI: 10.1002/epi4.12571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/27/2021] [Accepted: 12/08/2021] [Indexed: 11/25/2022] Open
Abstract
Objective New‐onset seizures affect up to 10% of people over their lifetime, however, their health economic impact has not been well‐studied. This prospective multicenter study will collect patient‐reported outcome measures (PROMs) from adults with new‐onset seizures seen in six Seizure Clinics across Melbourne, Australia and The University of Colorado, USA. Methods Approximately 450 eligible patients will be enrolled in the study at or following their initial attendance to Seizure Clinics at the study hospitals. Inclusion criteria for the study group are those with new‐onset acute symptomatic seizures, new‐onset unprovoked seizures, and new‐onset epilepsy. Inclusion criteria for the three comparator groups are those with noncardiac syncope, those with psychogenic nonepileptic seizures, as well as published PROMs data from the Australian general population. Exclusion criteria are those aged less than 18 years, those with a preexisting epilepsy diagnosis, and those with intellectual disabilities or other impairments which would preclude them from comprehending and completing the questionnaires. Patients will complete eight online questionnaires regarding the effect that their seizures (or seizure mimics) have had on various aspects of their life. These questionnaires will be readministered at 6 and 12 months. Patients with new‐diagnosis epilepsy will also be asked to share the reasons why they have accepted or declined antiseizure medications. Analysis Primary outcome measures will be quality of life, work productivity, informal care needs, and mood, at baseline compared to 6 and 12 months later for those with new‐onset seizures and comparing these outcomes to those in the three comparator groups. Secondary outcomes include mapping of QoLIE‐31 to the EQ‐5D‐5L in epilepsy, modelling indirect costs of new‐onset seizures, and exploring why patients may or may not wish to take antiseizure medications. Significance These data will form an evidence‐base for future studies that examine the effectiveness of various healthcare interventions for new‐onset seizure patients. Ethics and dissemination This study is approved by the Alfred Health Human Research Ethics Committee (SERP: 52 538, Alfred HREC: 307/19), the Austin Health Human Research Ethics Committee (HREC/59148/Austin‐2019), and the Colorado Multiple Institutional Review Board (COMIRB) (COMIRB #20‐3028). ANZCTR trial registration number ACTRN12621000908831.
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Affiliation(s)
- Emma Foster
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David N Vaughan
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
| | - Christopher Tailby
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
| | - Patrick W Carney
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,Eastern Health Clinical School, Monash University Faculty of Medicine, Nursing, and Health Sciences, Clayton, Victoria, Australia
| | - Wendyl D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, University of Melbourne, Fitzroy, Victoria, Australia
| | - Hue Mun Au Yong
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - John-Paul Nicolo
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Jacob Pellinen
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sara Carrillo de Albornoz
- Centre for Health Economics, Monash Business School, Monash University, Caulfield East, Victoria, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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24
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Machhi J, Yeapuri P, Lu Y, Foster E, Chikhale R, Herskovitz J, Namminga KL, Olson KE, Abdelmoaty MM, Gao J, Quadros RM, Kiyota T, Jingjing L, Kevadiya BD, Wang X, Liu Y, Poluektova LY, Gurumurthy CB, Mosley RL, Gendelman HE. CD4+ effector T cells accelerate Alzheimer's disease in mice. J Neuroinflammation 2021; 18:272. [PMID: 34798897 PMCID: PMC8603581 DOI: 10.1186/s12974-021-02308-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by pathological deposition of misfolded self-protein amyloid beta (Aβ) which in kind facilitates tau aggregation and neurodegeneration. Neuroinflammation is accepted as a key disease driver caused by innate microglia activation. Recently, adaptive immune alterations have been uncovered that begin early and persist throughout the disease. How these occur and whether they can be harnessed to halt disease progress is unclear. We propose that self-antigens would induct autoreactive effector T cells (Teffs) that drive pro-inflammatory and neurodestructive immunity leading to cognitive impairments. Here, we investigated the role of effector immunity and how it could affect cellular-level disease pathobiology in an AD animal model. METHODS In this report, we developed and characterized cloned lines of amyloid beta (Aβ) reactive type 1 T helper (Th1) and type 17 Th (Th17) cells to study their role in AD pathogenesis. The cellular phenotype and antigen-specificity of Aβ-specific Th1 and Th17 clones were confirmed using flow cytometry, immunoblot staining and Aβ T cell epitope loaded haplotype-matched major histocompatibility complex II IAb (MHCII-IAb-KLVFFAEDVGSNKGA) tetramer binding. Aβ-Th1 and Aβ-Th17 clones were adoptively transferred into APP/PS1 double-transgenic mice expressing chimeric mouse/human amyloid precursor protein and mutant human presenilin 1, and the mice were assessed for memory impairments. Finally, blood, spleen, lymph nodes and brain were harvested for immunological, biochemical, and histological analyses. RESULTS The propagated Aβ-Th1 and Aβ-Th17 clones were confirmed stable and long-lived. Treatment of APP/PS1 mice with Aβ reactive Teffs accelerated memory impairment and systemic inflammation, increased amyloid burden, elevated microglia activation, and exacerbated neuroinflammation. Both Th1 and Th17 Aβ-reactive Teffs progressed AD pathology by downregulating anti-inflammatory and immunosuppressive regulatory T cells (Tregs) as recorded in the periphery and within the central nervous system. CONCLUSIONS These results underscore an important pathological role for CD4+ Teffs in AD progression. We posit that aberrant disease-associated effector T cell immune responses can be controlled. One solution is by Aβ reactive Tregs.
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Affiliation(s)
- Jatin Machhi
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198 USA
| | - Pravin Yeapuri
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198 USA
| | - Yaman Lu
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198 USA
| | - Emma Foster
- Department of Biological Sciences, Northern Kentucky University, Highland Heights, KY 41099 USA
| | - Rupesh Chikhale
- University College London School of Pharmacy, Bloomsbury, London, WC1E 6DE UK
| | - Jonathan Herskovitz
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE 68198 USA
| | - Krista L. Namminga
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198 USA
| | - Katherine E. Olson
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198 USA
| | - Mai Mohamed Abdelmoaty
- Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE 68198 USA
- Therapeutic Chemistry Department, National Research Centre, Giza, Egypt
| | - Ju Gao
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198 USA
| | - Rolen M. Quadros
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198 USA
- Mouse Genome Engineering Core Facility, University of Nebraska Medical Center, Omaha, NE USA
| | - Tomomi Kiyota
- Department of Safety Assessment, Genentech Inc., South San Francisco, CA 94080 USA
| | - Liang Jingjing
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198 USA
| | - Bhavesh D. Kevadiya
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198 USA
| | - Xinglong Wang
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198 USA
| | - Yutong Liu
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198 USA
- Department of Radiology, University of Nebraska Medical Center, Omaha, NE 68198 USA
| | - Larisa Y. Poluektova
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198 USA
| | - Channabasavaiah B. Gurumurthy
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198 USA
- Mouse Genome Engineering Core Facility, University of Nebraska Medical Center, Omaha, NE USA
| | - R. Lee Mosley
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198 USA
| | - Howard E. Gendelman
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198 USA
- Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE 68198 USA
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25
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Simpson HD, Foster E, Ademi Z, Lawn N, Brodie MJ, Chen Z, Kwan P. Markov modelling of treatment response in a 30-year cohort study of newly diagnosed epilepsy. Brain 2021; 145:1326-1337. [PMID: 34694369 DOI: 10.1093/brain/awab401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 09/02/2021] [Accepted: 10/01/2021] [Indexed: 11/13/2022] Open
Abstract
People with epilepsy have variable and dynamic trajectories in response to antiseizure medications. Accurately modelling long-term treatment response will aid prognostication at the individual level and health resource planning at the societal level. Unfortunately, a robust model is lacking. We aimed to develop a Markov model to predict the probability of future seizure-freedom based on current seizure state and number of antiseizure medication regimens trialled. We included 1,795 people with newly diagnosed epilepsy who attended a specialist clinic in Glasgow, Scotland, between July 1982 and October 2012. They were followed up until October 2014 or death. We developed a simple Markov model, based on current seizure state only, and a more detailed model, based on both current seizure state and number of antiseizure medication regimens trialled. Sensitivity analyses were performed for the regimen-based states model to examine the effect of regimen changes due to adverse effects. The model was externally validated in a separate cohort of 455 newly diagnosis epilepsy patients seen in Perth, Australia, between May 1999 and May 2016. Our models suggested that once seizure-freedom was achieved, it was likely to persist, regardless of the number of antiseizure medications trialled to reach that point. The likelihood of achieving long-term seizure-freedom was highest with the first antiseizure medication regimen, at approximately 50%. The chance of achieving seizure-freedom fell with subsequent regimens. Fluctuations between seizure-free and not seizure-free states were highest earlier on, but decreased with chronicity of epilepsy. Seizure-freedom/recurrence risk tables were constructed with these probability data, similar to cardiovascular risk tables. Sensitivity analyses showed that the general trends and conclusions from the base model were maintained despite perturbing the model and input data with regimen changes due to adverse effects. Quantitative comparison with the external validation cohort showed excellent consistency at year 1, good at year 3 and moderate at year 5. Quantitative models, as used in this study, can provide pertinent clinical insights that are not apparent from simple statistical analysis alone. Attaining seizure freedom at any time in a patient's epilepsy journey will confer durable benefit. Seizure-freedom risk tables may be used to individualise the prediction of future seizure control trajectory.
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Affiliation(s)
- Hugh D Simpson
- Department of Neurology, Alfred Hospital, Melbourne VIC 3004, Australia
| | - Emma Foster
- Department of Neurology, Alfred Hospital, Melbourne VIC 3004, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne VIC 3800, Australia
| | - Zanfina Ademi
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne VIC 3800, Australia.,School of Public Health & Preventative Medicine, Monash University, Melbourne VIC 3800, Australia
| | - Nicholas Lawn
- Western Australia Adult Epilepsy Service, Sir Charles Gairdner Hospital, Perth WA 6009, Australia
| | | | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne VIC 3800, Australia.,School of Public Health & Preventative Medicine, Monash University, Melbourne VIC 3800, Australia.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville VIC 3050, Australia
| | - Patrick Kwan
- Department of Neurology, Alfred Hospital, Melbourne VIC 3004, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne VIC 3800, Australia.,School of Public Health & Preventative Medicine, Monash University, Melbourne VIC 3800, Australia.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville VIC 3050, Australia
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Lin R, Yu Y, Wang Y, Foster E, Kwan P, Lin M, Xia N, Xu H, Xie C, Yang Y, Wang X. Risk of Post-stroke Epilepsy Following Stroke-Associated Acute Symptomatic Seizures. Front Aging Neurosci 2021; 13:707732. [PMID: 34588971 PMCID: PMC8475904 DOI: 10.3389/fnagi.2021.707732] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/25/2021] [Indexed: 12/23/2022] Open
Abstract
Objective: Post-stroke epilepsy (PSE) is associated with increased morbidity and mortality. Stroke-associated acute symptomatic seizures are an important risk factor: 20.8–34.3% of these patients will go on to develop PSE. Identifying these “high risk” individuals may result in earlier PSE diagnosis, treatment, and avoidance of seizure-related morbidity. This study was to identify predictors of PSE development in patients with stroke-associated acute symptomatic seizures. Participants and Methods: This was a retrospective cohort study of 167 patients with stroke-associated acute symptomatic seizures admitted to the Neurology Department of a tertiary Hospital of China, from 1 May 2006 to 30 January 2020. Both those with primary ischemic stroke and intracerebral hemorrhage were included in the study. Patient demographics, medical history, stroke-associated, and seizure-related variables were evaluated with univariable analysis and multivariable Cox regression analysis. PSE was defined as unprovoked seizures occurring > 7 days post-stroke. Data points were extracted from medical records and supplemented by tele-interview. Results: Of the 167 patients with stroke-associated acute symptomatic seizures, 49 (29.3%) developed PSE. NIHSS score > 14 [hazard ratio (HR) 2.98, 95% CI 1.57–5.67], longer interval from stroke to acute symptomatic seizures (days 4–7 post-stroke) (HR 2.51, 95% CI 1.37–4.59) and multiple acute symptomatic seizures (HR 5.08, 95% CI 2.58–9.99) were independently associated with PSE development. This association remained in the sub-analysis within the ischemic stroke cohort. In the sub-analysis of the hemorrhagic stroke cohort, multilobar involvement (HR 4.80, 95% CI 1.49–15.39) was also independently associated with development of PSE. Further, we developed a nomogram to predict individual risk of developing PSE following stroke-associated acute symptomatic seizures. The nomogram showed a C-index of 0.73. Conclusion: More severe neurofunctional deficits (NIHSS score > 14), longer interval from stroke to acute symptomatic seizures (days 4–7 post-stroke), and multiple acute symptomatic seizures were independently associated with development of PSE in patients with stroke-associated acute symptomatic seizures. This knowledge may increase clinical vigilance for development of PSE, facilitating rapid diagnosis and treatment initiation, and subsequently reduce seizure-related morbidity.
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Affiliation(s)
- Ru Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yaoyao Yu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yi Wang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Emma Foster
- Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Patrick Kwan
- Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Mengqi Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Niange Xia
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huiqin Xu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chenglong Xie
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yunjun Yang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xinshi Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Alzheimer's Disease of Zhejiang Province, Institute of Aging, Wenzhou Medical University, Wenzhou, China
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Holper S, Foster E, Lloyd M, Rayner G, Rychkova M, Ali R, Winton-Brown TT, Velakoulis D, O'Brien TJ, Kwan P, Malpas CB. Clinical predictors of discordance between screening tests and psychiatric assessment for depressive and anxiety disorders among patients being evaluated for seizure disorders. Epilepsia 2021; 62:1170-1183. [PMID: 33735445 DOI: 10.1111/epi.16871] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This study was undertaken to identify factors that predict discordance between the screening instruments Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and Generalized Anxiety Disorder scale (GAD-7), and diagnoses made by qualified psychiatrists among patients with seizure disorders. Importantly, this is not a validation study; rather, it investigates clinicodemographic predictors of discordance between screening tests and psychiatric assessment. METHODS Adult patients admitted for inpatient video-electroencephalographic monitoring completed eight psychometric instruments, including the NDDI-E and GAD-7, and psychiatric assessment. Patients were grouped according to agreement between the screening instrument and psychiatrists' diagnoses. Screening was "discordant" if the outcome differed from the psychiatrist's diagnosis, including both false positive and false negative results. Bayesian statistical analyses were used to identify factors associated with discordance. RESULTS A total of 411 patients met inclusion criteria; mean age was 39.6 years, and 55.5% (n = 228) were female. Depression screening was discordant in 33% of cases (n = 136/411), driven by false positives (n = 76/136, 56%) rather than false negatives (n = 60/136, 44%). Likewise, anxiety screening was discordant in one third of cases (n = 121/411, 29%) due to false positives (n = 60/121, 50%) and false negatives (n = 61/121, 50%). Seven clinical factors were predictive of discordant screening for both depression and anxiety: greater dissociative symptoms, greater patient-reported adverse events, subjective cognitive impairment, negative affect, detachment, disinhibition, and psychoticism. When the analyses were restricted to only patients with psychogenic nonepileptic seizures (PNES) or epilepsy, the rate of discordant depression screening was higher in the PNES group (n = 29, 47%) compared to the epilepsy group (n = 70, 30%, Bayes factor for the alternative hypothesis = 4.65). SIGNIFICANCE Patients with seizure disorders who self-report a variety of psychiatric and other symptoms should be evaluated more thoroughly for depression and anxiety, regardless of screening test results, especially if they have PNES and not epilepsy. Clinical assessment by a qualified psychiatrist remains essential in diagnosing depressive and anxiety disorders among such patients.
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Affiliation(s)
- Sarah Holper
- Department of Neurology, Alfred Health, Prahran, Victoria, Australia.,Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Emma Foster
- Department of Neurology, Alfred Health, Prahran, Victoria, Australia.,Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Michael Lloyd
- Department of Psychiatry, Alfred Health, Melbourne, Victoria, Australia
| | - Genevieve Rayner
- Department of Neurology, Alfred Health, Prahran, Victoria, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Maria Rychkova
- Department of Neurology, Alfred Health, Prahran, Victoria, Australia.,Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Rashida Ali
- Department of Neurology, Alfred Health, Prahran, Victoria, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Toby T Winton-Brown
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Psychiatry, Alfred Health, Melbourne, Victoria, Australia
| | - Dennis Velakoulis
- Department of Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Terence J O'Brien
- Department of Neurology, Alfred Health, Prahran, Victoria, Australia.,Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Patrick Kwan
- Department of Neurology, Alfred Health, Prahran, Victoria, Australia.,Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Charles B Malpas
- Department of Neurology, Alfred Health, Prahran, Victoria, Australia.,Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.,Clinical Outcomes Research Unit, Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
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Wang X, Loi SM, Foster E, Chen Z, Velakoulis D, Kwan P. Predictors of New-Onset Epilepsy in People With Younger-Onset Neurocognitive Disorders. Front Aging Neurosci 2021; 13:637260. [PMID: 33815091 PMCID: PMC8010684 DOI: 10.3389/fnagi.2021.637260] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/23/2021] [Indexed: 01/19/2023] Open
Abstract
Objective: People with neurocognitive disorders (NCDs) have an increased risk of epilepsy. However, most studies investigating the risk of seizures in people with NCDs are limited to those with Alzheimer's disease (AD) and vascular dementia (VD), and those who developed dementia after age 65 years. A knowledge gap exists regarding factors associated with development of epilepsy in people with younger-onset NCD, and those with non-AD and non-VD dementia subtypes. In this study, we aimed to identify the factors associated with the development of epilepsy in people with younger-onset NCDs of varied etiologies, the majority of whom had symptom onset prior to age 65 years. Participants and Methods: This was a retrospective study reviewing the medical records of consecutive people admitted with cognitive impairment to a tertiary neuropsychiatry unit between 1 January 2004 and 30 April 2019. People diagnosed with primary NCDs were included in the analysis. The prevalence and characteristics of epilepsy were described. The factors associated with developing epilepsy were identified in a binary logistic regression model. Results: A total of 427 people were included. One hundred fourteen had Alzheimer's disease, 104 frontotemporal dementia, 51 vascular dementia, 69 movement disorder-associated dementia, and 89 unspecified NCD. The median age on admission was 59 years (range 33-86) and 75.2% (n = 321/427) had young-onset NCD with onset before 65 years of age. 40/427 (9.4%) people had epilepsy, and epilepsy onset clustered between 2 years before and 6 years after the onset of cognitive decline in 80% (n = 32/40). The most frequent seizure type was focal to bilateral tonic-clonic seizure (35%, n = 14/40). Most of the people (94.7%, n = 36/38) achieved seizure freedom with one or two antiseizure medications. People with unspecified NCD (compared to frontotemporal dementia and movement disorder-associated dementia, age of onset of NCDs ≤50 years, and current smoking status were independently associated with higher risk of developing epilepsy. Conclusion: Epilepsy is common in people with younger-onset NCDs, and a high index of suspicion is warranted particularly for those with unspecified subtype and smoking status. Smoking reduction or cessation should be further investigated as a potentially modifiable factor for risk reduction.
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Affiliation(s)
- Xinshi Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Neurology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Samantha M Loi
- Neuropsychiatry, The Royal Melbourne Hospital and Melbourne Neuropsychiatry Center, The University of Melbourne and The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Emma Foster
- Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Neurology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Zhibin Chen
- Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Dennis Velakoulis
- Neuropsychiatry, The Royal Melbourne Hospital and Melbourne Neuropsychiatry Center, The University of Melbourne and The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Patrick Kwan
- Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Neurology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Abstract
Echoing other articles in this special issue, this article re-evaluates a collection of feminist works that fell out of fashion as a consequence of academic feminism embracing poststructuralist and postmodernist trends. In line with fellow contributors, the article critically reflects upon the unsympathetic reading of feminisms considered to be essentialising and universalistic, in order to re-evaluate, in my case, ecofeminism. As an introduction, I reflect on my own perhaps unfair rejection of ecofeminism as a doctoral researcher and early career academic who, in critiquing 1990s international environmental governance, sought to problematise the essentialist premise on which it appeared to be based. The article thereafter challenges this well-rehearsed critique by carefully revisiting a sample of ecofeminist work produced between the late 1970s and the early 1990s. In an effort to avoid wholesale abandonment of the wealth of feminist theory often labelled as second wave, or the rendering of feminisms of the past as redundant as feminist theory changes over time, this article re-reads the work of ecofeminists, such as Starhawk, Susan Griffin and Vandana Shiva, to demonstrate their contemporary relevance. In so doing, the article argues that a contemporary re-reading of ecofeminism offers insights allowing for a radical rethinking of contemporary environmental governance.
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Dang YL, Foster E, Lloyd M, Rayner G, Rychkova M, Ali R, Carney PW, Velakoulis D, Winton-Brown TT, Kalincik T, Perucca P, O'Brien TJ, Kwan P, Malpas CB. Adverse events related to antiepileptic drugs. Epilepsy Behav 2021; 115:107657. [PMID: 33360400 DOI: 10.1016/j.yebeh.2020.107657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/04/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Adverse events (AEs) related to antiepileptic drugs (AEDs) may interfere with adequate dosing and patient adherence, leading to suboptimal seizure control, and relatedly, increased injuries, hospitalizations, and mortality. This study investigated the clinicodemographic factors associated with AEs related to AEDs as reported by the Liverpool Adverse Events Profile (LAEP), and explored the ability of LAEP to discriminate between epilepsy and psychogenic nonepileptic seizures (PNES). We hypothesized that female sex, mood disorders, AED-polytherapy, duration, and severity of epilepsy are associated with increased endorsement of AEs related to AEDs, and that endorsement of AEs related to AEDs would significantly differ between epilepsy and PNES patients. METHODS We prospectively enrolled adult patients admitted to two inpatient video-electroencephalogram monitoring units. Clinicodemographic variables and psychometric measures of depression, anxiety, and cognitive function were recorded. Patient-reported AE endorsement was obtained using the LAEP, which was reduced to four latent domains using exploratory structural equation modeling. General linear models identified variables associated with each domain. Logistic regression determined the ability of LAEP scores to differentiate between epilepsy and PNES. RESULTS 311 patients met inclusion criteria. Mean age was 38 years and 56% of patients were female. Network analysis demonstrated strong relationships between depression and anxiety with physical, sleep, psychiatric, and dermatological AE endorsement. Depression, female sex, and AED polytherapy were associated with greater AE endorsement. Epilepsy, compared to PNES, was associated with lower AE endorsement. Fewer prescribed AEDs and greater reported physical AE endorsement were associated with PNES diagnosis. SIGNIFICANCE There is a strong relationship between patient-reported AEs and psychiatric symptomatology. Those with PNES paradoxically endorse greater physical AEs despite receiving fewer AEDs. Patients who endorse AEs in clinical practice should be screened for comorbid depression or anxiety and treated accordingly.
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Affiliation(s)
- Yew Li Dang
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia
| | - Emma Foster
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia; Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.
| | - Michael Lloyd
- Department of Psychiatry, Alfred Health, Melbourne, Australia
| | - Genevieve Rayner
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia
| | - Maria Rychkova
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia; Department of Neurology, Alfred Health, Melbourne, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Rashida Ali
- Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Patrick W Carney
- Department of Medicine, Monash University and Eastern Health, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Dennis Velakoulis
- Department of Neuropsychiatry, The Royal Melbourne Hospital, Parkville, Australia
| | | | - Tomas Kalincik
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia; Clinical Outcomes Research (CORe) Unit, Department of Medicine (RMH), The University of Melbourne, Parkville, Australia
| | - Piero Perucca
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia; Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Terence J O'Brien
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia; Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Patrick Kwan
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia; Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Charles B Malpas
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia; Department of Neurology, Alfred Health, Melbourne, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Clinical Outcomes Research (CORe) Unit, Department of Medicine (RMH), The University of Melbourne, Parkville, Australia
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Ravi A, Foster E, Nikolov Z. Data on using single- and mixed-mode resins for capture chromatography of recombinant human thioredoxin from Escherichia coli. Data Brief 2020; 33:106500. [PMID: 33251305 PMCID: PMC7683221 DOI: 10.1016/j.dib.2020.106500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 12/02/2022] Open
Abstract
This paper provides the data collected from screening chromatographic resins for their ability to bind and purify recombinant human thioredoxin from Escherichia coli lysate. This data was used by “Capture chromatography with mixed-mode resins: A case study with recombinant human thioredoxin from Escherichia coli” [1] to determine the optimal resin to use as a capture step to initiate downstream processing of thioredoxin. Five chromatography resins were screened using a 96-well filter plate to experiment on a wide range of pH and conductivity conditions in a shorter amount of time while saving on materials. Thioredoxin-producing E. coli was cultivated, harvested, and lysed according to Ravi et al [1]. Thioredoxin containing lysate was dialyzed into the binding conditions, pH from 5.0 to 9.0 and conductivity from 2.0 to 10.0 mS, applied to each resin and incubated with shaking for 0.5 h. Data gathered after the incubation period consisted of host cell protein and thioredoxin concentrations remaining in the supernatant, which was considered flowthrough for the remainder of this study. Samples containing high concentrations of thioredoxin after the experimental period indicate that thioredoxin did not bind to the resin at those conditions and should not be utilized as a capture step. Additionally, samples that contain low concentrations of host-cell proteins after the experimental period indicate large amounts of host-cell proteins bound to the resin. The corresponding conditions may not contribute to higher purity. Operating all screening experiments at small volumes allows for selecting optimal binding conditions while minimizing the burden on upfront biomass production.
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Affiliation(s)
- Ayswarya Ravi
- Department of Biological and Agricultural Engineering, Texas A&M University, USA
| | - Emma Foster
- Department of Biological and Agricultural Engineering, Texas A&M University, USA
| | - Zivko Nikolov
- Department of Biological and Agricultural Engineering and National Center for Therapeutics Manufacturing, Texas A&M University, USA
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Trainor D, Foster E, Rychkova M, Lloyd M, Leong M, Wang AD, Velakoulis D, O'Brien TJ, Kwan P, Loi SM, Malpas CB. Development and validation of a screening questionnaire for psychogenic nonepileptic seizures. Epilepsy Behav 2020; 112:107482. [PMID: 33181887 DOI: 10.1016/j.yebeh.2020.107482] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/03/2020] [Accepted: 09/06/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Epilepsy and psychogenic nonepileptic seizures (PNES) are serious conditions, associated with substantial morbidity and mortality. Although prompt diagnosis is essential, these conditions are frequently misdiagnosed, delaying appropriate treatment. We developed and validated the Anxiety, Abuse, and Somatization Questionnaire (AASQ), a quick and clinically practical tool to differentiate PNES from epilepsy. METHOD We retrospectively identified psychological variables that differentiated epilepsy from PNES in a discovery cohort of patients admitted to a video-electroencephalography monitoring (VEM) unit from 2002 to 2017. From these findings, we developed the AASQ and prospectively validated it in an independent cohort of patients with gold-standard VEM diagnosis. RESULTS One thousand two hundred ninety-one patients were included in the retrospective study; mean age was 39.5 years (range: 18-99), 58% were female, 67% had epilepsy, and 33% had PNES. Psychometric data for 192 instrument items were reviewed, receiver operating characteristic curves were computed, and a 20-item AASQ was created. Prospective validation in 74 patients showed that a one-point increase in the AASQ score was associated with 11 times increase in the odds of having PNES compared with epilepsy. Low scores on the AASQ were associated with a low probability of PNES with a negative predictive value of 95%. SIGNIFICANCE The AASQ is quick, inexpensive, and clinically useful for workup of seizure disorders. The AASQ excludes PNES with a high degree of confidence and can predict PNES with significance when combined with basic clinicodemographic variables. Future research will investigate diagnostic performance of the AASQ in relevant clinical subgroups, such as patients with comorbid epilepsy and PNES.
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Affiliation(s)
- David Trainor
- Department of Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, Australia.
| | - Emma Foster
- The Epilepsy Unit, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Maria Rychkova
- The Epilepsy Unit, Alfred Health, Melbourne, Australia; Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Michael Lloyd
- Department of Psychiatry, Alfred Health, Melbourne, Australia
| | - Michelle Leong
- Clinical Outcomes Research Unit (CORe), Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Australia
| | - Albert D Wang
- Clinical Outcomes Research Unit (CORe), Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Australia
| | - Dennis Velakoulis
- Department of Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, Australia; The Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Australia
| | - Terence J O'Brien
- The Epilepsy Unit, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Australia
| | - Patrick Kwan
- The Epilepsy Unit, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Australia
| | - Samantha M Loi
- Department of Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, Australia; The Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Australia
| | - Charles B Malpas
- The Epilepsy Unit, Alfred Health, Melbourne, Australia; Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia; Clinical Outcomes Research Unit (CORe), Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Australia; Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Australia
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Baqai S, Foster E, Chan S. 371 Ovarian Torsion versus Ruptured Ovarian Cyst: Emergency Department Presentation and Outcomes. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Foster E, Chen Z, Zomer E, Rychkova M, Carney P, O'Brien TJ, Liew D, Jackson GD, Kwan P, Ademi Z. The costs of epilepsy in Australia. Neurology 2020; 95:e3221-e3231. [DOI: 10.1212/wnl.0000000000010862] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/20/2020] [Indexed: 01/13/2023] Open
Abstract
ObjectiveTo determine the health economic burden of epilepsy for Australians of working age by using life table modeling and to model whether improved seizure control may result in substantial health economic benefits.MethodsLife table modeling was used for working age Australians aged 15–69 years with epilepsy and the cohort was followed until age 70 years. Published 2017 population and epilepsy-related data regarding epilepsy prevalence, mortality, and productivity were used. This model was then re-simulated, assuming the cohort no longer had epilepsy. Differences in outcomes between these cohorts were attributed to epilepsy. Scenarios were also simulated in which the proportion of seizure-free patients increased from baseline 70% up to 75% and 80%.ResultsIn 2017, Australians of working age with epilepsy followed until age 70 years were predicted to experience over 14,000 excess deaths, more than 78,000 years of life lost, and over 146,000 productivity-adjusted life years lost due to epilepsy. This resulted in lost gross domestic product (GDP) of US $22.1 billion. Increasing seizure freedom by 5% and 10% would reduce health care costs, save years of life, and translate to US $2.6 billion and US $5.3 billion GDP retained for seizure freedom rates of 75% and 80%, respectively.ConclusionsOur study highlights the considerable societal and economic burden of epilepsy. Relatively modest improvements in overall seizure control could bring substantial economic benefits.
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Hemmant J, Young G, Pournaras C, Foster E, Chow K. A model to guide patient selection when managing ureteric stones with shockwave lithotripsy. Journal of Clinical Urology 2020. [DOI: 10.1177/2051415819890471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: The aim of this study was to create a model based upon significant prognostic factors to guide patient selection for shockwave lithotripsy. Patients and methods: We identified 150 patients attending for shockwave lithotripsy for ureteric stones between October 2010–February 2016. Data was collected retrospectively from electronic case notes and radiological images. All patients were treated with an on-site Storz Modulith SLX-F2 lithotripter. A model was created using computer software ‘R’. Results: One hundred and thirty-three patients were treated and 66% of those were deemed radiologically stone-free with shockwave lithotripsy. Four factors were found to be independently statistically significant with regards to stone-free status; age ( p=0.003), Hounsfield units ( p=0.002), prior nephrostomy insertion ( p=0.022) or prior stent insertion ( p=0.002). Our resulting model is:[Formula: see text] Discussion and conclusions: Our shockwave lithotripsy success would likely increase with improved patient selection. Age appears to be a novel significant factor in stone passage. This is an interesting observation worthy of further study given ageing populations in the developed world. The model will require further validation in order to confirm our findings, however the results have proven very encouraging. Level of evidence: 2c
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Affiliation(s)
- Joshua Hemmant
- Urology Department, Manchester University Hospitals NHS Foundation Trust, UK
| | - Graham Young
- Urology Department, Manchester University Hospitals NHS Foundation Trust, UK
| | - Christos Pournaras
- Urology Department, Manchester University Hospitals NHS Foundation Trust, UK
| | - Emma Foster
- Urology Department, Manchester University Hospitals NHS Foundation Trust, UK
| | - Karyee Chow
- Urology Department, Manchester University Hospitals NHS Foundation Trust, UK
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Foster E, Malloy MJ, Jokubaitis VG, Wrede CDH, Butzkueven H, Sasadeusz J, Van Doornum S, Macrae F, Unglik G, Brotherton JML, van der Walt A. Increased risk of cervical dysplasia in females with autoimmune conditions-Results from an Australia database linkage study. PLoS One 2020; 15:e0234813. [PMID: 32555638 PMCID: PMC7302686 DOI: 10.1371/journal.pone.0234813] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 06/02/2020] [Indexed: 12/29/2022] Open
Abstract
Background Autoimmune conditions (AICs) and/or their treatment may alter risk of human papilloma virus (HPV) infection and females with AICs are therefore at an increased risk of cervical dysplasia. However, inclusion of these at-risk populations in cervical cancer screening and HPV-vaccination guidelines, are mostly lacking. This study aimed to determine the prevalence of cervical dysplasia in a wide range of AICs and compare that to HIV and immunocompetent controls to support the optimisation of cervical cancer preventive health measures. Methods Data linkage was used to match cervical screening episodes to emergency department records of females with AICs or HIV to immunocompetent controls over a 14-year period. The primary outcome was histologically confirmed high-grade cervical disease. Results, measured as rates by cytology and histology classification per 1,000 females screened, were analysed per disease group, and intergroup comparisons were performed. Results Females with inflammatory bowel disease (2,683), psoriatic and enteropathic arthropathies (1,848), multiple sclerosis (MS) (1,426), rheumatoid arthritis (1,246), systemic lupus erythematosus and/or mixed connective tissue disease (SLE/MCTD) (702), HIV (44), and 985,383 immunocompetent controls were included. SLE/MCTD and HIV groups had greater rates of high-grade histological and cytological abnormalities compared to controls. Increased rates of low-grade cytological abnormalities were detected in all females with AICs, with the exception of the MS group. Conclusions Females with SLE/MCTD or HIV have increased rates of high-grade cervical abnormalities. The increased low-grade dysplasia rate seen in most females with AICs is consistent with increased HPV infection. These findings support expansion of cervical cancer preventative programs to include these at-risk females.
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Affiliation(s)
- Emma Foster
- Department of Neurology, MS and Neuroimmunology Service, Alfred Health, Melbourne, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
| | - Michael J. Malloy
- Victorian Cervical Screening Registry, VCS Population Health, VCS Foundation, Melbourne, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Vilija G. Jokubaitis
- Department of Neurology, MS and Neuroimmunology Service, Alfred Health, Melbourne, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - C. David H. Wrede
- Department of Oncology and Dysplasia, Royal Women’s Hospital, Melbourne, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
| | - Helmut Butzkueven
- Department of Neurology, MS and Neuroimmunology Service, Alfred Health, Melbourne, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Joe Sasadeusz
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Australia
| | - Sharon Van Doornum
- Rheumatology Department, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Finlay Macrae
- Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Melbourne, Australia
| | - Gary Unglik
- Department of Clinical Immunology and Allergy, The Royal Melbourne Hospital, Melbourne, Australia
| | - Julia M. L. Brotherton
- Victorian Cervical Screening Registry, VCS Population Health, VCS Foundation, Melbourne, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- * E-mail: (AVDW); (JMLB)
| | - Anneke van der Walt
- Department of Neurology, MS and Neuroimmunology Service, Alfred Health, Melbourne, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
- * E-mail: (AVDW); (JMLB)
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38
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Bradley J, Gardner G, Rowland MK, Fay M, Mann K, Holmes R, Foster E, Exley C, Don Bosco A, Hugueniot O, Moynihan P. Impact of a health marketing campaign on sugars intake by children aged 5-11 years and parental views on reducing children's consumption. BMC Public Health 2020; 20:331. [PMID: 32223751 PMCID: PMC7104521 DOI: 10.1186/s12889-020-8422-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 02/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The association between Free Sugars intake and non-communicable diseases such as obesity and dental caries is well documented and several countries are taking measures to reduce sugars intakes. Public Health England (PHE) instigated a range of approaches to reduce sugars, including a national health marketing campaign (Sugar Smart). The campaign aimed to raise awareness of the amount of sugars in foods and drinks and to encourage parents to reduce their children's intake. The aim of this study was to determine whether the campaign was effective in altering dietary behaviour, by assessing any impact of the campaign on sugars intake among children aged 5-11 years. Parental perceptions of the campaign and barriers to reducing sugars intake were also explored. METHODS Parents of 873 children aged 5-11 years, identified from an existing PHE database, were invited to take part. Dietary information was collected online using Intake24 before, during, and at 1, 10 and 12 months following the campaign. Change in sugars intake was assessed using mixed effects linear regression models. One-to-one telephone interviews were conducted with a purposive sample of parents to explore perceptions of the campaign and identify barriers and facilitators to reducing children's sugars intake. RESULTS Completion rates for dietary assessment ranged from 61 to 72% across the follow up time points. Qualitative telephone interviews were conducted with 20 parents. Total sugars intake decreased on average by ~ 6.2 g/day (SD 43.8) at peak campaign and the percentage of energy from total sugars significantly decreased immediately and 1 year post campaign. The percentage of energy from Free Sugars significantly decreased across all time points with the exception of the long term follow up at 12-months post campaign. The percentage of energy intake from total fat increased. Parents expressed a willingness to reduce sugars intakes, however, identified barriers including time constraints, the normalisation of sugary treats, and confusing information. CONCLUSIONS A health marketing campaign had a positive impact in reducing sugars intake but reductions in sugars were not sustained. Parents want to reduce their child's sugars intake but societal barriers and confusion over which sources of sugars to avoid hamper efforts to change.
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Affiliation(s)
- Jennifer Bradley
- Human Nutrition Research Centre, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.
| | - Grace Gardner
- Human Nutrition Research Centre, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.,School of Dental Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4BW, UK
| | - Maisie K Rowland
- Human Nutrition Research Centre, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Michaela Fay
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Kay Mann
- The Australian e-Health Research Centre, CSIRO, Brisbane, QLD, 4029, Australia
| | - Richard Holmes
- School of Dental Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4BW, UK
| | - Emma Foster
- Human Nutrition Research Centre, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Catherine Exley
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Ann Don Bosco
- Public Health England, 133 - 155 Waterloo Road, London, SE1 8UG, UK
| | - Orla Hugueniot
- Public Health England, 133 - 155 Waterloo Road, London, SE1 8UG, UK
| | - Paula Moynihan
- Adelaide Dental School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, 5005, Australia
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39
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Osadchiy T, Poliakov I, Olivier P, Rowland M, Foster E. Progressive 24-Hour Recall: Usability Study of Short Retention Intervals in Web-Based Dietary Assessment Surveys. J Med Internet Res 2020; 22:e13266. [PMID: 32012055 PMCID: PMC7055775 DOI: 10.2196/13266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 10/19/2019] [Accepted: 11/29/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Under-reporting because of the limitations of human memory is one of the key challenges in dietary assessment surveys that use the multiple-pass 24-hour recall. Research indicates that shortening a retention interval (ie, the time between the eating event and recall) reduces the burden on memory and may increase the accuracy of the assessment. OBJECTIVE This study aimed to explore the accuracy and acceptability of Web-based dietary assessment surveys based on a progressive recall, where a respondent is asked to record multiple recalls throughout a 24-hour period using the multiple-pass protocol and portion size estimation methods of the 24-hour recall. METHODS The experiment was conducted with a dietary assessment system, Intake24, that typically implements the multiple-pass 24-hour recall method where respondents record all meals they had for the previous day on a single occasion. We modified the system to allow respondents to add multiple recalls throughout the day using the multiple-pass protocol and portion size estimation methods of the 24-hour recall (progressive recall). We conducted a dietary assessment survey with 33 participants, where they were asked to record dietary intake using both 24-hour and progressive recall methods for weekdays only. We compared mean retention intervals (ie, the time between eating event and recall) for the 2 methods. To examine accuracy, we compared mean energy estimates and the mean number of reported foods. Of these participants, 23 were interviewed to examine the acceptability of the progressive recall. RESULTS Retention intervals were found to be, on average, 15.2 hours (SD 7.8) shorter during progressive recalls than those during 24-hour recalls. We found that the mean number of foods reported for evening meals for progressive recalls (5.2 foods) was significantly higher (P=.001) than that for 24-hour recalls (4.2 foods). The number of foods and the amount of energy reported for other meals remained similar across the 2 methods. In interviews, 65% (15/23) of participants said that the 24-hour recall is more convenient in terms of fitting in with their daily lifestyles, and 65% (15/23) of respondents indicated that they remembered meal content and portion sizes better with the progressive recall. CONCLUSIONS The analysis of interviews and data from our study indicate that progressive recalls provide minor improvements to the accuracy of dietary assessment in Intake24. Additional work is needed to improve the acceptability of progressive recalls in this system.
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Affiliation(s)
- Timur Osadchiy
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ivan Poliakov
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Patrick Olivier
- Centre of Organisational and Social Informatics, Faculty of Information Technology, Monash University, Melbourne, Australia
| | - Maisie Rowland
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Emma Foster
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
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40
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Foster E, Malpas CB, Ye K, Johnstone B, Carney PW, Velakoulis D, O'Brien TJ, Kwan P. Antiepileptic drugs are not independently associated with cognitive dysfunction. Neurology 2020; 94:e1051-e1061. [PMID: 32015172 DOI: 10.1212/wnl.0000000000009061] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 10/10/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that individual antiepileptic drugs (AEDs) are not associated with cognitive impairment beyond other clinically relevant factors, we performed a cross-sectional study of patients admitted to an inpatient video-EEG monitoring unit. METHODS We prospectively enrolled patients admitted to an inpatient specialist epilepsy program between 2009 and 2016. Assessments included objective cognitive function, quality of life subscales for subjective cognitive function, and questionnaires for anxiety and depressive symptoms. Bayesian model averaging identified predictors of cognitive function. Bayesian model selection approach investigated effect of individual AEDs on cognition. Conventional frequentist analyses were also performed. RESULTS A total of 331 patients met inclusion criteria. Mean age was 39.3 years and 61.9% of patients were women. A total of 45.0% of patients were prescribed AED polypharmacy, 25.1% AED monotherapy, and 29.9% no AED. Age, seizure frequency, and a diagnosis of concomitant epilepsy and psychogenic nonepileptic seizure were predictors of objective cognitive function. Depression, anxiety, and seizure frequency were predictors of subjective cognitive function. Individual AEDs were not independently associated with impaired cognitive function beyond other clinically relevant variables. CONCLUSIONS This study found that no AED was independently associated with cognitive dysfunction. Significant determinants of objective and subjective cognitive dysfunction included seizure frequency and depression, respectively. These findings suggest that optimizing therapy to prevent seizures is not likely to occur at the expense of cognitive function.
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Affiliation(s)
- Emma Foster
- From the Departments of Neurology (E.F., C.B.M., K.Y., B.J., T.J.O., P.K.) and Neuropsychiatry (D.V.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.F., C.B.M., T.J.O., P.K.), Alfred Health; Department of Neurosciences, Central Clinical School (E.F., T.J.O., P.K.), Monash University, Melbourne; Clinical Outcomes Research (CORe) Unit, Department of Medicine (RMH) (C.B.M.), The University of Melbourne, Parkville; Department of Medicine (P.W.C.), Monash University and Eastern Health; and Florey Institute of Neuroscience and Mental Health (P.W.C.), Melbourne, Australia.
| | - Charles B Malpas
- From the Departments of Neurology (E.F., C.B.M., K.Y., B.J., T.J.O., P.K.) and Neuropsychiatry (D.V.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.F., C.B.M., T.J.O., P.K.), Alfred Health; Department of Neurosciences, Central Clinical School (E.F., T.J.O., P.K.), Monash University, Melbourne; Clinical Outcomes Research (CORe) Unit, Department of Medicine (RMH) (C.B.M.), The University of Melbourne, Parkville; Department of Medicine (P.W.C.), Monash University and Eastern Health; and Florey Institute of Neuroscience and Mental Health (P.W.C.), Melbourne, Australia
| | - Karena Ye
- From the Departments of Neurology (E.F., C.B.M., K.Y., B.J., T.J.O., P.K.) and Neuropsychiatry (D.V.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.F., C.B.M., T.J.O., P.K.), Alfred Health; Department of Neurosciences, Central Clinical School (E.F., T.J.O., P.K.), Monash University, Melbourne; Clinical Outcomes Research (CORe) Unit, Department of Medicine (RMH) (C.B.M.), The University of Melbourne, Parkville; Department of Medicine (P.W.C.), Monash University and Eastern Health; and Florey Institute of Neuroscience and Mental Health (P.W.C.), Melbourne, Australia
| | - Benjamin Johnstone
- From the Departments of Neurology (E.F., C.B.M., K.Y., B.J., T.J.O., P.K.) and Neuropsychiatry (D.V.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.F., C.B.M., T.J.O., P.K.), Alfred Health; Department of Neurosciences, Central Clinical School (E.F., T.J.O., P.K.), Monash University, Melbourne; Clinical Outcomes Research (CORe) Unit, Department of Medicine (RMH) (C.B.M.), The University of Melbourne, Parkville; Department of Medicine (P.W.C.), Monash University and Eastern Health; and Florey Institute of Neuroscience and Mental Health (P.W.C.), Melbourne, Australia
| | - Patrick W Carney
- From the Departments of Neurology (E.F., C.B.M., K.Y., B.J., T.J.O., P.K.) and Neuropsychiatry (D.V.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.F., C.B.M., T.J.O., P.K.), Alfred Health; Department of Neurosciences, Central Clinical School (E.F., T.J.O., P.K.), Monash University, Melbourne; Clinical Outcomes Research (CORe) Unit, Department of Medicine (RMH) (C.B.M.), The University of Melbourne, Parkville; Department of Medicine (P.W.C.), Monash University and Eastern Health; and Florey Institute of Neuroscience and Mental Health (P.W.C.), Melbourne, Australia
| | - Dennis Velakoulis
- From the Departments of Neurology (E.F., C.B.M., K.Y., B.J., T.J.O., P.K.) and Neuropsychiatry (D.V.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.F., C.B.M., T.J.O., P.K.), Alfred Health; Department of Neurosciences, Central Clinical School (E.F., T.J.O., P.K.), Monash University, Melbourne; Clinical Outcomes Research (CORe) Unit, Department of Medicine (RMH) (C.B.M.), The University of Melbourne, Parkville; Department of Medicine (P.W.C.), Monash University and Eastern Health; and Florey Institute of Neuroscience and Mental Health (P.W.C.), Melbourne, Australia
| | - Terence J O'Brien
- From the Departments of Neurology (E.F., C.B.M., K.Y., B.J., T.J.O., P.K.) and Neuropsychiatry (D.V.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.F., C.B.M., T.J.O., P.K.), Alfred Health; Department of Neurosciences, Central Clinical School (E.F., T.J.O., P.K.), Monash University, Melbourne; Clinical Outcomes Research (CORe) Unit, Department of Medicine (RMH) (C.B.M.), The University of Melbourne, Parkville; Department of Medicine (P.W.C.), Monash University and Eastern Health; and Florey Institute of Neuroscience and Mental Health (P.W.C.), Melbourne, Australia
| | - Patrick Kwan
- From the Departments of Neurology (E.F., C.B.M., K.Y., B.J., T.J.O., P.K.) and Neuropsychiatry (D.V.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.F., C.B.M., T.J.O., P.K.), Alfred Health; Department of Neurosciences, Central Clinical School (E.F., T.J.O., P.K.), Monash University, Melbourne; Clinical Outcomes Research (CORe) Unit, Department of Medicine (RMH) (C.B.M.), The University of Melbourne, Parkville; Department of Medicine (P.W.C.), Monash University and Eastern Health; and Florey Institute of Neuroscience and Mental Health (P.W.C.), Melbourne, Australia
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41
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Holper S, Foster E, Chen Z, Kwan P. Emergency presentation of new onset
versus
recurrent undiagnosed seizures: A retrospective review. Emerg Med Australas 2019; 32:430-437. [DOI: 10.1111/1742-6723.13420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 10/19/2019] [Accepted: 10/23/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Sarah Holper
- Department of NeurologyThe Royal Melbourne Hospital Melbourne Victoria Australia
- Department of NeurologyCabrini Hospital Melbourne Victoria Australia
| | - Emma Foster
- Department of NeurologyThe Royal Melbourne Hospital Melbourne Victoria Australia
- Department of NeurologyCabrini Hospital Melbourne Victoria Australia
| | - Zhibin Chen
- Department of Medicine (RMH)The University of Melbourne Melbourne Victoria Australia
- School of Public Health and Preventive MedicineMonash University Melbourne Victoria Australia
| | - Patrick Kwan
- Department of NeurologyThe Royal Melbourne Hospital Melbourne Victoria Australia
- Department of NeurologyCabrini Hospital Melbourne Victoria Australia
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42
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Foster E, Chen Z, Ofori-Asenso R, Norman R, Carney P, O'Brien TJ, Kwan P, Liew D, Ademi Z. Comparisons of direct and indirect utilities in adult epilepsy populations: A systematic review. Epilepsia 2019; 60:2466-2476. [PMID: 31784994 DOI: 10.1111/epi.16396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Epilepsy is common and carries substantial morbidity, and therefore identifying cost-effective health interventions is essential. Cost-utility analysis is a widely used method for such analyses. For this, health conditions are rated in terms of utilities, which provide a standardized score to reflect quality of life. Utilities are obtained either indirectly using quality of life questionnaires, or directly from patients or the general population. We sought to describe instruments used to estimate utilities in epilepsy populations, and how results differ according to methods used. METHODS We undertook a systematic review of studies comparing at least two instruments for obtaining utilities in epilepsy populations. MEDLINE, Embase, ScienceDirect, Cochrane Library, Google Scholar, and gray literature were searched from inception to June 2019. Mean utilities were recorded and compared for each method. RESULTS Of the 38 unique records initially identified, eight studies met inclusion criteria. Utilities were highest for direct "tradeoff" methods, obtained via instruments including standard gamble (0.93) and time tradeoff (0.92), compared to indirect methods, obtained via instruments including EuroQoL five-dimensional form (range = 0.72-0.86) and Health Utilities Index Mark 3 (range = 0.52-0.71). Visual analog scale (VAS), a direct "nontradeoff" instrument, provided equal or lower utilities (range = 68.0-79.8) compared to indirect instruments. SIGNIFICANCE Direct methods, with the important exception of VAS, may provide higher utilities than indirect methods. More studies are needed to identify the most appropriate utility instruments for epilepsy populations, and to investigate whether there is variation between utilities for different types of epilepsy and other patient- and disease-specific factors.
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Affiliation(s)
- Emma Foster
- Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Richard Ofori-Asenso
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Richard Norman
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Patrick Carney
- Department of Medicine, Monash University and Eastern Health, Melbourne, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Terence J O'Brien
- Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Victoria, Australia
| | - Patrick Kwan
- Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Danny Liew
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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43
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Foster E, Carney P, Liew D, Ademi Z, O'Brien T, Kwan P. First seizure presentations in adults: beyond assessment and treatment. J Neurol Neurosurg Psychiatry 2019; 90:1039-1045. [PMID: 30948624 DOI: 10.1136/jnnp-2018-320215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 03/05/2019] [Accepted: 03/05/2019] [Indexed: 11/04/2022]
Abstract
Almost 10% of people will experience at least one seizure over a lifetime. Although common, first seizures are serious events and warrant careful assessment and management. First seizures may be provoked by acute or remote symptomatic factors including life-threatening metabolic derangements, drug toxicity or structural brain lesions. An unprovoked first seizure may herald the onset of epilepsy and may be accompanied by medical and psychiatric illnesses. Accidents, injuries and death associated with first seizures are likely under-reported. The cognitive and emotional impact of first seizures is often neglected. Evaluation of a patient presenting with a first seizure requires careful history-taking and early specialist assessment, however optimal management strategies have not been extensively investigated. Further, advances in technology and the role of eHealth interventions such as telemedicine may be of value in the care of patients who have experienced a first seizure. This article reviews the impact and implications of first seizures beyond the scope provided in current guidelines which tend to focus on assessment and management. It examines the effect of first seizures on the well-being of patients; assesses morbidity and premature mortality in first seizures and discusses current and future directions to optimise safety and health of people with first seizures, with a focus on adult patients. Recognition of these issues is essential to provide adequate care for people with first seizures.
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Affiliation(s)
- Emma Foster
- Neurology, Alfred Health, Melbourne, Victoria, Australia .,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Patrick Carney
- Department of Medicine, Eastern Health, Melbourne, Victoria, Australia.,Neuroscience and Mental Health, Florey Institute, Parkville, Victoria, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Terry O'Brien
- Neurology, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Patrick Kwan
- Neurology, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
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44
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Foster E, Lee C, Imamura F, Hollidge SE, Westgate KL, Venables MC, Poliakov I, Rowland MK, Osadchiy T, Bradley JC, Simpson EL, Adamson AJ, Olivier P, Wareham N, Forouhi NG, Brage S. Validity and reliability of an online self-report 24-h dietary recall method (Intake24): a doubly labelled water study and repeated-measures analysis. J Nutr Sci 2019; 8:e29. [PMID: 31501691 PMCID: PMC6722486 DOI: 10.1017/jns.2019.20] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/08/2019] [Accepted: 06/13/2019] [Indexed: 12/24/2022] Open
Abstract
Online self-reported 24-h dietary recall systems promise increased feasibility of dietary assessment. Comparison against interviewer-led recalls established their convergent validity; however, reliability and criterion-validity information is lacking. The validity of energy intakes (EI) reported using Intake24, an online 24-h recall system, was assessed against concurrent measurement of total energy expenditure (TEE) using doubly labelled water in ninety-eight UK adults (40-65 years). Accuracy and precision of EI were assessed using correlation and Bland-Altman analysis. Test-retest reliability of energy and nutrient intakes was assessed using data from three further UK studies where participants (11-88 years) completed Intake24 at least four times; reliability was assessed using intra-class correlations (ICC). Compared with TEE, participants under-reported EI by 25 % (95 % limits of agreement -73 % to +68 %) in the first recall, 22 % (-61 % to +41 %) for average of first two, and 25 % (-60 % to +28 %) for first three recalls. Correlations between EI and TEE were 0·31 (first), 0·47 (first two) and 0·39 (first three recalls), respectively. ICC for a single recall was 0·35 for EI and ranged from 0·31 for Fe to 0·43 for non-milk extrinsic sugars (NMES). Considering pairs of recalls (first two v. third and fourth recalls), ICC was 0·52 for EI and ranged from 0·37 for fat to 0·63 for NMES. EI reported with Intake24 was moderately correlated with objectively measured TEE and underestimated on average to the same extent as seen with interviewer-led 24-h recalls and estimated weight food diaries. Online 24-h recall systems may offer low-cost, low-burden alternatives for collecting dietary information.
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Affiliation(s)
- Emma Foster
- Human Nutrition Research Centre, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Clement Lee
- School of Mathematics, Statistics and Physics, Newcastle University, Newcastle upon Tyne, UK
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
| | - Fumiaki Imamura
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | | | | | | | - Ivan Poliakov
- Open Lab, School of Computing Science, Newcastle University, Newcastle upon Tyne, UK
| | - Maisie K. Rowland
- Human Nutrition Research Centre, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Timur Osadchiy
- Open Lab, School of Computing Science, Newcastle University, Newcastle upon Tyne, UK
| | - Jennifer C. Bradley
- Human Nutrition Research Centre, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Emma L. Simpson
- Open Lab, School of Computing Science, Newcastle University, Newcastle upon Tyne, UK
| | - Ashley J. Adamson
- Human Nutrition Research Centre, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Patrick Olivier
- Faculty of Information Technology, Monash University, Clayton, VIC, Australia
| | - Nick Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Nita G. Forouhi
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Soren Brage
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
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45
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Abbott AL, Merican J, Pearce DC, Juric A, Worsnop C, Foster E, Chambers B. Asymptomatic Carotid Stenosis Is Associated With Circadian and Other Variability in Embolus Detection. Front Neurol 2019; 10:322. [PMID: 31040812 PMCID: PMC6476949 DOI: 10.3389/fneur.2019.00322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/14/2019] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: Variability in transcranial Doppler (TCD) detection of embolic signals (ES) is important for risk stratification. We tested the effect of time of day on ES associated with 60–99% asymptomatic carotid stenosis. Materials and Methods: Subjects were from the Asymptomatic Carotid Stenosis Embolus Detection (ASED) Study such that half were previously ES-positive and half ES-negative with 6-monthly 60-min TCD monitoring. All underwent bilateral TCD monitoring for two 12-h sessions separated by 24 h. ES detection rates were calculated using 6 and 4-h intervals from midnight and effective TCD monitoring time. Results: Ten subjects (8 male, mean age 79.5 years) were monitored. Over 24 h, 5/10 study arteries with 60–99% asymptomatic carotid stenosis were ES-positive (range 1–28 ES/artery, 56 total ES from 177.9 total effective monitoring hours). The remaining five study arteries and all eight successfully monitored contralateral arteries were ES-negative. Using 6-h intervals the mean ES detection rate peaked at 0600-midday (0.64/h) and was lowest 1800-midnight (0.09/h) with an incidence rate ratio of 7.26 (95% CI 2.52–28.64, P ≤ 0.001). Using 4-h intervals the mean ES detection rate peaked at 0800-midday (0.64/h) and was lowest midnight-0400 (0.12/h) with an incidence rate ratio of 5.51 (95% CI 1.78–22.67, P = 0.001). Conclusions: Embolism associated with asymptomatic carotid stenosis shows circadian variation with highest rates 4–6 h before midday. This corresponds with peak circadian incidence of stroke and other vascular complications. These and ASED Study results show that monitoring frequency, duration, and time of day are important in ES detection.
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Affiliation(s)
- Anne L Abbott
- Central Clinical School, Monash University, Melbourne, VIC, Australia.,Neurology Network, Knox Private Hospital, Wantirna, VIC, Australia
| | - Julia Merican
- Neurology and Neurosurgery Centre, Princecourt Medical Centre, Kuala Lumpur, Malaysia
| | - Dora C Pearce
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.,School of Science, Engineering and Information Technology, Federation University, Ballarart, VIC, Australia
| | - Ana Juric
- Independent Researcher, Melbourne, VIC, Australia
| | - Christopher Worsnop
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia
| | - Emma Foster
- Central Clinical School, Monash University, Melbourne, VIC, Australia.,Neurology Department, Alfred Health, Melbourne, VIC, Australia.,Neurology Department, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Brian Chambers
- Department of Neurology, Austin Health, Melbourne, VIC, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia
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46
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Foster E, Ademi Z, Lawn N, Chen Z, Carney P, Liew D, O'Brien TJ, Kwan P. Determining the cost of first-ever seizures: A narrative review and future directions. Epilepsy Behav 2019; 90:291-294. [PMID: 30477989 DOI: 10.1016/j.yebeh.2018.10.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Emma Foster
- Department of Neurology, Alfred Health, Commercial Road, Melbourne, VIC 3000, Australia; Department of Neurology, The Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3052, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3000, Australia.
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3000, Australia
| | - Nicholas Lawn
- Western Australian Adult Epilepsy Service, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
| | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3000, Australia; Department of Medicine at Royal Melbourne Hospital, University of Melbourne, Parkville 3050, Australia
| | - Patrick Carney
- Department of Medicine, Monash University and Eastern Health, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3000, Australia
| | - Terence John O'Brien
- Department of Neurology, Alfred Health, Commercial Road, Melbourne, VIC 3000, Australia; Department of Neurology, The Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3052, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3000, Australia
| | - Patrick Kwan
- Department of Neurology, Alfred Health, Commercial Road, Melbourne, VIC 3000, Australia; Department of Neurology, The Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3052, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3000, Australia
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47
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Barclay CW, Jawad S, Foster E. Mini Dental Implants in the Management of The Atrophic Maxilla and Mandible: A New Implant Design and Preliminary Results. Eur J Prosthodont Restor Dent 2018; 26:190-196. [PMID: 30307720 DOI: 10.1922/ejprd_01830barclay07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although the edentulous population in the UK is falling, those that are rendered edentulous are becoming edentate later in life and with significantly resorbed ridges. This creates a challenge because the management of such patients and their ability to adapt to new dentures is impaired later in life. Despite widespread endorsement of two implants to retain lower complete dentures, the inability to comply has resulted in elderly patients with compromised ability to function and unable to eat a healthy diet. Mini dental implants may offer an ideal solution for the elderly edentulous population who may not be keen on invasive surgery for the placement of conventional dental implants. Further work is required to show the longevity of these restorations, however, existing research and clinical experience show that they potentially offer a simple solution to this group of patients. This paper presents the development of a new design of mini implant, based on clinical problems encountered during a pilot randomised controlled trial. The design of the new implant specifically aims to overcome problems in managing severely atrophic ridges. A preliminary survival study shows survival rates to be equivalent to other mini dental implants and highly satisfactory in the short to medium term.
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Affiliation(s)
| | - S Jawad
- University Dental Hospital of Manchester
| | - E Foster
- University Dental Hospital of Manchester
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48
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Rowland MK, Adamson AJ, Poliakov I, Bradley J, Simpson E, Olivier P, Foster E. Field Testing of the Use of Intake24-An Online 24-Hour Dietary Recall System. Nutrients 2018; 10:E1690. [PMID: 30404170 PMCID: PMC6266941 DOI: 10.3390/nu10111690] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/30/2018] [Accepted: 11/02/2018] [Indexed: 11/17/2022] Open
Abstract
Dietary assessment is important for monitoring and evaluating population intakes. Online tools can reduce the level of participant burden and the time taken to complete records, compared with other methods. The study aimed to field test an online dietary recall tool (Intake24) to test the suitability for collecting dietary information in Scottish national surveys and to develop the system based on feedback and emerging issues. Previous Scottish Health Survey participants, aged 11+ years, were invited to complete Intake24 and provide feedback about it. Of those who agreed to take part, 60% completed at least one recall. Intake24 was found to be user-friendly, enjoyable to use, and easy to follow and understand. Users agreed they would like to use Intake24 often, (44% compared with 15% who disagreed) and >75% felt the system accurately captured their dietary intakes. The main challenge reported was finding foods within the database. Of those completing fewer recalls than requested, the majority reported that they believed they had completed the required number or reported not receiving emails requesting they complete a further recall. Intake24 was found to be a user-friendly tool allowing dietary assessment without interviewer presence. Feedback indicated the method for recall reminders needs to be refined and tailored.
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Affiliation(s)
- Maisie K Rowland
- Human Nutrition Research Centre, Institute of Health & Society, Newcastle University, Newcastle upon Tyne NE2 4HH, UK.
| | - Ashley J Adamson
- Human Nutrition Research Centre, Institute of Health & Society, Newcastle University, Newcastle upon Tyne NE2 4HH, UK.
| | - Ivan Poliakov
- Open Lab, School of Computing Science, Newcastle University, Newcastle upon Tyne NE4 5TG, UK.
| | - Jennifer Bradley
- Human Nutrition Research Centre, Institute of Health & Society, Newcastle University, Newcastle upon Tyne NE2 4HH, UK.
| | - Emma Simpson
- Human Nutrition Research Centre, Institute of Health & Society, Newcastle University, Newcastle upon Tyne NE2 4HH, UK.
- Open Lab, School of Computing Science, Newcastle University, Newcastle upon Tyne NE4 5TG, UK.
| | - Patrick Olivier
- Open Lab, School of Computing Science, Newcastle University, Newcastle upon Tyne NE4 5TG, UK.
| | - Emma Foster
- Human Nutrition Research Centre, Institute of Health & Society, Newcastle University, Newcastle upon Tyne NE2 4HH, UK.
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49
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Foster E, McLean C, White O. Glioneuronal brainstem tumor - It's all in the eyes. J Clin Neurosci 2018; 60:151-153. [PMID: 30366780 DOI: 10.1016/j.jocn.2018.10.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/14/2018] [Indexed: 10/28/2022]
Abstract
A previously well man presented with several months' history of neurological symptoms including diplopia and balance difficulties. Examination revealed fluctuating neurological deficits, fatigable weakness and slowed saccades. Extensive testing revealed mildly elevated cerebrospinal fluid protein, strongly positive single fiber electromyography and a dorsal pontine lesion at the floor of the 4th ventricle. An autoimmune process was felt to best account for the myasthenic presentation while the differential diagnoses for the brainstem lesion included glioma. Aggressive immunotherapy failed to halt clinical deterioration; over months he developed generalized weakness, aspiration pneumonia and died. Post-mortem analysis revealed glioneuronal tumor infiltration throughout the brainstem, cerebellum and along the meningeal surface. This is an unusual case of an infiltrative brainstem lesion, with the presentation suggesting a primary diagnosis of myasthenia gravis. The progressive nature of the illness, despite aggressive immune therapy, together with slow saccades, underscored a more sinister process. Cerebral imaging should be performed in patients with fluctuating neurological symptoms, progressive deterioration, and ocular, bulbar, respiratory, or pyramidal pattern deficits, and differentials for contrast-enhancing brain lesions should include primary brain tumors. In such cases, biopsy must proceed if the disease is of relatively recent onset, to facilitate diagnosis and maximize treatment opportunities.
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Affiliation(s)
- Emma Foster
- The Royal Melbourne Hospital, Department of Neurology, Melbourne, Australia; Alfred Hospital, Department of Neurology, Melbourne, Australia.
| | - Catriona McLean
- Alfred Hospital, Department of Anatomical Pathology, Melbourne, Australia.
| | - Owen White
- Alfred Hospital, Department of Neurology, Melbourne, Australia.
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50
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Focht K, Foster E, Minniti N, Tedaldi E, Fischer-Smith T. C - 16The Relationship Between Subjective Cognitive Function and Neuropsychological Performance in an Urban HIV+ Population. Arch Clin Neuropsychol 2018. [DOI: 10.1093/arclin/acy061.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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