Pub Date : 2024-11-29DOI: 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
{"title":"Role for a video tool in educating youth with epilepsy about anticonvulsant and contraceptive drug interactions","authors":"Natalia I. Lopez , Camille A. Dang , Rovingaile Kriska M. Ponce , Sara Jacobellis , Madeline Niemann , Rinat Jonas , Laurie M. Douglass","doi":"10.1016/j.yebeh.2024.110154","DOIUrl":"10.1016/j.yebeh.2024.110154","url":null,"abstract":"<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 ","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"163 ","pages":"Article 110154"},"PeriodicalIF":2.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142747625","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}
Pub Date : 2024-11-29DOI: 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。
{"title":"Epilepsy and nicotine use: Exploring disparities in ENDS and cigarette use among US adults with epilepsy","authors":"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)","doi":"10.1016/j.yebeh.2024.110177","DOIUrl":"10.1016/j.yebeh.2024.110177","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"162 ","pages":"Article 110177"},"PeriodicalIF":2.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744389","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}
Pub Date : 2024-11-29DOI: 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.
{"title":"Shortage of antiseizure medication in Germany: How big is the problem?","authors":"Josephine Steidl , Sabine Krebs , Karel Kostev , Stefan Schwab , Hajo M. Hamer","doi":"10.1016/j.yebeh.2024.110162","DOIUrl":"10.1016/j.yebeh.2024.110162","url":null,"abstract":"<div><h3>Objectives</h3><div>We determined the frequency of drug shortages of antiseizure medication (ASM) availability in Germany.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div><div>16.7% (40/239) of ASM with drug shortages/disruptions were brand-name ASM and 83.3% (199/239) were generic ASM.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"162 ","pages":"Article 110162"},"PeriodicalIF":2.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-29DOI: 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.
{"title":"Integrating alternative and complementary medicine in the management of epilepsy and its comorbidities in low- and middle-income settings","authors":"Symon M. Kariuki , Charles R.J.C. Newton","doi":"10.1016/j.yebeh.2024.110172","DOIUrl":"10.1016/j.yebeh.2024.110172","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"162 ","pages":"Article 110172"},"PeriodicalIF":2.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744487","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}
Pub Date : 2024-11-29DOI: 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.
{"title":"Development of a questionnaire to measure patient-relevant needs and benefits in the treatment of epilepsy (PBI-Epilepsy)","authors":"Toni Maria Janke , Jeanne Cuny , Christine Blome , Doris Wittig-Moßner , Hajo Hamer","doi":"10.1016/j.yebeh.2024.110152","DOIUrl":"10.1016/j.yebeh.2024.110152","url":null,"abstract":"<div><h3>Objective</h3><div>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).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"162 ","pages":"Article 110152"},"PeriodicalIF":2.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Combining three-phase EEG pattern and ipsilateral isolated eye deviation to predict seizure focus in the frontal interhemispheric fissure","authors":"Mitsuyo Nishimura , Ayataka Fujimoto , Tohru Okanishi , Yosuke Masuda , Kota Araki , Hideo Enoki , Eiichi Ishikawa","doi":"10.1016/j.yebeh.2024.110175","DOIUrl":"10.1016/j.yebeh.2024.110175","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>p</em> = 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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"162 ","pages":"Article 110175"},"PeriodicalIF":2.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744381","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}
Pub Date : 2024-11-29DOI: 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 , Siying Chen , Yaling Huang , Yang Lu , Yi Chen , Liyun Ye , 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}
Pub Date : 2024-11-29DOI: 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.
{"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 , Cemal Özalp , 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}
Pub Date : 2024-11-21DOI: 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.
{"title":"Efficacy and tolerability of celastrol and edaravone in the multiple-hit rat model of infantile spasms","authors":"Oleksii Shandra , Yongjun Wang , Lisa D. Coles , Wenzhu B. Mowrey , Qianyun Li , Wei Liu , Solomon L. Moshé , 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}
Pub Date : 2024-11-20DOI: 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 , 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}