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Role for a video tool in educating youth with epilepsy about anticonvulsant and contraceptive drug interactions 视频工具在教育青少年癫痫患者关于抗惊厥药物和避孕药相互作用方面的作用
IF 2.3 3区 医学 Q2 BEHAVIORAL SCIENCES Pub Date : 2024-11-29 DOI: 10.1016/j.yebeh.2024.110154
Natalia I. Lopez , Camille A. Dang , Rovingaile Kriska M. Ponce , Sara Jacobellis , Madeline Niemann , Rinat Jonas , Laurie M. Douglass
<div><h3>Purpose</h3><div>Anti-seizure medications (ASM) can lower the efficacy of hormonal birth control (BC), while estrogen-containing BC can increase ASM metabolism, altering seizure frequency. Despite these adverse interactions, many youth with epilepsy demonstrate inadequate knowledge about this topic. Thus, there is a need to develop tools that empower youth with epilepsy to make more informed contraceptive decisions. This study assesses the use of a video-based educational tool to raise awareness of BC and ASM interactions in this population.</div></div><div><h3>Methods</h3><div>We created a video that gives an overview of possible interactions between certain BC methods and ASMs, mainly increased risk of pregnancy and change in seizure frequency. The video was shown to female patients aged 12 and older with epilepsy in a child neurology clinic and followed by a discussion with their treating neurologist. Fifteen patients completed two surveys that collected demographics, ASM regimen, BC history, and assessed exposure to and understanding of the subject matter before and after viewing the educational tool using 11-point Likert scales. We received seven responses from provider opinion surveys that were administered after the visit to assess the practicality of the video tool in teaching patients about their medication interactions. Data was analyzed with descriptive statistics and one-tailed paired t-tests (α = 0.05).</div></div><div><h3>Results</h3><div>Patients ranged from ages 16 to 24, with 46.7 % being in the 16 to 18 year-old range, 26.7 % in the 19 to 21 year-old range, and 26.7 % in the 22 to 24 year-old range. The median age was 19. 33 % of the patients reported having used BC, with 27 % reporting current interest in using BC. 33 % of patients were taking ASM that could reduce BC efficacy, and 27 % were on ASM with efficacy that can be reduced by BC. While 80 % of patients endorsed having previously discussed BC and ASM interactions with a doctor, patients rated their knowledge of the subject pre-video as moderately low with high interest in learning more about the topic. Patients’ understanding of how BC and ASM interactions can increase risk of pregnancy showed a significant increase post-video. Patients also indicated a high likelihood that they would think of the video when choosing a BC method and that they are more likely to start a discussion with their doctor about BC and ASM interactions because of the video. Treating neurologists showed high agreement that the video is useful in teaching their patients about BC and ASM interactions.</div></div><div><h3>Conclusion</h3><div>Youth with epilepsy deserve engaging resources that empower them to make informed decisions about BC. Despite most of our patients having had prior education about BC and ASM interactions, our results support the need for educational tools beyond patient-provider discussion and the efficacy of video as a tool to enhance understanding of this topic. The
目的抗癫痫药物(ASM)可降低激素节育(BC)的疗效,而含雌激素的BC可增加ASM代谢,改变癫痫发作频率。尽管存在这些不良相互作用,但许多青少年癫痫患者对这一主题的认识不足。因此,有必要开发工具,使癫痫青年能够做出更明智的避孕决定。本研究评估了视频教育工具的使用,以提高该人群对BC和ASM相互作用的认识。方法我们制作了一个视频,概述了某些BC方法与asm之间可能的相互作用,主要是增加妊娠风险和癫痫发作频率的变化。在儿童神经病学诊所,该视频被播放给12岁及以上的女性癫痫患者,随后与治疗她们的神经科医生进行了讨论。15名患者完成了两项调查,收集了人口统计学、ASM方案、BC病史,并使用11分李克特量表评估了在观看教育工具之前和之后对主题的接触和理解。我们收到了7份来自供应商意见调查的回复,这些意见调查是在访问后进行的,以评估视频工具在教授患者药物相互作用方面的实用性。资料分析采用描述性统计和单侧配对t检验(α = 0.05)。结果患者年龄在16 ~ 24岁之间,16 ~ 18岁占46.7%,19 ~ 21岁占26.7%,22 ~ 24岁占26.7%。中位年龄为19岁。33%的患者报告使用过BC, 27%的患者报告目前有兴趣使用BC。33%的患者服用可降低BC疗效的ASM, 27%的患者服用可因BC而降低疗效的ASM。虽然80%的患者认可之前与医生讨论过BC和ASM的相互作用,但患者认为他们在视频前对主题的了解程度中等低,对学习更多主题的兴趣很高。患者对BC和ASM相互作用如何增加妊娠风险的理解在录像后显著增加。患者还表示,在选择BC方法时,他们很可能会想到视频,并且由于视频,他们更有可能开始与医生讨论BC和ASM的相互作用。治疗神经科医生高度一致认为,该视频在教授患者BC和ASM的相互作用方面很有用。结论:青少年癫痫患者应该获得参与资源,使他们能够对BC做出明智的决定。尽管我们的大多数患者之前都接受过BC和ASM相互作用的教育,但我们的研究结果支持除了患者与提供者讨论之外,还需要教育工具,并且视频作为一种有效的工具来增强对该主题的理解。该工具还显示出影响未来患者对BC的决策的潜力,并使患者能够积极地与医生讨论BC。我们的研究结果支持教育视频作为一种有效的方式来教育青少年癫痫患者有关生殖健康问题,并促进他们积极参与决策。
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引用次数: 0
Epilepsy and nicotine use: Exploring disparities in ENDS and cigarette use among US adults with epilepsy 癫痫和尼古丁使用:探索美国成人癫痫患者ENDS和香烟使用的差异
IF 2.3 3区 医学 Q2 BEHAVIORAL SCIENCES Pub Date : 2024-11-29 DOI: 10.1016/j.yebeh.2024.110177
Miranda Gehris , Ateeqa Ijaz , Aditya Chakraborty , Rime Jebai , Wei Li , Olatokunbo Osibogun , Zeinab Mortazavizadeh , Seyedeh Yasaman Alemohammad , Erinoso Olufemi , Zoran Bursac , Ziyad Ben Taleb , Mohammad Ebrahimi Kalan (Ebbie)

Introduction

Individuals with epilepsy are at greater risk for tobacco use, which may exacerbate their health challenges. This study examines the prevalence and sociodemographic correlates of electronic nicotine delivery systems (ENDS), cigarette, and dual use among US adults with and without epilepsy.

Methods

Data from the 2021–2023 National Health Interview Surveys were analyzed (N = 86,655 adults aged ≥ 18 years), including 1,579 (1.89 %, estimated 14.5 million US adults) with self-reported epilepsy (outcome variable). Participants were categorized into mutually exclusive groups: never-use of either product [reference group], current (used on some days or daily) cigarette-only use, ENDS-only, dual-use, former cigarette-only, former ENDS-only, and former dual-use. Weighted logistic regression models assessed the relationship between epilepsy and tobacco use, adjusting for sociodemographic characteristics.

Results

Adults with epilepsy had higher rates of cigarette-only (16.51 % vs. 9.27 %), ENDS-only (5.56 % vs. 3.95 %), and dual use (3.53 % vs. 1.50 %) compared to those without epilepsy. Relative to never use, current cigarette-only use (AOR = 1.66, 95 %CI: 1.36–2.01), current ENDS-only use (AOR = 1.51, 95 %CI: 1.08–2.13), and current dual use (AOR = 2.29, 95 % CI: 1.56–3.48) were associated with higher odds of epilepsy after adjusting for demographic and health factors. Among adults with epilepsy, identifying as gay, lesbian, or bisexual was linked to higher odds of cigarette, ENDS, or dual use compared to straight individuals. Lower levels of education were associated with higher odds of cigarette smoking, while having health insurance was associated with lower odds among adults with epilepsy. Adults ≥ 35 were more likely to smoke cigarettes and less likely to use ENDS compared to younger age groups.

Conclusion

Cigarette, ENDS, and dual use rates were higher in adults with epilepsy than in those without epilepsy. Social factors like sexual orientation, education, and insurance status further influence tobacco use within this population. Tailored cessation interventions are warranted for this vulnerable population to reduce disease burden.
癫痫患者使用烟草的风险更大,这可能加剧他们的健康挑战。本研究调查了美国成人癫痫患者和非癫痫患者中电子尼古丁传递系统(ENDS)、香烟和双重使用的患病率和社会人口学相关性。方法分析来自2021-2023年全国健康访谈调查的数据(N = 86,655名年龄≥18岁的成年人),其中包括1,579名(1.89%,约1450万美国成年人)自我报告癫痫(结果变量)。参与者被分为两个相互排斥的组:从不使用任何一种产品[参照组],目前(几天或每天使用)只使用香烟,只使用ends,两用,以前只使用香烟,以前只使用ends,以前两用。加权逻辑回归模型评估癫痫和烟草使用之间的关系,并根据社会人口统计学特征进行调整。结果癫痫成人仅吸烟(16.51% vs. 9.27%)、仅使用ends (5.56% vs. 3.95%)和双重使用(3.53% vs. 1.50%)的比例高于非癫痫患者。相对于从不吸烟,目前仅吸烟(AOR = 1.66, 95% CI: 1.36-2.01)、目前仅吸烟(AOR = 1.51, 95% CI: 1.08-2.13)和目前双重吸烟(AOR = 2.29, 95% CI: 1.56-3.48)在调整人口统计学和健康因素后与较高的癫痫发生率相关。在患有癫痫的成年人中,与异性恋者相比,男同性恋、女同性恋或双性恋者吸烟、使用ENDS或双重用途的几率更高。受教育程度较低的人吸烟的几率较高,而拥有医疗保险的人患癫痫的几率较低。与年轻年龄组相比,35岁以上的成年人吸烟的可能性更大,使用ENDS的可能性更小。结论癫痫患者的香烟、ENDS和双重使用率高于非癫痫患者。性取向、教育和保险状况等社会因素进一步影响这一人群的烟草使用。有必要为这一弱势群体量身定制戒烟干预措施,以减轻疾病负担。
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引用次数: 0
Shortage of antiseizure medication in Germany: How big is the problem? 德国抗癫痫药物短缺:问题有多大?
IF 2.3 3区 医学 Q2 BEHAVIORAL SCIENCES Pub Date : 2024-11-29 DOI: 10.1016/j.yebeh.2024.110162
Josephine Steidl , Sabine Krebs , Karel Kostev , Stefan Schwab , Hajo M. Hamer

Objectives

We determined the frequency of drug shortages of antiseizure medication (ASM) availability in Germany.

Methods

Retrospective and descriptive analysis of databases of 2 pharmaceutical wholesalers in Germany with a market share of about 45% of the German market in July 2023 (chosen arbitrarily) focusing on antiseizure drug shortages (i.e. demand could not be met entirely) and disruptions (i.e. demand could not be met at all) on the level of formulations, ASM and of manufacturers.

Results

98/909 (10.8%) of formulations of ASM with Wholesaler A were listed with drug shortages and 131/872 (15%) of formulations were reported with drug shortages at Wholesaler B. 19 of 222 (8.6%) entire ASM at Wholesaler A and 12/213 (5.6%) of ASM with Wholesaler B were reported with drug shortages. 41/62 (66.1%) manufacturers at wholesaler A and 36/57 (63.2%) manufacturers at wholesaler B reported shortages. The three compounds affected most frequently by drug shortages were pregabalin, levetiracetam and carbamazepine. 1.7% (Wholesaler A) and 12.9% (Wholesaler B) of formulations were listed with disruptions.
16.7% (40/239) of ASM with drug shortages/disruptions were brand-name ASM and 83.3% (199/239) were generic ASM.

Conclusions

11% to 15% of ASM formulations had drug shortages in Germany in July 2023. Generic ASM were more frequently affected than brand-name ASM. About 2/3 of manufacturers were reported to have drug shortages.
目的确定德国抗癫痫药物(ASM)可用性的药物短缺频率。方法对2023年7月德国市场份额约为45%的2家药品批发商(任意选择)的数据库进行回顾性和描述性分析,重点分析抗癫痫药物在配方、ASM和制造商层面的短缺(即需求无法完全满足)和中断(即需求根本无法满足)。结果A批发商销售的ASM中有98/909个(10.8%)制剂存在药品短缺,B批发商销售的ASM中有131/872个(15%)制剂存在药品短缺,A批发商销售的整个ASM中222个(8.6%)制剂中有19个存在药品短缺,B批发商销售的ASM中有12/213个(5.6%)制剂存在药品短缺。批发商A的41/62(66.1%)制造商和批发商B的36/57(63.2%)制造商报告短缺。最常受到药物短缺影响的三种化合物是普瑞巴林、左乙拉西坦和卡马西平。1.7%(批发商A)和12.9%(批发商B)的制剂出现了中断,16.7%(40/239)的ASM出现了药品短缺/中断,83.3%(199/239)为仿制药ASM。结论2023年7月,德国有11% ~ 15%的ASM制剂出现药品短缺。仿制ASM比品牌ASM更容易受到影响。据报道,约有三分之二的制造商药品短缺。
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引用次数: 0
Integrating alternative and complementary medicine in the management of epilepsy and its comorbidities in low- and middle-income settings 在低收入和中等收入环境中将替代和补充医学纳入癫痫及其合并症的管理
IF 2.3 3区 医学 Q2 BEHAVIORAL SCIENCES Pub Date : 2024-11-29 DOI: 10.1016/j.yebeh.2024.110172
Symon M. Kariuki , Charles R.J.C. Newton
Traditional/alternative and complementary medicine (TCM) encompasses products, practices and practitioners that do not form part of conventional treatment and are not an integral part of the main health care systems. They are very common in the management of epilepsy and mental health conditions, particularly in low- and middle-income countries (LMIC). For instance, in a population-based survey in Africa, over 70% of people with epilepsy had visited a traditional health practitioner before the survey, with similarly high estimates reported in Asia and South America. Accessibility, cultural appropriateness/alignment, non-response to conventional (biomedical) medicine, and exercise of control over one’s treatment were some of the reasons TCM was preferred over conventional medicine. There is also emerging evidence that TCM products administered alone or together with anti-seizure medications result in improvement in seizure control, psychiatric comorbidities, and quality of life. Most of the convincing evidence is from biological-based therapies for example, multivitamin supplementation, ketogenic diet and cannabidiol extracts. Mind-based therapies e.g. Yoga and whole-body systems therapies e.g. Ayurdelic and Traditional Chinese Medicine have also generated interest in epilepsy care. There is a paucity of effectiveness studies of these therapies in LMIC such as Africa, where capacity to take these products through clinical trials is limited. There are however serious concerns on reliability of reported findings because of inadequate randomization, and small sample sizes, and concerns on quality and safety owing to lack of standardization of bioactive compounds, accidental or intention botanical substitution of products and unhygienic handling. There is growing interest in TCM worldwide because of its economic potential, concerns on safety and quality and potential for integration into the health care systems. There is urgent need to develop and implement national TCM regulatory policies and programmes aimed at expanding the knowledge base and providing guidance on quality assurance standards. However, LMIC continue to lag in implementation of these policies and guidelines, especially in the areas of research and development and regulation of TCM practice. Working with stakeholders, countries are advised to assess their own national situations in relation to TCM, and then develop practical solutions to accommodate these approaches. For instance, conduct surveys on benefits and risks of TCM in the management of epilepsy in the local context and use this information to promote appreciation of a role for TCM, which will ease integration into the main health systems.
传统/替代和补充医学(TCM)包括不构成常规治疗一部分的产品、做法和从业人员,也不是主要卫生保健系统的组成部分。它们在癫痫和精神卫生状况的管理中非常常见,特别是在低收入和中等收入国家。例如,在非洲进行的一项基于人群的调查中,超过70%的癫痫患者在调查前曾看过传统保健医生,亚洲和南美洲也报告了类似的高估计数。可及性、文化适宜性/一致性、对传统(生物医学)药物无反应以及对治疗的控制是中医优于传统医学的一些原因。也有新的证据表明,中药产品单独使用或与抗癫痫药物一起使用可改善癫痫发作控制、精神合并症和生活质量。大多数令人信服的证据来自基于生物的疗法,例如,多种维生素补充剂,生酮饮食和大麻二酚提取物。以精神为基础的疗法,如瑜伽和全身系统疗法,如阿育德尔疗法和中医,也引起了人们对癫痫治疗的兴趣。在非洲等中低收入国家缺乏对这些疗法的有效性研究,这些国家通过临床试验使用这些产品的能力有限。然而,由于不充分的随机化和小样本量,对报告结果的可靠性存在严重关切,并且由于缺乏生物活性化合物的标准化,意外或故意植物替代产品以及不卫生的处理,对质量和安全存在关切。由于其经济潜力、对安全性和质量的关注以及整合到卫生保健系统中的潜力,全世界对中医的兴趣越来越大。迫切需要制定和实施旨在扩大知识库和提供质量保证标准指导的国家中医药管理政策和规划。然而,中低收入国家在实施这些政策和指导方针方面仍然落后,特别是在中药研发和监管方面。建议各国与利益攸关方合作,评估与中医药有关的本国情况,然后制定适用于这些方法的实际解决方案。例如,就中医药在当地癫痫管理中的益处和风险进行调查,并利用这些信息促进对中医药作用的认识,这将有助于纳入主要卫生系统。
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引用次数: 0
Development of a questionnaire to measure patient-relevant needs and benefits in the treatment of epilepsy (PBI-Epilepsy) 制定一份问卷,以衡量癫痫治疗中与患者相关的需求和益处。
IF 2.3 3区 医学 Q2 BEHAVIORAL SCIENCES Pub Date : 2024-11-29 DOI: 10.1016/j.yebeh.2024.110152
Toni Maria Janke , Jeanne Cuny , Christine Blome , Doris Wittig-Moßner , Hajo Hamer

Objective

Therapeutic goals in epilepsy treatment may be highly individual. The aim of the present study was to develop a questionnaire assessing patients’ needs and benefits of epilepsy treatment, the Patient Benefit Index on Epilepsy (PBI-Epilepsy).

Methods

We recruited adult patients during their stay at a university based epilepsy centre. Patients completed a survey asking about their burden and treatment goals. Data were categorised using qualitative content analysis. The final category system was discussed in an expert panel. The questionnaire was pre-tested using cognitive debriefing and adapted until no changes were required anymore.

Results

In the open survey, 25 people with epilepsy participated (60.0 % female, 33.2 years, 1–55 years epilepsy). The final category system included nine main categories (namely psyche, working life, seizures, therapy, leisure activities, social relationships, mobility, body, everyday life activities). From this, the expert panel developed a first draft of the PBI-Epilepsy. The questionnaire went through five rounds of cognitive debriefing with 29 patients (51.7 % female, 34.6 years, 2–37 years epilepsy). We decided to develop two versions of the questionnaire depending on the patient’s treatment (medical or surgical). A bipolar response scale was used in the part asking about treatment benefits, as epilepsy treatment can lead to both improvement and deterioration. The final questionnaire consists of two parts (patient needs and treatment benefits) each encompassing 21 items.

Conclusion

We aimed to reflect the wide range of issues that are relevant for people with epilepsy while developing a questionnaire that is short and easy for patients to understand.
目的癫痫治疗的治疗目标可能高度个体化。本研究的目的是制定一份评估患者癫痫治疗需求和获益的问卷,即癫痫患者获益指数(PBI-Epilepsy)。方法我们招募在大学癫痫中心住院的成年患者。患者完成了一项调查,询问他们的负担和治疗目标。使用定性内容分析对数据进行分类。最后由专家小组讨论了分类系统。使用认知汇报对问卷进行预测试,并进行调整,直到不再需要更改为止。结果公开调查共25例癫痫患者,其中女性60.0%,年龄33.2岁,1 ~ 55岁癫痫患者。最后的分类系统包括九个主要类别(即心理、工作生活、癫痫、治疗、休闲活动、社会关系、流动性、身体、日常生活活动)。据此,专家小组制定了PBI-Epilepsy的初稿。对29例患者(女性51.7%,年龄34.6岁,癫痫2-37岁)进行5轮认知情况述评。我们决定根据患者的治疗(内科或外科)开发两个版本的问卷。在询问治疗益处的部分使用了双相反应量表,因为癫痫治疗可以导致改善和恶化。最终问卷由两部分组成(患者需求和治疗益处),每部分包含21个项目。结论本研究旨在反映与癫痫患者相关的广泛问题,同时编制一份简短且易于患者理解的问卷。
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引用次数: 0
Combining three-phase EEG pattern and ipsilateral isolated eye deviation to predict seizure focus in the frontal interhemispheric fissure 结合三相脑电图与同侧离体眼偏差预测额叶半球间裂发作灶
IF 2.3 3区 医学 Q2 BEHAVIORAL SCIENCES Pub Date : 2024-11-29 DOI: 10.1016/j.yebeh.2024.110175
Mitsuyo Nishimura , Ayataka Fujimoto , Tohru Okanishi , Yosuke Masuda , Kota Araki , Hideo Enoki , Eiichi Ishikawa

Objective

Identification of seizure focus on the interhemispheric fissure (IHF) is often challenging at the step of scalp video-EEG monitoring on preoperative evaluations. We previously reported ictal three-phase EEG patterns (3Ph-EEG) and isolated eye deviation (isolated ED) to side of the seizure focus during seizures, each of which is available for identifying the seizure focus for frontal IHF (F-IHF). This study aimed to evaluate the accuracy of predicting the F-IHF focus using a combination of 3Ph-EEG and isolated ED in patients with frontal lobe epilepsy and the accuracy of predicting lateralization of the F-IHF focus using the predominance of findings.

Methods

We collected 15 patients diagnosed with frontal lobe epilepsy showing clinical seizures arising only from the frontal lobe, from 131 patients with intracranial video-EEG performed between January 2012 and December 2019. All 15 patients were classified into the IHF group (n = 7) and the extra-IHF group (n = 8) based on intracranial video-EEG. We statistically evaluated the accuracies of predicting F-IHF onset using combinations of 3Ph-EEG and isolated ED on scalp-EEG: 1) 3Ph-EEG (+); 2) isolated ED (+); 3) 3Ph-EEG (+) and/or isolated ED (+); and 4) 3Ph-EEG (+) and isolated ED (+). We also evaluated the accuracy of predicting focus lateralization using 3Ph-EEG and isolated ED.

Results

Both 3Ph-EEG (+) and isolated ED (+) demonstrated good accuracy for identifying F-IHF foci. They showed identical sensitivities of 71.4 %, with odds ratios of 7.5 for 3Ph-EEG (+) and 17.5 for isolated ED (+), respectively. Only the combination of 3Ph-EEG (+) and/or isolated ED (+) showed significant associations (p = 0.007). This combination demonstrated the highest sensitivity (100 %) and modified odds ratio (39.0), indicating that all patients in the IHF group exhibited at least one of the following: 3Ph-EEG or isolated ED. The combination of 3Ph-EEG (+) and isolated ED (+) offered one of the highest specificities, at 87.5 %. To predict lateralization with the F-IHF focus, both the predominant side for the third phase of 3Ph-EEG (n = 5) and the direction of isolated ED (n = 5) were perfectly concordant with the F-IHF focus side (100 % for both).

Conclusion

The combination of 3Ph-EEG and isolated ED can detect the IHF seizure focus with higher sensitivity in patients with frontal lobe epilepsy compared with using each method individually. Moreover, the absence of these two features eliminated the possibility of an F-IHF focus. Based on 3Ph-EEG and the direction of isolated ED, the focus side could presume lateralization of the F-IHF focus. Combining 3Ph-EEG and ipsilateral isolated ED at presurgical evaluation may help in designating locations for intracranial EEG electrodes.
目的在术前评估头皮视频脑电图监测中,癫痫病灶的识别往往是一个挑战。我们之前报道了癫痫发作时的初始三相脑电图模式(3Ph-EEG)和孤立眼偏侧(孤立ED),这些都可用于识别额叶IHF (F-IHF)的癫痫发作灶。本研究旨在评估使用3Ph-EEG和孤立ED联合预测额叶癫痫患者F-IHF病灶的准确性,以及使用优势结果预测F-IHF病灶偏侧的准确性。方法收集2012年1月至2019年12月131例颅内视频脑电图患者中15例诊断为额叶癫痫,临床癫痫发作仅发生在额叶。根据颅内视频脑电图将15例患者分为IHF组(n = 7)和超IHF组(n = 8)。我们对3Ph-EEG和头皮ED联合预测F-IHF发病的准确性进行了统计评估:1)3Ph-EEG (+);2)孤立ED (+);3) 3Ph-EEG(+)和/或孤立ED (+);4) 3Ph-EEG(+)和离体ED(+)。结果3Ph-EEG(+)和分离ED(+)对F-IHF病灶的识别精度均较高。他们显示相同的敏感性为71.4%,3Ph-EEG(+)的比值比为7.5,孤立ED(+)的比值比为17.5。只有3Ph-EEG(+)和/或单独ED(+)合并出现显著相关性(p = 0.007)。这种组合显示出最高的敏感性(100%)和修正的优势比(39.0),表明IHF组的所有患者至少表现出以下一种:3Ph-EEG或孤立ED。3Ph-EEG(+)和孤立ED(+)的组合提供了最高的特异性之一,为87.5%。为了预测F-IHF灶侧化,3Ph-EEG第三期的优势侧(n = 5)和孤立ED的方向(n = 5)与F-IHF灶侧完全一致(两者100%一致)。结论3Ph-EEG与单独ED联合检测额叶癫痫IHF发作病灶的灵敏度高于单独方法。此外,缺少这两个特征消除了F-IHF焦点的可能性。根据3Ph-EEG和离体ED方向,病灶侧可以推测F-IHF病灶偏侧。在术前评估时结合3Ph-EEG和同侧孤立ED可能有助于指定颅内EEG电极的位置。
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引用次数: 0
Combining MRI radiomics and clinical features for early identification of drug-resistant epilepsy in people with newly diagnosed epilepsy 结合MRI放射组学和临床特征早期识别新诊断癫痫患者的耐药癫痫
IF 2.3 3区 医学 Q2 BEHAVIORAL SCIENCES Pub Date : 2024-11-29 DOI: 10.1016/j.yebeh.2024.110165
Shijun Yang , Siying Chen , Yaling Huang , Yang Lu , Yi Chen , Liyun Ye , Qunhui Liu

Objective

To identify newly diagnosed patients with drug-resistant epilepsy (DRE) based on radiomics and clinical features.

Methods

A radiomics approach was used to combine clinical features with magnetic resonance imaging (MRI) features extracted by the ResNet-18 deep learning model to predict DRE. Three machine learning classifiers were built, and k-fold cross-validation was used to assess the classifier outcomes, and other evaluation metrics of accuracy, sensitivity, specificity, F1 score, and area under the curve (AUC) were used to evaluate the performance of these models.

Results

One hundred and thirty-four newly diagnosed epilepsy patients with 13 available clinical features and 1394 MRI features extracted by the ResNet-18 model were included in our study. Then three machine learning classifiers were built based on5 clinical features and 8 MRI features, including Support Vector Machine (SVM), Gradient-Boosted Decision Tree (GBDT) and Random Forest. After internally validation, the GBDT model performed the best, with an average accuracy of 0.85 [95% confidence interval (CI) 0.77–0.91], sensitivity of 0.97 [95% CI 0.85–1.00], specificity of 0.96 [95% CI 0.83–1.00], F1 score of 0.81 [95% CI 0.77–0.89], AUC of 0.95 [95% CI 0.82–0.99], and ten-fold cross validation avg score of 0.96 [95% CI 0.89–0.99] in test set.

Significance

This study offers a novel approach for early diagnosis of DRE. Radiomics can provide potential diagnostic and predictive information to support personalized treatment decisions.
目的根据放射组学和临床特征对新诊断的耐药癫痫(DRE)患者进行鉴别。方法采用放射组学方法,将临床特征与ResNet-18深度学习模型提取的磁共振成像(MRI)特征相结合,预测DRE。构建了三个机器学习分类器,并使用k-fold交叉验证来评估分类器的结果,并使用准确性、灵敏度、特异性、F1评分和曲线下面积(AUC)等其他评估指标来评估这些模型的性能。结果134例新诊断癫痫患者纳入研究,这些患者具有13个临床特征和1394个通过ResNet-18模型提取的MRI特征。然后基于5个临床特征和8个MRI特征构建了支持向量机(SVM)、梯度增强决策树(GBDT)和随机森林3个机器学习分类器。经内部验证,GBDT模型表现最好,平均准确率为0.85[95%置信区间(CI) 0.77 ~ 0.91],灵敏度为0.97 [95% CI 0.85 ~ 1.00],特异性为0.96 [95% CI 0.83 ~ 1.00], F1评分为0.81 [95% CI 0.77 ~ 0.89], AUC为0.95 [95% CI 0.82 ~ 0.99],十倍交叉验证平均评分为0.96 [95% CI 0.89 ~ 0.99]。意义本研究为DRE的早期诊断提供了一种新的方法。放射组学可以提供潜在的诊断和预测信息,以支持个性化治疗决策。
{"title":"Combining MRI radiomics and clinical features for early identification of drug-resistant epilepsy in people with newly diagnosed epilepsy","authors":"Shijun Yang ,&nbsp;Siying Chen ,&nbsp;Yaling Huang ,&nbsp;Yang Lu ,&nbsp;Yi Chen ,&nbsp;Liyun Ye ,&nbsp;Qunhui Liu","doi":"10.1016/j.yebeh.2024.110165","DOIUrl":"10.1016/j.yebeh.2024.110165","url":null,"abstract":"<div><h3>Objective</h3><div>To identify newly diagnosed patients with drug-resistant epilepsy (DRE) based on radiomics and clinical features.</div></div><div><h3>Methods</h3><div>A radiomics approach was used to combine clinical features with magnetic resonance imaging (MRI) features extracted by the ResNet-18 deep learning model to predict DRE. Three machine learning classifiers were built, and <em>k</em>-fold cross-validation was used to assess the classifier outcomes, and other evaluation metrics of accuracy, sensitivity, specificity, F1 score, and area under the curve (AUC) were used to evaluate the performance of these models.</div></div><div><h3>Results</h3><div>One hundred and thirty-four newly diagnosed epilepsy patients with 13 available clinical features and 1394 MRI features extracted by the ResNet-18 model were included in our study. Then three machine learning classifiers were built based on5 clinical features and 8 MRI features, including Support Vector Machine (SVM), Gradient-Boosted Decision Tree (GBDT) and Random Forest. After internally validation, the GBDT model performed the best, with an average accuracy of 0.85 [95% confidence interval (CI) 0.77–0.91], sensitivity of 0.97 [95% CI 0.85–1.00], specificity of 0.96 [95% CI 0.83–1.00], F1 score of 0.81 [95% CI 0.77–0.89], AUC of 0.95 [95% CI 0.82–0.99], and ten-fold cross validation avg score of 0.96 [95% CI 0.89–0.99] in test set.</div></div><div><h3>Significance</h3><div>This study offers a novel approach for early diagnosis of DRE. Radiomics can provide potential diagnostic and predictive information to support personalized treatment decisions.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"162 ","pages":"Article 110165"},"PeriodicalIF":2.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The impact of a walking program on self-management, anxiety, stress, depression, quality of life, and seizure frequency in patients with epilepsy: A mixed methods approach using the COM-B behaviour change model 散步计划对癫痫患者自我管理、焦虑、压力、抑郁、生活质量和癫痫发作频率的影响:采用COM-B行为改变模型的混合方法
IF 2.3 3区 医学 Q2 BEHAVIORAL SCIENCES Pub Date : 2024-11-29 DOI: 10.1016/j.yebeh.2024.110149
Esin Kavuran , Cemal Özalp , Emrah Ay

Objective

This study aimed to investigate the effect of a walking program based on the COM-B Behavior Change Model on self-management, anxiety, stress, depression, quality of life, and seizure frequency in individuals with epilepsy.

Methods

A prospective, parallel-group controlled experimental design and mixed methods were used. A total of 78 individuals with epilepsy were included in the study and randomly assigned to the intervention (n = 38) and control (n = 40) groups. The intervention group participated in a weekly, twice-a-week, walking program for 12 weeks. The program was based on the COM-B model, focusing on increasing individuals’ capability, opportunity, and motivation levels. The control group received standard treatment. Self-management, anxiety, stress, depression, and quality of life were measured using scales. Seizure frequency was measured using daily logs. Qualitative data was collected through semi-structured interviews with 10 participants to understand barriers to walking in individuals with epilepsy.

Results

Qualitative data revealed time constraints, lack of motivation, and safety concerns as barriers to walking participation. After a 12-week intervention, a significant increase in self-management levels, a significant decrease in anxiety, stress, and depression levels, a significant improvement in quality of life, and a significant reduction in seizure frequency were observed in the intervention group. No significant changes were observed in these variables in the control group.

Conclusion

This study demonstrated that a walking program based on the COM-B Behavior Change Model had a positive impact on self-management, mental health, and quality of life in individuals with epilepsy and may help reduce seizure frequency.
目的探讨基于COM-B行为改变模型的步行训练对癫痫患者自我管理、焦虑、压力、抑郁、生活质量和发作频率的影响。方法采用前瞻性、平行组对照试验设计和混合方法。共有78名癫痫患者被纳入研究,并随机分为干预组(n = 38)和对照组(n = 40)。干预组参加每周两次的步行计划,为期12周。该计划以COM-B模型为基础,侧重于提高个人的能力、机会和动机水平。对照组给予标准治疗。使用量表测量自我管理、焦虑、压力、抑郁和生活质量。使用每日日志测量癫痫发作频率。通过对10名参与者的半结构化访谈收集定性数据,以了解癫痫患者行走障碍。结果定性数据显示,时间限制、缺乏动力和安全问题是参与步行的障碍。经过12周的干预后,观察到干预组患者自我管理水平显著提高,焦虑、压力和抑郁水平显著降低,生活质量显著改善,癫痫发作频率显著降低。在对照组中,这些变量未见明显变化。结论:基于COM-B行为改变模型的步行计划对癫痫患者的自我管理、心理健康和生活质量有积极影响,并可能有助于减少癫痫发作频率。
{"title":"The impact of a walking program on self-management, anxiety, stress, depression, quality of life, and seizure frequency in patients with epilepsy: A mixed methods approach using the COM-B behaviour change model","authors":"Esin Kavuran ,&nbsp;Cemal Özalp ,&nbsp;Emrah Ay","doi":"10.1016/j.yebeh.2024.110149","DOIUrl":"10.1016/j.yebeh.2024.110149","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to investigate the effect of a walking program based on the COM-B Behavior Change Model on self-management, anxiety, stress, depression, quality of life, and seizure frequency in individuals with epilepsy.</div></div><div><h3>Methods</h3><div>A prospective, parallel-group controlled experimental design and mixed methods were used. A total of 78 individuals with epilepsy were included in the study and randomly assigned to the intervention (n = 38) and control (n = 40) groups. The intervention group participated in a weekly, twice-a-week, walking program for 12 weeks. The program was based on the COM-B model, focusing on increasing individuals’ capability, opportunity, and motivation levels. The control group received standard treatment. Self-management, anxiety, stress, depression, and quality of life were measured using scales. Seizure frequency was measured using daily logs. Qualitative data was collected through semi-structured interviews with 10 participants to understand barriers to walking in individuals with epilepsy.</div></div><div><h3>Results</h3><div>Qualitative data revealed time constraints, lack of motivation, and safety concerns as barriers to walking participation. After a 12-week intervention, a significant increase in self-management levels, a significant decrease in anxiety, stress, and depression levels, a significant improvement in quality of life, and a significant reduction in seizure frequency were observed in the intervention group. No significant changes were observed in these variables in the control group.</div></div><div><h3>Conclusion</h3><div>This study demonstrated that a walking program based on the COM-B Behavior Change Model had a positive impact on self-management, mental health, and quality of life in individuals with epilepsy and may help reduce seizure frequency.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"162 ","pages":"Article 110149"},"PeriodicalIF":2.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Efficacy and tolerability of celastrol and edaravone in the multiple-hit rat model of infantile spasms 赛拉司琼和依达拉奉在婴儿痉挛症多发大鼠模型中的疗效和耐受性。
IF 2.3 3区 医学 Q2 BEHAVIORAL SCIENCES Pub Date : 2024-11-21 DOI: 10.1016/j.yebeh.2024.110159
Oleksii Shandra , Yongjun Wang , Lisa D. Coles , Wenzhu B. Mowrey , Qianyun Li , Wei Liu , Solomon L. Moshé , Aristea S. Galanopoulou

Objective

To test whether anti-inflammatory and antioxidant drugs that inhibit the nuclear factor kappa light chain enhancer of activated B cells (NF-kB), celastrol and edaravone, suppress spasms and improve developmental outcomes in the multiple-hit rat model of refractory infantile spasms (IS) due to structural lesions.

Methods

Postnatal day 3 (PN3) Sprague-Dawley rats were treated according to the multiple-hit IS model protocol. Using a randomized, blinded, vehicle-controlled, dose- and time-response study design, we tested the effects of single celastrol [1, 2, or 4 mg/kg intraperitoneally (i.p.), 10–14 rats/group] or edaravone (1, 10 or 30 mg/kg i.p., 14–17 rats/group) injections vs their vehicles on behavioral and electroclinical spasms and developmental milestones. Video-EEG monitoring was done on PN6-7 (n = 11–12 rats/group). Pulse celastrol treatment effects (PN4: 4 mg/kg, PN5-6: 2 mg/kg/day i.p.) were determined on spasms, developmental milestones and Barnes maze. Celastrol and edaravone pharmacokinetics in plasma and neocortex were assessed. Linear mixed model analysis of raw or normalized log-transformed spasm frequencies, considering repeated observations was used.

Results

Single (2–4 mg/kg i.p) or pulse celastrol, but not edaravone, reduced behavioral and electroclinical spasms frequencies within 5hrs. Pulse celastrol did not affect spasm-freedom, survival, developmental milestones or Barnes maze performance. Celastrol had erratic i.p. absorption with maximum concentrations observed between 2–4 h, when effects on spasms were seen. Edaravone had low blood-to-brain permeability.

Conclusions

Celastrol’s efficacy on spasms is partially explained by its better brain penetration than edaravone’s. NFkB inhibitors may be useful in treating drug-resistant IS but delivery methods with improved bioavailability and brain permeability are needed.
研究目的检测抑制活化B细胞核因子卡巴轻链增强子(NF-kB)的抗炎和抗氧化药物西司他洛尔(celastrol)和依达拉奉(edaravone)是否能抑制因结构性病变导致的难治性婴儿痉挛(IS)多重打击大鼠模型的痉挛并改善其发育结果:出生后第 3 天(PN3)的 Sprague-Dawley 大鼠按照多击 IS 模型方案进行治疗。我们采用随机、盲法、载体对照、剂量和时间反应研究设计,测试了单次腹腔注射西司他醇(1、2或4毫克/千克,10-14只/组)或依达拉奉(1、10或30毫克/千克,14-17只/组)对行为和电临床痉挛以及发育里程碑的影响。对PN6-7(n = 11-12只/组)进行了视频脑电图监测。脉冲西司他醇治疗(PN4:4 毫克/千克,PN5-6:2 毫克/千克/天,静脉注射)对痉挛、发育里程碑和巴恩斯迷宫的影响。评估了血浆和新皮层中的塞拉斯托和依达拉奉药代动力学。考虑到重复观察,采用线性混合模型分析原始或归一化对数变换的痉挛频率:结果:单次(2-4 毫克/千克 i.p.)或脉冲塞拉司琼(而非依达拉奉)可在 5 小时内降低行为和电临床痉挛频率。脉冲西司他醇不会影响痉挛自由度、存活率、发育里程碑或巴恩斯迷宫表现。西司他洛尔的静脉吸收不稳定,2-4 小时内浓度最高,此时对痉挛的影响显现出来。依达拉奉的血脑通透性较低:结论:塞拉斯特龙对痉挛的疗效部分归因于其比依达拉奉更好的脑渗透性。NFkB抑制剂可能有助于治疗耐药的IS,但需要改进生物利用度和脑渗透性的给药方法。
{"title":"Efficacy and tolerability of celastrol and edaravone in the multiple-hit rat model of infantile spasms","authors":"Oleksii Shandra ,&nbsp;Yongjun Wang ,&nbsp;Lisa D. Coles ,&nbsp;Wenzhu B. Mowrey ,&nbsp;Qianyun Li ,&nbsp;Wei Liu ,&nbsp;Solomon L. Moshé ,&nbsp;Aristea S. Galanopoulou","doi":"10.1016/j.yebeh.2024.110159","DOIUrl":"10.1016/j.yebeh.2024.110159","url":null,"abstract":"<div><h3>Objective</h3><div>To test whether anti-inflammatory and antioxidant drugs that inhibit the nuclear factor kappa light chain enhancer of activated B cells (NF-kB), celastrol and edaravone, suppress spasms and improve developmental outcomes in the multiple-hit rat model of refractory infantile spasms (IS) due to structural lesions.</div></div><div><h3>Methods</h3><div>Postnatal day 3 (PN3) Sprague-Dawley rats were treated according to the multiple-hit IS model protocol. Using a randomized, blinded, vehicle-controlled, dose- and time-response study design, we tested the effects of single celastrol [1, 2, or 4 mg/kg intraperitoneally (i.p.), 10–14 rats/group] or edaravone (1, 10 or 30 mg/kg i.p., 14–17 rats/group) injections vs their vehicles on behavioral and electroclinical spasms and developmental milestones. Video-EEG monitoring was done on PN6-7 (n = 11–12 rats/group). Pulse celastrol treatment effects (PN4: 4 mg/kg, PN5-6: 2 mg/kg/day i.p.) were determined on spasms, developmental milestones and Barnes maze. Celastrol and edaravone pharmacokinetics in plasma and neocortex were assessed. Linear mixed model analysis of raw or normalized log-transformed spasm frequencies, considering repeated observations was used.</div></div><div><h3>Results</h3><div>Single (2–4 mg/kg i.p) or pulse celastrol, but not edaravone, reduced behavioral and electroclinical spasms frequencies within 5hrs. Pulse celastrol did not affect spasm-freedom, survival, developmental milestones or Barnes maze performance. Celastrol had erratic i.p. absorption with maximum concentrations observed between 2–4 h, when effects on spasms were seen. Edaravone had low blood-to-brain permeability.</div></div><div><h3>Conclusions</h3><div>Celastrol’s efficacy on spasms is partially explained by its better brain penetration than edaravone’s. NFkB inhibitors may be useful in treating drug-resistant IS but delivery methods with improved bioavailability and brain permeability are needed.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"162 ","pages":"Article 110159"},"PeriodicalIF":2.3,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Letter to the Editor: Status epilepticus and peri-ictal MRI abnormalities 致编辑的信:癫痫状态和发作周磁共振成像异常。
IF 2.3 3区 医学 Q2 BEHAVIORAL SCIENCES Pub Date : 2024-11-20 DOI: 10.1016/j.yebeh.2024.110160
Simona Lattanzi , Stefano Meletti
{"title":"Letter to the Editor: Status epilepticus and peri-ictal MRI abnormalities","authors":"Simona Lattanzi ,&nbsp;Stefano Meletti","doi":"10.1016/j.yebeh.2024.110160","DOIUrl":"10.1016/j.yebeh.2024.110160","url":null,"abstract":"","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"162 ","pages":"Article 110160"},"PeriodicalIF":2.3,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Epilepsy & Behavior
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