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1.
Neurosurg Clin N Am ; 33(1): 113-134, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34801136

RESUMO

This review describes the clinical presentations and treatment options for commonly recognized epilepsy syndromes in the pediatric age group, based on the 2017 International League Against Epilepsy classification. Structural epilepsies that are amenable to surgical intervention are discussed. Lastly, emerging technologies are reviewed that are expanding our knowledge of underlying epilepsy pathologies and will guide future syndromic classification systems including genetic testing and tissue repositories.


Assuntos
Epilepsia , Síndromes Epilépticas , Criança , Epilepsia/diagnóstico , Epilepsia/terapia , Humanos
2.
Trials ; 22(1): 821, 2021 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-34801061

RESUMO

BACKGROUND: Many people living with epilepsy (PLWE) reside in rural communities, and epilepsy self-management may help address some of the gaps in epilepsy care for these communities. A prior randomized control trial of a remotely delivered, Web-based group format 12-week self-management program (SMART) conducted in Northeast Ohio, a primarily urban and suburban community, demonstrated improved outcomes in negative health events such as depression symptoms and quality of life. However, there is a paucity of research addressing the needs of PLWE in rural settings. METHODS: The present study leverages collaboration between investigators from 2 mid-western US states (Ohio and Iowa) to replicate testing of the SMART intervention and prioritize delivery to PLWE in rural and semi-rural communities. In phase 1, investigators will refine the SMART program using input from community stakeholders. A Community Advisory Board will then be convened to help identify barriers to trial implementation and strategies to overcome barriers. In phase 2, the investigators will conduct a 6-month prospective randomized control trial of the SMART program compared to 6-month waitlist controls, with the primary outcome being changes in negative health events defined as seizure, self-harm attempt, emergency department visit, or hospitalization. Additional outcomes of interest include quality of life and physical and mental health functioning. The study will also assess process measures of program adopters and system end-users to inform future outreach, education, and self-management strategies for PLWE. DISCUSSION: The method of this study employs lived experience of PLWE and those who provide care for PLWE in rural and underserved populations to refine a remotely delivered Web-based self-management program, to improve recruitment and retention, and to deliver the intervention. Pragmatic outcomes important to PLWE, payers, and policymakers will be assessed. This study will provide valuable insights on implementing future successful self-management programs. TRIAL REGISTRATION: ClinicalTrials.gov NCT04705441 . Registered on January 12, 2021.


Assuntos
Epilepsia , Autogestão , Epilepsia/diagnóstico , Epilepsia/terapia , Humanos , Estudos Prospectivos , Qualidade de Vida , População Rural
3.
BMC Med Educ ; 21(1): 572, 2021 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-34772401

RESUMO

BACKGROUND: Knowledge deficits with regard to epilepsy have been reported among healthcare professionals. This study was conducted to develop consensus-based aims, contents, intended learning outcomes, teaching, and evaluation methods for a course on epilepsy for postgraduate or continuing education in community health nursing programs. METHODS: A mixed method which combined a thorough search of literature, the nominal group technique, the Delphi technique, and survey of students' agreement was used. The databases MEDLINE/PUBMED, EMBASE, COCHRANE, CInAHL/EBESCO, SCOPUS, Google Scholar, Google Books, and Amazon were searched to identify potential aims, topics/contents, intended learning outcomes, teaching, and evaluation methods. Discussions and deliberations in serial meetings based on the nominal group technique were attended by educators/academicians (n = 12), neurologists (n = 2), practicing nurses (n = 5), pharmacists (n = 2), patients with epilepsy (n = 2), and students in postgraduate and continuing education programs (n = 7) to supplement and refine the data collected from the literature. The qualitative data were analyzed using RQDA tool for R. The Delphi technique was used among educators/academicians (n = 15), neurologists (n = 2), practicing nurses (n = 5), pharmacists (n = 2), patients with epilepsy (n = 3), and students in postgraduate and continuing education programs (n = 8) to achieve formal consensus. RESULTS: Consensus was achieved on 6 aims, 16 intended learning outcomes, and 27 topics in the course. Of the topics, 13 were relevant to nature of epilepsy and seizures, 2 were relevant to the impact of epilepsy and seizures on different life aspects of patients with epilepsy, 4 were relevant to advocating for the patients and supporting their choices, 5 were relevant to educating patients and their caregivers, and 3 were relevant to assessments and services. CONCLUSION: Consensus-based aims, topics/contents, intended learning outcomes, teaching, and evaluation methods of a course on epilepsy for postgraduate or continuing education in community health nursing programs were developed. Consensus-based courses could bridge knowledge gaps and improve educating community health nursing programs on epilepsy. Further studies are needed to determine if such consensus-based courses could promote care of patients with epilepsy.


Assuntos
Enfermagem em Saúde Comunitária , Epilepsia , Consenso , Educação Continuada , Epilepsia/terapia , Humanos , Aprendizagem
4.
BMC Med Inform Decis Mak ; 21(1): 282, 2021 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-34645428

RESUMO

BACKGROUND: A variety of smartphone apps and wearables are available both to help patients monitor their health and to support health care professionals (HCPs) in providing clinical care. As part of the RADAR-CNS consortium, we have conducted research into the application of wearables and smartphone apps in the care of people with multiple sclerosis, epilepsy, or depression. METHODS: We conducted a large online survey study to explore the experiences of HCPs working with patients who have one or more of these conditions. The survey covered smartphone apps and wearables used by clinicians and their patients, and how data from these technologies impacted on the respondents' clinical practice. The survey was conducted between February 2019 and March 2020 via a web-based platform. Detailed statistical analysis was performed on the answers. RESULTS: Of 1009 survey responses from HCPs, 1006 were included in the analysis after data cleaning. Smartphone apps are used by more than half of responding HCPs and more than three quarters of their patients use smartphone apps or wearable devices for health-related purposes. HCPs widely believe the data that patients collect using these devices impacts their clinical practice. Subgroup analyses show that views on the impact of this data on different aspects of clinical work varies according to whether respondents use apps themselves, and, to a lesser extent, according to their clinical setting and job role. CONCLUSIONS: Use of smartphone apps is widespread among HCPs participating in this large European survey and caring for people with epilepsy, multiple sclerosis and depression. The majority of respondents indicate that they treat patients who use wearables and other devices for health-related purposes and that data from these devices has an impact on clinical practice.


Assuntos
Epilepsia , Aplicativos Móveis , Esclerose Múltipla , Atenção à Saúde , Depressão , Epilepsia/terapia , Pessoal de Saúde , Humanos , Esclerose Múltipla/terapia , Smartphone , Inquéritos e Questionários , Tecnologia
5.
J Vet Intern Med ; 35(5): 2350-2358, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34472639

RESUMO

BACKGROUND: Implantable vagus nerve stimulation (VNS) devices can be used to treat epilepsy in dogs. Adverse effects and short-term complications associated with delivering suggested therapeutic electrical stimulation (>1.5 mA) are not well-described. OBJECTIVES: To compare complications and adverse effects observed with standard and rapid protocols of current increase. ANIMALS: Sixteen client-owned dogs with idiopathic epilepsy. METHODS: Nonrandomized, nonblinded prospective cohort study. Surgical complications, stimulation-related adverse effects, modifications to stimulator settings, number of hospital visits, and time to reach 1.5 mA stimulation current without intolerable adverse effects were described in dogs receiving current increases every 1 to 3 weeks (slow ramping) and dogs receiving current increases every 8 to 12 hours (fast ramping). RESULTS: Self-resolving surgery site seromas formed in 6 dogs. No other surgical complications were observed. Fourteen dogs reached 1.5 mA. Coughing (11/14 dogs; 5 slow, 6 fast ramping) was the most common adverse effect. Intolerable coughing that limited current increases despite changing other stimulus parameters occurred in 6/7 of the fast-ramping group and in none of the slow-ramping group. Median time to 1.5 mA was 72 days (range, 28-98) in the slow-ramping group and 77 days (range, 3-152) in the fast-ramping group. Median number of clinic visits was 6 for the slow-ramping group (range, 5-6) and 3 for the fast-ramping group (range, 1-7). CONCLUSIONS AND CLINICAL IMPORTANCE: Coughing is a common adverse effect of VNS in dogs and generally is well tolerated, particularly if current is increased slowly and other stimulation parameters are adapted for effect.


Assuntos
Doenças do Cão , Epilepsia , Estimulação do Nervo Vago , Animais , Doenças do Cão/terapia , Cães , Epilepsia/terapia , Epilepsia/veterinária , Estudos Prospectivos , Próteses e Implantes , Nervo Vago , Estimulação do Nervo Vago/efeitos adversos , Estimulação do Nervo Vago/veterinária
6.
Epilepsy Behav ; 123: 108218, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34479039

RESUMO

INTRODUCTION: Epilepsy-specific quality indicators and performance measures have been published and revised multiple times. The application of epilepsy-specific quality measures has been demonstrated in a few healthcare systems. However, there is no information to date on changes in epilepsy performance measures over time, and across settings, in a national sample. The Department of Veterans Affairs (VA) healthcare system provides an opportunity to study the changes in epilepsy-specific performance over time, in acute versus chronic epilepsy care, as well as in primary versus specialty care. METHODS: Chart extractions of newly diagnosed epilepsy and chronic care of Veterans with epilepsy within the VA system were performed. Veterans with ICD-9-CM diagnosis 345.XX and 780.39 from 2007-2014 were identified. Epilepsy-specific performance measures based on the Quality Indicators in Epilepsy Treatment (QUIET) VA measurement were ascertained for each Veteran with epilepsy. Difference in care across time (2009, 2012, and 2014), source of epilepsy care (primary care only, neurology only, and shared care between neurology and primary care) was analyzed. Differences in proportion of care measures across variables were compared using chi-square statistics. RESULTS: Chart reviews of 2386 Veterans with epilepsy included 297 women (11.2%), 281 (10.5%) receiving acute care and 2105 (89.5%) receiving chronic care. Across all years 203 (72.5%) had electroencephalograph ordered/performed, 225 (80.4%) had neuroimaging ordered/performed, 106 (37.9%) were instructed about driving precautions, 71 (25.4%) were educated about safety and injury prevention, and 251 (89.6%) had anti-seizure medication monotherapy initiated. The proportion of people with new-onset seizures educated about diagnosis and type of seizure increased over time 30 (34.9%) in 2008, 42 (43.8%) in 2012, and 52 (53.1%). Of the 2105 Veterans receiving chronic care 864 (41.1%) encounters documented compliance of anti-seizure medication, 361 (17.15%) encounters addressed driving restrictions, 1345 (63.9%) encounters documented general education and counseling, 250 (11.9%) of encounters documented safety and injury prevention, 488 (23.2%) of encounters documented medication side effects, and 463 (22.0%) of encounters documented discussion of treatment options. With chronic epilepsy care, documentation of quality measures did not change with time. Veterans who were co-managed by primary care and neurology had a higher proportion of driving instruction and safety instructions compared to neurology or primary care alone. DISCUSSION: In general, the epilepsy performance measures were high (>70% of new-onset epilepsy) for documentation diagnostic procedures (such as EEG and neuroimaging) and low across key educational and counseling measures (<50%). Despite the emphasis on the importance of psychosocial education and holistic management in the academic literature, through advocacy work, and during professional meetings, there was not a significant improvement in education and counseling over time. Some aspects of psychosocial education were performed better among primary care providers compared to neurologists. However, more attention and work need to be dedicated on implementing and documenting education and counseling people with epilepsy in the clinical setting.


Assuntos
Epilepsia , Veteranos , Epilepsia/epidemiologia , Epilepsia/terapia , Feminino , Pessoal de Saúde , Humanos , Neurologistas , Atenção Primária à Saúde
7.
Epilepsy Behav ; 123: 108273, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34507093

RESUMO

PURPOSE: There remain major challenges for the clinician in managing patients with epilepsy effectively. Choosing anti-seizure medications (ASMs) is subject to trial and error. About one-third of patients have drug-resistant epilepsy (DRE). Surgery may be considered for selected patients, but time from diagnosis to surgery averages 20 years. We reviewed the potential use of machine learning (ML) predictive models as clinical decision support tools to help address some of these issues. METHODS: We conducted a comprehensive search of Medline and Embase of studies that investigated the application of ML in epilepsy management in terms of predicting ASM responsiveness, predicting DRE, identifying surgical candidates, and predicting epilepsy surgery outcomes. Original articles addressing these 4 areas published in English between 2000 and 2020 were included. RESULTS: We identified 24 relevant articles: 6 on ASM responsiveness, 3 on DRE prediction, 2 on identifying surgical candidates, and 13 on predicting surgical outcomes. A variety of potential predictors were used including clinical, neuropsychological, imaging, electroencephalography, and health system claims data. A number of different ML algorithms and approaches were used for prediction, but only one study utilized deep learning methods. Some models show promising performance with areas under the curve above 0.9. However, most were single setting studies (18 of 24) with small sample sizes (median number of patients 55), with the exception of 3 studies that utilized large databases and 3 studies that performed external validation. There was a lack of standardization in reporting model performance. None of the models reviewed have been prospectively evaluated for their clinical benefits. CONCLUSION: The utility of ML models for clinical decision support in epilepsy management remains to be determined. Future research should be directed toward conducting larger studies with external validation, standardization of reporting, and prospective evaluation of the ML model on patient outcomes.


Assuntos
Epilepsia Resistente a Medicamentos , Epilepsia , Algoritmos , Eletroencefalografia , Epilepsia/terapia , Humanos , Aprendizado de Máquina
8.
Epilepsy Behav ; 123: 108282, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34509036

RESUMO

OBJECTIVE: Adults living with intellectual and developmental disability (IDD) and epilepsy (IDD-E) face challenges in addition to those faced by the general population of adults with epilepsy, which may be associated with distinct priorities for improving health-related quality of life (HR-QOL). This study sought to (1) conduct a survey of HR-QOL priorities identified by adults with IDD-E and caregivers, and (2) perform an exploratory cross-sectional comparison to adults with epilepsy who do not have IDD. METHODS: This cross-sectional study recruited 65 adults with IDD-E and 134 adults with epilepsy without IDD and caregivers. Using a three-step development process, 256 items from existing quality-of-life scales recommended by the American Academy of Neurology (AAN) were rated by patients/caregivers for their importance as HR-QOL priorities. HR-QOL items identified as critical to the majority of the sample of adults with IDD-E were reported. Health-related quality of life priorities were compared between adults with IDD-E and adults with epilepsy without IDD. RESULTS: Health-related quality of life was significantly lower in adults with IDD-E. Health-related quality of life domains identified as critical priorities by adults with IDD-E included seizure burden, anti-seizure medication side effects, seizure unpredictability, and family impact. Priorities for improving HR-QOL differed between adults with and without IDD-E, with concerns about family impact, difficulty finding appropriate living conditions, inadequate assistance, and difficulty transitioning from pediatric-to-adult care valued significantly more among those with IDD-E. SIGNIFICANCE: Intellectual and developmental disability is an important determinant of HR-QOL among adults with epilepsy. We report HR-QOL priorities identified by adults with IDD-E and their caregivers. These results may help epilepsy clinicians and researchers develop tailored strategies to address priorities of the patient with IDD-E/caregiver community.


Assuntos
Epilepsia , Deficiência Intelectual , Adulto , Cuidadores , Criança , Estudos Transversais , Deficiências do Desenvolvimento , Epilepsia/complicações , Epilepsia/terapia , Humanos , Qualidade de Vida
9.
Seizure ; 92: 189-194, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34551365

RESUMO

PURPOSE: This study aimed to investigate the incidence and predictors of epilepsy after anti-neuronal antibody-positive autoimmune encephalitis (AIE). The clinical outcomes of patients with epilepsy after AIE were also explored. METHODS: A total of 111 AIE patients were retrospectively evaluated. Post-AIE epilepsy (PAEE) was defined as at least one unprovoked seizure occurring six or more months after discharge from hospital. RESULTS: The incidence of acute symptomatic seizures was 80.2% (89/111) in our AIE patients. Furthermore, of the 89 AIE patients with seizures, 29 (32.6%) presented with seizures as the initial symptom. Overall, 44 out of 111 AIE patients (39.6%) had unprovoked seizures after six months, meeting our definition of PAEE. The independent risk factors for PAEE incidence included an initial presentation with new-onset refractory status epilepticus (NORSE), delayed immunotherapy treatment, the complication of a lung infection during admission, the requirement for mechanical ventilation during hospitalization, parietal lesions observed in magnetic resonance imaging (MRI), and focal slow waves on electroencephalographic (EEG) monitoring. CONCLUSIONS: Early initiation of immunotherapy and lung infection treatment may reduce the risk of conversion of symptomatic seizures to chronic epilepsy in the acute phase of AIE. In general, PAEE patients could have a good prognosis if treated properly and in a timely fashion.


Assuntos
Epilepsia , Doença de Hashimoto , Eletroencefalografia , Encefalite , Epilepsia/epidemiologia , Epilepsia/etiologia , Epilepsia/terapia , Humanos , Prognóstico , Estudos Retrospectivos
10.
Seizure ; 92: 82-88, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34481321

RESUMO

PURPOSE: To examine the association between epilepsy and frequency and time of initiation of prenatal care use among pregnant women in Finland. METHODS: We conducted a nationally representative, population-based cross-sectional study including pregnant women with epilepsy in Finland between 2000-2014. Selected demographic and clinical data were obtained by linking multiple national health registers and census. Crude and adjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated using logistic regression analysis. Effect modification of the main association was examined by parity. RESULTS: We examined 10,798 and 921,873 women with and without epilepsy, respectively, and the two groups differed significantly on prenatal care constructs. Women with epilepsy were more likely to have 25 or more total prenatal visits (10.4 % vs. 5.8%) and earlier initiation of prenatal care (at <8 weeks of gestation) (30.8% vs. 24.7%) compared to women without epilepsy. Epilepsy was significantly associated with 25 or more prenatal care visits (aOR=1.84; 95% CI=1.71, 1.98). The association between epilepsy and early initiation of prenatal care (<8 weeks) was significantly modified by parity, where multiparous women had increased odds of early prenatal care initiation (aOR=1.32; 95% CI=1.24, 1.41) compared to nulliparous women (aOR=1.19; 95% CI=1.11, 1.28). CONCLUSIONS: Finnish healthcare, which is publicly funded and freely accessible, provided pregnant women with epilepsy adequate and timely prenatal care. Parity modified the period when prenatal care was initiated as multiparous women were initiated early to receive prenatal care compared to nulliparous women.


Assuntos
Epilepsia , Cuidado Pré-Natal , Estudos Transversais , Epilepsia/epidemiologia , Epilepsia/terapia , Feminino , Finlândia/epidemiologia , Humanos , Paridade , Gravidez , Gestantes
11.
Life Sci ; 285: 119972, 2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34560081

RESUMO

Epilepsy is a debilitating condition, primarily refractory individuals, leading to the search for new efficient therapies. Electrical stimulation is an important method used for years to treat several neurological disorders. Currently, electrical stimulation is used to reduce epileptic crisis in patients and shows promising results. Even though the use of electricity to treat neurological disorders has grown worldwide, there are still many caveats that must be clarified, such as action mechanisms and more efficient stimulation treatment parameters. Thus, this review aimed to explore the comprehension of the main stimulation methods in animal models of epilepsy using rodents to develop new experimental protocols and therapeutic approaches.


Assuntos
Terapia por Estimulação Elétrica/métodos , Epilepsia/terapia , Animais , Modelos Animais de Doenças , Ratos
12.
J Neurodev Disord ; 13(1): 40, 2021 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-34530725

RESUMO

BACKGROUND: CDKL5 deficiency disorder (CDD) is associated with refractory infantile onset epilepsy, global developmental delay, and variable features that include sleep, behavioral disturbances, and movement disorders. Current treatment is primarily symptom-based and informed by experience in caring for this population. METHODS: We describe medication and non-medication approaches to treatment of epilepsy and additional key neurologic symptoms (sleep disturbances, behavioral issues, movement disorders, and swallowing dysfunction) in a cohort of 177 individuals meeting criteria for CDD, 154 evaluated at 4 CDKL5 Centers of Excellence in the USA and 40 identified through the NIH Natural History Study of Rett and Related Disorders. RESULTS: The four most frequently prescribed anti-seizure medications were broad spectrum, prescribed in over 50% of individuals. While the goal was not to ascertain efficacy, we obtained data from 86 individuals regarding response to treatment, with 2-week response achieved in 14-48% and sustained 3-month response in 5-36%, of those with known response. Additional treatments for seizures included cannabis derivatives, tried in over one-third of individuals, and clinical trial medications. In combination with pharmacological treatment, 50% of individuals were treated with ketogenic diet for attempted seizure control. Surgical approaches included vagus nerve stimulators, functional hemispherectomy, and corpus callosotomy, but numbers were too limited to assess response. Nearly one-third of individuals received pharmacologic treatment for sleep disturbances, 13% for behavioral dysregulation and movement disorders, and 43% had gastrostomy tubes. CONCLUSIONS: Treatment for neurologic features of CDD is currently symptom-based and empiric rather than CDD-specific, though clinical trials for CDD are emerging. Epilepsy in this population is highly refractory, and no specific anti-seizure medication was associated with improved seizure control. Ketogenic diet is commonly used in patients with CDD. While behavioral interventions are commonly instituted, information on the use of medications for sleep, behavioral management, and movement disorders is sparse and would benefit from further characterization and optimization of treatment approaches. The heterogeneity in treatment approaches highlights the need for systematic review and guidelines for CDD. Additional disease-specific and disease-modifying treatments are in development.


Assuntos
Epilepsia , Síndromes Epilépticas , Espasmos Infantis , Epilepsia/genética , Epilepsia/terapia , Síndromes Epilépticas/genética , Síndromes Epilépticas/terapia , Humanos , Proteínas Serina-Treonina Quinases/genética , Espasmos Infantis/genética , Espasmos Infantis/terapia
13.
J Pediatr Nurs ; 60: 311-313, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34420830

RESUMO

PURPOSE: Describe the knowledge and fears of parents of children diagnosed with epilepsy in the hospital and clinic settings. DESIGN AND METHODS: Descriptive, comparative study design. Knowledge was measured with the 16-item Epilepsy Knowledge Scale and epilepsy-related fears was operationalized by the Epilepsy-related Fears in Parents Questionnaire (EFPQ) addressing short and long-term fears. The sample included 40 parents of children diagnosed with epilepsy who were cared for on a pediatric ortho/neuro hospital unit (N = 27) or pediatric neurology clinic (N = 13). RESULTS: Parents were middle aged adults (mean 39 years), mostly mothers with 80% college education. Their children ranged in ages from less than one to 18 years of age (Mean = 8.5) across a variety of ethnic backgrounds who were most often diagnosed with epilepsy at a young age (<1 year to 3 years). Percentage of correct answers ranged from 31% (5 correct) to 100% (16 correct); mean 12 correct or 75%. Subjects/parents were afraid! They had many fears: Short-term (possible range 8-40) with responses ranging from 9 to 40 (mean 28); Future/long-term (possible range 9-45) ranging from 9 to 45 (mean 32). They were afraid when their child is in the care of others - something might happen, and their child could die during a seizure. There was no statistically significant difference in responses between hospital or clinic parents. DISCUSSION: Parents who participated in this study were knowledgeable but fearful with immediate and long term concerns. PRACTICE IMPLICATIONS: Nurses need to provide verbal and written education materials. Address triggers. Talk to parents about their fears related to epilepsy. Identify parental support. Validate parents' skills in knowing what to do when their child has a seizure.


Assuntos
Epilepsia , Pais , Adolescente , Adulto , Criança , Pré-Escolar , Epilepsia/diagnóstico , Epilepsia/terapia , Medo , Feminino , Humanos , Lactente , Pessoa de Meia-Idade , Mães , Inquéritos e Questionários
14.
Auton Neurosci ; 235: 102856, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34343824

RESUMO

Convulsive seizures are the most consistently reported risk factor for SUDEP. However, the precise mechanisms by which convulsive seizures trigger fatal cardiopulmonary changes are still unclear. Additionally, it is not clear why some seizures cause death when most do not. This article reviews the physiologic changes that occur during and after convulsive seizures and how these may contribute to SUDEP. Seizures activate specific cortical and subcortical regions that can cause potentially lethal cardiorespiratory changes. Clinical factors, including sleep state, medication treatment and withdrawal, positioning and posturing during seizures, and underlying structural or genetic conditions may also affect specific aspects of seizures that may contribute to SUDEP. While seizure control, either through medication or surgical treatment, is the primary intervention that reduces SUDEP risk, unfortunately, seizures cannot be fully controlled despite maximal treatment in a significant proportion of people with epilepsy. Thus specific interventions to prevent adverse seizure-related cardiopulmonary consequences are needed. The potential roles of repositioning/stimulation after seizures, oxygen supplementation, cardiopulmonary resuscitation and clinical treatment options in reducing SUDEP risk are explored. Ultimately, understanding of these factors may lead to interventions that could reduce or prevent SUDEP.


Assuntos
Epilepsia , Morte Súbita Inesperada na Epilepsia , Morte Súbita/etiologia , Morte Súbita/prevenção & controle , Epilepsia/terapia , Humanos , Fatores de Risco , Convulsões , Sono
15.
Sci Rep ; 11(1): 17127, 2021 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-34429470

RESUMO

There has been a significant rise in robotic trajectory guidance devices that have been utilised for stereotactic neurosurgical procedures. These devices have significant costs and associated learning curves. Previous studies reporting devices usage have not undertaken prospective parallel-group comparisons before their introduction, so the comparative differences are unknown. We study the difference in stereoelectroencephalography electrode implantation time between a robotic trajectory guidance device (iSYS1) and manual frameless implantation (PAD) in patients with drug-refractory focal epilepsy through a single-blinded randomised control parallel-group investigation of SEEG electrode implantation, concordant with CONSORT statement. Thirty-two patients (18 male) completed the trial. The iSYS1 returned significantly shorter median operative time for intracranial bolt insertion, 6.36 min (95% CI 5.72-7.07) versus 9.06 min (95% CI 8.16-10.06), p = 0.0001. The PAD group had a better median target point accuracy 1.58 mm (95% CI 1.38-1.82) versus 1.16 mm (95% CI 1.01-1.33), p = 0.004. The mean electrode implantation angle error was 2.13° for the iSYS1 group and 1.71° for the PAD groups (p = 0.023). There was no statistically significant difference for any other outcome. Health policy and hospital commissioners should consider these differences in the context of the opportunity cost of introducing robotic devices.Trial registration: ISRCTN17209025 ( https://doi.org/10.1186/ISRCTN17209025 ).


Assuntos
Estimulação Encefálica Profunda/métodos , Eletrodos Implantados , Epilepsia/terapia , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Estimulação Encefálica Profunda/efeitos adversos , Estimulação Encefálica Profunda/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/instrumentação
16.
Epilepsy Behav ; 123: 108247, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34418640

RESUMO

OBJECTIVE: The effect of vagus nerve stimulation (VNS), an important auxiliary therapy for treating drug-resistant epilepsy (DRE), on autonomic nerve function is still controversial. Heart rate variability is a widely used indicator of autonomic nerve function. To clarify the relationship between VNS and heart rate variability (HRV), we performed a meta-analysis to systematically evaluate the effect of VNS on HRV in patients with epilepsy. METHODS: We performed a systematic review by searching the following online databases: PubMed, Web of Science, EMBASE and the Cochrane Library. The key search terms were "vagal nerve stimulation," "epilepsy" and "heart rate variability". Other features of VNS in patients with epilepsy include postoperative changes in low-frequency (LF), high-frequency (HF) and low-frequency/high-frequency (LF/HF) heart rate variability, which were used as evaluation indices, and the Newcastle-Ottawa Quality Assessment Scale and Stata 14.0 statistical software were used for literature quality evaluation and meta-analysis. RESULTS: Twelve studies published in English were obtained, and 229 patients with epilepsy who underwent VNS were ultimately included after elimination of duplicate articles and those that did not meet the inclusion criteria. Regarding LF heart rate variability, in the response subgroup, patients with DRE with VNS presented a lower value (-0.58) before surgery than after surgery, with a 95% confidence interval (CI) ranging from -1.00 to -0.15. For HF heart rate variability, patients with DRE with VNS had a lower value (-0.45) before surgery than after surgery in the response subgroup, with a 95% CI ranging from -0.74 to -0.17. No differences were found for LF/HF values or the LF and HF values of other subgroups. CONCLUSION: VNS has little effect on the balance of sympathetic and parasympathetic nerve activity and would not be expected to cause cardiovascular autonomic dysfunction in patients with DRE. For patients with DRE, VNS can control seizures and has little effect on autonomic nervous function.


Assuntos
Epilepsia Resistente a Medicamentos , Epilepsia , Preparações Farmacêuticas , Estimulação do Nervo Vago , Epilepsia Resistente a Medicamentos/terapia , Epilepsia/terapia , Frequência Cardíaca , Humanos , Nervo Vago
17.
Epilepsy Behav ; 123: 108249, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34464829

RESUMO

OBJECTIVES: The primary aim of this qualitative study was to explore the views of health professionals, with little previous clinical mental health training, of an adapted modular cognitive-behavioral intervention (MATCH-ADTC) for common mental health problems in children and young people with epilepsy. METHODS: Healthcare Professionals (HCPs) and their supervisors were interviewed at the start (n = 23) and end (n = 15) of the six-month training period. The interviews were transcribed verbatim and analyzed using thematic analysis. RESULTS: Three higher order themes with sub-themes were identified: (1) strengths of the MATCH-ADTC content and manual; (2) expectations of the treatment; and (3) improving practice with MATCH-ADTC. Overall impressions of the training and treatment were largely positive, with HCPs viewing MATCH-ADTC as an acceptable treatment for the families that they worked with. HCPs highlighted some challenges in delivering an integrated service, particularly relating to the time commitment involved and their own confidence in delivering the intervention, as many participants did not have a mental health background. CONCLUSIONS: The findings suggested that the intervention and training was acceptable to HCPs working in pediatric epilepsy services, and confidence grew over the six-month training period. Further research is needed to understand how to best train, supervise, and support HCPs in pediatric epilepsy services to deliver mental health treatments.


Assuntos
Epilepsia , Saúde Mental , Adolescente , Criança , Epilepsia/terapia , Pessoal de Saúde , Humanos , Percepção , Pesquisa Qualitativa
18.
J Neural Eng ; 18(4)2021 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-34388739

RESUMO

Objective. Epilepsy is one of the most common severe brain disorders. Ultrasound deep brain stimulation (UDBS) has shown a potential capability to suppress seizures. However, because seizures occur sporadically, it is necessary to develop a closed-loop system to suppress them. Therefore, we developed a closed-loop wearable UDBS system that delivers ultrasound to the hippocampus to suppress epileptic seizures.Approach.Mice were intraperitoneally injected with 10 mg kg-1kainic acid and divided into sham and UDBS groups. Epileptic seizures were detected by applying both long short-term memory (LSTM) and bidirectional LSTM (BILSTM) networks according to EEG signal characteristics. When epileptic seizures were detected, the closed-loop UDBS system automatically activated a trigger switch to stimulate the hippocampus for 10 min and continuously record EEG signals until 20 min after ultrasonic stimulation. EEG signals were analyzed using the MATLAB software. After EEG recording, we observed the survival rate of the experimental mice for 72 h.Main results.The BiLSTM network was found to have preferable classification performance over the LSTM network. The closed-loop UDBS system with BiLSTM could automatically detect epileptic seizures using EEG signals and effectively reduce epileptic EEG power spectral density and seizure duration by 10.73%, eventually improving the survival rate of early epileptic mice from 67.57% in the sham group to 88.89% in the UDBS group.Significance.The closed-loop UDBS system developed in this study could be an effective clinical tool for the control of epilepsy.


Assuntos
Estimulação Encefálica Profunda , Epilepsia , Dispositivos Eletrônicos Vestíveis , Animais , Eletroencefalografia , Epilepsia/diagnóstico por imagem , Epilepsia/terapia , Camundongos , Convulsões/terapia
19.
Epilepsia ; 62(10): 2322-2332, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34428314

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has affected the care of all patients around the world. The International League Against Epilepsy (ILAE) COVID-19 and Telemedicine Task Forces examined, through surveys to people with epilepsy (PWE), caregivers, and health care professionals, how the pandemic has affected the well-being, care, and services for PWE. The ILAE included a link on their website whereby PWE and/or their caregivers could fill out a survey (in 11 languages) about the impact of the COVID-19 pandemic, including access to health services and impact on mental health, including the 6-item Kessler Psychological Distress Scale. An anonymous link was also provided whereby health care providers could report cases of new-onset seizures or an exacerbation of seizures in the context of COVID-19. Finally, a separate questionnaire aimed at exploring the utilization of telehealth by health care professionals since the pandemic began was available on the ILAE website and also disseminated to its members. Seventeen case reports were received; data were limited and therefore no firm conclusions could be drawn. Of 590 respondents to the well-being survey (422 PWE, 166 caregivers), 22.8% PWE and 27.5% caregivers reported an increase in seizure frequency, with difficulty in accessing medication and health care professionals reported as barriers to care. Of all respondents, 57.1% PWE and 21.5% caregivers had severe psychological distress (k score >13), which was significantly higher among PWE than caregivers (p<0.01). An increase in telemedicine use during the COVID-19 pandemic was reported by health care professionals, with 40% of consultations conducted by this method. Although 74.9% of health care providers thought that this impacted positively, barriers to care were also identified. As we move forward, there is a need to ensure ongoing support and care for PWE to prevent a parallel pandemic of unmet health care needs.


Assuntos
COVID-19 , Epilepsia/terapia , Pandemias , Cuidadores , Comunicação , Atenção à Saúde/estatística & dados numéricos , Epilepsia/psicologia , Acesso aos Serviços de Saúde , Humanos , Angústia Psicológica , Convulsões/epidemiologia , Estresse Psicológico/etiologia , Estresse Psicológico/psicologia , Inquéritos e Questionários , Telemedicina
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