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1.
Orv Hetil ; 161(46): 1939-1943, 2020 11 15.
Artigo em Húngaro | MEDLINE | ID: mdl-33190124

RESUMO

Összefoglaló. Bevezetés: A COVID-19-járvány világszerte hónapokra átalakította a járóbeteg-ellátás muködését is. Magyarországon a 2020. március 11-tol 2020. június 17-ig fennálló egészségügyi veszélyhelyzeti rendelkezések szabták meg az új kereteket. Célkituzés: Az elso veszélyhelyzeti periódus második felében, 2020. április 22. és 2020. május 5. között mértük fel az epilepsziaellátásban részt vevo orvosok véleményét, hogy milyen mértékben változott a betegek ellátása, és hogyan élték meg a változásokat személyesen. Módszer: Internetes kérdoíves véleményfelmérés történt, a Magyar Epilepszia Liga 2020. április 16-17-re tervezett, de a COVID-19-járvány miatt elhalasztott XV. kongresszusára regisztrált neurológusok között. Kilenc egyszeres vagy többszörös feleletválasztós kérdés és 'szabad kommentár' mezok álltak rendelkezésre. Eredmények: A megkeresett 116 neurológus közül 33-an válaszoltak (28%), összesen 30 kommentár került rögzítésre. 73%-uk szerint a változások komoly nehézséget okoztak, 15%-uk gondolta, hogy ennek súlyos következményei lesznek. Új betegek fogadása 53%-ban leállt, 25%-ban nagy nehézségekbe ütközött. A gondozott betegek problémáit 49%-ban a távvizit lehetoségeivel élve meg tudták oldani, de 24%-ban ez nem sikerült. A beteg távollétében lebonyolított vizitek 68%-a dokumentált telefonbeszélgetések formájában zajlott. Az orvosok kétharmada veszélyeztetve érezte magát, hogy elkapja a vírust, ebbol 40% úgy érezte, nem kap elegendo védelmet, 6% (2 fo) kapta el a fertozést. Következtetés: A COVID-19-járvány a leginkább az új szakvélemények kiadását érintette, de a gondozási feladatokat sem mindig lehetett megfeleloen megoldani. A károkat jelentosen enyhítette az ellátószemélyzet rugalmassága. A telefonvizitek, szükség esetén, az epileptológiában pótolhatják a személyes orvos-beteg találkozásokat. A járvány visszatérésének veszélye miatt a távvizit-alkalmazások technikai fejlesztése és ezek dokumentálási kérdéseinek megoldása fontos. A járványidoszakban a személyzet védelmére nagy figyelmet kell fordítani a fertozodés elkerülése és az orvosok biztonságérzetének fokozása érdekében. Orv Hetil. 2020; 161(46): 1939-1943. INTRODUCTION: COVID-19 pandemic has transformed the operation of outpatient care worldwide for months. The new framework was set in Hungary by the health emergency regulations that existed from 11. 03. 2020 to 17. 06. 2020. OBJECTIVE: In the second half of the emergency period, between 22. 04. 2020 and 05. 05. 2020, we surveyed the opinion of physicians involved in epilepsy care about the extent to which patient care had changed and how they experienced the changes in person. METHOD: An internet questionnaire survey was conducted among neurologists registered for the annual congress of the Hungarian Chapter of the International League Against Epilepsy. Nine single- or multiple-choice questions and 'free comment' fields were available. RESULTS: Of 116 neurologists contacted, 33 responded (28%), and a total of 30 comments were recorded. 73% said the changes caused a serious difficulty, 15% thought it would have serious consequences. Reception of new patients was stopped in 53%, and 25% encountered great difficulties. In 49%, the problems of the cared patients could be solved using remote visits, but 24% could not solve them properly. 68% of outpatient visits took the form of documented telephone conversations. Two-thirds of doctors feared catching the virus, 40% of whom felt they were not getting enough protection. 6% caught the infection. CONCLUSION: The COVID-19 pandemic has mostly affected the issuance of new expert opinions, but care tasks have not always been adequately addressed. The damage was significantly mitigated by the flexibility of the care staff. Telephone visits, if necessary, can replace personal doctor-patient encounters in epileptology. The technical development of remote visit applications and their documentation issues are important. During the pandemic period, great care must be taken to protect staff in order to avoid infection and increase the sense of safety of doctors. Orv Hetil. 2020; 161(46): 1939-1943.


Assuntos
Infecções por Coronavirus , Epilepsia , Pandemias , Pneumonia Viral , Infecções por Coronavirus/epidemiologia , Epilepsia/terapia , Pesquisas sobre Serviços de Saúde , Humanos , Hungria/epidemiologia , Pneumonia Viral/epidemiologia
2.
Epilepsy Behav ; 112: 107483, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33181898

RESUMO

INTRODUCTION: When the SARS-CoV-2 pandemic reached Europe in 2020, a German governmental order forced clinics to immediately suspend elective care, causing a problem for patients with chronic illnesses such as epilepsy. Here, we report the experience of one clinic that converted its outpatient care from personal appointments to telemedicine services. METHODS: Documentations of telephone contacts and telemedicine consultations at the Epilepsy Center Frankfurt Rhine-Main were recorded in detail between March and May 2020 and analyzed for acceptance, feasibility, and satisfaction of the conversion from personal to telemedicine appointments from both patients' and medical professionals' perspectives. RESULTS: Telephone contacts for 272 patients (mean age: 38.7 years, range: 17-79 years, 55.5% female) were analyzed. Patient-rated medical needs were either very urgent (6.6%, n = 18), urgent (23.5%, n = 64), less urgent (29.8%, n = 81), or nonurgent (39.3%, n = 107). Outpatient service cancelations resulted in a lack of understanding (9.6%, n = 26) or anger and aggression (2.9%, n = 8) in a minority of patients, while 88.6% (n = 241) reacted with understanding, or relief (3.3%, n = 9). Telemedicine consultations rather than a postponed face-to-face visit were requested by 109 patients (40.1%), and these requests were significantly associated with subjective threat by SARS-CoV-2 (p = 0.004), urgent or very urgent medical needs (p = 0.004), and female gender (p = 0.024). Telemedicine satisfaction by patients and physicians was high. Overall, 9.2% (n = 10) of patients reported general supply problems due to SARS-CoV-2, and 28.4% (n = 31) reported epilepsy-specific problems, most frequently related to prescriptions, or supply problems for antiseizure drugs (ASDs; 22.9%, n = 25). CONCLUSION: Understanding and acceptance of elective ambulatory visit cancelations and the conversion to telemedicine consultations was high during the coronavirus disease 2019 (COVID-19) lockdown. Patients who engaged in telemedicine consultations were highly satisfied, supporting the feasibility and potential of telemedicine during the COVID-19 pandemic and beyond.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/organização & administração , Infecções por Coronavirus/prevenção & controle , Epilepsia/terapia , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Telemedicina/organização & administração , Adolescente , Adulto , Idoso , Assistência Ambulatorial/métodos , Agendamento de Consultas , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Encaminhamento e Consulta , Telefone , Adulto Jovem
5.
Artigo em Inglês | MEDLINE | ID: mdl-33017927

RESUMO

Vagal Nerve Stimulation (VNS) is an option in the treatment of drug-resistant epilepsy. However, approximately a quarter of VNS subjects does not respond to the therapy. In this retrospective study, we introduce heart-rate features to distinguish VNS responders and non-responders. Standard pre-implantation measurements of 66 patients were segmented in relation to specific stimuli (open/close eyes, photic stimulation, hyperventilation, and rests between). Median interbeat intervals were found for each segment and normalized (NMRR). Five NMRRs were significant; the strongest feature achieved significance with p=0.013 and AUC=0.66. Low mutual correlation and independence on EEG signals mean that presented features could be considered as an addition for models predicting VNS response using EEG.


Assuntos
Epilepsia , Estimulação do Nervo Vago , Eletroencefalografia , Epilepsia/terapia , Frequência Cardíaca , Humanos , Estudos Retrospectivos
6.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2524-2527, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018520

RESUMO

Surgical resection of the seizure onset zone (SOZ) could potentially lead to seizure-freedom in medically refractory epilepsy patients. However, localizing the SOZ can be a time consuming and tedious process involving visual inspection of intracranial electroencephalographic (iEEG) recordings captured during passive patient monitoring. Single pulse electrical stimulation (SPES) is currently performed on patients undergoing invasive EEG monitoring for the main purposes of mapping functional brain networks such as language and motor networks. We hypothesize that evoked responses from SPES can also be used to localize the SOZ as they may express the natural frequencies and connectivity of the iEEG network. To test our hypothesis, we construct patient specific single-input multi-output transfer function models from the evoked responses recorded from five epilepsy patients that underwent SPES evaluation and iEEG monitoring. Our preliminary results suggest that the stimulation electrodes that produced the highest gain transfer functions, as measured by the ${\mathcal{H}_\infty }$ norm, correspond to those electrodes clinically defined in the SOZ in successfully treated patients.Clinical Relevance- This study creates an innovative tool that allows clinicians to identify the seizure onset zone in medically refractory epilepsy patients using quantitative metrics thereby increasing surgical success outcomes, mitigating patient risks, and decreasing costs.


Assuntos
Epilepsia Resistente a Medicamentos , Epilepsia , Epilepsia Resistente a Medicamentos/terapia , Estimulação Elétrica , Eletrocorticografia , Epilepsia/terapia , Humanos , Convulsões/terapia
7.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3384-3387, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018730

RESUMO

Vagus nerve stimulation (VNS) is a neurostimulation therapy for epilepsy and severe depression and has been recently shown to be effective for other conditions. Despite its demonstrated safety and efficacy, long-term and off-target effects of VNS remain to be fully determined. One of the complications reported in epilepsy is stimulation-induced sleep abnormalities. As epilepsy itself can impact sleep quality, contribution of VNS alone in such off-target effects remain mainly unknown. In this study, we analyzed data from long-term VNS experiments in rats to characterize effects of VNS on circadian rhythms derived from heart rate and heart rate variability (HRV). We have also explored possible sex differences in long-term effects of VNS on intrinsic biological rhythms. Compared with control animals, significant VNS-induced changes in circadian rhythms were observed particularly in female rats over 24h and 6h light cycles (1PM-7PM). These findings enhance our understanding of VNS contribution and biological sex role on sleep difficulties reported by using VNS therapy.


Assuntos
Epilepsia , Estimulação do Nervo Vago , Animais , Ritmo Circadiano , Epilepsia/terapia , Feminino , Frequência Cardíaca , Masculino , Ratos
9.
J Pharmacol Sci ; 144(3): 102-118, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32921391

RESUMO

Chronic microglial activation is associated with the pathogenesis of several CNS disorders. Microglia show phenotypic diversity and functional complexity in diseased CNS. Thus, understanding the pathology-specific heterogeneity of microglial behavior is crucial for the future development of microglia-modulating therapy for variety of CNS disorders. This review summarizes up-to-date knowledge on how microglia contribute to CNS homeostasis during development and throughout adulthood. We discuss the heterogeneity of microglial phenotypes in the context of CNS disorders with an emphasis on neurodegenerative diseases, demyelinating diseases, CNS trauma, and epilepsy. We conclude this review with a discussion about the disease-specific heterogeneity of microglial function and how it could be exploited for therapeutic intervention.


Assuntos
Doenças do Sistema Nervoso Central/etiologia , Doenças do Sistema Nervoso Central/terapia , Microglia/patologia , Microglia/fisiologia , Doenças do Sistema Nervoso Central/patologia , Doenças Desmielinizantes/etiologia , Doenças Desmielinizantes/patologia , Doenças Desmielinizantes/terapia , Epilepsia/etiologia , Epilepsia/patologia , Epilepsia/terapia , Homeostase , Humanos , Doenças Neurodegenerativas/etiologia , Doenças Neurodegenerativas/patologia , Doenças Neurodegenerativas/terapia , Fenótipo
10.
Rozhl Chir ; 99(7): 304-310, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32972148

RESUMO

INTRODUCTION: Vagus nerve stimulation is a palliative treatment for patients with refractory epilepsy to reduce the frequency and intensity of seizures. A bipolar helical electrode is placed around the left vagus nerve at the cervical level and is connected to the pulse generator placed in a subcutaneous pocket, most commonly in the subclavian region. METHODS: Between March 1998 and October 2019, we performed 196 procedures related to the vagal nerve stimulation at the Neurosurgery Department in Motol University Hospital. Of these, 126 patients were vagal nerve stimulator implantation surgeries for intractable epilepsy. The cases included 69 female and 57 male patients with mean age at the time of the implantation surgery 22±12.4 years (range 2.158.4 years). RESULTS: Nine patients (7.1%) were afflicted by complications related to implantation. Surgical complications included postoperative infection in 1.6%, VNS-associated arrhythmias in 1.6%, jugular vein bleeding in 0.8% and vocal cord paresis in 2.4%. One patient with vocal cord palsy also suffered from severe dysphagia. One patient (0.8%) did not tolerate extra stimulation with magnet due to a prolonged spasm in his throat. The extra added benefit of vagus stimulation in one patient was a significant reduction of previously regular severe headaches. CONCLUSION: Vagus nerve stimulation is an appropriate treatment for patients with drug-resistant epilepsy who are not candidates for focal resective surgery. Implantation of the vagus nerve stimulator is a relatively safe operative procedure.


Assuntos
Epilepsia/terapia , Estimulação do Nervo Vago/efeitos adversos , Pré-Escolar , Feminino , Humanos , Masculino , Procedimentos Neurocirúrgicos , Complicações Pós-Operatórias , Resultado do Tratamento , Nervo Vago
11.
Epileptic Disord ; 22(4): 439-442, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32759092

RESUMO

The COVID-19 pandemic shook European healthcare systems, with unavoidable gaps in the management of patients with chronic diseases. We describe the impact of the pandemic on epilepsy care in three tertiary epilepsy centres from Spain and Italy, the most affected European countries. The three epilepsy centres, members of the European EpiCARE network, manage more than 5,700 people with epilepsy. In Bologna and Barcelona, the hospitals housing the epilepsy centres were fully converted into COVID-19 units. We describe the reorganization of the clinics and report on the frequency of SARS-CoV-2 in people with epilepsy as well as the frequency of seizures in patients admitted to the COVID units. Finally, we elaborate on critical issues regarding the second phase of the pandemic. The activities related to epilepsy care were reduced to less than 10% and were deprioritized. Discharges were expedited and elective epilepsy surgeries, including vagal nerve stimulator implantations, cancelled. Hospitalizations and EEG examinations were limited to emergencies. The outpatient visits for new patients were postponed, and follow-up visits mostly managed by telehealth. Antiseizure medication weaning plans and changes in vagal nerve stimulator settings were halted. Among the 5,700 people with epilepsy managed in our centres, only 14 tested positive for SARS-CoV-2, without obvious impact on their epilepsy. None of the 2,122 patients admitted to COVID units experienced seizures among the early symptoms. Epilepsy care was negatively impacted by the pandemic, irrespective of COVID-19 epidemiology or conversion of the hospital into a COVID-19 centre. The pandemic did not silence the needs of people with epilepsy, and this must be considered in the planning of the second phase.


Assuntos
Infecções por Coronavirus , Epilepsia/terapia , Necessidades e Demandas de Serviços de Saúde/tendências , Pandemias , Pneumonia Viral , Infecções por Coronavirus/complicações , Eletroencefalografia/estatística & dados numéricos , Epilepsia/complicações , Epilepsia/cirurgia , Europa (Continente) , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Unidades Hospitalares/organização & administração , Hospitalização/estatística & dados numéricos , Humanos , Itália , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Pneumonia Viral/complicações , Convulsões/epidemiologia , Convulsões/etiologia , Espanha , Telemedicina
12.
Epilepsy Behav ; 111: 107282, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32759065

RESUMO

Telehealth's first literature reference is an article in 1879 in the Lancet about using the telephone to reduce unnecessary office visits (Institute of Medicine & Board on Health Care Services, 2012). However, providers have been slow to adopt telehealth into their clinical practice secondary to barriers such as cost and reimbursement (Kane and Gillis, 2018) [2]. The advent of shelter in place orders combined with the ongoing need defined by the Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma "for all Americans, and particularly vulnerable populations who are at heightened risk, to be able to access their providers" has resulted in the rapid implementation of telehealth across multiple specialties. The goal of this paper is to provide a practical framework for translating quality care in epilepsy as defined by the American Academy of Neurology (AAN) guidelines into a virtual care environment. We will also discuss the use and limitations of point of care testing in epilepsy management.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Epilepsia/terapia , Pandemias , Pneumonia Viral , Telemedicina , Criança , Humanos , Convulsões/terapia , Fatores de Tempo
13.
Pediatr Clin North Am ; 67(4): 629-634, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32650859

RESUMO

A team of providers, researchers, patients, and families created a novel telehealth tool to improve communication across a variety of systems involved in pediatric epilepsy care. This tool facilitates in-home telemedicine appointments and saves costs for patients and hospital systems alike within the context of a population highly affected by health care disparities.


Assuntos
Epilepsia/terapia , Telemedicina/métodos , Adolescente , Criança , Comunicação , Epilepsia/economia , Disparidades em Assistência à Saúde , Humanos , Assistência Centrada no Paciente , Telemedicina/economia , Comunicação por Videoconferência
14.
Adv Exp Med Biol ; 1207: 163-169, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32671745

RESUMO

Epilepsy is a long-term neurological disease characterized by convulsions that can be recurrent. It is mainly caused by an imbalance between excitation and inhibition in the central nervous system. Currently, the pathogenesis is still unclear, although it may be related to changes in ion channels, neurotransmitters and glial cells. In recent years, increasing attention has been paid to the role of autophagy in the development of epilepsy. This chapter focuses on the role of the mTOR pathway in epileptogenesis and the relationship between autophagy, glycogen metabolism and Lafora disease and discusses the potential role of autophagy as a target for the treatment of epilepsy.


Assuntos
Autofagia , Epilepsia , Autofagia/efeitos dos fármacos , Epilepsia/terapia , Humanos , Doença de Lafora , Convulsões
15.
J Child Neurol ; 35(13): 924-933, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32666891

RESUMO

OBJECTIVE: To evaluate the effect of the COVID-19 pandemic on global access to care and practice patterns for children with epilepsy. METHODS: We conducted a cross-sectional, online survey of pediatric neurologists across the world affiliated with the International Child Neurology Association, the Chinese Child Neurology Society, the Child Neurology Society, and the Pediatric Epilepsy Research Consortium. Results were analyzed in relation to regional burden of COVID-19 disease. RESULTS: From April 10 to 24, 2020, a sample of 212 respondents from 49 countries indicated that the COVID-19 pandemic has dramatically changed many aspects of pediatric epilepsy care, with 91.5% reporting changes to outpatient care, 90.6% with reduced access to electroencephalography (EEG), 37.4% with altered management of infantile spasms, 92.3% with restrictions in ketogenic diet initiation, 93.4% with closed or severely limited epilepsy monitoring units, and 91.3% with canceled or limited epilepsy surgery. Telehealth use had increased, with 24.7% seeing patients exclusively via telehealth. Changes in practice were related both to COVID-19 burden and location. CONCLUSIONS: In response to COVID-19, pediatric epilepsy programs have implemented crisis standards of care that include increased telemedicine, decreased EEG use, changes in treatments of infantile spasms, and cessation of epilepsy surgery. The long-term impact of these abrupt changes merit careful study.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/métodos , Epilepsia/terapia , Pesquisas sobre Serviços de Saúde/métodos , Internacionalidade , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Telemedicina/métodos , Criança , Estudos Transversais , Eletroencefalografia/estatística & dados numéricos , Saúde Global , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Neurologistas , Neurologia/métodos , Pediatras , Pediatria/métodos
16.
Epilepsy Behav ; 111: 107262, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32645620

RESUMO

Access to quality healthcare remains a challenge that is complicated by mounting pressures to control costs, and now, as we witness, the unprecedented strain placed on our healthcare delivery systems due to the COVID-19 pandemic. Challenges in healthcare access have driven a need for innovative approaches ensuring connectivity to health providers. Telehealth services and virtual clinics offer accessible disease management pathways for patients living in health resource limited areas or, as in the case of the COVID-19 pandemic, where there may be potential barriers to existing healthcare resources. Those suffering with serious chronic disorders often cannot be seen by a healthcare specialist due to their limited availability, or the lack of a specialist within a reasonable proximity. Epilepsy represents such a disorder where most of the world's population lacks the availability of necessary specialists. Virtual clinics allow for specialist care and an ability to perform necessary ambulatory electroencephalogram (EEG) monitoring by placing the technologies directly in patients' homes or at local clinics near the patients' homes. By moving the diagnostic process out of the hospital or epilepsy center, it becomes possible to overcome growing gaps in neurology services. Virtual clinics have the potential to expand access to high-quality, cost-effective care for the patient. The virtual clinic remotely connects those in need of medical support with specialists anywhere in the world, at any time of the day.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Epilepsia/terapia , Pandemias , Pneumonia Viral , Eletroencefalografia , Epilepsia/epidemiologia , Epilepsia/fisiopatologia , Acesso aos Serviços de Saúde , Humanos , Monitorização Ambulatorial , Telemedicina
17.
Epilepsy Behav ; 111: 107238, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32593874

RESUMO

The purpose of this descriptive study was to, from the perspective of adult people with epilepsy (PWE) and caregivers of PWE, explore the effects of the current pandemic and resulting societal changes on epilepsy self-management. Ninety-four respondents completed a mixed-methods quantitative and qualitative survey focused on their epilepsy self-management experiences during the coronavirus disease-19 (COVID-19) pandemic. Respondents noted significant disruption in epilepsy self-management. Lack of ability to obtain medications or see epilepsy providers, as well as increased stress, social isolation, and changes in routine were all reported as troublesome, and more than one-third of the sample reported an increase in seizure frequency since the onset of the pandemic. Suggestions are given regarding how to support PWE during future COVID-19 outbreaks and to better prepare PWE and their caregivers for any life-altering events, such as a pandemic, with robust self-management skills that will allow them to maintain the highest level of function possible.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Epilepsia , Pandemias , Pneumonia Viral , Convulsões , Autogestão , Adulto , Idoso , Idoso de 80 Anos ou mais , Cuidadores , Epilepsia/epidemiologia , Epilepsia/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Convulsões/epidemiologia , Convulsões/terapia , Inquéritos e Questionários , Adulto Jovem
18.
Neurology ; 95(2): e213-e223, 2020 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-32546650

RESUMO

OBJECTIVE: To incorporate standardized documentation into an epilepsy clinic and to use these standardized data to compare patients' perception of epilepsy diagnosis to provider documentation. METHODS: Using quality improvement methodology, we implemented interventions to increase documentation of epilepsy diagnosis, seizure frequency, and type from 49.8% to 70% of adult nonemployee patients seen by 6 providers over 5 months of routine clinical care. The main intervention consisted of an interactive SmartPhrase that mirrored a documentation template developed by the Epilepsy Learning Healthcare System. We assessed the weekly proportion of complete SmartPhrases among eligible patient encounters with a statistical process control chart. We used a subset of patients with established epilepsy care linked to existing patient-reported survey data to examine the proportion of patient-to-provider agreement on epilepsy diagnosis (yes vs no/unsure). We also examined sociodemographic and clinical characteristics of patients who disagreed vs agreed with provider's documentation of epilepsy diagnosis. RESULTS: The median SmartPhrase weekly completion rate was 78%. Established patients disagreed with providers with respect to epilepsy diagnosis in 18.5% of encounters (κ = 0.13), indicating that they did not have or were unsure if they had epilepsy despite having a provider-documented epilepsy diagnosis. Patients who disagreed with providers were similar to those who agreed with respect to age, sex, ethnicity, marital status, seizure frequency, type, and other quality-of-life measures. CONCLUSION: This project supports the feasibility of implementing standardized documentation of data relevant to epilepsy care in a tertiary epilepsy clinic and highlights an opportunity for improvement in patient-provider communication.


Assuntos
Documentação/normas , Epilepsia/terapia , Pessoal de Saúde/normas , Adulto , Comunicação , Epilepsia/psicologia , Feminino , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Qualidade de Vida , Convulsões/classificação , Convulsões/epidemiologia , Fatores Socioeconômicos , Inquéritos e Questionários , Centros de Atenção Terciária/normas , Resultado do Tratamento
19.
Epilepsy Behav ; 111: 107211, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32540769

RESUMO

Teleneurology in Spain had not been implemented so far in clinical practice, except in urgent patients with stroke. Telemedicine was hardly used in epilepsy, and patients and neurologists usually preferred onsite visits. Our goal was to study impressions of adult and pediatric epileptologists about the use of telemedicine after emergent implementation during the new coronavirus 2019 (COVID-19) pandemic. METHODS: An online survey was sent to the members of the Spanish Epilepsy Society and the members of the Epilepsy Study Group of the Catalan Neurological Society, inquiring about different aspects of telemedicine in epilepsy during the pandemic lockdown. RESULTS: A total of 66 neurologists responded, mostly adult neurologists (80.3%), the majority with a monographic epilepsy clinic (4 out of 5). Of all respondents, 59.1% reported to attend more than 20 patients with epilepsy (PWE) a week. During the pandemic, respondents handled their epilepsy clinics mainly with telephone calls (88%); only 4.5% used videoconference. Changes in antiseizure medications were performed less frequently than during onsite visits by 66.6% of the epileptologists. Scales were not administered during these visits, and certain types of information such as sudden expected unrelated death in epilepsy (SUDEP) were felt to be more appropriate to discuss in person. More than 4 out of 5 of the neurologists (84.8%) stated that they would be open to perform some telematic visits in the future. CONCLUSIONS: In Spain, emergent implantation of teleneurology has shown to be appropriate for the care of many PWE. Technical improvements, extended use of videoconference and patient selection may improve results and patient and physician satisfaction.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Epilepsia/terapia , Pandemias , Pneumonia Viral , Telemedicina , Adulto , Morte Súbita , Serviço Hospitalar de Emergência , Humanos , Pessoa de Meia-Idade , Espanha , Inquéritos e Questionários
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