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Mioramalala S, Mroueh L, Bruand PE, Raharinivo MM, Rafanomezantsoa RM, Gérard D, Ratsimbasoa A, Preux PM, Boumédiène F. Effects of an intervention program to improve mental health and epilepsy care in Madagascar. Compr Psychiatry 2024; 132:152484. [PMID: 38626596 DOI: 10.1016/j.comppsych.2024.152484] [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: 06/08/2023] [Revised: 03/28/2024] [Accepted: 04/07/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Despite the high prevalence of mental disorders and epilepsy in low- and middle-income countries, nearly 80% of patients are not treated. In Madagascar, initiatives to improve access to epilepsy and mental health care, including public awareness and training of general practitioners (GPs), were carried out between 2013 and 2018. Our study's main objective was to assess the effectiveness of these initiatives, two to five years post-intervention. METHODS This quasi-experimental study (intervention vs. control areas) included five surveys assessing: general population's Knowledge Attitudes and Practices (KAP), GPs' KAP , number of epilepsy and mental health consultations at different levels of the healthcare system, diagnostic accuracy, and treatments' availability. OUTCOMES In the general population, KAP scores were higher in intervention areas for epilepsy (11.4/20 vs. 10.3/20; p = 0.003). For mental disorders, regardless of the area, KAP scores were low, especially for schizophrenia (1.1/20 and 0.1/20). Among GPs, KAP scores were higher in intervention areas for schizophrenia (6.0/10 vs. 4.5/10; p = 0.008) and epilepsy (6.9/10 vs. 6.2/10; p = 0.044). Overall, there was a greater proportion of mental health and epilepsy consultations in intervention areas (4.5% vs 2.3%). Although low, concordance between GPs' and psychiatrists' diagnoses was higher in intervention areas. There was a greater variety of anti-epileptic and psychotropic medications available in intervention areas. INTERPRETATION This research has helped to better understand the effectiveness of initiatives implemented in Madagascar to improve epilepsy and mental health care and to identify barriers which will need to be addressed. FUNDING Sanofi Global Health, as part of the Fight Against STigma Program.
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Affiliation(s)
- Sedera Mioramalala
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France; Université de Fianarantsoa, Faculté des Sciences, ED GEOCHIMED, Chimie Médicinale, Fianarantsoa, Madagascar
| | - Lara Mroueh
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Pierre-Emile Bruand
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | | | | | - Daniel Gérard
- Ville Evrard Public Hospital, Department 93G10, Neuilly sur Marne, France
| | - Arsène Ratsimbasoa
- Université de Fianarantsoa, Faculté de Médecine, Fianarantsoa, Madagascar
| | - Pierre-Marie Preux
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Farid Boumédiène
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France.
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Leone M, Berardelli A, Somse P, Padovani A, Guidotti G. The WHO-Intersectoral Global Action Plan (IGAP) on epilepsy and other neurologic disorders in sub-Saharan Africa: an Italian Society of Neurology intervention model. Neurol Sci 2024; 45:2927-2929. [PMID: 38285325 DOI: 10.1007/s10072-024-07338-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/18/2024] [Indexed: 01/30/2024]
Affiliation(s)
- Massimo Leone
- Department of Neuroalgology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
- , .
- Drug Relief Through Excellent and Advanced Means (DREAM) program, Community of Sant'Egidio, Rome, Italy.
- Global Health Telemedicine, Rome, Italy.
| | - Alfredo Berardelli
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University, Rome, Italy
- IRCCS Neuromed, Isernia, Italy
| | - Pierre Somse
- Minister of Health, Bangui, Central African Republic
| | - Alessandro Padovani
- Dipartimento Di Scienze Cliniche Sperimentali, Clinica Neurologica, Università Degli Studi Di Brescia, UO Neurologia 2, ASST Spedali Civili, Policlinico Satellite, Brescia, Italy
| | - Giovanni Guidotti
- Drug Relief Through Excellent and Advanced Means (DREAM) program, Community of Sant'Egidio, Rome, Italy
- Health Department, Azienda Sanitaria Locale (ASL), Roma 1, Regione Lazio, , Rome, Italy
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Deng DZ, Husari KS. Approach to Patients with Seizures and Epilepsy: A Guide for Primary Care Physicians. Prim Care 2024; 51:211-232. [PMID: 38692771 DOI: 10.1016/j.pop.2024.02.008] [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] [Indexed: 05/03/2024]
Abstract
Seizures and epilepsy are common neurologic conditions that are frequently encountered in the outpatient primary care setting. An accurate diagnosis relies on a thorough clinical history and evaluation. Understanding seizure semiology and classification is crucial in conducting the initial assessment. Knowledge of common seizure triggers and provoking factors can further guide diagnostic testing and initial management. The pharmacodynamic characteristics and side effect profiles of anti-seizure medications are important considerations when deciding treatment and counseling patients, particularly those with comorbidities and in special populations such as patient of childbearing potential.
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Affiliation(s)
- Doris Z Deng
- Department of Neurology, Comprehensive Epilepsy Center, Johns Hopkins University, 600 N. Wolfe Street, Meyer 2-147, Baltimore, MD 21287, USA
| | - Khalil S Husari
- Department of Neurology, Comprehensive Epilepsy Center, Johns Hopkins University, 600 N. Wolfe Street, Meyer 2-147, Baltimore, MD 21287, USA.
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Sauls RM, Buro AW, Kirby RS. Lifestyle Behavioral Interventions and Health-Related Outcomes Among People with Epilepsy: A Review of Randomized Controlled Trials. Am J Health Promot 2024; 38:720-730. [PMID: 38414186 DOI: 10.1177/08901171241235731] [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] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To gather and assess current literature on the prevalence and efficacy of lifestyle behavioral interventions (sleep, nutrition, physical activity) for health outcomes, including QOL, psychological well-being, behavioral changes, and seizure frequency, among PWE. DATA SOURCE A review was conducted of English-language articles identified from PubMed, Scopus, and Embase between January 2013 to January 2023. STUDY INCLUSION AND EXCLUSION CRITERIA Inclusion criteria were randomized controlled trials (RCT) with human subjects diagnosed with epilepsy who participated in a lifestyle behavioral intervention. DATA EXTRACTION Two researchers independently completed the title, abstract, and full-text reviews. Information extracted includes study population, duration, type of intervention, findings, and outcomes. DATA SYNTHESIS Data was narratively synthesized to show level of evidence and degree of consistency in findings. Results: 4001 studies identified, 66 full texts reviewed, and 24 included. A majority (n = 16) of studies utilized diet specific RCTs, and some focused on physical activity (n = 7) and sleep (n = 1). Diet-specific RCTs (eg, ketogenic, Modified Atkins) reported reduced seizure frequency with adverse effects, such as gastrointestinal complications. Physical activity-based interventions found that maintained levels of exercise improved QOL and psychological well-being. However, physical activity and diet-based interventions did not have lasting effects after study conclusion. Only the behavioral sleep intervention reported that sleep quality improved significantly and was maintained post-intervention. CONCLUSION Future research is needed to establish the relationship between lifestyle behavioral interventions on QOL and other health outcomes (eg, seizure frequency).
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Affiliation(s)
- Rachel M Sauls
- Department of Non-Therapeutic Research Operations, H. Lee Moffitt Cancer Center, Tampa, FL, USA
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Acadia W Buro
- College of Population Health, University of New Mexico, Albuquerque, NM, USA
| | - Russell S Kirby
- College of Public Health, University of South Florida, Tampa, FL, USA
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Yamada H, Aoki S, Nezu T, Neshige S, Motoda A, Yamazaki Y, Maruyama H. Emergency medical service response for cases of stroke-suspected seizure: A population-based study. J Stroke Cerebrovasc Dis 2024; 33:107681. [PMID: 38493957 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107681] [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: 12/21/2023] [Revised: 03/02/2024] [Accepted: 03/14/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVES We evaluated the on-scene time of emergency medical services (EMS) for cases where discrimination between acute stroke and epileptic seizures at the initial examination was difficult and identified factors linked to delays in such scenarios. MATERIALS AND METHODS A retrospective review of cases with suspected seizure using the EMS database of fire departments across six Japanese cities between 2016 and 2021 was conducted. Patient classification was based on transport codes. We defined cases with stroke-suspected seizure as those in whom epileptic seizure was difficult to differentiate from stroke and evaluated their EMS on-scene time compared to those with epileptic seizures. RESULTS Among 30,439 cases with any seizures, 292 cases of stroke-suspected seizure and 8,737 cases of epileptic seizure were included. EMS on-scene time in cases of stroke-suspected seizure was shorter than in those with epileptic seizure after propensity score matching (15.1±7.2 min vs. 17.0±9.0 min; p = 0.007). Factors associated with delays included transport during nighttime (odds ratio [OR], 1.73, 95 % confidence interval [CI] 1.02-2.93, p = 0.041) and transport during the 2020-2021 pandemic (OR, 1.77, 95 % CI 1.08-2.90, p = 0.022). CONCLUSION This study highlighted the difference between the characteristics in EMS for stroke and epileptic seizure by evaluating the response to cases with stroke-suspected seizure. Facilitating prompt and smooth transfers of such cases to an appropriate medical facility after admission could optimize the operation of specialized medical resources.
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Affiliation(s)
- Hidetada Yamada
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan.
| | - Tomohisa Nezu
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Shuichiro Neshige
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Atsuko Motoda
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Yu Yamazaki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
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Gotlieb E, Agarwal P, Blank LJ, Kwon CS, Muxfeldt M, Young JJ, Jette N. Disparities in Teleneurology Use in Medicaid Beneficiaries With Epilepsy by Practice Setting: Promoting Health Equity in Academic Centers. Neurology 2024; 102:e209348. [PMID: 38608210 DOI: 10.1212/wnl.0000000000209348] [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: 04/14/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Medicaid beneficiaries in many American academic medical centers can receive care in a separate facility than those not covered by Medicaid. We aimed to identify possible disparities in care by evaluating the association between facility type (integrated faculty practice or Medicaid-only outpatient clinic) and telehealth utilization in people with epilepsy. METHODS We performed retrospective analyses using structured data from the Mount Sinai Health System electronic medical record data from January 2003 to August 2021. We identified people of all ages with epilepsy who were followed by an epileptologist after January 3, 2018, using a validated ICD-9-CM/10-CM coded case definition. We evaluated associations between practice setting and telehealth utilization, an outcome measure that captures the evolving delivery of neurologic care in a post-coronavirus disease 2019 era, using multivariable logistic regression. RESULTS We identified 4,586 people with epilepsy seen by an epileptologist, including Medicaid beneficiaries in the Medicaid outpatient clinic (N = 387), Medicaid beneficiaries in the faculty practice after integration (N = 723), and non-Medicaid beneficiaries (N = 3,476). Patients not insured by Medicaid were significantly older (average age 40 years vs 29 in persons seen in Medicaid-only outpatient clinic and 28.5 in persons insured with Medicaid seen in faculty practice [p < 0.0001]). Medicaid beneficiaries were more likely to have drug-resistant epilepsy (DRE), with 51.94% of people seen in Medicaid-only outpatient clinic, 41.63% of Medicaid beneficiaries seen in faculty practice, and 37.2% of non-Medicaid beneficiaries having DRE (p < 0.0001). Medicaid outpatient clinic patients were less likely to have telehealth visits (phone or video); 81.65% of patients in the Medicaid outpatient clinic having no telehealth visits vs 71.78% of Medicaid beneficiaries in the faculty practice and 70.89% of non-Medicaid beneficiaries (p < 0.0001). In an adjusted logistic regression analysis, Medicaid beneficiaries had lower odds (0.61; 95% CI 0.46-0.81) of using teleneurology compared with all patients seen in faculty practice (p = 0.0005). DISCUSSION Compared with the Medicaid-only outpatient clinic, we found higher telehealth utilization in the integrated faculty practice with no difference by insurance status (Medicaid vs other). Integrated care may be associated with better health care delivery in people with epilepsy; thus, future research should examine its impact on other epilepsy-related outcomes.
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Affiliation(s)
- Evelyn Gotlieb
- From the Departments of Neurology (L.J.B., M.M., J.J.Y., N.J.), Population Health Science (P.A., L.J.B., N.J.), and Policy and Institute for Healthcare Delivery Science (P.A., L.J.B., N.J.), Icahn School of Medicine at Mount Sinai (E.G., P.A.), New York; Departments of Neurology, Neurosurgery, and Epidemiology, and the Gertrude H. Sergievsky Center (C.-S.K.), Columbia University, New York, NY; and Department of Clinical Neurosciences (N.J.), University of Calgary, AB, Canada
| | - Parul Agarwal
- From the Departments of Neurology (L.J.B., M.M., J.J.Y., N.J.), Population Health Science (P.A., L.J.B., N.J.), and Policy and Institute for Healthcare Delivery Science (P.A., L.J.B., N.J.), Icahn School of Medicine at Mount Sinai (E.G., P.A.), New York; Departments of Neurology, Neurosurgery, and Epidemiology, and the Gertrude H. Sergievsky Center (C.-S.K.), Columbia University, New York, NY; and Department of Clinical Neurosciences (N.J.), University of Calgary, AB, Canada
| | - Leah J Blank
- From the Departments of Neurology (L.J.B., M.M., J.J.Y., N.J.), Population Health Science (P.A., L.J.B., N.J.), and Policy and Institute for Healthcare Delivery Science (P.A., L.J.B., N.J.), Icahn School of Medicine at Mount Sinai (E.G., P.A.), New York; Departments of Neurology, Neurosurgery, and Epidemiology, and the Gertrude H. Sergievsky Center (C.-S.K.), Columbia University, New York, NY; and Department of Clinical Neurosciences (N.J.), University of Calgary, AB, Canada
| | - Churl-Su Kwon
- From the Departments of Neurology (L.J.B., M.M., J.J.Y., N.J.), Population Health Science (P.A., L.J.B., N.J.), and Policy and Institute for Healthcare Delivery Science (P.A., L.J.B., N.J.), Icahn School of Medicine at Mount Sinai (E.G., P.A.), New York; Departments of Neurology, Neurosurgery, and Epidemiology, and the Gertrude H. Sergievsky Center (C.-S.K.), Columbia University, New York, NY; and Department of Clinical Neurosciences (N.J.), University of Calgary, AB, Canada
| | - Maria Muxfeldt
- From the Departments of Neurology (L.J.B., M.M., J.J.Y., N.J.), Population Health Science (P.A., L.J.B., N.J.), and Policy and Institute for Healthcare Delivery Science (P.A., L.J.B., N.J.), Icahn School of Medicine at Mount Sinai (E.G., P.A.), New York; Departments of Neurology, Neurosurgery, and Epidemiology, and the Gertrude H. Sergievsky Center (C.-S.K.), Columbia University, New York, NY; and Department of Clinical Neurosciences (N.J.), University of Calgary, AB, Canada
| | - James J Young
- From the Departments of Neurology (L.J.B., M.M., J.J.Y., N.J.), Population Health Science (P.A., L.J.B., N.J.), and Policy and Institute for Healthcare Delivery Science (P.A., L.J.B., N.J.), Icahn School of Medicine at Mount Sinai (E.G., P.A.), New York; Departments of Neurology, Neurosurgery, and Epidemiology, and the Gertrude H. Sergievsky Center (C.-S.K.), Columbia University, New York, NY; and Department of Clinical Neurosciences (N.J.), University of Calgary, AB, Canada
| | - Nathalie Jette
- From the Departments of Neurology (L.J.B., M.M., J.J.Y., N.J.), Population Health Science (P.A., L.J.B., N.J.), and Policy and Institute for Healthcare Delivery Science (P.A., L.J.B., N.J.), Icahn School of Medicine at Mount Sinai (E.G., P.A.), New York; Departments of Neurology, Neurosurgery, and Epidemiology, and the Gertrude H. Sergievsky Center (C.-S.K.), Columbia University, New York, NY; and Department of Clinical Neurosciences (N.J.), University of Calgary, AB, Canada
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Wang Q, Zhang Y, Xue H, Zeng Y, Lu G, Fan H, Jiang L, Wu J. Lead-free dual-frequency ultrasound implants for wireless, biphasic deep brain stimulation. Nat Commun 2024; 15:4017. [PMID: 38740759 DOI: 10.1038/s41467-024-48250-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/25/2024] [Indexed: 05/16/2024] Open
Abstract
Ultrasound-driven bioelectronics could offer a wireless scheme with sustainable power supply; however, current ultrasound implantable systems present critical challenges in biocompatibility and harvesting performance related to lead/lead-free piezoelectric materials and devices. Here, we report a lead-free dual-frequency ultrasound implants for wireless, biphasic deep brain stimulation, which integrates two developed lead-free sandwich porous 1-3-type piezoelectric composite elements with enhanced harvesting performance in a flexible printed circuit board. The implant is ultrasonically powered through a portable external dual-frequency transducer and generates programmable biphasic stimulus pulses in clinically relevant frequencies. Furthermore, we demonstrate ultrasound-driven implants for long-term biosafety therapy in deep brain stimulation through an epileptic rodent model. With biocompatibility and improved electrical performance, the lead-free materials and devices presented here could provide a promising platform for developing implantable ultrasonic electronics in the future.
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Affiliation(s)
- Qian Wang
- College of Materials Science and Engineering, Sichuan University, Chengdu, China
| | - Yusheng Zhang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
| | - Haoyue Xue
- College of Materials Science and Engineering, Sichuan University, Chengdu, China
| | - Yushun Zeng
- Alfred E. Mann Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
| | - Gengxi Lu
- Alfred E. Mann Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
| | - Hongsong Fan
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China.
| | - Laiming Jiang
- College of Materials Science and Engineering, Sichuan University, Chengdu, China.
| | - Jiagang Wu
- College of Materials Science and Engineering, Sichuan University, Chengdu, China.
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Su HW, Chen HT, Kao CL, Hung KC, Lin YT, Liu PH, Lin CM, Chen IW. Efficacy and safety of herbal medicine combined with acupuncture in pediatric epilepsy treatment: A meta-analysis of randomized controlled trials. PLoS One 2024; 19:e0303201. [PMID: 38723054 PMCID: PMC11081325 DOI: 10.1371/journal.pone.0303201] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 04/21/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of herbal medicine and acupuncture combination for pediatric epilepsy treatment. METHODS Databases were searched from their interception until October 2023 to identify randomized controlled trials focusing on the therapeutic efficacy of herbal medicine-acupuncture combination (intervention group) for pediatric epilepsy. The primary outcome was the risk of treatment failure, whereas the secondary outcomes included the risk of post-treatment electroencephalogram (EEG) abnormalities and adverse events. Subgroup analyses were conducted based on the type of herbal compound formulas. Meta-regression analysis was conducted to examine the influence of patient demographics and clinical history on the therapeutic efficacy of herbal medicine-acupuncture combination for pediatric epilepsy. To assess the cumulative evidence, trial sequential analysis (TSA) was performed. RESULTS The analysis included 10 trials involving a total of 882 pediatric patients. Meta-analysis revealed that the intervention group had a lower risk of treatment failure than the control group (risk ratio [RR] = 0.3, 95% confidence interval [CI]: 0.19-0.47, P<0.00001, I2 = 0%, 10 trials). Subgroup analyses showed that therapeutic efficacy was consistent among the different herbal compound formulas. Meta-regression analysis revealed that the efficacy of the treatments did not significantly vary with patient age, male sex, and duration of seizure history. TSA suggested that herbal medicine-acupuncture combination exerted a robust and conclusive effect on seizure treatment. Although the combined used of herbal medicine and acupuncture was not associated with a lower risk of post-treatment EEG abnormalities (RR = 0.82, 95%CI:0.6-1.11, P = 0.2, 3 trials), the risk of adverse events was reduced (RR = 0.27, 95%CI:0.18-0.41, P<0.00001, 4 trials). CONCLUSION The meta-analysis suggested that combined use of herbal medicine and acupuncture is a promising and safe clinical approach for pediatric epilepsy treatment. Further large-scale studies are necessary to conclusively determine the efficacy and safety of herbal medicine and acupuncture in pediatric epilepsy treatment.
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Affiliation(s)
- Hong-Wen Su
- Department of Chinese Medicine, Chi Mei Medical Center, Tainan City, Taiwan
| | - Hsiao-Tien Chen
- Department of Chinese Medicine, Chi Mei Medical Center, Tainan City, Taiwan
| | - Chia-Li Kao
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Yao-Tsung Lin
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Ping-Hsin Liu
- Department of Anesthesiology, E-Da Dachang Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Chien-Ming Lin
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan
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Yang J, Zhang P, Li L, Cheng GQ. [Interpretation of treatment of seizures in the neonate: guidelines and consensus-based recommendations-special report from the ILAE Task Force on Neonatal Seizures(2023)]. Zhonghua Er Ke Za Zhi 2024; 62:412-415. [PMID: 38623007 DOI: 10.3760/cma.j.cn112140-20231210-00421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Affiliation(s)
- J Yang
- Department of Neonatalogy, Children's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hospital of Beijing Children's Hospital, Urumqi 830001, China
| | - P Zhang
- Department of Neonatalogy, Children's Hospital of Fudan University, Shanghai 201102, China
| | - L Li
- Department of Neonatalogy, Children's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hospital of Beijing Children's Hospital, Urumqi 830001, China
| | - G Q Cheng
- Department of Neonatalogy, Children's Hospital of Fudan University, Shanghai 201102, China
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Tsai SY, Lee WT, Lee CC, Jeng SF, Weng WC. Five-year follow-up of a clinic-based sleep intervention for paediatric epilepsy: A randomized clinical trial. J Sleep Res 2024; 33:e14059. [PMID: 37770048 DOI: 10.1111/jsr.14059] [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: 07/12/2023] [Revised: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023]
Abstract
Sleep disturbances in children with epilepsy are prevalent, and are associated with substantial adverse medical and psychosocial consequences. This study is a 5-year follow-up of a clinic-based sleep intervention study that randomized 100 toddlers and preschool-age children with epilepsy to a usual care group or a sleep intervention group. The intervention group received standard paediatric neurology care plus three education sessions during the child's routine clinic visit. The outcomes measured were: (1) child sleep by actigraphy and parental report; and (2) maternal sleep and depression. We aimed to evaluate the long-term benefits of a clinic-based sleep intervention for paediatric epilepsy. In total, 42 families (42.0%) participated. The average child's age at follow-up was 9.55 years. Thirty-eight (90.5%) children were not obtaining sufficient sleep at baseline, and 40 (95.2%) at the 5-year follow-up. The numbers of children with clinically significant sleep disturbances were 40 (95.2%) at baseline and 36 (85.7%) at the 5-year follow-up. Fourteen mothers (33.3%) had poor sleep quality and high depressive symptoms at both assessment time points. There were no differences (P > 0.05) in the child and maternal outcomes between the two trial arms. Overall, there was no evidence that a clinic-based sleep intervention that effectively improved multiple aspects of sleep in toddlers and preschool-age children with epilepsy had long-lasting beneficial effects. Our findings suggest that sleep interventions for families of children with epilepsy require ongoing reinforcement and monitoring during routine paediatric neurology care to prevent sleep problems from persisting or recurring.
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Affiliation(s)
- Shao-Yu Tsai
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Wang-Tso Lee
- Department of Pediatric Neurology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chien-Chang Lee
- Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan
| | - Suh-Fang Jeng
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Chin Weng
- Department of Pediatric Neurology, National Taiwan University Children's Hospital, Taipei, Taiwan
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11
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Landais R, Sultan M, Thomas RH. The promise of AI Large Language Models for Epilepsy care. Epilepsy Behav 2024; 154:109747. [PMID: 38518673 DOI: 10.1016/j.yebeh.2024.109747] [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: 01/31/2024] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 03/24/2024]
Abstract
Artificial intelligence (AI) has been supporting our digital life for decades, but public interest in this has exploded with the recognition of large language models, such as GPT-4. We examine and evaluate the potential uses for generative AI technologies in epilepsy and neurological services. Generative AI could not only improve patient care and safety by refining communication and removing certain barriers to healthcare but may also extend to streamlining a doctor's practice through strategies such as automating paperwork. Challenges with the integration of generative AI in epilepsy services are also explored and include the risk of producing inaccurate and biased information. The impact generative AI could have on the provision of healthcare, both positive and negative, should be understood and considered carefully when deciding on the steps that need to be taken before AI is ready for use in hospitals and epilepsy services.
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Affiliation(s)
- Raphaëlle Landais
- Faculty of Medical Sciences, Newcastle University, Newcastle-Upon-Tyne NE1 7RU, United Kingdom
| | - Mustafa Sultan
- Manchester University NHS Foundation Trust, Manchester M13 9PT, United Kingdom
| | - Rhys H Thomas
- Department of Neurology, Royal Victoria Infirmary, Queen Victoria Rd, Newcastle-Upon-Tyne NE1 4LP, United Kingdom; Translational and Clinical Research Institute, Henry Wellcome Building, Framlington Place, Newcastle-Upon-Tyne NE2 4HH, United Kingdom.
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12
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Pellinen J, Foster EC, Wilmshurst JM, Zuberi SM, French J. Improving epilepsy diagnosis across the lifespan: approaches and innovations. Lancet Neurol 2024; 23:511-521. [PMID: 38631767 DOI: 10.1016/s1474-4422(24)00079-6] [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: 10/30/2023] [Revised: 02/11/2024] [Accepted: 02/16/2024] [Indexed: 04/19/2024]
Abstract
Epilepsy diagnosis is often delayed or inaccurate, exposing people to ongoing seizures and their substantial consequences until effective treatment is initiated. Important factors contributing to this problem include delayed recognition of seizure symptoms by patients and eyewitnesses; cultural, geographical, and financial barriers to seeking health care; and missed or delayed diagnosis by health-care providers. Epilepsy diagnosis involves several steps. The first step is recognition of epileptic seizures; next is classification of epilepsy type and whether an epilepsy syndrome is present; finally, the underlying epilepsy-associated comorbidities and potential causes must be identified, which differ across the lifespan. Clinical history, elicited from patients and eyewitnesses, is a fundamental component of the diagnostic pathway. Recent technological advances, including smartphone videography and genetic testing, are increasingly used in routine practice. Innovations in technology, such as artificial intelligence, could provide new possibilities for directly and indirectly detecting epilepsy and might make valuable contributions to diagnostic algorithms in the future.
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Affiliation(s)
- Jacob Pellinen
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Emma C Foster
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jo M Wilmshurst
- Red Cross War Memorial Children's Hospital and University of Cape Town Neuroscience Institute, Cape Town, South Africa
| | - Sameer M Zuberi
- Royal Hospital for Children and University of Glasgow School of Health & Wellbeing, Glasgow, UK
| | - Jacqueline French
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, NY, USA
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13
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İşcan Ayyildiz N, Bingöl N. The effects of web-based animation-supported progressive relaxation exercises applied to individuals with epilepsy on fatigue and sleep quality: A randomized controlled study. Epilepsy Behav 2024; 154:109734. [PMID: 38554645 DOI: 10.1016/j.yebeh.2024.109734] [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: 12/07/2023] [Revised: 02/09/2024] [Accepted: 03/03/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE The study was conducted to determine the effects of Progressive Relaxation Exercise, supported by mobile-based animation, on fatigue and sleep quality of individuals with epilepsy. MATERIAL-METHOD The study was conducted in a randomized controlled design with a pretest-posttest model on epileptic individuals who applied to Giresun University, Faculty of Medicine, Neurology Outpatient Clinic between February and December 2022. By using power analysis, the sample of the study was determined as 60 epilepsy patients (30 in the Control Group, 30 in the Experimental Group). The data were collected by face-to-face interview technique with the Personal Information Form, Pittsburgh Sleep Quality Index (PSQI), and Fatigue Severity Scale (FSS). Frequencies, percentages, arithmetic mean, standard deviations, Pearson Correlation Analysis, Paired t-Test, Student's t-Test, and Chi-Square Test were used in the evaluation of the study data. RESULTS When the Control Group's mean scores in the pre-test and post-tests, which were performed with an interval of 6 weeks, were compared, a statistically significant difference was detected between the FSS and PSQI scores (p>0.05). The mean Fatigue Severity Scale score was found to be 5.24 ± 0.69 before the Progressive Relaxation Exercises and 3.82 ± 0.77 after the exercises. The mean scores of the individuals on the Fatigue Severity Scale after the relaxation exercises were found to be lower at a statistically significant level than the mean scores before the relaxation exercises (p<0.001). The differences between subjective sleep quality (p<0.001), sleep latency (p<0.001), daytime dysfunction (p<0.001), and total sleep quality (p<0.001) score averages after the Progressive Relaxation Exercises were statistically significant compared to the pre-exercises status. When the post-test scores of the participants in the Experimental Group was examined, significant, moderate, and positive differences were detected between the FSS and Total PSQI scores (r: 0.373-p: 0.042), Subjective Sleep Quality (r: 0.487-p: 0.006), which is one of the sub-dimensions of PSQI, Sleeping Pill Use (r: 0.531-p: 0.003), and Daytime Dysfunction (r: 0.461-p: 0.01) scores. CONCLUSION It was determined that individuals with epilepsy experience fatigue and deterioration in sleep quality and there is a reciprocal relationship between the severity of fatigue and sleep quality in these individuals. Progressive Relaxation Exercises applied with the animation-supported web-based mobile intervention technique reduce the fatigue levels of individuals and increase sleep quality.
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Affiliation(s)
| | - Nuray Bingöl
- Department of Medical Nursing, Faculty of Nursing, Ataturk University, Erzurum, Turkey.
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14
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Chu PC, Yu HY, Fisher RS, Liu HL. Neuromodulatory Focused Ultrasound for Epilepsy: Are Animal Models Useful? ACS Chem Neurosci 2024; 15:1728-1731. [PMID: 38634833 PMCID: PMC11066834 DOI: 10.1021/acschemneuro.4c00198] [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: 04/02/2024] [Accepted: 04/11/2024] [Indexed: 04/19/2024] Open
Abstract
Ultrasound neuromodulation is a potential alternative therapy for suppressing epileptic discharges. Recently, several human clinical trials have reported promising results from repeated focused ultrasound (FUS) treatments for temporal lobe epilepsy. In this Viewpoint, we highlight the valuable guidance of preclinical validation methods for choosing the optimal FUS parameters, thus ensuring consistency with the outcomes of clinical trials and leading human trials to the safest and most effective approaches.
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Affiliation(s)
- Po-Chun Chu
- Department
of Electrical Engineering, National Taiwan
University, Taipei
City 10617, Taiwan
| | - Hsiang-Yu Yu
- Department
of Neurology, Taipei Veteran General Hospital, Taipei City 11217, Taiwan
- School of
Medicine, National Yang Ming Chiao Tung
University, Taipei City 112304, Taiwan
| | - Robert S. Fisher
- Department
of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, California 94305, United States
| | - Hao-Li Liu
- Department
of Electrical Engineering, National Taiwan
University, Taipei
City 10617, Taiwan
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15
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Zhang YW, Cheng GY, Wang X, Cheng WP. Analysis of mechanism of core points in acupuncture and moxibustion treatment for epilepsy based on data mining. Zhen Ci Yan Jiu 2024; 49:415-423. [PMID: 38649211 DOI: 10.13702/j.1000-0607.20230019] [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] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVES To explore the mechanism of core points in acupuncture and moxibustion treatment for epilepsy by using data mining technique, so as to provide a reference for clinical practice and experimental research. METHODS The data comes from relevant documents collected from CNKI, Wanfang, SinoMed, VIP, PubMed, Embase, Cochrane Library, EBSCO, Web of Science databases. The selected acupoints were analyzed in descriptive statistics, high-frequency acupoints group and core acupoint prescription. Further, potential target mining, "core acupoint prescription-target-epilepsy" network construction, protein-protein interactions (PPI) network establishment and core target extraction, gene ontology (GO) and KEGG gene enrichment analysis of the core acupoint prescription were carried out to predict its anti-epileptic potential mechanism. RESULTS A total of 122 acupoint prescriptions were included. The core acupoint prescriptions were Baihui (GV20), Hegu (LI4), Neiguan (PC6), Shuigou (GV26) and Taichong (LR3). 277 potential targets were identified, among which 134 were shared with epilepsy. The core targets were extracted by PPI network topology analysis, including signal transducer and activator of transcription 3, tumor necrosis factor (TNF), interleukin (IL)-6, protein kinase B1, c-Jun N-terminal kinase, brain-derived neurotrophic factor, tumor protein 53, vascular endothelial growth factor A, Caspase-3, epidermal growth factor receptor, etc. The main anti-epileptic pathways of the core acupoints were predicted by KEGG enrichment, including lipid and atherosclerosis, neurodegeneration, phosphatidylinositol-3-kinase/protein B kinase signaling pathway, mitogen-activated protein kinase signaling pathway, cyclic adenosine monophosphate signaling pathway, TNF signaling pathway, IL-17 signaling pathway, hypoxia-inducible factor-1 signaling pathway, apoptosis, etc., involving neuronal death, synaptic plasticity, oxidative stress, inflammation and other related biological process. CONCLUSIONS The core acupoint prescription of acupuncture and moxibustion intervention for epilepsy can act on multiple targets and multiple pathways to exert anti-epileptic effects, which can provide a theoretical basis for further clinical application and mechanism research.
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Affiliation(s)
- Yi-Wen Zhang
- The First Clinical Medical College, Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Guang-Yu Cheng
- The Sixth Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin 150040
| | - Xuan Wang
- The Second Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin 150040
| | - Wei-Ping Cheng
- The Second Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin 150040.
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16
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Hong R, Zheng T, Marra V, Yang D, Liu JK. Multi-scale modelling of the epileptic brain: advantages of computational therapy exploration. J Neural Eng 2024; 21:021002. [PMID: 38621378 DOI: 10.1088/1741-2552/ad3eb4] [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: 08/29/2023] [Accepted: 04/15/2024] [Indexed: 04/17/2024]
Abstract
Objective: Epilepsy is a complex disease spanning across multiple scales, from ion channels in neurons to neuronal circuits across the entire brain. Over the past decades, computational models have been used to describe the pathophysiological activity of the epileptic brain from different aspects. Traditionally, each computational model can aid in optimizing therapeutic interventions, therefore, providing a particular view to design strategies for treating epilepsy. As a result, most studies are concerned with generating specific models of the epileptic brain that can help us understand the certain machinery of the pathological state. Those specific models vary in complexity and biological accuracy, with system-level models often lacking biological details.Approach: Here, we review various types of computational model of epilepsy and discuss their potential for different therapeutic approaches and scenarios, including drug discovery, surgical strategies, brain stimulation, and seizure prediction. We propose that we need to consider an integrated approach with a unified modelling framework across multiple scales to understand the epileptic brain. Our proposal is based on the recent increase in computational power, which has opened up the possibility of unifying those specific epileptic models into simulations with an unprecedented level of detail.Main results: A multi-scale epilepsy model can bridge the gap between biologically detailed models, used to address molecular and cellular questions, and brain-wide models based on abstract models which can account for complex neurological and behavioural observations.Significance: With these efforts, we move toward the next generation of epileptic brain models capable of connecting cellular features, such as ion channel properties, with standard clinical measures such as seizure severity.
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Affiliation(s)
- Rongqi Hong
- School of Computer Science, Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Tingting Zheng
- School of Computer Science, Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | | | - Dongping Yang
- Research Centre for Frontier Fundamental Studies, Zhejiang Lab, Hangzhou, People's Republic of China
| | - Jian K Liu
- School of Computer Science, Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
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17
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Liu HY, Zeng S, Chen YW, Yi M, Tan XY, Xie JH, Wu X, Zhu LH. A simulation training of family management for parents of children with epilepsy: a randomized clinical trial. Ital J Pediatr 2024; 50:77. [PMID: 38641843 PMCID: PMC11027396 DOI: 10.1186/s13052-024-01646-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/07/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Epilepsy is a chronic neurological disorder that is more likely to be diagnosed in children. The main treatment involves long-term use of anti-epileptic drugs and above all, home care is of great importance. As there has not been a widely accepted home care protocols, simulating a home care environment is necessary for caregivers to develop skills of proper home care. This study aims to evaluate the effectiveness of a simulation training of family management style (STOFMS) for parents of children with epilepsy in China. METHODS A randomized controlled trial was conducted on 463 children with epilepsy and their families. They were recruited from March 2020 to November 2022 and randomly assigned to the STOFMS group or the conventional group in a 1:1 ratio. Scores of family management measures, 8-item of Morisky Medication Adherence and epilepsy clinical symptom of both groups were collected at three points of time: within 24 h after admission (T0), 3 months after discharge (T1), and 6 months after discharge (T2). Changes due to intervention were compared across groups by repeated-measures ANOVA. The study report followed the CONSORT 2010 checklist. RESULTS There were statistically significant differences between the two groups at T2. A considerable increase over the baseline was observed in the total management level score and subscale scores in the STOFMS group at T1, compared with essentially no change in the control group. In terms of medication adherence, the STOFMS group performance improved greatly at T1 and T2 compared with the control group. The same result was also found in clinical efficacy at T2 (p < 0.05). CONCLUSION STOFMS is an effective intervention to improve family management level, treatment adherence and clinical efficacy for children with epilepsy. TRIAL REGISTRATION The registration number is ChiCTR2200065128. Registered at 18 October 2022, http://www.medresman.org.cn.
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Affiliation(s)
- Hua-Yan Liu
- Hunan Children's Hospital, Changsha, Hunan, China
| | - Shan Zeng
- Hunan Children's Hospital, Changsha, Hunan, China
| | - Yue-Wei Chen
- Hunan Children's Hospital, Changsha, Hunan, China
| | - Min Yi
- Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Xiao-Yan Tan
- Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Jian-Hui Xie
- Hunan Children's Hospital, Changsha, Hunan, China
| | - Xia Wu
- Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Li-Hui Zhu
- Hunan Children's Hospital, Changsha, Hunan, China.
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18
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R AB, K SR, Chandran D, Hegde S, Upadhya R, Se PK, Shenoy S, Devi V, Upadhya D. Cell-specific extracellular vesicle-encapsulated exogenous GABA controls seizures in epilepsy. Stem Cell Res Ther 2024; 15:108. [PMID: 38637847 PMCID: PMC11027552 DOI: 10.1186/s13287-024-03721-4] [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: 12/14/2023] [Accepted: 04/05/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Epilepsy affects ∼60 million people worldwide. Most antiseizure medications in the market act on voltage-gated sodium or calcium channels, indirectly modulating neurotransmitter GABA or glutamate levels or multiple targets. Earlier studies made significant efforts to directly deliver GABA into the brain with varied success. Herein, we have hypothesized to directly deliver exogenous GABA to the brain with epilepsy through extracellular vesicles (EVs) from human GABA-producing cells and their progenitors as EVs largely mimic their parent cell composition. METHODS Human neural stem cells (NSCs), medial ganglionic eminence (MGE) cells, and GABAergic interneurons (INs) were generated from induced pluripotent stem cells (iPSCs) and characterized. EVs were isolated from NSCs, MGE cells, and INs and characterized for size and distribution, morphological features, and molecular markers. Exogenous GABA was passively loaded to the isolated EVs as a zwitterion at physiological pH, and the encapsulated dose of GABA was quantified. Epilepsy was developed through status epilepticus induction in Fisher rats by administration of repeated low doses of kainic acid. The extent of the seizures was measured for 10 h/ day for 3-6 months by video recording and its evaluation for stage III, IV and V seizures as per Racine scale. EVs from INs, MGE cells, and NSCs encapsulated with exogenous GABA were sequentially tested in the 4th, 5th, and 6th months by intranasal administration in the rats with epilepsy for detailed seizure, behavioral and synapse analysis. In separate experiments, several controls including exogenic GABA alone and EVs from INs and MGE cells were evaluated for seizure-controlling ability. RESULTS Exogenic GABA could enter the brain through EVs. Treatment with EVs from INs and MGE cells encapsulated with GABA significantly reduced total seizures, stage V seizures, and total time spent in seizure activity. EVs from NSCs encapsulated with GABA demonstrated limited seizure control. Exogenic GABA alone and EVs from INs and MGE cells individually failed to control seizures. Further, exogenic GABA with EVs from MGE cells improved depressive behavior while partially improving memory functions. Co-localization studies confirmed exogenous GABA with presynaptic vesicles in the hippocampus, indicating the interaction of exogenous GABA in the brain with epilepsy. CONCLUSION For the first time, the study demonstrated that exogenous GABA could be delivered to the brain through brain cell-derived EVs, which could regulate seizures in temporal lobe epilepsy. It is identified that the cellular origin of EVs plays a vital role in seizure control with exogenous GABA.
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Affiliation(s)
- Abhijna Ballal R
- Centre for Molecular Neurosciences, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Shivakumar Reddy K
- Centre for Molecular Neurosciences, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Divya Chandran
- Centre for Molecular Neurosciences, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Sumukha Hegde
- Centre for Molecular Neurosciences, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Raghavendra Upadhya
- Manipal Centre for Biotherapeutics Research, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Praveen Kumar Se
- Department of Pharmacology, Manipal Tata Medical College, Jamshedpur, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Smita Shenoy
- Department of Pharmacology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Vasudha Devi
- Department of Pharmacology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Dinesh Upadhya
- Centre for Molecular Neurosciences, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India.
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19
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Xia Y, Duan Y, Sha L, Lai W, Zhang Z, Hou J, Chen L. Whole-cycle management of women with epilepsy of child-bearing age: ontology construction and application. BMC Med Inform Decis Mak 2024; 24:101. [PMID: 38637746 PMCID: PMC11027401 DOI: 10.1186/s12911-024-02509-z] [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: 11/04/2023] [Accepted: 04/15/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The effective management of epilepsy in women of child-bearing age necessitates a concerted effort from multidisciplinary teams. Nevertheless, there exists an inadequacy in the seamless exchange of knowledge among healthcare providers within this context. Consequently, it is imperative to enhance the availability of informatics resources and the development of decision support tools to address this issue comprehensively. MATERIALS AND METHODS The development of the Women with Epilepsy of Child-Bearing Age Ontology (WWECA) adhered to established ontology construction principles. The ontology's scope and universal terminology were initially established by the development team and subsequently subjected to external evaluation through a rapid Delphi consensus exercise involving domain experts. Additional entities and attribute annotation data were sourced from authoritative guideline documents and specialized terminology databases within the respective field. Furthermore, the ontology has played a pivotal role in steering the creation of an online question-and-answer system, which is actively employed and assessed by a diverse group of multidisciplinary healthcare providers. RESULTS WWECA successfully integrated a total of 609 entities encompassing various facets related to the diagnosis and medication for women of child-bearing age afflicted with epilepsy. The ontology exhibited a maximum depth of 8 within its hierarchical structure. Each of these entities featured three fundamental attributes, namely Chinese labels, definitions, and synonyms. The evaluation of WWECA involved 35 experts from 10 different hospitals across China, resulting in a favorable consensus among the experts. Furthermore, the ontology-driven online question and answer system underwent evaluation by a panel of 10 experts, including neurologists, obstetricians, and gynecologists. This evaluation yielded an average rating of 4.2, signifying a positive reception and endorsement of the system's utility and effectiveness. CONCLUSIONS Our ontology and the associated online question and answer system hold the potential to serve as a scalable assistant for healthcare providers engaged in the management of women with epilepsy (WWE). In the future, this developmental framework has the potential for broader application in the context of long-term management of more intricate chronic health conditions.
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Affiliation(s)
- Yilin Xia
- Department of Neurology, West China Hospital, Sichuan University, #37 Guoxue Alley, Wuhou District, 610041, Chengdu, Sichuan Province, China
| | - Yifei Duan
- Department of Neurology, West China Hospital, Sichuan University, #37 Guoxue Alley, Wuhou District, 610041, Chengdu, Sichuan Province, China
| | - Leihao Sha
- Department of Neurology, West China Hospital, Sichuan University, #37 Guoxue Alley, Wuhou District, 610041, Chengdu, Sichuan Province, China
| | - Wanlin Lai
- Department of Neurology, West China Hospital, Sichuan University, #37 Guoxue Alley, Wuhou District, 610041, Chengdu, Sichuan Province, China
| | - Zhimeng Zhang
- Department of Neurology, West China Hospital, Sichuan University, #37 Guoxue Alley, Wuhou District, 610041, Chengdu, Sichuan Province, China
| | - Jiaxin Hou
- Department of Neurology, West China Hospital, Sichuan University, #37 Guoxue Alley, Wuhou District, 610041, Chengdu, Sichuan Province, China
| | - Lei Chen
- Department of Neurology, West China Hospital, Sichuan University, #37 Guoxue Alley, Wuhou District, 610041, Chengdu, Sichuan Province, China.
- Pazhou Lab, Guangzhou, China.
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20
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Zelano J. [An increasing prevalence of epilepsy and stagnating or decreasing health care resources makes nationwide implementation challenging]. Lakartidningen 2024; 121:23189. [PMID: 38591842] [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] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
The Swedish national guidelines for epilepsy stipulate regular health care contacts in the years following diagnosis, referral for epilepsy surgery in cases of pharmacoresistant epilepsy, multidisciplinary teams, and adequate patient information particularly for women of childbearing age. The last years have seen advances in many research areas of relevance for the basic epilepsy care, and Sweden has contributed regarding pharmacotherapy, seizure-related risks, sudden unexpected death in epilepsy (SUDEP), and digital tools. An increasing prevalence of epilepsy and stagnating or decreasing health care resources makes nationwide implementation of this knowledge challenging and increases the risk of unequal access to care. Innovation and focus on prioritized groups, such as newly diagnosed and persons with pharmacoresistant epilepsy or comorbidities, will be needed.
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Affiliation(s)
- Johan Zelano
- docent, överläkare, Neurosjukvården, Sahlgrenska universitetssjukhuset, Göteborg
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21
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Jagadish S, Czech TM, Zimmerman MB, Glykys J. Epilepsy Incidence and Developmental Outcomes After Early Discontinuation of Antiseizure Medication in Neonatal Hypoxic-Ischemic Encephalopathy. Pediatr Neurol 2024; 153:48-55. [PMID: 38320458 DOI: 10.1016/j.pediatrneurol.2024.01.009] [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: 10/06/2023] [Revised: 12/20/2023] [Accepted: 01/06/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Neonatal seizures caused by hypoxic-ischemic encephalopathy (HIE) have significant morbidity and mortality. There is variability in clinical practice regarding treatment duration with antiseizure medication (ASM) after resolution of provoked neonatal seizures. We examined epilepsy incidence and developmental outcomes in post-HIE neonates discharged or not on ASM. METHODS We conducted a retrospective chart review of all HIE-admitted neonates to the University of Iowa Hospitals & Clinics neonatal intensive care unit between January 2008 and February 2021 who presented with encephalopathy, underwent therapeutic hypothermia, and developed seizures. Neonates were divided into two groups depending on whether ASM was continued or discontinued on discharge. We evaluated the incidence of epilepsy and developmental outcomes on follow-up in these two cohorts up to 12 months. RESULTS Sixty-nine neonates met the study criteria. ASM was continued on discharge in 41 neonates (59%) and discontinued before discharge in 28 (41%). At the 12-month follow-up, nine neonates (13%) had a diagnosis of epilepsy, out of which seven neonates had ASM continued on discharge (odds ratio [OR]: 2.84; 95% confidence interval [CI]: 0.48, 29.9)]. There was no statistical difference between the development of postneonatal epilepsy between the two groups (P value 0.29). There was no significant difference in developmental outcome between the two groups after adjusting for covariates like magnetic resonance imaging (MRI) brain abnormality and number of seizure days (OR: 0.68; 95% CI: 0.21, 2.22; P = 0.52). CONCLUSION We found no significant risk of seizure recurrence by age 12 months in infants who had discontinued ASM before discharge compared with those who had continued ASM. There was no difference in developmental outcomes at the 12-month follow-up between groups after adjusting for brain MRI abnormality and the number of seizure days during admission. Our results support early discontinuation of ASM after resolution of acute provoked seizures in neonates with HIE.
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Affiliation(s)
- Spoorthi Jagadish
- Child Neurology Residency Program, Stead Family Department of Pediatrics, The University of Iowa, Iowa City, Iowa; Division of Child Neurology, Stead Family Department of Pediatrics, The University of Iowa, Iowa City, Iowa
| | - Theresa Marie Czech
- Division of Child Neurology, Stead Family Department of Pediatrics, The University of Iowa, Iowa City, Iowa; Department of Neurology, The University of Iowa, Iowa City, Iowa
| | | | - Joseph Glykys
- Division of Child Neurology, Stead Family Department of Pediatrics, The University of Iowa, Iowa City, Iowa; Department of Neurology, The University of Iowa, Iowa City, Iowa; Iowa Neuroscience Institute, The University of Iowa, Iowa City, Iowa.
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22
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Smith Malm C, Klecki J, Lisovska K, Zelano J. Survey of an online system for information to women with epilepsy of childbearing age and management during pregnancy: A 3-year evaluation. Epilepsia Open 2024; 9:558-567. [PMID: 38135910 PMCID: PMC10984308 DOI: 10.1002/epi4.12893] [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: 12/27/2022] [Revised: 11/16/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE We developed an online tool for women with epilepsy consisting of two modules: one with information on pregnancy-related issues (information module) and one for reminders about blood test and communication about dose changes (pregnancy module). Our aim was to assess perceived value, user-friendliness and improvement of patient knowledge in users. METHODS The system was launched in 2019 and patients invited by epilepsy nurses were asked to participate in a survey 1 month after the invitation for the information module, and 1 month postnatally for the pregnancy module. RESULTS By November 2022, the system had been used by 96 individuals out of 100 invited in the pregnancy module, in a total of 114 pregnancies. One hundred and eleven women had been invited to the information module, and 70 of these accessed it. The survey received 96 answers (44 information, 52 pregnancy). User-friendliness was rated as good or very good by a little over half of the users; 55% in the information module and 52% in the pregnancy module. Among pregnant women, 83% found the TDM part useful and most would prefer a similar system in future pregnancies. Sixty-four percent of users of the information module and 48% of the pregnancy module found that the system had increased their knowledge. Two knowledge questions were answered correctly by a significantly higher proportion of those that had accessed the online information. SIGNIFICANCE There was great demand for online communication during pregnancy and our experiences of implementation can hopefully assist digitalization of epilepsy care elsewhere. Online information also seems to increase knowledge about pregnancy-related issues, but our invitation-only method of inclusion was not effective for widespread dissemination. Patient-initiated access with optional epilepsy-team contact if questions arise could be an alternative. PLAIN LANGUAGE SUMMARY We have performed a survey of users of a new Internet-based tool for information to women of childbearing age and communication about dose changes during pregnancy. Users were overall satisfied with the tool and answered some knowledge questions more accurately after accessing the information.
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Affiliation(s)
| | - Judith Klecki
- Department of NeurologySahlgrenska university hospitalGothenburgSweden
| | - Kristina Lisovska
- Department of NeurologySahlgrenska university hospitalGothenburgSweden
| | - Johan Zelano
- Department of NeurologySahlgrenska university hospitalGothenburgSweden
- Institute of neuroscience and physiology, Department of clinical neuroscience, Sahlgrenska AcademyGothenburg UniversityGothenburgSweden
- Wallenberg Center of Molecular and Translational MedicineGothenburg UniversityGothenburgSweden
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23
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van Diessen E, van Amerongen RA, Zijlmans M, Otte WM. Potential merits and flaws of large language models in epilepsy care: A critical review. Epilepsia 2024; 65:873-886. [PMID: 38305763 DOI: 10.1111/epi.17907] [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: 10/13/2023] [Revised: 12/30/2023] [Accepted: 01/19/2024] [Indexed: 02/03/2024]
Abstract
The current pace of development and applications of large language models (LLMs) is unprecedented and will impact future medical care significantly. In this critical review, we provide the background to better understand these novel artificial intelligence (AI) models and how LLMs can be of future use in the daily care of people with epilepsy. Considering the importance of clinical history taking in diagnosing and monitoring epilepsy-combined with the established use of electronic health records-a great potential exists to integrate LLMs in epilepsy care. We present the current available LLM studies in epilepsy. Furthermore, we highlight and compare the most commonly used LLMs and elaborate on how these models can be applied in epilepsy. We further discuss important drawbacks and risks of LLMs, and we provide recommendations for overcoming these limitations.
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Affiliation(s)
- Eric van Diessen
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
- Department of Pediatrics, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Ramon A van Amerongen
- Faculty of Science, Bioinformatics and Biocomplexity, Utrecht University, Utrecht, The Netherlands
| | - Maeike Zijlmans
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
- Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands
| | - Willem M Otte
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
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24
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Gandy M, Coleman H, Cutler H, Jones MP, Karin E, Kwan P, Nikpour A, Parratt K, Rayner G, Titov N, Todd L, Seil E, Winton‐Brown T, Wu W, Dear BF. Comparative effectiveness of digital mental healthcare models for adults with epilepsy: A study protocol of a randomized controlled trial. Epilepsia Open 2024; 9:808-818. [PMID: 38345357 PMCID: PMC10984311 DOI: 10.1002/epi4.12913] [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: 11/22/2023] [Accepted: 01/25/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE Mental health complaints are prevalent among people with epilepsy, yet there are major barriers that prevent access to psychological care, including high out-of-pocket costs and a lack of accessible specialized services. The purpose of the current study is to examine the comparative efficacy, acceptability, cost-effectiveness, and long-term outcomes of a digital psychological intervention when delivered under two models of care (i.e., guided vs. unguided) in supporting the mental health and functioning of adults with epilepsy. METHOD Approximately 375 participants across Australia will be enrolled. Eligible participants will have a confirmed diagnosis of epilepsy, experience difficulties with their emotional health, be at least 18 years of age, and live in Australia. Participants will be randomized (2:2:1) to receive the Wellbeing Neuro Course, a 10-week internet-delivered program, with (i.e., guided) or without guidance by a mental health clinician (i.e., unguided), or be allocated to a treatment-as-usual waiting-list control group. Participants will complete online questionnaires at pre-, post-treatment, and 3- and 12-month follow-up and consent to have their data linked to their medical records to capture healthcare system resource use and costs. ANALYSIS Primary outcome measures will be symptoms of depression and anxiety. A cost-utility analysis will be undertaken using the Australian healthcare system perspective and according to current economic evaluation guidelines. Resource use and costs to the healthcare system during the study period will be captured via data linkage to relevant administrative datasets in Australia. SIGNIFICANCE The results of this trial will provide important data concerning the relative outcomes of these different models of care and will inform the integration of digital psychological interventions translation into healthcare services. ETHICS AND DISSEMINATION The Human Research Ethics Committee of Macquarie University approved the proposed study (Reference No: 520231325151475). The results will be disseminated through peer-reviewed publication(s). ANZCTR TRIAL REGISTRATION NUMBER ACTRN12623001327673. PLAIN LANGUAGE SUMMARY This study seeks to find out if a 10-week online psychological treatment can improve the mental health and well-being of Australian adults with epilepsy. Around 375 participants will be randomly assigned to different groups: one will receive treatment with guidance from mental health clinician (guided group), one without guidance (unguided group), and one starting later (waiting control group). All participants will fill out the same outcome measures online. The main goal of this research is to compare these groups and assess how well the treatment works in improving mental health outcomes.
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Affiliation(s)
- Milena Gandy
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Honor Coleman
- Melbourne School of Psychological SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Henry Cutler
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
- Macquarie University Centre for the Health EconomySydneyNew South WalesAustralia
- Macquarie University Business SchoolSydneyNew South WalesAustralia
| | - Michael P. Jones
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Eyal Karin
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Armin Nikpour
- Department of NeurologyRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
| | - Kaitlyn Parratt
- Department of NeurologyRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
- The Epilepsy Society of AustraliaSouth AustraliaAustralia
| | - Genevieve Rayner
- Melbourne School of Psychological SciencesThe University of MelbourneMelbourneVictoriaAustralia
- Comprehensive Epilepsy ProgramAlfred HospitalMelbourneVictoriaAustralia
| | - Nickolai Titov
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
- MindSpotMQ Health, Macquarie UniversityNew South WalesAustralia
| | - Lisa Todd
- Epilepsy Action AustraliaSydneyNew South WalesAustralia
| | - Elizabeth Seil
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
- Macquarie University Centre for the Health EconomySydneyNew South WalesAustralia
- Macquarie University Business SchoolSydneyNew South WalesAustralia
| | - Toby Winton‐Brown
- Comprehensive Epilepsy ProgramAlfred HospitalMelbourneVictoriaAustralia
| | - Wendy Wu
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Blake F. Dear
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
- MindSpotMQ Health, Macquarie UniversityNew South WalesAustralia
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25
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Marchi A, Guex R, Denis M, El Youssef N, Pizzo F, Bénar CG, Bartolomei F. Neurofeedback and epilepsy: Renaissance of an old self-regulation method? Rev Neurol (Paris) 2024; 180:314-325. [PMID: 38485630 DOI: 10.1016/j.neurol.2024.02.386] [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: 10/03/2023] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 04/28/2024]
Abstract
Neurofeedback is a brain-computer interface tool enabling the user to self-regulate their neuronal activity, and ultimately, induce long-term brain plasticity, making it an interesting instrument to cure brain disorders. Although this method has been used successfully in the past as an adjunctive therapy in drug-resistant epilepsy, this approach remains under-explored and deserves more rigorous scientific inquiry. In this review, we present early neurofeedback protocols employed in epilepsy and provide a critical overview of the main clinical studies. We also describe the potential neurophysiological mechanisms through which neurofeedback may produce its therapeutic effects. Finally, we discuss how to innovate and standardize future neurofeedback clinical trials in epilepsy based on evidence from recent research studies.
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Affiliation(s)
- A Marchi
- Epileptology and Cerebral Rhythmology, Timone Hospital, AP-HM, Marseille, France.
| | - R Guex
- Inserm, INS, institut de neuroscience des systèmes, Aix-Marseille University, Marseille, France
| | - M Denis
- Epileptology and Cerebral Rhythmology, Timone Hospital, AP-HM, Marseille, France
| | - N El Youssef
- Epileptology and Cerebral Rhythmology, Timone Hospital, AP-HM, Marseille, France
| | - F Pizzo
- Epileptology and Cerebral Rhythmology, Timone Hospital, AP-HM, Marseille, France; Inserm, INS, institut de neuroscience des systèmes, Aix-Marseille University, Marseille, France
| | - C-G Bénar
- Inserm, INS, institut de neuroscience des systèmes, Aix-Marseille University, Marseille, France
| | - F Bartolomei
- Epileptology and Cerebral Rhythmology, Timone Hospital, AP-HM, Marseille, France; Inserm, INS, institut de neuroscience des systèmes, Aix-Marseille University, Marseille, France
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26
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Diaz-Peregrino R, San-Juan D, Arritola-Uriarte A, Contreras-Salazar Á, Del Moral-Bastida J, Miranda-Ojeda R. Epilepsy and education: A case-control analysis of the impact of an intensive epilepsy training program on undergraduate medical students. Epilepsy Behav 2024; 153:109717. [PMID: 38428173 DOI: 10.1016/j.yebeh.2024.109717] [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: 11/30/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/03/2024]
Abstract
AIMS To evaluate the knowledge, attitudes, and practical skills of students submitted to a 6-week intensive training in epilepsy compared to students without any training but mandatory neurology classes. METHODS It is a case-control study. After completing a 6-week intensive Academic, Clinical, and Research Program in epilepsy, TUMSs answered a validated Knowledge Attitudes and Practices (KAP) questionnaire. The control group, composed of undergraduate students who shared the same age, academic year, and compulsory hours for learning about epilepsy as TUMSs, was also assessed through the KAP instrument. Answers from both groups were submitted to Fisher exact and the χ2 test to observe differences among groups. Descriptive statistics were also performed. RESULTS TUMSs displayed better results in theoretical knowledge such as the definition and causes of epilepsy, and the application of paraclinical studies essential for diagnosing epilepsy. From their perspective, people with epilepsy encounter restricted opportunities for preserving their social life and employment and they are more prone to workplace accidents. They are convinced that facing epilepsy presents a notable risk due to the difficulties linked with diagnosis, considering epilepsy a challenging disease for general practitioners to identify and follow up. Likewise, they exhibited improvement in treatment adjustment and treatment monitoring of patients with epilepsy, mainly in pregnancy cases. Finally, they had greater knowledge about what to do when they witness a person experiencing a seizure. CONCLUSION Our study showed that a 6-week intensive education program in epilepsy increased the knowledge and practical skills and changed the attitude toward patients with epilepsy of undergraduate students.
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Affiliation(s)
- Roberto Diaz-Peregrino
- Department of Neurosurgery, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.
| | - Daniel San-Juan
- Epilepsy Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | | | | | - Raúl Miranda-Ojeda
- Faculty of Medicine, Autonomous University of the State of Mexico, Toluca, Mexico
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27
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Kostov KH, Kostov H, Larsson PG, Henning O, Aaberg KM, Egge A, Peltola J, Lossius MI. Norwegian population-based study of effectiveness of vagus nerve stimulation in patients with developmental and epileptic encephalopathies. Epilepsia Open 2024; 9:704-716. [PMID: 38318727 PMCID: PMC10984305 DOI: 10.1002/epi4.12908] [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: 08/10/2023] [Revised: 01/03/2024] [Accepted: 01/23/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE Evaluate the long-term efficacy of vagus nerve stimulation (VNS) in patients with developmental and epileptic encephalopathies (DEE) compared with epilepsy patients without intellectual disability (ID). METHODS Long-term outcomes from a Norwegian VNS quality registry are reported in 105 patients with DEEs (Lennox-Gastaut syndrome [LGS] n = 62; Dravet n = 16; Rett n = 9; other syndromes n = 18) were compared with 212 epilepsy patients without ID, with median follow-up of 88 and 72 months, respectively. Total seizure reduction was evaluated at 6, 12, 24, 36, and 60 months. Effect on different seizure types was evaluated at baseline and last observation carried forward (LOCF). RESULTS Median monthly seizure frequency at LOCF was reduced by 42.2% (p < 0.001) in patients with DEE and by 55.8% (p < 0.001) in patients without ID. In DEE patients, ≥50% seizure reduction at 6 and 24 months were 17.1% and 37.1%, respectively, and 33.5% and 48.6% for patients without ID. Seizure reduction ≥75% at 60 months occurred in 14.3% of DEE patients and 23.1% of patients without ID. Highest median reduction was for atonic seizures, most notably 64.6% for LGS patients. A better effect was seen at 2 years among DEE patients with unchanged medication compared with those with changed medication (54.5% vs. 35.6% responders, p = 0.078). More DEE patients were reported to have greater improvement in ictal or postictal severity (43.8% vs. 28.3%, p = 0.006) and alertness (62.9% vs. 31.6%, p < 0.001) than patients without ID. For both groups, use of the magnet reduced seizure severity. Hoarseness was the most common adverse effect in both groups. In addition, DEE patients were frequently reported to have sleep disturbance, general discomfort, or abdominal problems. SIGNIFICANCE Our data indicate that VNS is very effective for atonic seizures. Patients without ID had best overall seizure reduction, however, patients with DEE had higher retention rates probably due to other positive effects. PLAIN LANGUAGE SUMMARY DEE refers to a group of patients with severe epilepsy and intellectual disability. Many of these patients have restricted lifestyles with frequent seizures. VNS is a treatment option for patients who do not respond well to medicines, either because of insufficient effect or serious adverse effects. Our study shows that VNS is well tolerated in this patient group and leads to a reduction in all seizure types, most notably for seizures leading to fall. Many patients experience other positive effects like shorter and milder seizures, as well as improvement in alertness.
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Affiliation(s)
- Konstantin H. Kostov
- Neurological Department, National Center for EpilepsyOslo University HospitalOsloNorway
| | - Hrisimir Kostov
- Neurophysiological Department, National Center for EpilepsyOslo University HospitalOsloNorway
| | | | - Oliver Henning
- Neurophysiological Department, National Center for EpilepsyOslo University HospitalOsloNorway
| | - Kari Modalsli Aaberg
- Pediatric Department, National Center for EpilepsyOslo University HospitalOsloNorway
| | - Arild Egge
- Neurosurgical DepartmentOslo University HospitalOsloNorway
| | - Jukka Peltola
- Department of NeurologyTampere University and Tampere University HospitalTampereFinland
| | - Morten Ingvar Lossius
- Neurological Department, National Center for EpilepsyOslo University HospitalOsloNorway
- Department for Clinical MedicineInstitute for Clinical Medicine, University of OsloOsloNorway
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28
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Agudelo-Hernández F, Toro GIS, Plata-Casas LI. Human rights and support groups to improve quality of life, self-care and disability in epilepsy: [Rights and support groups for epilepsy]. Seizure 2024; 117:229-234. [PMID: 38507937 DOI: 10.1016/j.seizure.2024.03.007] [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: 01/15/2024] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND People with epilepsy have multiple barriers to recovering their quality of life. The objective of the present study was to determine the impact of a community group intervention focused on the components of mutual aid and human rights, to improve the quality of life in people with epilepsy. METHODS Prospective quasi-experimental study, incorporating pre- and post-intervention evaluations. There were 102 people who underwent an intervention focused on the central components of mutual aid groups (Active agency, Coping strategies, Emotion recognition and management, Problem solving, Supportive interaction, Identity construction, Trust, and Social networks) and in the QualityRights strategy. As evaluation instruments, scales were used to determine quality of life (QOLIE-10), treatment adherence (Morisky Test), self-care behaviors, perception of disability and quality in the provision of health services. RESULTS Correlations were shown between the variables proposed for quality of life. The intervention showed an improvement in all variables and a moderate to large effect in the self-care domain. There was a significant effect size in the self-care and quality of life variables with the intervention. Pharmacological adherence showed a moderate effect size in young people, adults and older adults. Regarding the perception of disability, the effect size was found only in adults. The pharmacological adherence variable also had a moderate effect size. This does specify the age groups, but not in the general sample. CONCLUSION Seizure-free time constitutes a fundamental element in recovery. However, psychosocial conditions constitute key elements to achieve a better quality of life in people with epilepsy.
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29
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Merlet I, Guillery M, Weyl L, Hammal M, Maliia M, Maliia S, Biraben A, Ricordeau C, Drapier D, Nica A. EEG changes induced by meditative practices: State and trait effects in healthy subjects and in patients with epilepsy. Rev Neurol (Paris) 2024; 180:326-347. [PMID: 38503588 DOI: 10.1016/j.neurol.2024.02.387] [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: 11/17/2023] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 03/21/2024]
Abstract
The effect of meditation on brain activity has been the topic of many studies in healthy subjects and in patients suffering from chronic diseases. These effects are either explored during meditation practice (state effects) or as a longer-term result of meditation training during the resting-state (trait). The topic of this article is to first review these findings by focusing on electroencephalography (EEG) changes in healthy subjects with or without experience in meditation. Modifications in EEG baseline rhythms, functional connectivity and advanced nonlinear parameters are discussed in regard to feasibility in clinical applications. Secondly, we provide a state-of-the-art of studies that proposed meditative practices as a complementary therapy in patients with epilepsy, in whom anxiety and depressive symptoms are prevalent. In these studies, the effects of standardized meditation programs including elements of traditional meditation practices such as mindfulness, loving-kindness and compassion are explored both at the level of psychological functioning and on the occurrence of seizures. Lastly, preliminary results are given regarding our ongoing study, the aim of which is to quantify the effects of a mindfulness self-compassion (MSC) practice on interictal and ictal epileptic activity. Feasibility, difficulties, and prospects of this study are discussed.
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Affiliation(s)
- I Merlet
- Universitiy of Rennes, INSERM, LTSI - UMR 1099, F-35000 Rennes, France.
| | - M Guillery
- Centre Hospitalier Guillaume-Regnier (CHGR), University of Rennes, 35000 Rennes, France.
| | - L Weyl
- Centre Hospitalier Guillaume-Regnier (CHGR), University of Rennes, 35000 Rennes, France.
| | - M Hammal
- Centre Hospitalier Guillaume-Regnier (CHGR), University of Rennes, 35000 Rennes, France.
| | - M Maliia
- Universitiy of Rennes, INSERM, LTSI - UMR 1099, F-35000 Rennes, France; Epilepsy Unit, Reference Center for Rare Epilepsies, Neurology Department, Rennes University Hospital, Rennes, France; Center for Clinical Investigation CIC-P INSERM 1414, F-35000 Rennes, France.
| | - S Maliia
- Centre Hospitalier Guillaume-Regnier (CHGR), University of Rennes, 35000 Rennes, France.
| | - A Biraben
- Universitiy of Rennes, INSERM, LTSI - UMR 1099, F-35000 Rennes, France; Epilepsy Unit, Reference Center for Rare Epilepsies, Neurology Department, Rennes University Hospital, Rennes, France; Center for Clinical Investigation CIC-P INSERM 1414, F-35000 Rennes, France.
| | - C Ricordeau
- Epilepsy Resource Team, 54, rue Saint-Helier, 35000 Rennes, France.
| | - D Drapier
- Centre Hospitalier Guillaume-Regnier (CHGR), University of Rennes, 35000 Rennes, France.
| | - A Nica
- Universitiy of Rennes, INSERM, LTSI - UMR 1099, F-35000 Rennes, France; Epilepsy Unit, Reference Center for Rare Epilepsies, Neurology Department, Rennes University Hospital, Rennes, France; Center for Clinical Investigation CIC-P INSERM 1414, F-35000 Rennes, France.
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30
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Ryvlin P. Editorial: Epilepsy advances in 2023. Curr Opin Neurol 2024; 37:97-98. [PMID: 38451481 DOI: 10.1097/wco.0000000000001251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Affiliation(s)
- Philippe Ryvlin
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
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31
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De Aveiro B, Winsor A, Davies J, Nicholson TR, Pal DK, Richardson MP, Pick S. Mental health and neurodevelopmental patient-reported outcome measures (PROMs) for children and young people with epilepsy: A systematic review. Epilepsy Behav 2024; 153:109671. [PMID: 38368788 DOI: 10.1016/j.yebeh.2024.109671] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/20/2024]
Abstract
Children and young people with epilepsy are at higher risk of mental health disorders and atypical neurodevelopmental outcomes compared to the general population. It is essential to detect such comorbidities early in children with epilepsy and provide appropriate interventions, to improve clinical outcomes. We aimed to identify and evaluate the measurement properties of Patient-Reported Outcome Measures (PROMs) that have been validated specifically to measure mental health and neurodevelopmental outcomes in children and/or young people with epilepsy. We searched Embase, Medline, and PsycINFO in May 2023 for relevant studies. Mental health was defined as psychological symptoms (e.g., anxiety, depression, psychosis) and/or behavioural difficulties (e.g., conduct disorders). Neurodevelopmental outcomes included neurodevelopmental disorder traits such as attention-deficit hyperactivity disorder (ADHD) and autistic spectrum disorders. We assessed methodological quality using Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidance. Twelve papers were identified that psychometrically evaluated 13 relevant PROMs (two epilepsy-specific, eleven generic). The appraisal of the PROMs was limited by the availability of only one or two published articles for each, and incomplete psychometric evaluations in some cases. The tool demonstrating the strongest evidence was The Neurological Disorders Depression Inventory-Epilepsy for Youth. The ADHD Rating Scale-IV and The Paediatric Symptom Checklist -17 demonstrated good evidence in favour of at least two measurement properties. This review identified only a small number of mental health and neurodevelopmental PROMs evaluated specifically in paediatric epilepsy. There is a need for further validation of mental health and neurodevelopmental PROMs in children with epilepsy.
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Affiliation(s)
- Bianca De Aveiro
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alice Winsor
- Department of Basic and Clinical Neuroscience and MRC Centre for Neurodevelopmental Disorders Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jessica Davies
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Timothy R Nicholson
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Deb K Pal
- Department of Basic and Clinical Neuroscience and MRC Centre for Neurodevelopmental Disorders Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mark P Richardson
- Department of Basic and Clinical Neuroscience and MRC Centre for Neurodevelopmental Disorders Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Susannah Pick
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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32
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Le MAT, Nguyen TT, Le Van T. Translation and validation of the Vietnamese Epilepsy Self-Management Scale (V-ESMS). Epilepsy Behav 2024; 153:109721. [PMID: 38428175 DOI: 10.1016/j.yebeh.2024.109721] [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: 11/07/2023] [Revised: 01/30/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVES This study aimed to translate and validate the Vietnamese version of the Epilepsy Self-Management Scale (V-ESMS). METHODS The translation and cross-cultural adaptation of the original version of the ESMS into Vietnamese followed the Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes Measures guideline with "forward-backward" translation and culturally adapted. The participants were recruited consecutively at neurology clinics at Nguyen Tri Phuong Hospital and University Medical Center, Ho Chi Minh City, from January 2022 to July 2022 and required to complete the V-ESMS. The validity was assessed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Cronbach's alpha and intraclass correlation coefficient (ICC) were used to evaluate internal and temporal reliability, respectively. RESULTS A total of 200 participants were recruited for analysis. The V-ESMS included 36 items and five domains. The factor loading ranged between 0.313 and 0.927; most items loaded in their hypothesized factors proved in the original scale. Using the CFA, theCMIN/DF, comparative fit index, and root mean square error of approximation were 2.883, 0.80, and 0.097, respectively. The Cronbach's alpha in each domain was 0.79-0.907; the scale was 0.936. The ICC from 0.94 to 0.98 showed excellent test-retest reliability. CONCLUSION The 36-item V-ESMS with five domains presented good validity and reliability. This instrument could be used to assess self-management in people with epilepsy in Vietnam.
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Affiliation(s)
- Minh-An Thuy Le
- Department of Neurology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam; Department of Neurology, Nguyen Tri Phuong Hospital, Ho Chi Minh City, Viet Nam.
| | - Truong Thuong Nguyen
- Department of Neurology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Tuan Le Van
- Department of Neurology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
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Hill SF, Yu W, Ziobro J, Chalasani S, Reger F, Meisler MH. Long-Term Downregulation of the Sodium Channel Gene Scn8a Is Therapeutic in Mouse Models of SCN8A Epilepsy. Ann Neurol 2024; 95:754-759. [PMID: 38113311 DOI: 10.1002/ana.26861] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/06/2023] [Accepted: 12/14/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE De novo mutations of the voltage-gated sodium channel gene SCN8A cause developmental and epileptic encephalopathy (DEE). Most pathogenic variants result in gain-of-function changes in activity of the sodium channel Nav1.6, poorly controlled seizures, and significant comorbidities. In previous work, an antisense oligonucleotide (ASO) reduced Scn8a transcripts and increased lifespan after neonatal administration to a mouse model. Here, we tested long-term ASO treatment initiated after seizure onset, as required for clinical application. METHODS ASO treatment was initiated after observation of a convulsive seizure and repeated at 4 to 6 week intervals for 1 year. We also tested the long-term efficacy of an AAV10-short hairpin RNA (shRNA) virus administered on P1. RESULTS Repeated treatment with the Scn8a ASO initiated after seizure onset provided long-term survival and reduced seizure frequency during a 12 month observation period. A single treatment with viral shRNA was also protective during 12 months of observation. INTERPRETATION Downregulation of Scn8a expression that is initiated after the onset of seizures is effective for long-term treatment in a model of SCN8A-DEE. Repeated ASO administration or a single dose of viral shRNA prevented seizures and extended survival through 12 months of observation. ANN NEUROL 2024;95:754-759.
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Affiliation(s)
- Sophie F Hill
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States
- Department of Human Genetics, University of Michigan, Ann Arbor, MI
| | - Wenxi Yu
- Department of Human Genetics, University of Michigan, Ann Arbor, MI
| | - Julie Ziobro
- Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Sanjna Chalasani
- Department of Human Genetics, University of Michigan, Ann Arbor, MI
| | - Faith Reger
- Department of Human Genetics, University of Michigan, Ann Arbor, MI
| | - Miriam H Meisler
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States
- Department of Human Genetics, University of Michigan, Ann Arbor, MI
- Department of Neurology, University of Michigan, Ann Arbor, MI
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Schulze-Bonhage A, Nitsche MA, Rotter S, Focke NK, Rao VR. Neurostimulation targeting the epileptic focus: Current understanding and perspectives for treatment. Seizure 2024; 117:183-192. [PMID: 38452614 DOI: 10.1016/j.seizure.2024.03.001] [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: 02/06/2024] [Revised: 02/29/2024] [Accepted: 03/02/2024] [Indexed: 03/09/2024] Open
Abstract
For the one third of people with epilepsy whose seizures are not controlled with medications, targeting the seizure focus with neurostimulation can be an effective therapeutic strategy. In this focused review, we summarize a discussion of targeted neurostimulation modalities during a workshop held in Frankfurt, Germany in September 2023. Topics covered include: available devices for seizure focus stimulation; alternating current (AC) and direct current (DC) stimulation to reduce focal cortical excitability; modeling approaches to simulate DC stimulation; reconciling the efficacy of focal stimulation with the network theory of epilepsy; and the emerging concept of 'neurostimulation zones,' which are defined as cortical regions where focal stimulation is most effective for reducing seizures and which may or may not directly involve the seizure onset zone. By combining experimental data, modeling results, and clinical outcome analysis, rational selection of target regions and stimulation parameters is increasingly feasible, paving the way for a broader use of neurostimulation for epilepsy in the future.
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Affiliation(s)
- Andreas Schulze-Bonhage
- Epilepsy Center, University Medical Center, University of Freiburg, Germany; European Reference Network EpiCare, Belgium; NeuroModul Basic, University of Freiburg, Freiburg, Germany.
| | - Michael A Nitsche
- Dept. Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; Bielefeld University, University Hospital OWL, Protestant Hospital of Bethel Foundation, University Clinic of Psychiatry and Psychotherapy, Germany; German Center for Mental Health (DZPG), Germany
| | - Stefan Rotter
- Bernstein Center Freiburg & Faculty of Biology, University of Freiburg, Germany
| | - Niels K Focke
- Epilepsy Center, Clinic for Neurology, University Medical Center Göttingen, Germany
| | - Vikram R Rao
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, USA
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Maliia MD, Nica A, Baxter J, Corniola MV. Focused ultrasounds: What is their future in epileptology? A critical review. Rev Neurol (Paris) 2024; 180:348-353. [PMID: 38092574 DOI: 10.1016/j.neurol.2023.10.014] [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: 09/06/2023] [Revised: 09/26/2023] [Accepted: 10/08/2023] [Indexed: 04/28/2024]
Abstract
High intensity focused ultrasounds (HIFU) are being increasingly advocated as a useful tool in the management of focal drug-resistant epilepsy. Our aim was to review current literature on the topic and perform an inventory of open trials assessing HIFU effectiveness and safety in epilepsy management. To do so, a review was conducted and yielded one prospective clinical trials, two case reports and one safety study were retrieved, indicating that HIFU is still in its infancy when it comes to focal drug-resistant epilepsy therapy. Efforts should be made to develop this technology using multicentric prospective data with larger cohorts and prolonged follow-up.
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Affiliation(s)
- M D Maliia
- "Van Gogh" Epilepsy Surgery Unit, Neurology Department, CIC 1414, University Hospital, Rennes, France; Laboratory of Signal and Image Analysis, LTSI, Inserm U1099, University Rennes 1, Rennes, France
| | - A Nica
- "Van Gogh" Epilepsy Surgery Unit, Neurology Department, CIC 1414, University Hospital, Rennes, France; Laboratory of Signal and Image Analysis, LTSI, Inserm U1099, University Rennes 1, Rennes, France
| | - J Baxter
- Laboratory of Signal and Image Analysis, LTSI, Inserm U1099, University Rennes 1, Rennes, France
| | - M V Corniola
- Laboratory of Signal and Image Analysis, LTSI, Inserm U1099, University Rennes 1, Rennes, France; Neurosurgery Department, Rennes University Hospital, Rennes, France; Faculty of Medicine, University of Rennes, Rennes, France; Medicis lab, Inserm UMR 1099 LTSI, University of Rennes, Rennes, France; Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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Joshi CN, Karakas C, Eschbach K, Samanta D, Auguste K, Desai V, Singh R, McGoldrick P, Wolf S, Abel TJ, Novotny E, Oluigbo C, Reddy SB, Alexander A, Price A, Reeders P, Mcnamara N, Romanowski EF, Mutchnick I, Ostendorf AP, Shaikhouni A, Knox A, Aungaroon G, Olaya J, Muh CR. Pediatric neuromodulation for drug-resistant epilepsy: Survey of current practices, techniques, and outcomes across US epilepsy centers. Epilepsia Open 2024; 9:785-792. [PMID: 38421143 PMCID: PMC10984294 DOI: 10.1002/epi4.12902] [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: 11/29/2023] [Revised: 12/26/2023] [Accepted: 01/11/2024] [Indexed: 03/02/2024] Open
Abstract
Neuromodulation via Responsive Neurostimulation (RNS) or Deep Brain Stimulation (DBS) is an emerging treatment strategy for pediatric drug-resistant epilepsy (DRE). Knowledge gaps exist in patient selection, surgical technique, and perioperative care. Here, we use an expert survey to clarify practices. Thirty-two members of the Pediatric Epilepsy Research Consortium were surveyed using REDCap. Respondents were from 17 pediatric epilepsy centers (missing data in one): Four centers implant RNS only while 13 implant both RNS and DBS. Thirteen RNS programs commenced in or before 2020, and 10 of 12 DBS programs began thereafter. The busiest six centers implant 6-10 new RNS devices per year; all DBS programs implant <5 annually. The youngest RNS patient was 3 years old. Most centers (11/12) utilize MP2RAGE and/or FGATIR sequences for planning. Centromedian thalamic nuclei were the unanimous target for Lennox-Gastaut syndrome. Surgeon exposure to neuromodulation occurred mostly in clinical practice (14/17). Clinically significant hemorrhage (n = 2) or infection (n = 3) were rare. Meaningful seizure reduction (>50%) was reported by 81% (13/16) of centers. RNS and DBS are rapidly evolving treatment modalities for safe and effective treatment of pediatric DRE. There is increasing interest in multicenter collaboration to gain knowledge and facilitate dialogue. PLAIN LANGUAGE SUMMARY: We surveyed 32 pediatric epilepsy centers in USA to highlight current practices of intracranial neuromodulation. Of the 17 that replied, we found that most centers are implanting thalamic targets in pediatric drug-resistant epilepsy using the RNS device. DBS device is starting to be used in pediatric epilepsy, especially after 2020. Different strategies for target identification are enumerated. This study serves as a starting point for future collaborative research.
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Affiliation(s)
- Charuta N Joshi
- Children's Health, University of Texas Southwest, Dallas, Texas, USA
| | - Cemal Karakas
- Department of Neurology, Division of Child Neurology, Norton Neuroscience Institute, University of Louisville, Louisville, Kentucky, USA
| | - Krista Eschbach
- Department of Pediatrics, Children's Hospital Colorado, Section of Neurology, University of Colorado, Aurora, Colorado, USA
| | - Debopam Samanta
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Kurtis Auguste
- Department of Pediatric Neurosurgery, Benioff Children's Hospital, UCSF Weill Institute for Neurosciences, San Francisco, California, USA
| | - Virendra Desai
- Department of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma, USA
| | - Rani Singh
- Division of Neurology, Department of Pediatrics, Atrium Health/Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Patricia McGoldrick
- Department of Pediatric Neurology, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Steven Wolf
- Department of Pediatric Neurology, Boston Children's Health Physicians, New York Medical Center, Valhalla, New York, USA
| | - Taylor J Abel
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Edward Novotny
- Department of Neurology and Pediatrics, University of Washington, Seattle, Washington, USA
- Center for Integrative Brain Research Seattle Children's Research Institute, Seattle, Washington, USA
| | - Chima Oluigbo
- Department of Neurosurgery, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Shilpa B Reddy
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Allyson Alexander
- Department of Pediatrics, Children's Hospital Colorado, Section of Neurology, University of Colorado, Aurora, Colorado, USA
- Division of Neurosurgery, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Angela Price
- Division of Pediatric Neurosurgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Puck Reeders
- Department of Neuroscience, Brain Institute, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Nancy Mcnamara
- Department of Pediatrics, Division of Pediatric Neurology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Erin Fedak Romanowski
- Department of Pediatrics, Division of Pediatric Neurology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Ian Mutchnick
- Norton Neuroscience Institute, Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Adam P Ostendorf
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA
| | - Ammar Shaikhouni
- Department Neurosurgery, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA
| | - Andrew Knox
- Department of Neurology, University of Wisconsin, Madison, Wisconsin, USA
| | - Gewalin Aungaroon
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Joffre Olaya
- Division of Neurosurgery, Children's Hospital Orange County, Orange, California, USA
| | - Carrie R Muh
- Department of Neurosurgery, Maria Fareri Children's Hospital, New York Medical Center, Valhalla, New York, USA
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Jeelani M. miRNAs in epilepsy: A review from molecular signatures to therapeutic intervention. Int J Biol Macromol 2024; 263:130468. [PMID: 38417757 DOI: 10.1016/j.ijbiomac.2024.130468] [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: 12/27/2023] [Revised: 02/17/2024] [Accepted: 02/24/2024] [Indexed: 03/01/2024]
Abstract
Epilepsy is a medical disorder marked by sporadic seizures accompanied by alterations in consciousness. The molecular mechanisms responsible for epilepsy and the factors contributing to alterations in neuronal structure compromised apoptotic responses in neurons, and disturbances in regeneration pathways in glial cells remain unidentified. MicroRNAs (miRNAs) are short noncoding RNA that consist of a single strand. They typically contain 21 to 23 nucleotides. miRNAs participate in the process of RNA silencing and the regulation of gene expression after transcription by selectively binding to mRNA molecules that possess complementary sequences. The disruption of miRNA regulation has been associated with the development of epilepsy, and manipulating a single miRNA can impact various cellular processes, hence serving as a potent intervention approach. Despite existing obstacles in the delivery and safety of miRNA-based treatments, researchers are actively investigating the potential of miRNAs to operate as regulators of brain activity and as targets for treating and preventing epilepsy. Hence, the utilization of miRNA-based therapeutic intervention shows potential for future epilepsy management. The objective of our present investigation was to ascertain the involvement of miRNAs in the causation and advancement of epilepsy. Moreover, they have undergone scrutiny for their potential utilization in therapeutic intervention.
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Affiliation(s)
- Mohammed Jeelani
- Department of Physiology, College of Medicine, University of Bisha, Bisha 61922, Saudi Arabia.
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38
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Gouveia FV, Warsi NM, Suresh H, Matin R, Ibrahim GM. Neurostimulation treatments for epilepsy: Deep brain stimulation, responsive neurostimulation and vagus nerve stimulation. Neurotherapeutics 2024; 21:e00308. [PMID: 38177025 DOI: 10.1016/j.neurot.2023.e00308] [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: 09/05/2023] [Revised: 11/29/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024] Open
Abstract
Epilepsy is a common and debilitating neurological disorder, and approximately one-third of affected individuals have ongoing seizures despite appropriate trials of two anti-seizure medications. This population with drug-resistant epilepsy (DRE) may benefit from neurostimulation approaches, such as vagus nerve stimulation (VNS), deep brain stimulation (DBS) and responsive neurostimulation (RNS). In some patient populations, these techniques are FDA-approved for treating DRE. VNS is used as adjuvant therapy for children and adults. Acting via the vagus afferent network, VNS modulates thalamocortical circuits, reducing seizures in approximately 50 % of patients. RNS uses an adaptive (closed-loop) system that records intracranial EEG patterns to activate the stimulation at the appropriate time, being particularly well-suited to treat seizures arising within eloquent cortex. For DBS, the most promising therapeutic targets are the anterior and centromedian nuclei of the thalamus, with anterior nucleus DBS being used for treating focal and secondarily generalized forms of DRE and centromedian nucleus DBS being applied for treating generalized epilepsies such as Lennox-Gastaut syndrome. Here, we discuss the indications, advantages and limitations of VNS, DBS and RNS in treating DRE and summarize the spatial distribution of neuroimaging observations related to epilepsy and stimulation using NeuroQuery and NeuroSynth.
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Affiliation(s)
| | - Nebras M Warsi
- Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada; Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Hrishikesh Suresh
- Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada; Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rafi Matin
- Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - George M Ibrahim
- Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada; Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
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Decker BM, Clary HM, Holmes MG, Al-Faraj AO, Esmaeili B, Waldman G, Becker DA, Johnson J, Voinescu PE, Gerard EE. Letter regarding "Seizure control in women with epilepsy undergoing assisted reproductive technology". Epilepsia 2024; 65:1141-1144. [PMID: 38098189 DOI: 10.1111/epi.17862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 03/01/2024]
Affiliation(s)
- Barbara M Decker
- Department of Neurological Sciences, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Heidi Munger Clary
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Manisha G Holmes
- Department of Neurology, Westchester Medical Center Health Network, Valhalla, New York, USA
| | - Abrar O Al-Faraj
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Behnaz Esmaeili
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Genna Waldman
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Danielle A Becker
- Department of Neurology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Julia Johnson
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Paula E Voinescu
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elizabeth E Gerard
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Mertens A, Boon P, Vonck K. Neurostimulation for childhood epilepsy. Dev Med Child Neurol 2024; 66:440-444. [PMID: 37448317 DOI: 10.1111/dmcn.15692] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/06/2023] [Indexed: 07/15/2023]
Abstract
The experience with neurostimulation for childhood epilepsy is far less extensive than for adults. Nevertheless, the implementation of these techniques could be of great value, especially considering the detrimental effects of ongoing seizures on the developing brain. In this review, we discuss the available evidence for neurostimulation for childhood epilepsy. Vagus nerve stimulation (VNS) is the most studied neurostimulation modality in children. Based on mostly retrospective, open-label studies, we can conclude that VNS has a similar safety and efficacy profile in children compared to adults. Although there is little available evidence for deep brain stimulation (DBS) and responsive neurostimulation (RNS) in children, both DBS and RNS show promise in reducing seizure frequency with few complications. The implementation of non-invasive techniques with a more appealing safety profile has gained interest. Small randomized control trials and open-label studies have investigated transcranial direct current simulation for childhood epilepsy, demonstrating promising but inconsistent findings.
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Affiliation(s)
- Ann Mertens
- Department of Neurology, 4Brain, Ghent University Hospital, Ghent, Belgium
| | - Paul Boon
- Department of Neurology, 4Brain, Ghent University Hospital, Ghent, Belgium
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Kristl Vonck
- Department of Neurology, 4Brain, Ghent University Hospital, Ghent, Belgium
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Sepulveda R, Chong J, Shegog R, Martin K, Begley C, Addy R, Rosales O, Nuño T, Soto S, Rosales C, Labiner D. Experiences of using the MINDSET Self-Management mobile health app among Hispanic Patients:Results of a qualitative study. Epilepsy Behav 2024; 153:109702. [PMID: 38412570 DOI: 10.1016/j.yebeh.2024.109702] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Interventions focusing on epilepsy self-management (ESM) are vital for promoting the health of people living with epilepsy. E-technology and mobile health (mHealth) tools are becoming increasingly integrated into practice to promote self-management strategies for chronic diseases, enhance care delivery, and reduce health disparities. Management Information and Decision Support Epilepsy Tool (MINDSET), a bilingual decision support tool (available in English and Spanish), was found to be both feasible and effective in facilitating goal-based ESM in the clinic. PURPOSE To assess the experience of using MINDSET as an ESM intervention among Hispanic patients with epilepsy to inform future interventional studies. METHODS This study used a Qualitative Descriptive (QD) framework to provide a rich and straightforward description of patients' subjective experiences using MINDSET. Participants were enrolled in the intervention group of a larger parent study (RCT) to assess the efficacy of MINDSET among Hispanic People with Epilepsy (PWE). The purposive, convenient, criterion-based sample for this qualitative analysis comprised of 42 patients who agreed to participate in a semi-structured interview at the end of the larger RCT. This RCT was conducted between August 2017 and January 2019. Spanish and English-speaking Hispanic adult patients (n = 94) with epilepsy in Arizona (n = 53) and Texas (n = 41) were randomly assigned within 6 neurology clinics to treatment (MINDSET plus Usual Care, hereafter referred to as MINDSET; n = 46) and comparison (Usual Care Only; n = 48) conditions. RESULTS Patient demographics, epilepsy conditions, and ESM behavioral characteristics were representative of the intervention group. Study participants were Hispanic, mainly of Mexican descent (94 %), with a mean age of 39 years, mostly female (53 %), and most of the participants reported having had one or more seizures per month (54 %). The MINDSET intervention revealed five ESM themes: (1) Awareness and Realization of Epilepsy Self-Management, (2) Communication and Partnership with Health Care Providers HCP, (3) Epilepsy Self-Management and Quality of Life, (4) Seizure Control, and (5) Optimism and Agency. CONCLUSION The participants who used MINDSET as a self-management intervention reported an overall positive experience. Qualitative data in this study show that MINDSET is a valuable ESM tool for Hispanic patients with epilepsy. Findings from this qualitative study were consistent with results from a larger parent study that recognized MINDSET as an effective platform for improving epilepsy self-management adherence.
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Affiliation(s)
- Refugio Sepulveda
- University of Arizona, Department of Neurology, College of Medicine, Tucson, AZ; University of Arizona, Division of Public Health Practice & Translational Research, Mel & Enid Zuckerman College of Public Health, Phoenix, AZ.
| | - Jenny Chong
- University of Arizona, Department of Neurology, College of Medicine, Tucson, AZ
| | - Ross Shegog
- University of Texas School of Public Health, Behavioral Science, Houston, TX, United States of America
| | - Kimberly Martin
- Epilepsy Foundation Central & South Texas, San Antonio, TX, United States of America
| | - Charles Begley
- University of Texas School of Public Health, Behavioral Science, Houston, TX, United States of America
| | - Robert Addy
- University of Texas School of Public Health, Behavioral Science, Houston, TX, United States of America
| | - Omar Rosales
- University of Arizona, Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, Tucson, AZ
| | - Tomas Nuño
- University of Arizona, Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, Tucson, AZ
| | - Shiela Soto
- University of Arizona, Division of Public Health Practice & Translational Research, Mel & Enid Zuckerman College of Public Health, Phoenix, AZ
| | - Cecilia Rosales
- University of Arizona, Division of Public Health Practice & Translational Research, Mel & Enid Zuckerman College of Public Health, Phoenix, AZ
| | - David Labiner
- University of Arizona, Department of Neurology, College of Medicine, Tucson, AZ
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Gandy M, Dudeney J. Integrated psychological care for youth with epilepsy. Lancet 2024; 403:1208-1209. [PMID: 38461836 DOI: 10.1016/s0140-6736(24)00309-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/12/2024] [Indexed: 03/12/2024]
Affiliation(s)
- Milena Gandy
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sidney NSW 2109, Australia.
| | - Joanne Dudeney
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sidney NSW 2109, Australia
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Bennett SD, Cross JH, Chowdhury K, Ford T, Heyman I, Coughtrey AE, Dalrymple E, Byford S, Chorpita B, Fonagy P, Moss-Morris R, Reilly C, Smith JA, Stephenson T, Varadkar S, Blackstone J, Quartly H, Hughes T, Lewins A, Moore E, Walji F, Welch A, Whelan E, Zacharia A, D'Oelsnitz A, Shah M, Xu L, Vezyroglou A, Mitchell K, Nizza IE, Ganguli P, Shafran R. Clinical effectiveness of the psychological therapy Mental Health Intervention for Children with Epilepsy in addition to usual care compared with assessment-enhanced usual care alone: a multicentre, randomised controlled clinical trial in the UK. Lancet 2024; 403:1254-1266. [PMID: 38461840 DOI: 10.1016/s0140-6736(23)02791-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/16/2023] [Accepted: 12/11/2023] [Indexed: 03/12/2024]
Abstract
BACKGROUND Mental health difficulties are common in children and young people with chronic health conditions, but many of those in need do not access evidence-based psychological treatments. The study aim was to evaluate the clinical effectiveness of integrated mental health treatment for children and young people with epilepsy, a common chronic health condition known to be associated with a particularly high rate of co-occurring mental health difficulties. METHODS We conducted a parallel group, multicentre, open-label, randomised controlled trial of participants aged 3-18 years, attending epilepsy clinics across England and Northern Ireland who met diagnostic criteria for a common mental health disorder. Participants were randomised (1:1; using an independent web-based system) to receive the Mental Health Intervention for Children with Epilepsy (MICE) in addition to usual care, or assessment-enhanced usual care alone (control). Children and young people in both groups received a full diagnostic mental health assessment. MICE was a modular psychological intervention designed to treat common mental health conditions in children and young people using evidence-based approaches such as cognitive behaviour therapy and behavioural parenting strategies. Usual care for mental health disorders varied by site but typically included referral to appropriate services. Participants, along with their caregivers, and clinicians were not masked to treatment allocation but statisticians were masked until the point of analysis. The primary outcome, analysed by modified intention-to-treat, was the parent-report Strengths and Difficulties Questionnaire (SDQ) at 6 months post-randomisation. The study is complete and registered with ISRCTN (57823197). FINDINGS 1401 young people were potentially deemed eligible for study inclusion. Following the exclusion of 531 young people, 870 participants were assessed for eligibility and completed the SDQ, and 480 caregivers provided consent for study inclusion between May 20, 2019, and Jan 31, 2022. Between Aug 28, 2019, and Feb 21, 2022, 334 participants (mean ages 10·5 years [SD 3·6] in the MICE group vs 10·3 [4·0] in control group at baseline) were randomly assigned to an intervention using minimisation balanced by age, primary mental health disorder, diagnosis of intellectual disability, and autistic spectrum disorder at baseline. 168 (50%) of the participants were female and 166 (50%) were male. 166 participants were randomly assigned to the MICE group and 168 were randomly assigned to the control group. At 6 months, the mean SDQ difficulties for the 148 participants in the MICE group was 17·6 (SD 6·3) and 19·6 (6·1) for the 148 participants in the control group. The adjusted effect of MICE was -1·7 (95% CI -2·8 to -0·5; p=0·0040; Cohen's d, 0·3). 14 (8%) patients in the MICE group experienced at least one serious adverse event compared with 24 (14%) in the control group. 68% percent of serious adverse events (50 events) were admission due to seizures. INTERPRETATION MICE was superior to assessment-enhanced usual care in improving symptoms of emotional and behavioural difficulties in young people with epilepsy and common mental health disorders. The trial therefore shows that mental health comorbidities can be effectively and safely treated by a variety of clinicians, utilising an integrated intervention across ages and in the context of intellectual disability and autism. The evidence from this trial suggests that such a model should be fully embedded in epilepsy services and serves as a model for other chronic health conditions in young people. FUNDING UK National Institute for Health Research Programme Grants for Applied Research programme and Epilepsy Research UK Endeavour Project Grant.
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Affiliation(s)
- Sophie D Bennett
- UCL Great Ormond Street Institute of Child Health, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK; Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - J Helen Cross
- UCL Great Ormond Street Institute of Child Health, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK; Young Epilepsy, Surrey, UK
| | - Kashfia Chowdhury
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | - Tamsin Ford
- Department of Psychiatry, Cambridge University, Cambridge, UK; Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK; Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Anna E Coughtrey
- UCL Great Ormond Street Institute of Child Health, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Emma Dalrymple
- UCL Great Ormond Street Institute of Child Health, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Peter Fonagy
- Division of Psychology & Language Sciences, University College London, London, UK
| | - Rona Moss-Morris
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Jonathan A Smith
- School of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Terence Stephenson
- UCL Great Ormond Street Institute of Child Health, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Sophia Varadkar
- UCL Great Ormond Street Institute of Child Health, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - James Blackstone
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | - Harriet Quartly
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | - Tyler Hughes
- UCL Great Ormond Street Institute of Child Health, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Amy Lewins
- UCL Great Ormond Street Institute of Child Health, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Elana Moore
- UCL Great Ormond Street Institute of Child Health, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Fahreen Walji
- UCL Great Ormond Street Institute of Child Health, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Alice Welch
- UCL Great Ormond Street Institute of Child Health, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Emily Whelan
- UCL Great Ormond Street Institute of Child Health, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Alice Zacharia
- UCL Great Ormond Street Institute of Child Health, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Anaïs D'Oelsnitz
- UCL Great Ormond Street Institute of Child Health, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Mariam Shah
- UCL Great Ormond Street Institute of Child Health, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Laila Xu
- UCL Great Ormond Street Institute of Child Health, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Aikaterini Vezyroglou
- UCL Great Ormond Street Institute of Child Health, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Kirsten Mitchell
- UCL Great Ormond Street Institute of Child Health, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Isabella E Nizza
- School of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Poushali Ganguli
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
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Xiao W, Li P, Kong F, Kong J, Pan A, Long L, Yan X, Xiao B, Gong J, Wan L. Unraveling the Neural Circuits: Techniques, Opportunities and Challenges in Epilepsy Research. Cell Mol Neurobiol 2024; 44:27. [PMID: 38443733 PMCID: PMC10914928 DOI: 10.1007/s10571-024-01458-5] [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: 12/25/2023] [Accepted: 01/24/2024] [Indexed: 03/07/2024]
Abstract
Epilepsy, a prevalent neurological disorder characterized by high morbidity, frequent recurrence, and potential drug resistance, profoundly affects millions of people globally. Understanding the microscopic mechanisms underlying seizures is crucial for effective epilepsy treatment, and a thorough understanding of the intricate neural circuits underlying epilepsy is vital for the development of targeted therapies and the enhancement of clinical outcomes. This review begins with an exploration of the historical evolution of techniques used in studying neural circuits related to epilepsy. It then provides an extensive overview of diverse techniques employed in this domain, discussing their fundamental principles, strengths, limitations, as well as their application. Additionally, the synthesis of multiple techniques to unveil the complexity of neural circuits is summarized. Finally, this review also presents targeted drug therapies associated with epileptic neural circuits. By providing a critical assessment of methodologies used in the study of epileptic neural circuits, this review seeks to enhance the understanding of these techniques, stimulate innovative approaches for unraveling epilepsy's complexities, and ultimately facilitate improved treatment and clinical translation for epilepsy.
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Affiliation(s)
- Wenjie Xiao
- Department of Anatomy and Neurobiology, Central South University Xiangya Medical School, Changsha, Hunan Province, China
| | - Peile Li
- Department of Anatomy and Neurobiology, Central South University Xiangya Medical School, Changsha, Hunan Province, China
| | - Fujiao Kong
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Jingyi Kong
- Department of Anatomy and Neurobiology, Central South University Xiangya Medical School, Changsha, Hunan Province, China
| | - Aihua Pan
- Department of Anatomy and Neurobiology, Central South University Xiangya Medical School, Changsha, Hunan Province, China
| | - Lili Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoxin Yan
- Department of Anatomy and Neurobiology, Central South University Xiangya Medical School, Changsha, Hunan Province, China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Jiaoe Gong
- Department of Neurology, Hunan Children's Hospital, Changsha, Hunan Province, China.
| | - Lily Wan
- Department of Anatomy and Neurobiology, Central South University Xiangya Medical School, Changsha, Hunan Province, China.
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Zhang M, Yang L, Li Z, Fei F, Zhou Y, Jiang D, Zheng Y, Cheng H, Wang Y, Xu C, Fang J, Wang S, Chen Z, Wang Y. Low-frequency stimulation in the zona incerta attenuates seizure via driving GABAergic neuronal activity. Neurobiol Dis 2024; 192:106424. [PMID: 38290566 DOI: 10.1016/j.nbd.2024.106424] [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: 11/19/2023] [Revised: 01/15/2024] [Accepted: 01/26/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Managing refractory epilepsy presents a significant a substantial clinical challenge. Deep brain stimulation (DBS) has emerged as a promising avenue for addressing refractory epilepsy. However, the optimal stimulation targets and effective parameters of DBS to reduce seizures remian unidentified. OBJECTIVES This study endeavors to scrutinize the therapeutic potential of DBS within the zona incerta (ZI) across diverse seizure models and elucidate the associated underlying mechanisms. METHODS We evaluated the therapeutic potential of DBS with different frequencies in the ZI on kainic acid (KA)-induced TLE model or M1-cortical seizures model, pilocarpine-induced M1-cortical seizure models, and KA-induced epilepsy model. Further, employing calcium fiber photometry combined with cell-specific ablation, we sought to clarified the causal role of ZI GABAergic neurons in mediating the therapeutic effects of DBS. RESULTS Our findings reveal that DBS in the ZI alleviated the severity of seizure activities in the KA-induced TLE model. Meanwhile, DBS attenuated seizure activities in KA- or pilocarpine-induced M1-cortical seizure model. In addition, DBS exerts a mitigating influence on KA induced epilepsy model. DBS in the ZI showed anti-seizure effects at low frequency spectrum, with 5 Hz exhibiting optimal efficacy. The low-frequency DBS significantly increased the calcium activities of ZI GABAergic neurons. Furthermore, selective ablation of ZI GABAergic neurons with taCasp3 blocked the anti-seizure effect of low-frequency DBS, indicating the anti-seizure effect of DBS is mediated by the activation of ZI GABAergic neurons. CONCLUSION Our results demonstrate that low-frequency DBS in the ZI attenuates seizure via driving GABAergic neuronal activity. This suggests that the ZI represents a potential DBS target for treating both hippocampal and cortical seizure through the activation of GABAergic neurons, thereby holding therapeutic significance for seizure treatment.
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Affiliation(s)
- Mengdi Zhang
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, PR China; Zhejiang Rehabilitation Medical Center, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, PR China
| | - Lin Yang
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, PR China; First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, PR China
| | - Zhongxia Li
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, PR China
| | - Fan Fei
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, PR China
| | - Yuan Zhou
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, PR China
| | - Dongxiao Jiang
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, PR China
| | - Yuyi Zheng
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, PR China
| | - Hui Cheng
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, PR China
| | - Yu Wang
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, PR China
| | - Cenglin Xu
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, PR China
| | - Jiajia Fang
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital & Forth Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Shuang Wang
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital & Forth Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Zhong Chen
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, PR China; Epilepsy Center, Department of Neurology, Second Affiliated Hospital & Forth Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China.
| | - Yi Wang
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, PR China; Zhejiang Rehabilitation Medical Center, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, PR China; Epilepsy Center, Department of Neurology, Second Affiliated Hospital & Forth Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China.
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Mercier A, Dorris L. A systematic review of psychosocial interventions for children and young people with epilepsy. Eur J Paediatr Neurol 2024; 49:35-44. [PMID: 38364750 DOI: 10.1016/j.ejpn.2024.02.002] [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: 10/06/2023] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Epilepsy is a lifelong neurological disorder that has a profound impact on the lives of millions of children and young people throughout the world, and is linked with mental ill-health and a poorer quality of life. Psychosocial interventions have showed promise for children and young people with epilepsy (CYPE), however there is an absence of large-scale RCT's that would add robustness to the evidence base. The present systematic review provides an update and extension of findings from an earlier review by Corrigan et al. to assess the state of the literature in 2023. METHODS The present systematic review carried out a search of six electronic databases. Forward and backward chaining was carried out on review articles as well as the studies returned through the search to source additional studies. In total, ten articles were included in this review and appraised for quality using the Crowe Critical Appraisal Tool (CCAT). RESULTS Forty percent (4/10) of the included studies were rated as high quality according to the CCAT, which represents a significant proportional increase since Corrigan et al.'s review. A meta-analysis of results was not possible due to significant methodological heterogeneity, and the variability of outcome measures, however effect sizes were reported or calculated for the majority of studies (7/10), which facilitated comparison. Despite the issues of relatively small samples, there are promising findings with regard to psychosocial interventions increasing epilepsy knowledge, coping strategies, self-efficacy, and quality of life markers. CONCLUSIONS There is a growing evidence base supporting the efficacy of psychosocial interventions for children and young people with epilepsy. This evidence base is also increasing in quality. Particular components of treatment that prove to be effective include psychoeducation, components based on cognitive behavioural therapy principles, as well as mindfulness techniques. This aligns with the evidence-based recommendations for adult populations. Intervention goals centre around improving quality of life, reducing symptom distress, and increasing knowledge and skills. The instruments used to measure these outcomes are predominantly standardised, however remain heterogeneous between studies which impacts the overall robustness of the evidence base.
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Affiliation(s)
| | - Liam Dorris
- School of Health and Wellbeing, University of Glasgow, UK; Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK.
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Budhiraja A, Mehta A, Alhamo MA, Swedarsky R, Dahle S, Isseroff RR. Vagus nerve stimulation: Potential for treating chronic wounds. Wound Repair Regen 2024; 32:108-117. [PMID: 38235529 DOI: 10.1111/wrr.13151] [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: 07/23/2023] [Revised: 11/16/2023] [Accepted: 12/10/2023] [Indexed: 01/19/2024]
Abstract
Vagus nerve stimulation (VNS) has been approved as a treatment for various conditions, including drug-resistant epilepsy, migraines, chronic cluster headaches and treatment-resistant depression. It is known to have anti-inflammatory, anti-nociceptive and anti-adrenergic effects, and its therapeutic potential for diverse pathologies is being investigated. VNS can be achieved through invasive (iVNS) or non-invasive (niVNS) means, targeting different branches of the vagus nerve. iVNS devices require surgical implantation and have associated risks, while niVNS devices are generally better tolerated and have a better safety profile. Studies have shown that both iVNS and niVNS can reduce inflammation and pain perception in patients with acute and chronic conditions. VNS devices, such as the VNS Therapy System and MicroTransponder Vivistim, have received Food and Drug Administration approval for specific indications. Other niVNS devices, like NEMOS and gammaCore, have shown effectiveness in managing epilepsy, pain and migraines. VNS has also demonstrated potential in autoimmune disorders, such as rheumatoid arthritis and Crohn's disease, as well as neurological disorders like epilepsy and migraines. In addition, VNS has been explored in cardiovascular disorders, including post-operative atrial fibrillation and myocardial ischemia-reperfusion injury, and has shown positive outcomes. The mechanisms behind VNS's effects include the cholinergic anti-inflammatory pathway, modulation of cytokines and activation of specialised pro-resolving mediators. The modulation of inflammation by VNS presents a promising avenue for investigating its potential to improve the healing of chronic wounds. However, more research is needed to understand the specific mechanisms and optimise the use of VNS in wound healing. Ongoing clinical trials may support the use of this modality as an adjunct to improve healing.
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Affiliation(s)
- Anuj Budhiraja
- California Northstate University College of Medicine, Elk Grove, California, USA
| | - Alisha Mehta
- California Northstate University College of Medicine, Elk Grove, California, USA
| | - Moyasar A Alhamo
- Department of Dermatology, University of California, Davis, California, USA
| | | | - Sara Dahle
- Department of Dermatology, University of California, Davis, California, USA
- Podiatry Section, VA Northern California Health Care System, California, USA
| | - R Rivkah Isseroff
- Department of Dermatology, University of California, Davis, California, USA
- Dermatology Section, VA Northern California Health Care System, California, USA
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Monfort E, Latour P. Fostering patient engagement through the co-design of seizure detection and monitoring technologies: A roadmap for collaboration between research and development. Rev Neurol (Paris) 2024; 180:211-215. [PMID: 38040546 DOI: 10.1016/j.neurol.2023.10.005] [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: 07/23/2023] [Accepted: 10/02/2023] [Indexed: 12/03/2023]
Abstract
The large number of technological developments suggests that patients with epilepsy can be better supported in the management of their seizures, especially when their condition is drug resistant. Patients and their caregivers, who are generally supportive of seizure detection and monitoring technologies, can provide relevant information to improve their effectiveness. We propose a comprehensive co-design approach to support more efficient development of seizure detection and monitoring technologies. Such an approach should follow the steps of the research and development process, take into account the temporal requirements characteristic of seizure management, focus on the themes of autonomy and self-management, and be guided by disease experts. If co-design practices are to continue to contribute to their development, they must also meet the scientific requirements of validity and reproducibility.
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Affiliation(s)
- E Monfort
- University of Grenoble Alpes, CNRS, TIMC, UFR SHS, 1251, avenue Centrale, CS 40700, 38000 Grenoble cedex 9, France.
| | - P Latour
- Medical Center of La Teppe, 26600 Tain-l'Hermitage, France
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Sharma A, Parfyonov M, Tiefenbach J, Hogue O, Nero N, Jehi L, Serletis D, Bingaman W, Gupta A, Rammo R. Predictors of therapeutic response following thalamic neuromodulation for drug-resistant pediatric epilepsy: A systematic review and individual patient data meta-analysis. Epilepsia 2024; 65:542-555. [PMID: 38265348 DOI: 10.1111/epi.17883] [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: 08/23/2023] [Revised: 12/02/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
We sought to perform a systematic review and individual participant data meta-analysis to identify predictors of treatment response following thalamic neuromodulation in pediatric patients with medically refractory epilepsy. Electronic databases (MEDLINE, Ovid, Embase, and Cochrane) were searched, with no language or data restriction, to identify studies reporting seizure outcomes in pediatric populations following deep brain stimulation (DBS) or responsive neurostimulation (RNS) implantation in thalamic nuclei. Studies featuring individual participant data of patients with primary or secondary generalized drug-resistant epilepsy were included. Response to therapy was defined as >50% reduction in seizure frequency from baseline. Of 417 citations, 21 articles reporting on 88 participants were eligible. Mean age at implantation was 13.07 ± 3.49 years. Fifty (57%) patients underwent DBS, and 38 (43%) RNS. Sixty (68%) patients were implanted in centromedian nucleus and 23 (26%) in anterior thalamic nucleus, and five (6%) had both targets implanted. Seventy-four (84%) patients were implanted bilaterally. The median time to last follow-up was 12 months (interquartile range = 6.75-26.25). Sixty-nine percent of patients achieved response to treatment. Age, target, modality, and laterality had no significant association with response in univariate logistic regression. Until thalamic neuromodulation gains widespread approval for use in pediatric patients, data on efficacy will continue to be limited to small retrospective cohorts and case series. The inherent bias of these studies can be overcome by using individual participant data. Thalamic neuromodulation appears to be a safe and effective treatment for epilepsy. Larger, prolonged prospective, multicenter studies are warranted to further evaluate the efficacy of DBS over RNS in this patient population where resection for curative intent is not a safe option.
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Affiliation(s)
- Akshay Sharma
- Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Maksim Parfyonov
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jakov Tiefenbach
- Center for Neurologic Restoration, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Olivia Hogue
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Neil Nero
- Education Institute, Floyd D. Loop Alumni Library, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lara Jehi
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Demitre Serletis
- Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - William Bingaman
- Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ajay Gupta
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Richard Rammo
- Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Center for Neurologic Restoration, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Zhao T, Zhang X, Cui X, Chen Y, Wang N, Bin Wang, Ren Z, Sun L, Zhao P, Xu J, Han X. Awareness, attitudes and first aid knowledge of epilepsy among university students - A cross-sectional study in Henan Province, China. Epilepsy Res 2024; 201:107315. [PMID: 38364765 DOI: 10.1016/j.eplepsyres.2024.107315] [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: 11/01/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE Epilepsy is a debilitating disease that can lead to series of social and psychological issues, impairing the quality of life of people with epilepsy (PWE). This survey aimed to investigate the awareness, attitudes, and first-aid knowledge of epilepsy in university students METHOD: This cross-sectional study was conducted in Henan Province, China between January 1 and April 30, 2022. Students majored in education, medicine, science and engineering from 8 universities attended the study. The survey questionnaire comprised 28 questions covering 4 sections: demographic characteristics, awareness of epilepsy, attitudes toward PWE and knowledge of first aid for seizures. RESULTS A total of 2376 university students completed the questionnaire. 94.7% heard of epilepsy. In the first aid knowledge section, individual question was correctly answered by at least 50% students, 9.3% students correctly answered all questions. Attitude toward PWE was independently (R2 =0.108, F=73.227, p < 0.001) associated with both awareness of epilepsy (B=0.411, p < 0.001) and first aid knowledge of epilepsy (B=0.047, p = 0.001). Among the three majors, medical students had more positive attitudes toward PWE than students majored in education, science and engineering (p < 0.05). However, medical students performed worse among the groups when answering the first aid knowledge questions. CONCLUSION This survey showed that university students in Central China had a good awareness of epilepsy. For medical students, improvements are necessary for the awareness of the first aid knowledge for seizure.
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Affiliation(s)
- Ting Zhao
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Xuefei Zhang
- Department of Basic Medicine, Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Xiaoxiao Cui
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Yanan Chen
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Na Wang
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Bin Wang
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Zhe Ren
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Lei Sun
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Pan Zhao
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Jun Xu
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Xiong Han
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China.
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