Pub Date : 2024-09-23DOI: 10.1016/j.yebeh.2024.110033
Hiba A. Haider
Status epilepticus (SE) is a time-sensitive, potentially life-threatening neuro-emergency associated with poor functional outcomes and increased hospital resource utilization especially when it progresses to refractory or super-refractory forms. Timely recognition & treatment improves outcomes, however gaps between recommended and implemented care are common and pervasive.
This review provides a roadmap for incorporating the relatively new field of Implementation Science in promoting the systematic uptake of evidence-based practices into the real-world care of patients with SE. A multifaceted approach − including better integration of real-world implementation and research infrastructure, an emphasis on standardizing and harmonization clinical data, re-examining funding priorities, regulatory reform, and the formation of transdisciplinary teams and learning collaboratives − has the potential to advance the care of patients in SE from its current status quo.
This topic was presented at the 9th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures held in April 2024.
癫痫状态（SE）是一种具有时间敏感性、可能危及生命的神经急症，与不良的功能预后和更多的医院资源使用相关，尤其是当癫痫发展为难治性或超难治性癫痫时。本综述为将相对较新的 "实施科学"（Implementation Science）领域纳入促进将循证实践系统地应用到 SE 患者的实际护理中提供了路线图。多方面的方法--包括更好地整合现实世界中的实施和研究基础设施、强调临床数据的标准化和统一性、重新审查资金的优先次序、监管改革以及组建跨学科团队和学习合作--都有可能从目前的现状出发，推动对 SE 患者的护理。
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Pub Date : 2024-09-22DOI: 10.1016/j.yebeh.2024.110055
Dandan Mao, Sixiu Li, Yang Xu, Hui Chen, Ping Liu, Wenguang Hu
Background
Infantile epileptic spasms syndrome (IESS) is a severe epileptic condition characterized by persistent uncontrolled seizures, with some children experiencing recurrent seizures despite multiple pharmacological therapies. The prognostic risk factors associated with IESS remain unclear. This study aimed to evaluate the factors influencing the efficacy and relapse of adrenocorticotropic hormone (ACTH) treatment for IESS in infants, as well as to assess the correlation between the Burden of Amplitudes and Epileptiform Discharges (BASED) score and clinical outcomes.
Methods
A retrospective analysis was conducted on a cohort of 88 pediatric patients diagnosed with IESS who received ACTH therapy at our hospital from February 2016 to August 2023. Patients were categorized into response (n = 47) and non-response (n = 41) groups based on their treatment response at day 28. Responders were further classified into relapse and non-relapse groups. A modified Poisson regression model and receiver operating characteristic (ROC) curves were employed to evaluate the positive predictive values.
Results
In this study, a total of 47 patients (53.4 %) responded to ACTH treatment. Patients in the response group demonstrated significantly greater reductions in BASED scores by day 14 of ACTH treatment, yielding an area under the curve (AUC) of 0.859 (95 % CI: 0.782–0.937, P＜0.05), with a sensitivity of 68.1 % and a specificity of 95.1 %. The optimal cut-off point was established at ≥ 2, corresponding to a Youden index of 0.632. Notably, patients who were on anti-seizure medications (ASMs) before ACTH treatment and those with developmental delay prior to the onset of spasms exhibited lower short-term response rates (P＜0.05), although these factors did not demonstrate predictive value. Among the responders, 20 cases (42.6 %) experienced a relapse, with only those patients showing specific abnormalities on cranial magnetic resonance imaging (MRI) exhibiting a statistically higher proportion of relapse.
Conclusion
Patients receiving ASMs before ACTH treatment and those with developmental delays prior to the onset of spasms may have a less favorable therapeutic response. A reduction in BASED scores of 2 or greater by day 14 of ACTH treatment may signify a potentially positive treatment response. Additionally, patients with IESS who present with specific abnormalities on cranial MRI may have an increased likelihood of relapse following ACTH treatment.
{"title":"Factors influencing efficacy and relapse of adrenocorticotropic hormone in infantile epileptic spasms syndrome","authors":"Dandan Mao, Sixiu Li, Yang Xu, Hui Chen, Ping Liu, Wenguang Hu","doi":"10.1016/j.yebeh.2024.110055","DOIUrl":"10.1016/j.yebeh.2024.110055","url":null,"abstract":"<div><h3>Background</h3><div>Infantile epileptic spasms syndrome (IESS) is a severe epileptic condition characterized by persistent uncontrolled seizures, with some children experiencing recurrent seizures despite multiple pharmacological therapies. The prognostic risk factors<!--> <!-->associated with IESS remain unclear. This study aimed to evaluate the factors influencing the efficacy and relapse of adrenocorticotropic hormone (ACTH) treatment for IESS in infants, as well as to assess the correlation between the Burden of Amplitudes and Epileptiform Discharges (BASED) score and clinical outcomes.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on a cohort of 88 pediatric patients diagnosed with IESS who received ACTH therapy at our hospital from February 2016 to August 2023. Patients were categorized into response (n = 47) and non-response (n = 41) groups based on their treatment response at day 28. Responders were further classified into relapse and non-relapse groups. A modified Poisson regression model and receiver operating characteristic (ROC) curves were employed to evaluate the positive predictive values.</div></div><div><h3>Results</h3><div>In this study, a total of 47 patients (53.4 %) responded to ACTH treatment. Patients in the response group demonstrated significantly greater reductions in BASED scores by day 14 of ACTH treatment, yielding an area under the curve (AUC) of 0.859 (95 % CI: 0.782–0.937, P＜0.05), with a sensitivity of 68.1 % and a specificity of 95.1 %. The optimal cut-off point was established at ≥ 2, corresponding to a Youden index of 0.632. Notably, patients<!--> <!-->who were on anti-seizure medications (ASMs) before ACTH treatment and those with developmental delay prior to the onset of spasms exhibited lower short-term response rates (P＜0.05), although these factors did not demonstrate predictive value. Among the responders, 20 cases (42.6 %) experienced a relapse, with only those patients showing specific abnormalities on cranial magnetic resonance imaging (MRI) exhibiting a statistically higher proportion of relapse.</div></div><div><h3>Conclusion</h3><div>Patients receiving ASMs before ACTH treatment and those with developmental delays prior to the onset of spasms may have a less favorable therapeutic response. A reduction in BASED scores of 2 or greater by day 14 of ACTH treatment may signify a potentially positive treatment response. Additionally, patients with IESS who present with specific abnormalities on cranial MRI may have an increased likelihood of relapse following ACTH treatment.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1525505024004372/pdfft?md5=41b027df4c645eb5171d4764d867d4e0&pid=1-s2.0-S1525505024004372-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307442","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 : 2024-09-22DOI: 10.1016/j.yebeh.2024.110052
Tzu-Yun Hsieh , Ting-Yu Su , Kai-Yin Hung , Mei-Shin Hsu , Ying-Jui Lin , Hsuan-Chang Kuo , Pi-Lien Hung
Aim
Epilepsy with genetic etiology is high prevalence of DRE, which is reported responsive to ketogenic diet therapy (KDT). Our retrospective cohort study attempted to investigate the KD responsiveness between DRE with genetic and non-genetic etiology.
Method
Non-fasting gradual KD initiation protocol (GRAD-KD) and five-day diet program was implemented. Participants were categorized into genetic epilepsy or non-genetic epilepsy groups based on genetic tests. Monthly seizure frequencies and seizure reduction rate after KDT 3 months and 6 months were compared between two groups.
Results
Forty-six patients with genetic epilepsy and ninety-four patients with non-genetic epilepsy were recruited. Among 46 patients with genetic epilepsy, 12 patients withdrew from diet before 3 months of KDT, and 7 patients withdrew from diet before 6 months of KDT, thus, 27 patients retained the diet. Among 94 patients with non-genetic epilepsy, 20 patients withdrew from diet before 3 months of KDT, and 21 patients withdrew from diet before 6 months of KDT, 53 patients retained the diet. For the 46 patients with genetic epilepsy, 12 patients had pathogenic variants related to developmental and epileptic encephalopathy (DEE), whereas other 34 patients had disease-causing variants other than DEE. The mean monthly seizure frequencies showed significantly decreased both in patient with genetic-and non-genetic epilepsy after 6 months of KDT, however, the seizure reduction rate was significantly higher in patients with genetic epilepsy than patients with non-genetic epilepsy after 6 months of KDT. In addition, our data demonstrated that KDT could significantly reduce seizure burden in patients with non-DEE than patients with DEE. In addition, the patients with non-DEE significantly achieved greater seizure reduction rate than patients with DEE after 6 months of KDT.
Interpretation:
Our data highlighted that KD effectiveness is more outstanding in decreasing seizure burdens for epileptic patients with genetic etiology than those without causative gene mutation. Additionally, KDT is also significantly effective for decreasing more seizure burdens for non-DEE patients than for DEE patients. We suggested epileptic patients caused by genetic mutation should implement KDT as early as possible.
目的：遗传性癫痫是 DRE 的高发病症，据报道对生酮饮食疗法（KDT）有反应。我们的回顾性队列研究试图调查遗传性和非遗传性病因的 DRE 对生酮饮食疗法的反应性：方法：采用非空腹渐进生酮饮食启动方案（GRAD-KD）和五天饮食计划。根据基因检测结果将参与者分为遗传性癫痫组和非遗传性癫痫组。比较两组患者在KDT 3个月和6个月后的每月发作频率和发作减少率：结果：招募了 46 名遗传性癫痫患者和 94 名非遗传性癫痫患者。在 46 名遗传性癫痫患者中，12 名患者在 KDT 3 个月前退出饮食，7 名患者在 KDT 6 个月前退出饮食，因此 27 名患者保留了饮食。在 94 名非遺傳性癲癇患者中，20 名患者在接受 "關鍵性治療 "3 個月前退出飲食，21 名患者在接受 "關鍵性治療 "6 個月前退出飲食，53 名患者保留飲食。在46名遗传性癫痫患者中，12名患者的致病变异与发育和癫痫性脑病（DEE）有关，而其他34名患者的致病变异与DEE无关。经过 6 个月的 KDT 治疗后，遗传性和非遗传性癫痫患者的每月平均癫痫发作频率均明显降低，但遗传性癫痫患者的癫痫发作减少率明显高于非遗传性癫痫患者。此外，我们的数据还表明，KDT 能明显减轻非遗传性癫痫患者的癫痫发作负担，而非遗传性癫痫患者的发作负担则明显低于遗传性癫痫患者。此外，在接受 6 个月的 KDT 后，非 DEE 患者的癫痫发作减少率明显高于 DEE 患者：我们的数据强调，与无致病基因突变的癫痫患者相比，有遗传病因的癫痫患者在减少癫痫发作方面的效果更为突出。此外，KDT 在减少非 DEE 患者癫痫发作方面的效果也明显优于 DEE 患者。我们建议由基因突变引起的癫痫患者应尽早实施 KDT。
{"title":"Ketogenic diet effectiveness is superior for drug resistant epilepsy with causative genetic mutation than those without genetic etiology","authors":"Tzu-Yun Hsieh , Ting-Yu Su , Kai-Yin Hung , Mei-Shin Hsu , Ying-Jui Lin , Hsuan-Chang Kuo , Pi-Lien Hung","doi":"10.1016/j.yebeh.2024.110052","DOIUrl":"10.1016/j.yebeh.2024.110052","url":null,"abstract":"<div><h3>Aim</h3><div>Epilepsy with genetic etiology is high prevalence of DRE, which is reported responsive to ketogenic diet therapy (KDT). Our retrospective cohort study attempted to investigate the KD responsiveness between DRE with genetic and non-genetic etiology.</div></div><div><h3>Method</h3><div>Non-fasting gradual KD initiation protocol (GRAD-KD) and five-day diet program was implemented. Participants were categorized into genetic epilepsy or non-genetic epilepsy groups based on genetic tests. Monthly seizure frequencies and seizure reduction rate after KDT 3 months and 6 months were compared between two groups.</div></div><div><h3>Results</h3><div>Forty-six patients with genetic epilepsy and ninety-four patients with non-genetic epilepsy were recruited. Among 46 patients with genetic epilepsy, 12 patients withdrew from diet before 3 months of KDT, and 7 patients withdrew from diet before 6 months of KDT, thus, 27 patients retained the diet. Among 94 patients with non-genetic epilepsy, 20 patients withdrew from diet before 3 months of KDT, and 21 patients withdrew from diet before 6 months of KDT, 53 patients retained the diet. For the 46 patients with genetic epilepsy, 12 patients had pathogenic variants related to developmental and epileptic encephalopathy (DEE), whereas other 34 patients had disease-causing variants other than DEE. The mean monthly seizure frequencies showed significantly decreased both in patient with genetic-and non-genetic epilepsy after 6 months of KDT, however, the seizure reduction rate was significantly higher in patients with genetic epilepsy than patients with non-genetic epilepsy after 6 months of KDT. In addition, our data demonstrated that KDT could significantly reduce seizure burden in patients with non-DEE than patients with DEE. In addition, the patients with non-DEE significantly achieved greater seizure reduction rate than patients with DEE after 6 months of KDT.</div></div><div><h3>Interpretation:</h3><div>Our data highlighted that KD effectiveness is more outstanding in decreasing seizure burdens for epileptic patients with genetic etiology than those without causative gene mutation. Additionally, KDT is also significantly effective for decreasing more seizure burdens for non-DEE patients than for DEE patients. We suggested epileptic patients caused by genetic mutation should implement KDT as early as possible.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307443","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 : 2024-09-21DOI: 10.1016/j.yebeh.2024.110060
Serpil Özcan , Bahar Çiftçi
Objective
It is seen that religious coping methods are used in the literature, but the existing literature on religious coping methods and coping strategies used by epilepsy patients is insufficient. Therefore, this study aimed to determine the positive and negative religious coping levels of epilepsy patients.
Methods
This research is a descriptive research type. The research data were collected from patients with epilepsy living in a province in eastern Turkey between April and June 2024. The research population consists of epilepsy patients living in Erzurum province. The sample consisted of 154 patients who agreed to participate in the study. Data collection tools were “Questionnaire Form” and “Religious Coping Scale.” Frequency, percentage calculations, mean and standard deviation values were used to evaluate the data. One Way Anova, Independent Sample t-test, Mann-Whitney U, and Pearson correlation tests were also used.
Results
Positive religious coping scores (22.90 ± 5.35) and Negative religious coping scores (7.24 ± 3.25) of epilepsy patients were found to be at high levels. Participants’ gender, marital status, occupation, income status, prayer, fasting, and Quran reading habits significantly affected their positive religious coping behaviors (p < 0.05). In addition, it was determined that as the age of the participants increased, they resorted to positive religious coping behaviors more (r: 0.215, p < 0.05).
Conclusions
The results of the study show that the positive and negative religious coping levels of epilepsy patients are high. In addition, the participants prefer positive religious coping behaviors more.
{"title":"Exploring religious coping strategies epilepsy patients in Turkey: A descriptive study","authors":"Serpil Özcan , Bahar Çiftçi","doi":"10.1016/j.yebeh.2024.110060","DOIUrl":"10.1016/j.yebeh.2024.110060","url":null,"abstract":"<div><h3>Objective</h3><p>It is seen that religious coping methods are used in the literature, but the existing literature on religious coping methods and coping strategies used by epilepsy patients is insufficient. Therefore, this study aimed to determine the positive and negative religious coping levels of epilepsy patients.</p></div><div><h3>Methods</h3><p>This research is a descriptive research type. The research data were collected from patients with epilepsy living in a province in eastern Turkey between April and June 2024. The research population consists of epilepsy patients living in Erzurum province. The sample consisted of 154 patients who agreed to participate in the study. Data collection tools were “Questionnaire Form” and “Religious Coping Scale.” Frequency, percentage calculations, mean and standard deviation values were used to evaluate the data. One Way Anova, Independent Sample <em>t</em>-test, Mann-Whitney U, and Pearson correlation tests were also used.</p></div><div><h3>Results</h3><p>Positive religious coping scores (22.90 ± 5.35) and Negative religious coping scores (7.24 ± 3.25) of epilepsy patients were found to be at high levels. Participants’ gender, marital status, occupation, income status, prayer, fasting, and Quran reading habits significantly affected their positive religious coping behaviors (p < 0.05). In addition, it was determined that as the age of the participants increased, they resorted to positive religious coping behaviors more (r: 0.215, p < 0.05).</p></div><div><h3>Conclusions</h3><p>The results of the study show that the positive and negative religious coping levels of epilepsy patients are high. In addition, the participants prefer positive religious coping behaviors more.</p></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271882","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 : 2024-09-21DOI: 10.1016/j.yebeh.2024.110054
Cody L. Nathan, Morgan Kinsinger, Asia Giammarco-Hock, Elizabeth Cunningham, Elizabeth Gerard, Stephan Schuele, Stephen VanHaerents
Introduction
Evaluation by an epileptologist can help distinguish epileptic seizures from seizure mimickers. Proper and timely diagnosis of a seizure or new onset epilepsy is of critical importance due to implications regarding treatment, prognosis, quality of life, morbidity, and mortality. The goal of our study is to describe the demographics and clinical characteristics of patients referred to a first seizure clinic at a tertiary academic center within Chicago, Illinois.
Methods
This is a retrospective cohort study of adult patients referred to our clinic. Patients were identified through the electronic medical record from March 2021 to March 2022. Charts were reviewed to assess pertinent clinical characteristics and patient demographic data.
Results
A total of 123 out of 138 (89.0 %) scheduled patients checked in to the visit between March 2021-March 2022, of which 87/123 (70.7 %) were diagnosed with a seizure. Other diagnoses included syncope (17/123, 13.8 %), undifferentiated event (16/123, 13.0 %), suspected psychogenic non-epileptic event (2/123, 1.6 %), and migraine (1, 0.8 %). Of those with a seizure, 73/87 (83.9 %) were unprovoked and 14/87 (16.1 %) were provoked. The average wait time to be seen as a new patient by an epileptologist was significantly shorter with the establishment of this clinic compared to the year prior (17 days versus 53 days, p value < 0.001). The majority of patients had an EEG prior to or after the visit (121/123, 98.4 %), of which 24/121 (19.8 %) had interictal epileptiform activity. Findings relevant to the patient’s cause of epilepsy were found in 26/108 (24.1 %) of patients who underwent an MRI or CT scan of the head. There were 40/123 (32.5 %) patients prescribed an anti-seizure medication (ASM) prior to the first office visit and 65/123 (52.8 %) patients prescribed an ASM within the first three office visits.
Conclusion
A first seizure evaluation clinic in an urban setting is an achievable and efficient way to evaluate patients with paroxysmal events concerning for seizure in a timely manner. Most patients in this clinic were diagnosed with epileptic seizures. Timely ancillary testing with head imaging and EEG can help contribute to the diagnosis of epilepsy and guide treatment.
{"title":"Clinical characteristics of a first seizure evaluation clinic in an academic center","authors":"Cody L. Nathan, Morgan Kinsinger, Asia Giammarco-Hock, Elizabeth Cunningham, Elizabeth Gerard, Stephan Schuele, Stephen VanHaerents","doi":"10.1016/j.yebeh.2024.110054","DOIUrl":"10.1016/j.yebeh.2024.110054","url":null,"abstract":"<div><h3>Introduction</h3><div>Evaluation by an epileptologist can help distinguish epileptic seizures from seizure mimickers. Proper and timely diagnosis of a seizure or new onset epilepsy is of critical importance due to implications regarding treatment, prognosis, quality of life, morbidity, and mortality. The goal of our study is to describe the demographics and clinical characteristics of patients referred to a first seizure clinic at a tertiary academic center within Chicago, Illinois.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study of adult patients referred to our clinic. Patients were identified through the electronic medical record from March 2021 to March 2022. Charts were reviewed to assess pertinent clinical characteristics and patient demographic data.</div></div><div><h3>Results</h3><div>A total of 123 out of 138 (89.0 %) scheduled patients checked in to the visit between March 2021-March 2022, of which 87/123 (70.7 %) were diagnosed with a seizure. Other diagnoses included syncope (17/123, 13.8 %), undifferentiated event (16/123, 13.0 %), suspected psychogenic non-epileptic event (2/123, 1.6 %), and migraine (1, 0.8 %). Of those with a seizure, 73/87 (83.9 %) were unprovoked and 14/87 (16.1 %) were provoked. The average wait time to be seen as a new patient by an epileptologist was significantly shorter with the establishment of this clinic compared to the year prior (17 days versus 53 days, p value < 0.001). The majority of patients had an EEG prior to or after the visit (121/123, 98.4 %), of which 24/121 (19.8 %) had interictal epileptiform activity. Findings relevant to the patient’s cause of epilepsy were found in 26/108 (24.1 %) of patients who underwent an MRI or CT scan of the head. There were 40/123 (32.5 %) patients prescribed an anti-seizure medication (ASM) prior to the first office visit and 65/123 (52.8 %) patients prescribed an ASM within the first three office visits.</div></div><div><h3>Conclusion</h3><div>A first seizure evaluation clinic in an urban setting is an achievable and efficient way to evaluate patients with paroxysmal events concerning for seizure in a timely manner. Most patients in this clinic were diagnosed with epileptic seizures. Timely ancillary testing with head imaging and EEG can help contribute to the diagnosis of epilepsy and guide treatment.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282322","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 : 2024-09-21DOI: 10.1016/j.yebeh.2024.110051
Jing Zhang , Qiaomei Jing , Shangbin Li , Ye Liu , Zhe Lin , Xinyu Han , Ge Xu , Sihua Dai , Jing Zhang , Changjun Ren
Objective
To systematically assess the risk factors for secondary epilepsy in children with febrile seizures, in order to promptly identify early signs of epilepsy and establish a reliable foundation for timely clinical intervention and improved prognosis.
Methods
The databases, including CNKI, WanFang, VIP, CBM, PubMed, Embase, Web of Science, and the Cochrane Library were searched for relevant studies, up to October 2023. Two researchers independently collected and extracted data from selected studies, adhering to predefined criteria. Statistical analysis was performed using Stata 15.0.
Results
A total of 23 studies included 714 cases in the case group and 5269 cases in the control group. The results of Meta-analysis showed that preterm birth (OR=3.30, P=0.02), history of perinatal asphyxia (OR=3.94, P=0.001), age at the first seizure < 12 months (OR=2.93, P=0.003), peak temperature < 39℃ (OR=2.51, P<0.001), onset of fever to seizure < 1 h (OR=5.61, P<0.001), Complex FS(OR=4.08, P<0.001), duration of the seizure > 15 min (OR=6.21, P<0.001), Multiple seizures (≥2/episode) in one attack (OR=2.92, P<0.001), focal seizures (OR=2.53, P=0.018), recurrent FS (≥2) (OR=3.49, P<0.001), neurodevelopmental abnormality(OR=8.68, P<0.001), developmental delay(OR=10.04, P<0.001), family history of epilepsy (OR=2.74, P=0.004), family history of FS (OR=2.07, P=0.022), electroencephalogram (EEG) abnormal(OR=4.06, P<0.001)and Brain imaging abnormalities (OR=2.84, P=0.002)were Risk factors for secondary epilepsy following FS in Children. Notably, gender (female) was not a significant factor.
Conclusions
This study provides a comprehensive and systematic discussion of the risk factors associated with secondary epilepsy in children with febrile seizures. It actively formulates intervention measures for modifiable risk factors and conducts early detection and continuous follow-up observation for non-modifiable high-risk children, thereby reducing the risk of epilepsy.
{"title":"Risk factors for secondary epilepsy following febrile seizures in children: A meta-analysis","authors":"Jing Zhang , Qiaomei Jing , Shangbin Li , Ye Liu , Zhe Lin , Xinyu Han , Ge Xu , Sihua Dai , Jing Zhang , Changjun Ren","doi":"10.1016/j.yebeh.2024.110051","DOIUrl":"10.1016/j.yebeh.2024.110051","url":null,"abstract":"<div><h3>Objective</h3><p>To systematically assess the risk factors for secondary epilepsy in children with febrile seizures, in order to promptly identify early signs of epilepsy and establish a reliable foundation for timely clinical intervention and improved prognosis.</p></div><div><h3>Methods</h3><p>The databases, including CNKI, WanFang, VIP, CBM, PubMed, Embase, Web of Science, and the Cochrane Library were searched for relevant studies, up to October 2023. Two researchers independently collected and extracted data from selected studies, adhering to predefined criteria. Statistical analysis was performed using Stata 15.0.</p></div><div><h3>Results</h3><p>A total of 23 studies included 714 cases in the case group and 5269 cases in the control group. The results of Meta-analysis showed that preterm birth (OR=3.30, P=0.02), history of perinatal asphyxia (OR=3.94, P=0.001), age at the first seizure < 12 months (OR=2.93, P=0.003), peak temperature < 39℃ (OR=2.51, P<0.001), onset of fever to seizure < 1 h (OR=5.61, P<0.001), Complex FS(OR=4.08, P<0.001), duration of the seizure > 15 min (OR=6.21, P<0.001), Multiple seizures (≥2/episode) in one attack (OR=2.92, P<0.001), focal seizures (OR=2.53, P=0.018), recurrent FS (≥2) (OR=3.49, P<0.001), neurodevelopmental abnormality(OR=8.68, P<0.001), developmental delay(OR=10.04, P<0.001), family history of epilepsy (OR=2.74, P=0.004), family history of FS (OR=2.07, P=0.022), electroencephalogram (EEG) abnormal(OR=4.06, P<0.001)and Brain imaging abnormalities (OR=2.84, P=0.002)were Risk factors for secondary epilepsy following FS in Children. Notably, gender (female) was not a significant factor.</p></div><div><h3>Conclusions</h3><p>This study provides a comprehensive and systematic discussion of the risk factors associated with secondary epilepsy in children with febrile seizures. It actively formulates intervention measures for modifiable risk factors and conducts early detection and continuous follow-up observation for non-modifiable high-risk children, thereby reducing the risk of epilepsy.</p></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1525505024004335/pdfft?md5=58b876a40ab325f2b49d66996aa971e0&pid=1-s2.0-S1525505024004335-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271881","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}
Epilepsy fundamentally involves a struggle with “control,” commonly framed in terms of reducing the frequency and severity of seizures. This paper seeks to understand how people with epilepsy (PWE) think about and define control, as well as the psychosocial outcomes of self-managing epilepsy and low perceived control.
Here, we employ a qualitative analysis of interviews with 64 adults with epilepsy in treatment in a tertiary referral center in New York City, conducted between July 2020 and July 2022 as part of a larger study of the lived experiences of PWE. The interviews were coded, and thematic analysis was used to identify participants’ constructions of control and the breadth of illness intrusiveness they experienced.
Findings indicate that applying the illness intrusiveness concept to epilepsy aligns with existing research, revealing that PWE are impacted in numerous ways beyond seizure frequency and severity. Participants reported significant anxiety related to the unpredictability of seizures and the potential embarrassment of having seizures in public. These insights highlight that illness self-management and social challenges are critical components of the experience of having epilepsy.
Our findings underscore the need for a wholistic approach to improving quality of life for PWE that recognizes the broader context of illness intrusiveness. By understanding and enhancing perceived control, future interventions can better support the mental health and overall well-being of PWE.
{"title":"The concept of “control” in people with epilepsy: A qualitative study","authors":"Itzel A. Camarillo , Sylwia Misiewicz , Karolynn Siegel , Ruth Ottman","doi":"10.1016/j.yebeh.2024.110059","DOIUrl":"10.1016/j.yebeh.2024.110059","url":null,"abstract":"<div><p>Epilepsy fundamentally involves a struggle with “control,” commonly framed in terms of reducing the frequency and severity of seizures. This paper seeks to understand how people with epilepsy (PWE) think about and define control, as well as the psychosocial outcomes of self-managing epilepsy and low perceived control.</p><p>Here, we employ a qualitative analysis of interviews with 64 adults with epilepsy in treatment in a tertiary referral center in New York City, conducted between July 2020 and July 2022 as part of a larger study of the lived experiences of PWE. The interviews were coded, and thematic analysis was used to identify participants’ constructions of control and the breadth of illness intrusiveness they experienced.</p><p>Findings indicate that applying the illness intrusiveness concept to epilepsy aligns with existing research, revealing that PWE are impacted in numerous ways beyond seizure frequency and severity. Participants reported significant anxiety related to the unpredictability of seizures and the potential embarrassment of having seizures in public. These insights highlight that illness self-management and social challenges are critical components of the experience of having epilepsy.</p><p>Our findings underscore the need for a wholistic approach to improving quality of life for PWE that recognizes the broader context of illness intrusiveness. By understanding and enhancing perceived control, future interventions can better support the mental health and overall well-being of PWE.</p></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271883","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 : 2024-09-21DOI: 10.1016/j.yebeh.2024.110034
João Ferreira , Miguel França , Mariana Rei , Ricardo Peixoto , Sidsel Armand Larsen , Adriano Bernini , Lígia Lopes , Carlos Conde , João Claro
Objectives
As epilepsy management medical devices emerge as potential technological solutions for prediction and prevention of sudden death in epilepsy (SUDEP), there is a gap in understanding the features and priorities that should be included in the design of these devices. This study aims to bridge the gap between current technology and emerging needs by leveraging insights from persons with epilepsy (PWE) and caregivers (CG) on current epilepsy management devices and understanding how SUDEP awareness influences preferences and design considerations for potential future solutions.
Methods
Two cross-sectional surveys were designed to survey PWE and CG on medical device design features, SUDEP awareness, and participation in medical device research. Data analysis included both qualitative thematic analysis and quantitative statistical analysis.
Results
The survey revealed that among 284 responses, CG were more aware of SUDEP than PWE. Comfort was identified as the primary concern regarding wearable medical devices for epilepsy management with significant differences between PWE and CG regarding acceptance and continuous use preferences. The thematic analysis identified integration with daily life, aesthetic and emotional resonance, adaptability to seizure characteristics, and user-centric design specifications as crucial factors to be considered for enhanced medical device adoption. The integration of a companion app is seen as an important tool to enhance communication and data sharing.
Discussion
This study reveals that while SUDEP awareness can promote the development of future SUDEP predictive and preventive medical devices, these should be designed to mitigate its impact on daily life and anxiety of both PWE and CG. Comfort and acceptance are seen as key priorities to support continuous use and are seen as a technical requirement of future medical devices for SUDEP prediction and prevention. Widespread adoption requires these technologies to be customizable to adapt to different lifestyles and social situations. A holistic approach should be used in the design of future medical devices to capture several dimensions of PWE and CG epilepsy management journey and uphold communication between healthcare professionals, PWE and CG.
Conclusion
Data from this study highlight the importance of considering user preferences and experiences in the design of epilepsy management medical devices with potential applicability for SUDEP prediction and prevention. By employing user-centered design methods this research provides valuable insights to inform the development of future SUDEP prediction and prevention devices.
{"title":"Towards user-centered design of medical devices for SUDEP prediction and prevention: Insights from persons with epilepsy and caregivers","authors":"João Ferreira , Miguel França , Mariana Rei , Ricardo Peixoto , Sidsel Armand Larsen , Adriano Bernini , Lígia Lopes , Carlos Conde , João Claro","doi":"10.1016/j.yebeh.2024.110034","DOIUrl":"10.1016/j.yebeh.2024.110034","url":null,"abstract":"<div><h3>Objectives</h3><div>As epilepsy management medical devices emerge as potential technological solutions for prediction and prevention of sudden death in epilepsy (SUDEP), there is a gap in understanding the features and priorities that should be included in the design of these devices. This study aims to bridge the gap between current technology and emerging needs by leveraging insights from persons with epilepsy (PWE) and caregivers (CG) on current epilepsy management devices and understanding how SUDEP awareness influences preferences and design considerations for potential future solutions.</div></div><div><h3>Methods</h3><div>Two cross-sectional surveys were designed to survey PWE and CG on medical device design features, SUDEP awareness, and participation in medical device research. Data analysis included both qualitative thematic analysis and quantitative statistical analysis.</div></div><div><h3>Results</h3><div>The survey revealed that among 284 responses, CG were more aware of SUDEP than PWE. Comfort was identified as the primary concern regarding wearable medical devices for epilepsy management with significant differences between PWE and CG regarding acceptance and continuous use preferences. The thematic analysis identified integration with daily life, aesthetic and emotional resonance, adaptability to seizure characteristics, and user-centric design specifications as crucial factors to be considered for enhanced medical device adoption. The integration of a companion app is seen as an important tool to enhance communication and data sharing.</div></div><div><h3>Discussion</h3><div>This study reveals that while SUDEP awareness can promote the development of future SUDEP predictive and preventive medical devices, these should be designed to mitigate its impact on daily life and anxiety of both PWE and CG. Comfort and acceptance are seen as key priorities to support continuous use and are seen as a technical requirement of future medical devices for SUDEP prediction and prevention. Widespread adoption requires these technologies to be customizable to adapt to different lifestyles and social situations. A holistic approach should be used in the design of future medical devices to capture several dimensions of PWE and CG epilepsy management journey and uphold communication between healthcare professionals, PWE and CG.</div></div><div><h3>Conclusion</h3><div>Data from this study highlight the importance of considering user preferences and experiences in the design of epilepsy management medical devices with potential applicability for SUDEP prediction and prevention. By employing user-centered design methods this research provides valuable insights to inform the development of future SUDEP prediction and prevention devices.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282327","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 : 2024-09-21DOI: 10.1016/j.yebeh.2024.110035
Sandra Milena Campiño-Valderrama , Paula Andrea Duque , Yeison Alberto Garcés-Gómez
Epilepsy is a disease that commonly manifests in childhood and can significantly affect the quality of life for both sufferers and their families. As such, it necessitates comprehensive and high-quality healthcare.
Objective
To assess the impact of an educational intervention targeted to caregivers of children and adolescents with epilepsy.
Materials and Methods
A cross-sectional study conducted between February and November 2022, involving 140 patients and their primary caregivers who intentionally sought medical consultation at a pediatric hospital in Caldas, Colombia. Initial nursing consultations were conducted to identify clinical and demographic characteristics and to assess knowledge about the disease, its management, and care. Subsequently, a comprehensive educational process was implemented using various educational aids. After 60 days, feedback was provided to evaluate the caregivers’ learning.
Results
Focal epilepsy, generalized epilepsy and idiopathic focal epilepsy predominated in the medical diagnoses. The etiology highlighted genetic cause and structural 70% of caregivers were female. Caregivers’ schooling: 10% of caregivers did not have schooling, 28% had primary education, 46% had secondary education, 16% had postgraduate education. Caregivers demonstrated knowledge about epilepsy and its management, with the majority scoring above 50%. The posttest indicated improvement in learning processes, and caregivers expressed that it benefited them in learning first aid.
Conclusion
Establishing educational programs tailored to the needs of individuals and promoting care plans are essential for improving the living conditions of patients with epilepsy and their caregivers.
{"title":"Nursing education strategy for caregivers of children and adolescents with epilepsy","authors":"Sandra Milena Campiño-Valderrama , Paula Andrea Duque , Yeison Alberto Garcés-Gómez","doi":"10.1016/j.yebeh.2024.110035","DOIUrl":"10.1016/j.yebeh.2024.110035","url":null,"abstract":"<div><div>Epilepsy is a disease that commonly manifests in childhood and can significantly affect the quality of life for both sufferers and their families. As such, it necessitates comprehensive and high-quality healthcare.</div></div><div><h3>Objective</h3><div>To assess the impact of an educational intervention targeted to caregivers of children and adolescents with epilepsy.</div></div><div><h3>Materials and Methods</h3><div>A cross-sectional study conducted between February and November 2022, involving 140 patients and their primary caregivers who intentionally sought medical consultation at a pediatric hospital in Caldas, Colombia. Initial nursing consultations were conducted to identify clinical and demographic characteristics and to assess knowledge about the disease, its management, and care. Subsequently, a comprehensive educational process was implemented using various educational aids. After 60 days, feedback was provided to evaluate the caregivers’ learning.</div></div><div><h3>Results</h3><div>Focal epilepsy, generalized epilepsy and idiopathic focal epilepsy predominated in the medical diagnoses. The etiology highlighted genetic cause and structural 70% of caregivers were female. Caregivers’ schooling: 10% of caregivers did not have schooling, 28% had primary education, 46% had secondary education, 16% had postgraduate education. Caregivers demonstrated knowledge about epilepsy and its management, with the majority scoring above 50%. The posttest indicated improvement in learning processes, and caregivers expressed that it benefited them in learning first aid.</div></div><div><h3>Conclusion</h3><div>Establishing educational programs tailored to the needs of individuals and promoting care plans are essential for improving the living conditions of patients with epilepsy and their caregivers.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282324","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 : 2024-09-21DOI: 10.1016/j.yebeh.2024.110005
Stefano Meletti , Giada Giovannini , Simona Lattanzi , Arian Zaboli , Niccolò Orlandi , Gianni Turcato , Francesco Brigo
Background and Objectives
to identify predictors of progression to refractory status epilepticus (RSE) using a machine learning technique.
Methods
Consecutive patients aged ≥ 14 years with SE registered in a 9-years period at Modena Academic Hospital were included in the analysis. We evaluated the risk of progression to RSE using logistic regression and a machine learning analysis by means of classification and regression tree analysis (CART) to develop a predictive model of progression to RSE.
Results
705 patients with SE were included in the study; of those, 33 % (233/705) evolved to RSE. The progression to RSE was an independent risk factor for 30-day mortality, with an OR adjusted for previously identified possible univariate confounders of 4.086 (CI 95 % 2.390–6.985; p < 0.001). According to CART the most important variable predicting evolution to RSE was the impaired consciousness before treatment, followed by acute symptomatic hypoxic etiology and periodic EEG patterns. The decision tree identified 14 nodes with a risk of evolution to RSE ranging from 1.5 % to 90.8 %. The overall percentage of success in classifying patients of the decision tree was 79.4 %; the percentage of accurate prediction was high, 94.1 %, for those patients not progressing to RSE and moderate, 49.8 %, for patients evolving to RSE.
Conclusions
Decision-tree analysis provided a meaningful risk stratification based on few variables that are easily obtained at SE first evaluation: consciousness before treatment, etiology, and severe EEG patterns. CART models must be viewed as potential new method for the stratification RSE at single subject level deserving further exploration and validation.
背景和目的：利用机器学习技术确定难治性癫痫状态（RSE）进展的预测因素：分析对象包括在摩德纳学术医院登记的连续 9 年间年龄≥ 14 岁的 SE 患者。我们利用逻辑回归和分类与回归树分析（CART）的机器学习分析方法评估了发展为 RSE 的风险，以建立发展为 RSE 的预测模型：研究共纳入了 705 名 SE 患者，其中 33%（233/705）发展为 RSE。进展为 RSE 是 30 天死亡率的独立风险因素，根据之前确定的可能的单变量混杂因素调整后的 OR 为 4.086（CI 95 % 2.390-6.985；P 结论：决策树分析提供了一个有意义的预测模型：决策树分析提供了一种有意义的风险分层方法，其依据是在 SE 首次评估时很容易获得的几个变量：治疗前的意识、病因和严重脑电图模式。必须将 CART 模型视为在单个受试者水平上对 RSE 进行分层的潜在新方法，值得进一步探索和验证。
{"title":"Progression to refractory status epilepticus: A machine learning analysis by means of classification and regression tree analysis","authors":"Stefano Meletti , Giada Giovannini , Simona Lattanzi , Arian Zaboli , Niccolò Orlandi , Gianni Turcato , Francesco Brigo","doi":"10.1016/j.yebeh.2024.110005","DOIUrl":"10.1016/j.yebeh.2024.110005","url":null,"abstract":"<div><h3>Background and Objectives</h3><div>to identify predictors of progression to refractory status epilepticus (RSE) using a machine learning technique.</div></div><div><h3>Methods</h3><div>Consecutive patients aged ≥ 14 years with SE registered in a 9-years period at Modena Academic Hospital were included in the analysis. We evaluated the risk of progression to RSE using logistic regression and a machine learning analysis by means of classification and regression tree analysis (CART) to develop a predictive model of progression to RSE.</div></div><div><h3>Results</h3><div>705 patients with SE were included in the study; of those, 33 % (233/705) evolved to RSE. The progression to RSE was an independent risk factor for 30-day mortality, with an OR adjusted for previously identified possible univariate confounders of 4.086 (CI 95 % 2.390–6.985; p < 0.001). According to CART the most important variable predicting evolution to RSE was the impaired consciousness before treatment, followed by acute symptomatic hypoxic etiology and periodic EEG patterns. The decision tree identified 14 nodes with a risk of evolution to RSE ranging from 1.5 % to 90.8 %. The overall percentage of success in classifying patients of the decision tree was 79.4 %; the percentage of accurate prediction was high, 94.1 %, for those patients not progressing to RSE and moderate, 49.8 %, for patients evolving to RSE.</div></div><div><h3>Conclusions</h3><div>Decision-tree analysis provided a meaningful risk stratification based on few variables that are easily obtained at SE first evaluation: consciousness before treatment, etiology, and severe EEG patterns. CART models must be viewed as potential new method for the stratification RSE at single subject level deserving further exploration and validation.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S152550502400386X/pdfft?md5=64fb06f453f1a384d1ba397575f0b2c0&pid=1-s2.0-S152550502400386X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282326","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}
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