Global Health and Epilepsy: Update and Future Directions.

PURPOSE OF REVIEW: Efforts to improve epilepsy care outcomes in low- and middle-income countries (LMICs) are occurring through global health work. Despite an increase in these efforts, several barriers exist and a significant epilepsy treatment gap remains. This paper will review barriers to epilepsy care in LMICs and summarize recent published and unpublished data about global health projects which aimed to improve epilepsy care in these regions, focusing on work in the past 5 years. RECENT FINDINGS: There are multiple recent and ongoing projects including clinical, research, education, and advocacy programs. We conclude that collaborative efforts are necessary in order to develop long-term and sustainable projects. The creation of a database and a formal method of communication between stakeholders can contribute to improving the efficiency and impact of global health efforts in epilepsy.

How can transition to adult care be best orchestrated for adolescents with epilepsy?

Objective evidence is limited for the value of transition programs for youth with chronic illness moving from pediatric to adult care; however, such programs intuitively "make sense". We describe the strengths and weaknesses of a variety of transition programs from around the world for adolescents with epilepsy. Consequences of poorly organized transition beyond suboptimal seizure control may include an increased risk of sudden unexpected death in epilepsy (SUDEP), poor psychological and social outcome, and inadequate management of comorbidities. The content of transition programs for those with normal intelligence differs from those with intellectual disability, but both groups may benefit from an emphasis on sporting activities. Concerns that may interfere with optimal transition include lack of nursing or social work services, limited numbers of adult neurologists/epileptologists confident in the treatment of complex pediatric epilepsy problems, institutional financial support, and time constraints for pediatric and adult physicians who treat epilepsy and the provision of multidisciplinary care. Successful programs eventually need to rely on a several adult physicians, nurses, and other key healthcare providers and use novel approaches to complex care. More research is needed to document the value and effectiveness of transition programs for youth with epilepsy to persuade institutions and healthcare professionals to support these ventures.

Position Statement on the Use of Medical Cannabis for the Treatment of Epilepsy in Canada.

In Canada, recreational use of cannabis was legalized in October 2018. This policy change along with recent publications evaluating the efficacy of cannabis for the medical treatment of epilepsy and media awareness about its use have increased the public interest about this agent. The Canadian League Against Epilepsy Medical Therapeutics Committee, along with a multidisciplinary group of experts and Canadian Epilepsy Alliance representatives, has developed a position statement about the use of medical cannabis for epilepsy. This article addresses the current Canadian legal framework, recent publications about its efficacy and safety profile, and our understanding of the clinical issues that should be considered when contemplating cannabis use for medical purposes.

Énoncé de position quant à l'utilisation du cannabis médical dans le traitement de l'épilepsie. L'utilisation du cannabis à des fins récréatives a été légalisée au Canada en octobre 2018. Parallèlement à ce changement de politique, de récentes publication visant à évaluer l'efficacité du cannabis dans le traitement de l'épilepsie, de même qu'une sensibilisation médiatique accrue en ce qui concerne son utilisation, ont eu pour effet d'augmenter l'intérêt du grand public à son égard. Le Comité médical thérapeutique de la Ligue canadienne contre l'épilepsie (LCCE), de concert avec un groupe multidisciplinaire d'experts et des représentants de l'Alliance canadienne de l'épilepsie, a ainsi élaboré un énoncé de position en ce qui regarde l'utilisation du cannabis médical dans le traitement de l'épilepsie. Cet article entend donc aborder le cadre légal qui prévaut actuellement au Canada et examiner de récentes publications s'étant penchées sur le profil sécuritaire et sur l'efficacité du cannabis. De plus, nous voulons apporter un éclairage au sujet des aspects cliniques dont il faudrait tenir compte au moment d'envisager l'utilisation du cannabis à des fins médicales.

Depth electrodes in pediatric epilepsy surgery.

BACKGROUND: The surgical removal of the epileptogenic zone in medically intractable seizures depends on accurate localization to minimize the neurological sequelae and prevent future seizures. To date, few studies have demonstrated the use of depth electrodes in a pediatric epilepsy population. Here, we report our study of pediatric epilepsy patients at our epilepsy center who were successfully operated for medically intractable seizures following the use of intracranial depth electrodes. In addition, we detail three individuals with distinct clinical scenarios in which depth electrodes were helpful and describe our technical approach to implantation and surgery. METHODS: We retrospectively reviewed 18 pediatric epilepsy patients requiring depth electrode studies who presented at the University of Alberta Comprehensive Epilepsy Program between 1999 and 2010 with medically intractable epilepsy. Patients underwent cortical resection following depth electrode placement according to the Comprehensive Epilepsy Program surgical protocols after failure of surface electroencephalogram and magnetic resonance imaging to localize ictal onset zone. RESULT: The ictal onset zone was successfully identified in all 18 patients. Treatment of all surgical patients resulted in successful seizure freedom (Engel class I) without neurological complications. CONCLUSION: Intracranial depth electrode use is safe and able to provide sufficient information for the identification of the epileptogenic zone in pediatric epilepsy patients previously not considered for epilepsy surgery.

Parent Satisfaction With Pediatric Nurse Practitioner Care in Specialty Services.

INTRODUCTION: This study examined parent satisfaction with care provided to their children by Pediatric Nurse Practitioners (PNPs) in specialty areas at a tertiary care pediatric hospital. METHOD: A convenience sample of parents of children cared for by 19 PNPs in different specialty settings completed a confidential survey consisting of demographic information and the Parents' Perception of Satisfaction with Care from the Pediatric Nurse Practitioners Instrument (PPSC-PNP). Data were analyzed using SPSS (IBM, Armonk, NY). RESULTS: The overall PPSC-PNP mean score was 129.82/140. Mean subscale scores ranged from 27.15 to 28.51/30. The general satisfaction score showed a mean score of 18.31/20. No statistical difference was found in parental satisfaction when scores were analyzed by the child's age, parent participant, or patient setting. DISCUSSION: These findings indicate that parents are highly satisfied with the care their children receive from PNPs across various subspecialties regardless of the child's age and clinical setting.

Development and implementation of an adolescent epilepsy transition clinic.

This article describes the collaborative development of a nurse-led transition clinic within the Comprehensive Epilepsy Program at the Stollery Children's Hospital and at the University of Alberta Hospital. Developed in 2005, our program has been instrumental in assisting 97 teens and their parents' transition from pediatric to adult epilepsy care. Through our Adolescent Epilepsy Transition Clinic, we address concerns expressed by teens and their parents when shifting from pediatric to adult healthcare services, including fear of the unknown, change in appointment location, loss of established relationships, and anticipated decrease in the quality of care posttransition. We also address concerns of adult and pediatric healthcare providers related to the adolescents' working knowledge of how their particular type of epilepsy and its management interact with typical adolescent developmental challenges and future career and lifestyle choices. The results from a process evaluation are presented and offer new insights for improving adolescent transition.

Discontinuation of antiepileptic drugs after pediatric epilepsy surgery.

In children with medically intractable seizures, epilepsy surgery is now a widely accepted option. Successful discontinuation of antiepileptic drugs after epilepsy surgery has been reported in adults, but rarely in children. Surgical outcome and need for antiepileptic drugs after temporal and extratemporal lobe resection were retrospectively reviewed for 80 pediatric patients from the Comprehensive Epilepsy Program at the University of Alberta. For 1 year after surgery, children were maintained on at least one antiepileptic drug. Antiepileptic drug discontinuation was attempted in all patients with a nonepileptic electroencephalogram after 1 year seizure-free. Less than half of the patients (44%) eventually relapsed without antiepileptic drugs. Of the 40 patients in the temporal lobe group, 13 (32%) relapsed without antiepileptic drugs, as did 22 of the 40 extratemporal lobe resection patients (55%). Success rates for antiepileptic drug discontinuation after surgery were higher in the temporal lobe than in the extratemporal lobe group. Long-term antiepileptic drugs are not necessary in all cases, and for many children medication can be withdrawn after epilepsy surgery.

Intelligence quotient is not affected by epilepsy surgery in childhood.

Epilepsy surgery is known to help children with intractable seizures. The effect of epilepsy surgery itself on cognition in childhood is less well studied. We report our experience at the University of Alberta Hospital on the effects of epilepsy surgery on cognition. All children undergoing epilepsy surgery at the Comprehensive Epilepsy Program from 1990-2005 were examined. Sixty-seven patients received both preoperative and postoperative neuropsychologic evaluations. We compared verbal, performance, and full scale intelligent quotients and the Child Behavioral Checklist preoperatively and postoperatively. Forty-eight patients demonstrated excellent surgical outcomes, with significant reductions in disabling seizures. Overall, no significant change occurred in neuropsychologic parameters examined after surgery. Epilepsy surgery in childhood offers excellent surgical outcomes for seizure control, and does not adversely affect intelligence quotient.