1
|
Smith Malm C, Klecki J, Lisovska K, Zelano J. Survey of an online system for information to women with epilepsy of childbearing age and management during pregnancy: A 3-year evaluation. Epilepsia Open 2024; 9:558-567. [PMID: 38135910 PMCID: PMC10984308 DOI: 10.1002/epi4.12893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 11/16/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE We developed an online tool for women with epilepsy consisting of two modules: one with information on pregnancy-related issues (information module) and one for reminders about blood test and communication about dose changes (pregnancy module). Our aim was to assess perceived value, user-friendliness and improvement of patient knowledge in users. METHODS The system was launched in 2019 and patients invited by epilepsy nurses were asked to participate in a survey 1 month after the invitation for the information module, and 1 month postnatally for the pregnancy module. RESULTS By November 2022, the system had been used by 96 individuals out of 100 invited in the pregnancy module, in a total of 114 pregnancies. One hundred and eleven women had been invited to the information module, and 70 of these accessed it. The survey received 96 answers (44 information, 52 pregnancy). User-friendliness was rated as good or very good by a little over half of the users; 55% in the information module and 52% in the pregnancy module. Among pregnant women, 83% found the TDM part useful and most would prefer a similar system in future pregnancies. Sixty-four percent of users of the information module and 48% of the pregnancy module found that the system had increased their knowledge. Two knowledge questions were answered correctly by a significantly higher proportion of those that had accessed the online information. SIGNIFICANCE There was great demand for online communication during pregnancy and our experiences of implementation can hopefully assist digitalization of epilepsy care elsewhere. Online information also seems to increase knowledge about pregnancy-related issues, but our invitation-only method of inclusion was not effective for widespread dissemination. Patient-initiated access with optional epilepsy-team contact if questions arise could be an alternative. PLAIN LANGUAGE SUMMARY We have performed a survey of users of a new Internet-based tool for information to women of childbearing age and communication about dose changes during pregnancy. Users were overall satisfied with the tool and answered some knowledge questions more accurately after accessing the information.
Collapse
Affiliation(s)
| | - Judith Klecki
- Department of NeurologySahlgrenska university hospitalGothenburgSweden
| | - Kristina Lisovska
- Department of NeurologySahlgrenska university hospitalGothenburgSweden
| | - Johan Zelano
- Department of NeurologySahlgrenska university hospitalGothenburgSweden
- Institute of neuroscience and physiology, Department of clinical neuroscience, Sahlgrenska AcademyGothenburg UniversityGothenburgSweden
- Wallenberg Center of Molecular and Translational MedicineGothenburg UniversityGothenburgSweden
| |
Collapse
|
2
|
Rebello A, Chandrasekharan SV, Kumar Rudrabhatla P, Vincent SJ, Menon RN, Radhakrishnan A. Satisfaction among persons with epilepsy towards physical consultation versus online video consultation for follow-up. Epilepsy Behav 2023; 140:109081. [PMID: 36804715 DOI: 10.1016/j.yebeh.2022.109081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/18/2022] [Accepted: 12/29/2022] [Indexed: 02/19/2023]
Abstract
PURPOSE Telemedicine gained popularity in the setting of the COVID-19 pandemic. We aimed to study the satisfaction levels of persons with epilepsy (PWE) with online video consultation (OVC) and physical consultation (PC). METHODS This was a cross-sectional questionnaire-based study conducted in a tertiary referral care center for epilepsy in India. All PWE who had availed of both OVC and PC were included. Those who did not give consent to a questionnaire were excluded. A questionnaire was given to assess patients' satisfaction regarding OVC and PC. Scores for each question for both OVC and PC were compared. RESULTS One hundred and forty-one patients who had PC earlier and later availed of OVC from December 2020 to July 2021 formed the cohort. Seventy one patients who responded to the questionnaire were included. 49% and 51% of the patients belonged to urban and rural regions respectively. 8.5% of the patients were off anti-seizure medications (ASM), while 5.6% and 85.9% were on single and multiple ASMs respectively. There were no differences between PC and OVC regarding ease of getting the appointment, privacy during a consultation, patients' perceived chances of missing consultations, and overall comfort and experience on either type of consultation. Physical consultation scored more than OVC in patients' satisfaction with the time doctor spent with them, an opportunity to communicate their queries well, clarifications received from the doctor, and the likelihood of patients recommending the particular type of consultation to others(p < 0.05). CONCLUSIONS Online video consultation can be a satisfactory alternative to PC and can improve patient satisfaction if some of the issues in OVC are addressed properly.
Collapse
Affiliation(s)
- Alex Rebello
- R Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Soumya V Chandrasekharan
- R Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Pavan Kumar Rudrabhatla
- R Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Sanu J Vincent
- R Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Ramshekhar N Menon
- R Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Ashalatha Radhakrishnan
- R Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
| |
Collapse
|
3
|
Salaria P, Akshinthala P, Kapavarapu R, M AR. Identification of novel C-15 fluoro isosteviol derivatives for GABA-AT inhibition by in silico investigations. J Mol Model 2023; 29:76. [PMID: 36826597 DOI: 10.1007/s00894-023-05479-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 02/17/2023] [Indexed: 02/25/2023]
Abstract
CONTEXT The treatment of epilepsy is associated with the inhibition of γ-aminobutyric acid-aminotransferase (GABA-AT), which suppresses the concentration of a key neurotransmitter GABA. Isosteviol, a natural bioactive molecule, has been reported to possess an anticonvulsant property. In this work, we first reported a series of C-15 fluoro isosteviol analogs which are bearing different functional groups at C-16 to investigate the interactions with GABA-AT by applying molecular docking and molecular dynamic simulation approach. The results revealed that all fluoro isosteviol analogs displayed a greater binding affinity than references vigabatrin, an FDA-approved GABA-AT inactivator, and CPP-115, which has Orphan Drug Designation status, and positioned at the same binding site as references. Furthermore, molecular dynamic (MD) simulation studies on minimum (A1), maximum (E1) binding energy score of fluoro isosteviol analogs, and isosteviol (G1) revealed their stable complex formation in terms of RMSD, RMSF, RG, and hydrogen bond formation. All analogs were found to have drug-like nature, non-toxic, >80% absorption, and the majority tend to penetrate brain-blood-barrier (BBB). The investigations found in this study can help in the development of isosteviol derivatives as drugs for the treatment of epilepsy. METHODS The two-dimensional (2D) ligand structures were drawn using ChembioDraw Ultra 14.0. Molecular docking with Autodock4 and molecular dynamic simulation with GROMACS version 2020.1 were performed. The CHARMM27 all-atom force field was applied for writing the topology. Biovia Discovery Studio DS2021 was used for viewing and analyzing the protein-ligand complexes. The data generated from molecular dynamic simulation trajectories were plotted using the Origin® 8 software. The Open Babel software was utilized for extracting SMILEs files of all the fluoro isosteviol analogs. The drug-likeness and ADMET of the molecules were evaluated by SwissADME and ADMETlab 2.0 web tools.
Collapse
Affiliation(s)
- Punam Salaria
- School of Sciences (Chemistry), National Institute of Technology Andhra Pradesh, Tadepalligudem, Andhra Pradesh, India
| | - Parameswari Akshinthala
- Department of Science and Humanities, MLR Institute of Technology, Dundigal, Hyderabad, Telangana, India
| | - Ravikumar Kapavarapu
- Department of Pharmaceutical Chemistry and Photochemistry, Nirmala College of Pharmacy, Mangalagiri, Andhra Pradesh, India
| | - Amarendar Reddy M
- School of Sciences (Chemistry), National Institute of Technology Andhra Pradesh, Tadepalligudem, Andhra Pradesh, India.
| |
Collapse
|
4
|
Samia P, Sahu JK, Ali A, Caraballo RH, Chan J, Coan AC, Fortini PS, Gwer S, Jocic-Jakubi B, Kissani N, Rivera Y, Sarfo FS, Singh MB, Trinka E, Yoo JY, Yu HY, Zelano J, Cross JH. Telemedicine for Individuals with epilepsy: Recommendations from International League Against Epilepsy Telemedicine Task Force. Seizure 2023; 106:85-91. [PMID: 36803864 DOI: 10.1016/j.seizure.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
Worldwide, People with Epilepsy (PWE) are confronted with several barriers to face-to-face consultations. These obstacles hamper appropriate clinical follow-up and also increase the treatment gap for Epilepsy. Telemedicine holds the potential to enhance management as follow-up visits for PWE are focused on more on clinical history and counselling rather than physical examination. Besides consultation, telemedicine can also be used for remote EEG diagnostics and tele-neuropsychology assessments. In this article, the Telemedicine Task Force of the International League Against Epilepsy (ILAE) outlines recommendations regarding optimal practice in utilizing in the management of individuals with epilepsy. We formulated recommendations for minimum technical requirements, preparing for the first tele-consultation and the specificities for follow-up consultations. Special considerations are necessary for specific populations, including paediatric patients, patients who are not conversant with tele-medicine and those with intellectual disability. Telemedicine for individuals with epilepsy should be vigorously promoted with the aim of improving the quality of care and ultimately reduce the wide clinician access related treatment gap across several regions of the globe.
Collapse
|
5
|
Rosellini I, Vianello M, Palmieri A, Guidoni SV, Giopato F, Ghazaryan A, Fuccaro M, Terrin A, Vitaliani R, Rigoni MT, Pietrobon F, Bonifati DM. Patient satisfaction with televisit in chronic neurologic disorders during Covid-19 pandemic. Acta Neurol Belg 2023;:1-9. [PMID: 36635442 DOI: 10.1007/s13760-023-02173-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 01/02/2023] [Indexed: 01/14/2023]
Abstract
BACKGROUND Covid-19 pandemic has boosted telemedicine in medical clinical practice. Experience in the management of chronic neurological disorders is limited as well as patient opinion. During Covid-19 pandemic, we evaluated patients' satisfaction and opinion about televisits in a large group of patients with chronic neurological disorders. METHODS All patients with chronic neurological disorders who had a virtual visit during the first phase of pandemic were invited to fill an online anonymous questionnaire about their global satisfaction and satisfaction regarding continuity of care, possibility to stay at home, doctor-patient relationship, the future of teleconsultation after pandemic and the possibility of understanding medical information and instructions. RESULTS We received 123 questionnaires among 232 e-mail (response rate 53%). Almost all (120 out of 121 patients, 99%) were satisfied with the overall experience with video-consultation. Comprehension of medical information was the same for 113 out of 122 patients (93%) and also the doctor-patient relationship was the same for 107 out of 122 respondents (88%) or better for 10 (8%). Ninety-three percent of patients (112 out of 120) were keen to integrate televisits with the traditional modality and only 11 out of 121 patients (9%) judged televisits as an option to discard. As a whole, 114 out of 122 respondents (93%) would suggest this modality to other patients. CONCLUSIONS Our large cohort of patients with chronic neurologic disorders rated experience with televisits satisfactory. Comprehension of medical information and doctor-patient interaction was considered good. Eventually, patients are keen to integrate this modality with traditional follow-up visits.
Collapse
|
6
|
Shaarani I, Jounblat M, Jounblat H, Ghanem A, Mansour R, Taleb R. Developing and Validating a Tool to Assess Telemedicine Acceptance Among Physicians During Pandemic Using a Technology Acceptance Model. Telemed J E Health 2022. [DOI: 10.1089/tmj.2022.0348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
7
|
Parodi C, Viganò I, Ottaviano E, Massa V, Borghi E, Beretta S, Di Francesco JC, Badioni V, Vignoli A; COV-EPI Study Group. Long-term analysis of the effects of COVID-19 in people with epilepsy: Results from a multicenter on-line survey across the pandemic waves. Epilepsy Behav 2022; 135:108900. [PMID: 36115083 DOI: 10.1016/j.yebeh.2022.108900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/12/2022] [Accepted: 08/22/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE The worldwide pandemic caused by SARS-CoV-2 virus posed many challenges to the scientific and medical communities, including the protection and management of fragile populations. People with epilepsy (PWE) are a heterogenous group of subjects, with different treatment regimens and severity of symptoms. During the National lockdown, in Italy many patients with chronic conditions lost their regular follow-up program. The aim of this study was to investigate the impact of COVID-19 on their health status, from the start of the pandemic (March 2020) to July 2021 and one year later. METHODS We proposed an online questionnaire to subjects followed up at different epilepsy centers located in Milano, Monza & Lodi, three of Lombardy, Northern Italy, the most affected areas by the pandemic. Survey evaluated age, sex, characteristics of patients, type of epilepsy and therapies, COVID-19 diagnosis, vaccines, sleep quality, and anxiety status. RESULTS Among 178 analyzed surveys, 37 individuals reported symptoms of COVID-19 in closed contacts, including 9 with molecular diagnosis and 16 PWE performing the nasopharyngeal swab with 3 positive cases. One year later, 35 individuals reported at least one symptom overlapping with those typical of COVID-19, 8 received COVID-19 diagnosis, among which 6 were positive for SARS-CoV-2 infection. According to the sleep quality scale assessment, most PWE (52.3%) had poor sleep quality. Assessing anxiety status, 32 (38.1%) had a pathological score. CONCLUSION In this multicenter study, we observed that PWE do not appear to be at a higher risk of severe COVID-19. It will be fundamental monitoring this group to assess possible differences in long-COVID-19 and/or neuro-COVID-19 prevalence. On the other hand, our survey confirmed the impact of the pandemic on anxiety and quality of sleep in PWE. Thus, it is important to promptly recognize and treat psychological distress in PWE, because it could be a risk factor in seizure aggravation and quality-of-life deterioration. Telemedicine appears to be a useful tool to support patients with chronic diseases, such as epilepsy.
Collapse
|
8
|
Lavin B, Gray CL, Brodie M. Telemedicine and Epilepsy Care. Neurol Clin 2022; 40:717-727. [DOI: 10.1016/j.ncl.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
9
|
Valencia I, Berg AT, Hirsch LJ, Lopez MR, Melmed K, Rosengard JL, Tatum WO, Jobst BC. Epilepsy and COVID 2021. Epilepsy Curr. [DOI: 10.1177/15357597221101268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Coronavirus 19 (COVID-19) has infected over 400 million people worldwide. Although COVID-19 causes predominantly respiratory symptoms, it can affect other organs including the brain, producing neurological symptoms. People with epilepsy (PWE) have been particularly impacted during the pandemic with decreased access to care, increased stress, and worsening seizures in up to 22% of them probably due to multiple factors. COVID-19 vaccines were produced in a record short time and have yielded outstanding protection with very rare serious side effects. Studies have found that COVID-19 vaccination does not increase seizures in the majority of PWE. COVID-19 does not produce a pathognomonic EEG or seizure phenotype, but rather 1 that can be seen in other types of encephalopathy. COVID-19 infection and its complications can lead to seizures, status epilepticus and post-COVID inflammatory syndrome with potential multi-organ damage in people without pre-existing epilepsy. The lack of access to care during the pandemic has forced patients and doctors to rapidly implement telemedicine. The use of phone videos and smart telemedicine are helping to treat patients during this pandemic and are becoming standard of care. Investment in infrastructure is important to make sure patients can have access to care even during a pandemic.
Collapse
|
10
|
Abreu M, Carmo AS, Franco A, Parreira S, Vidal B, Costa M, Peralta AR, da Silva HP, Bentes C, Fred A. Mobile Applications for Epilepsy: Where Are We? Where Should We Go? A Systematic Review. Signals 2022; 3:40-65. [DOI: 10.3390/signals3010005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The development of mobile health for epilepsy has grown in the last years, bringing new applications (apps) to the market and improving already existing ones. In this systematic review, we analyse the scope of mobile apps for seizure detection and epilepsy self-management, with two research questions in mind: what are the characteristics of current solutions and do they meet users’ requirements? What should be considered when designing mobile health for epilepsy? We used PRISMA methodology to search within App Store and Google Play Store from February to April of 2021, reaching 55 potential apps. A more thorough analysis regarding particular features was performed on 26 of those apps. The content of these apps was evaluated in five categories, regarding if there was personalisable content; features related to medication management; what aspects of seizure log were present; what type of communication prevailed; and if there was any content related to seizure alarm or seizure action plans. Moreover, the 26 apps were evaluated through using MARS by six raters, including two neurologists. The analysis of MARS categories was performed for the top and bottom apps, to understand the core differences. Overall, the lowest MARS scores were related to engagement and information, which play a big part in long-term use, and previous studies raised the concern of assuring continuous use, especially in younger audiences. With that in mind, we identified conceptual improvement points, which were divided in three main topics: customisation, simplicity and healthcare connection. Moreover, we summarised some ideas to improve m-health apps catered around long-term adherence. We hope this work contributes to a better understanding of the current scope in mobile epilepsy management, endorsing healthcare professionals and developers to provide off-the-shelf solutions that engage patients and allows them to better manage their condition.
Collapse
|
11
|
Skinner HJ, Casares M, Wombles C, Brooks K, Hussain A, Hee Seo J, Gireesh ED, Claudio AO, Lee KH, Hill M, Westerveld M. Comparison of care accessibility, costs, and quality with face-to-face and telehealth epilepsy clinic visits. Epilepsy Behav 2022; 127:108510. [PMID: 34991054 DOI: 10.1016/j.yebeh.2021.108510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/09/2021] [Accepted: 12/12/2021] [Indexed: 11/17/2022]
Abstract
During the COVID-19 pandemic, restrictions on reimbursement for telehealth visits were lifted and this visit type was suddenly available to patients around the United States of America. Telehealth visits offer potential cost savings for patients and families, which may vary by region of the world studied. Also, aggressiveness of the care patients receive may differ, and patients or families may be more likely to choose one visit type over another based on seizure control. This is a prospective face-to-face clinic versus telehealth clinic visit comparison study involving patients with seizures, their legal guardians, and caretakers who attend clinic. We compared travel distance, work-related factors, childcare, satisfaction of care, changes in seizure medication or diagnostics tests ordered, and willingness to cancel appointments to better understand the behavioral patterns of patients, caretakers, and providers. Our results indicate that many patients and families still prefer in-person interactions with their medical providers. Patient and family satisfaction levels were equal with both visit types. No significant difference was seen in medical management between face-to-face and telehealth visits. Also, prior seizure control did not dictate the type of visit chosen. Telehealth participants were significantly more willing to cancel appointments if asked to switch to face-to-face then face-to-face participants asked to complete telehealth visits. Surprisingly, we found that patients and families choosing telehealth were not statistically more likely to be employed or take less time off work. Also, distance from home to office was not significantly shorter for participants choosing face-to-face visits. Offering a combination of telehealth and face-to-face visits appears to be the optimal strategy in caring for patients with controlled and uncontrolled seizure disorders to ensure adherence with clinic visits and satisfaction with care. Our study suggests that providers are equally willing to adjust medications or order additional diagnostic testing regardless of visit type. Patients and families may be less likely to cancel telehealth visits than face-to-face visits; this finding may translate to improved seizure control and long-term decreased cost of care.
Collapse
Affiliation(s)
| | | | | | | | | | - Joo Hee Seo
- Advent Health Orlando Epilepsy, United States
| | | | | | - Ki H Lee
- Advent Health Orlando Epilepsy, United States
| | | | | |
Collapse
|
12
|
GHOTBI TAHEREH, SALAMI JAVAD, KALTEH EHSANALLAH, GHELICHI-GHOJOGH MOUSA. Self-management of patients with chronic diseases during COVID19: a narrative review. J Prev Med Hyg 2022; 62:E814-E821. [PMID: 35603256 PMCID: PMC9104668 DOI: 10.15167/2421-4248/jpmh2021.62.4.2132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/26/2021] [Indexed: 12/02/2022]
Abstract
INTRODUCTION COVID-19 pandemic has affected the self-management of patients with chronic disease all over the world. The present study COVID-19 is a review to investigate the chronic patient self-management challenges during the corona epidemic, and providing solutions to solve this problem. METHODS The relevant literature on chronic patient self-management is investigated (from March 2019 to Jan 2021). Databases including Google Scholar, PubMed, Science Direct, Springer were used to search articles from the Latin articles. Also, keywords in this study included self-management, chronic disease, COVID-19. Finally, 26 relevant articles were used in this study. RESULTS Studies assessed the effective role of self-management in control and prevention of complications of chronic diseases and the challenges related to self-management programs during COVID-19, in addition the role of the health team in patients' self-management during the corona epidemics. CONCLUSION the main challenges for chronic patients during the COVID-19 include decreased healthcare service and regular follow-ups because of physical restrictions; economic problems, change in lifestyle, and lack of rapid compliance with the changes. In this regard, the health team should provide the best healthcare services using the available resources to reduce suffer and pain of the patients.
Collapse
Affiliation(s)
| | - JAVAD SALAMI
- Shiraz University of Medical Sciences, Shiraz, Iran
- Correspondence: Javad Salami, Shiraz University of Medical Sciences, Shiraz, Iran - Tel.: (98) 715 2726308 - Fax: (98) 715 2726308 - E-mail:
| | - EHSAN ALLAH KALTEH
- MSc of Epidemiology, Golestan University of Medical Sciences, Gorgan, Iran
| | - MOUSA GHELICHI-GHOJOGH
- PhD Candidate in Epidemiology, Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| |
Collapse
|
13
|
Assenza G, Ricci L, Lanzone J, Boscarino M, Vico C, Narducci F, Sancetta B, Di Lazzaro V, Tombini M. Understanding and managing the impact of the COVID-19 pandemic and lockdown on patients with epilepsy. Expert Rev Neurother 2022; 22:145-153. [PMID: 35098850 DOI: 10.1080/14737175.2022.2031984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic represented a relevant issue for people with epilepsy (PwE). Medical care and social restrictions exposed PwE to a high risk of seizure worsening. Medical institutions answered to the pandemic assuring only emergency care and implementing a remote assistance that highlighted the technological obsolescence of the medical care paradigms for PwE. AREA COVERED We reviewed the literature on the COVID-19-related factors influencing the epilepsy course, from the evidence of seizure risk in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infected PwE to anti-Sars-Cov-2 drugs interactions with antiseizure medications and the perceived changes of seizures in PwE. EXPERT OPINION COVID-19 pandemic was a problematic experience for PwE. We must make treasure of the lessons learned during this period of social restrictions and employ the recent technological advances to improve PwE assistance, in particular telemedicine and electronic media for patients' education.
Collapse
Affiliation(s)
- Giovanni Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Lorenzo Ricci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Jacopo Lanzone
- Neurorehabilitation Department, IRCCS Salvatore Maugeri Foundation, Institute of Milan, Milan, Italy.,Department of Systems Medicine, Neuroscience, University of Rome Tor Vergata, Rome, Italy
| | - Marilisa Boscarino
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Carlo Vico
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Flavia Narducci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Biagio Sancetta
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Mario Tombini
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| |
Collapse
|
14
|
Valderas C, Méndez G, Echeverría A, Suarez N, Julio K, Sandoval F. COVID-19 and neurologic manifestations: a synthesis from the child neurologist's corner. World J Pediatr 2022; 18:373-382. [PMID: 35476245 PMCID: PMC9044375 DOI: 10.1007/s12519-022-00550-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/29/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Since December 2019, the SARS-CoV-2 virus has been a global health issue. The main clinical presentation of this virus is a flu-like disease; however, patients with diverse neurologic manifestations have also been reported. In this review, we attempt to summarize, discuss and update the knowledge of the neurologic manifestations in the pediatric population affected by SARS-CoV-2 infection and the pandemic's effects in children with neurologic diseases. DATA SOURCES This review analyzes studies found on the PubMed database using the following keywords: Neurologic manifestations COVID-19, Neurological COVID-19, coronavirus, SARS-CoV-2, pediatric COVID-19, COVID-19 in children, MIS-C, Pediatric Inflammatory Multisystem Syndrome, Guillain Barré Syndrome, Stroke, ADEM, and Anti-NMDA encephalitis. All studies cited were published between 2004 and 2022, and represent the most relevant articles in the field. The World Health Organization COVID-19 online dashboard was assessed to obtain updated epidemiological data. RESULTS The most common neurologic symptoms in the pediatric population are headache, seizures, encephalopathy, and muscle weakness. These can be present during COVID-19 or weeks after recovering from it. Children who presented with multi-system inflammatory syndrome had a higher incidence of neurologic manifestations, which conferred a greater risk of morbidity and mortality. Several neuro-pathophysiological mechanisms have been proposed, including direct virus invasion, hyper-inflammatory reactions, multi-systemic failure, prothrombotic states, and immune-mediated processes. On the other hand, the COVID-19 pandemic has affected patients with neurologic diseases, making it challenging to access controls, treatment, and therapies. CONCLUSIONS Various neurologic manifestations have been associated with children's SARS-CoV-2 infection. It is important to identify and give them proper and opportune treatment because they can be potentially grave and life-threatening; some can lead to long-lasting sequelae. Different neuro-pathophysiological mechanisms have been proposed, however, a causal relationship between SARS-CoV-2 infection and neurologic manifestations remains to be proven. Patients with neurologic diseases are especially affected by COVID-19, not only by the disease itself but also by its complications and pandemic management measures.
Collapse
Affiliation(s)
- Carolina Valderas
- Department of Neurology, Hospital Dr. Exequiel González Cortés, Gran Avenida José Miguel Carrera 3300, 8900085 Santiago, Región Metropolitana Chile
| | - Gastón Méndez
- Department of Neurology, Hospital Dr. Exequiel González Cortés, Gran Avenida José Miguel Carrera 3300, 8900085 Santiago, Región Metropolitana Chile
| | - Alejandra Echeverría
- Department of Neurology, Hospital Dr. Exequiel González Cortés, Gran Avenida José Miguel Carrera 3300, 8900085 Santiago, Región Metropolitana Chile
| | - Nelson Suarez
- Department of Neurology, Hospital Dr. Exequiel González Cortés, Gran Avenida José Miguel Carrera 3300, 8900085 Santiago, Región Metropolitana Chile
| | - Katherin Julio
- Department of Neurology, Hospital Dr. Exequiel González Cortés, Gran Avenida José Miguel Carrera 3300, 8900085 Santiago, Región Metropolitana Chile
| | - Francisca Sandoval
- Department of Neurology, Hospital Dr. Exequiel González Cortés, Gran Avenida José Miguel Carrera 3300, 8900085, Santiago, Región Metropolitana, Chile.
| |
Collapse
|
15
|
Crocker J, Liu K, Smith M, Nakamoto M, Mitchell C, Zhu E, Ma E, Morden FT, Chong A, Van N, Dang N, Borman P, Carrazana E, Viereck J, Liow KK. Early Impact of the COVID-19 Pandemic on Outpatient Neurologic Care in Hawai'i. Hawaii J Health Soc Welf 2022; 81:6-12. [PMID: 35028589 PMCID: PMC8742305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In March 2020, Hawai'i instituted public health measures to prevent the spread of Coronavirus disease 2019 (COVID-19), including stay-at-home orders, closure of non-essential businesses and parks, use of facial coverings, social distancing, and a mandatory 14-day quarantine for travelers. In response to these measures, Hawai'i Pacific Neuroscience (HPN) modified practice processes to ensure continuity of neurological treatment. A survey of patients was performed to assess the impact of the COVID-19 pandemic and pandemic-related practice processes for quality improvement. Overall, 367 patients seen at HPN between April 22, 2020, and May 18, 2020, were surveyed via telephone. Almost half (49.6%) participated in a telemedicine appointment, with the majority finding it easy to use (87.4%) and as valuable as face-to-face appointments (68.7%). Many (44.5%) patients said they would have missed a health care appointment without the availability of telemedicine, and 47.3% indicated they might prefer to use telemedicine over in-person appointments in the future. Many reported new or worsening mental health problems, including depression (27.6%), anxiety (38.3%), or sleep disturbances (37.4%). A significant number reported worsening of their condition, with 33.1% of patients who experience migraines reporting increased symptom severity or frequency, 45.8% patients with Alzheimer's disease reporting worsened symptoms, 38.5% of patients with Parkinson's disease who had a recent fall, and 50.0% of patients with multiple sclerosis experiencing new or worsened symptoms. Insights from this survey applied to the practice's pandemic-related processes include emphasizing lifestyle modification, screening for changes in mental health, optimizing treatment plans, and continuing the option of telemedicine.
Collapse
Affiliation(s)
- Julie Crocker
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
| | - Keke Liu
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
| | - Maiya Smith
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
| | - Max Nakamoto
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
| | - Catherine Mitchell
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawai‘i Pacific Neuroscience, Honolulu, HI (CM, EZ, PB, EC, JV, KKL)
| | - Ena Zhu
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawai‘i Pacific Neuroscience, Honolulu, HI (CM, EZ, PB, EC, JV, KKL)
| | - Enze Ma
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
| | - Frances Tiffany Morden
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
| | - Ariel Chong
- University of Hawai‘i at Manoa, Honolulu, HI (AC, NV)
| | - Nicholas Van
- University of Hawai‘i at Manoa, Honolulu, HI (AC, NV)
| | - Nong Dang
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
| | - Pat Borman
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawai‘i Pacific Neuroscience, Honolulu, HI (CM, EZ, PB, EC, JV, KKL)
| | - Enrique Carrazana
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawai‘i Pacific Neuroscience, Honolulu, HI (CM, EZ, PB, EC, JV, KKL)
| | - Jason Viereck
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawai‘i Pacific Neuroscience, Honolulu, HI (CM, EZ, PB, EC, JV, KKL)
- Clinical & Translational Research, Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JV, KKL)
| | - Kore Kai Liow
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawai‘i Pacific Neuroscience, Honolulu, HI (CM, EZ, PB, EC, JV, KKL)
- Clinical & Translational Research, Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JV, KKL)
| |
Collapse
|
16
|
Neshige S, Aoki S, Takebayashi Y, Shishido T, Yamazaki Y, Iida K, Maruyama H. A longitudinal seizure outcome following the COVID-19 pandemic in 2020 and 2021: Transient exacerbation or sustainable mitigation. J Neurol Sci 2021; 434:120100. [PMID: 34952346 PMCID: PMC8689575 DOI: 10.1016/j.jns.2021.120100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/05/2021] [Accepted: 12/14/2021] [Indexed: 01/08/2023]
Abstract
Objective To study the longitudinal seizure outcomes of people with epilepsy (PWE) following the acute and chronic phases of the coronavirus disease 2019 (COVID-19) pandemic. Methods Consecutive PWE who were treated at the epilepsy center of Hiroshima University Hospital between 2018 and 2021 were enrolled. We evaluated the incidence of seizure frequency increase or decrease following the pandemic during observational periods in 2020 and 2021. Data between 2018 and 2019 were used as a control set. The sustainability of the altered seizure frequency condition was evaluated throughout the study period. We analyzed the clinical, psychological, and social factors associated with PWE with seizure exacerbation or amelioration. Results Among the 223 PWE who were evaluated (mean age 37.8 ± 16.3 years), seizure frequency increased for 40 (16.8%) and decreased for 34 (15.2%) after the pandemic began. While seizure exacerbation tended to be a transient episode during 2020, seizure amelioration was likely to maintain excellent status over the observation periods; the sustainability of the altered seizure frequency condition was more prominent for amelioration than exacerbation (p < 0.001). Seizure exacerbation was significantly associated with “no housemate” (odds ratio [OR] 3.37; p = 0.045) and “comorbidity of insomnia” (OR 5.80; p = 0.004). Conversely, “structural abnormality of MRI” (OR 2.57; p = 0.039) and “two-generation householding” (OR 3.70; p = 0.004) were independently associated with seizure amelioration. Conclusion This longitudinal observation confirmed that seizure exacerbation and amelioration emerged during the COVID-19 pandemic. The COVID-19 pandemic has shed light on the stark difference that social support systems can make on outcomes for PWE.
Collapse
Affiliation(s)
- Shuichiro Neshige
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical and Health Sciences, Japan; Epilepsy Center, Hiroshima University Hospital, Japan.
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical and Health Sciences, Japan
| | - Yoshiko Takebayashi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical and Health Sciences, Japan
| | - Takeo Shishido
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical and Health Sciences, Japan
| | - Yu Yamazaki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical and Health Sciences, Japan
| | - Koji Iida
- Epilepsy Center, Hiroshima University Hospital, Japan; Department of Neurosurgery, Hiroshima University, Graduate School of Biomedical and Health Sciences, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical and Health Sciences, Japan; Epilepsy Center, Hiroshima University Hospital, Japan
| |
Collapse
|
17
|
Pacheco-Barrios K, Navarro-Flores A, Cardenas-Rojas A, de Melo PS, Uygur-Kucukseymen E, Alva-Diaz C, Fregni F, Burneo JG. Burden of epilepsy in Latin America and The Caribbean: a trend analysis of the Global Burden of Disease Study 1990 - 2019. Lancet Reg Health Am 2022; 8:100140. [PMID: 36778734 DOI: 10.1016/j.lana.2021.100140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background The epilepsy prevalence in Latin America and the Caribbean (LAC) had remained high over the last 20 years. Data on the burden of epilepsy are needed for healthcare planning and resource allocation. However, no systematic analysis had been performed for epilepsy burden in LAC. Methods We extracted data of all LAC countries from the Global Burden of Disease (GBD) study from 1990 to 2019. Epilepsy burden was measured as prevalence, mortality, and disability-adjusted life-years (DALYs; defined by the sum of years of life lost [YLLs] for premature mortality and years lived with disability [YLDs]), by age, sex, year, and country. Absolute numbers, rates, and 95% uncertainty intervals were reported. We performed correlational analyses among burden metrics and Socio-demographic Index (SDI). Findings The burden of epilepsy decreased around 20% in LAC, led by YLLs reduction. In 2019, 6·3 million people were living with active epilepsy of all causes (95% UI 5·3 - 7·4), with 3·22 million (95% UI 2·21 - 4·03) and 3·11 million (95% UI 2·21 to 4·03) cases of epilepsy with identifiable aetiology and idiopathic epilepsy, respectively. The number of DALYs represented the 9·51% (1.37 million, 95% UI 0·99 -1·86) of the global epilepsy burden in 2019. The age-standardized burden was 175·9 per 100 000 population (95% UI 119·4 - 253·3), which tend to have a bimodal age distribution (higher in the youth and elderly) and was driven by high YLDs estimates. The burden was higher in men and older adults, primarily due to high YLLs and mortality. Alcohol use was associated with 17% of the reported DALYs. The SDI estimates significantly influenced this burden (countries with high SDI have less epilepsy burden and mortality, but not prevalence or disability). Interpretation The epilepsy burden has decreased in LAC over the past 30 years. Even though, LAC is still ranked as the third region with the highest global epilepsy burden. This reduction was higher in children, but burden and mortality increased for older adults. The epilepsy burden is disability predominant; however, the mortality-related estimates are still higher than in other regions. Alcohol consumption and countries' development are important determinants of this burden. There is an urgent need to improve access to epilepsy care in LAC, particularly for older adults. Strengthening primary care with online learning and telemedicine tools, and promoting risk factors modification should be prioritized in the region. Funding This research was self-funded by the authors.
Collapse
|
18
|
Babtain F, Atteyah D, Milyani H, Banjer T, Alqadi K, Baeesa S, Al Said Y. The safety and efficacy of modifying the admission protocol to the epilepsy monitoring unit in response to the COVID-19 pandemic. Epilepsy Behav 2021; 122:108229. [PMID: 34364025 DOI: 10.1016/j.yebeh.2021.108229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/10/2021] [Accepted: 07/16/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic has impacted admission to epilepsy monitoring units (EMUs) for classification and presurgical evaluation of patients with refractory epilepsy. We modified the EMU admission protocol via anti-seizure medications (ASM) withdrawal implemented one day before admission; thus, we aimed to evaluate the efficacy and safety of this modified protocol. METHODS In January 2021, we initiated ASM tapering 24 h before-rather than on the first day after-EMU admission, contrasting with the previous protocol. We retrospectively reviewed EMU admissions between January and April of 2018, 2019, and 2021, and identified the time required to record the first seizure, and EMU yield to confirm or change the epilepsy classification. We also evaluated the safety of the modified protocol, by monitoring the seizure frequency for up to 5 months after the discharge from the hospital. RESULTS One hundred four patients were included (mean age: 30 years, men: 43%); excluding a longer disease duration and abundance of normal routine electro-encephalogram (EEG) in patients admitted before the pandemic, no differences were observed in patients' characteristics. On average, it took 41 h and 21 h to record the first seizure using the standard and modified protocols, respectively (p < 0.001, 95% CI: 10-30). Other characteristics were investigated both before and after the COVID-19 pandemic, and epilepsy classifications were confirmed twice using the modified protocol (OR = 2.4, p = 0.04, 95% CI: 1.1-5.5). Multivariate regression analysis confirmed the shorter time to record the first seizure using the modified admission protocol (23 h less, p < 0.001; 95% CI: 12-34). Finally, 36 (86%) patients admitted during the pandemic exhibited no increase in seizure frequency after the discharge from the hospital. CONCLUSIONS Initiating ASM withdrawal one day before EMU admission was deemed to be an efficient and safe way to confirm epilepsy classification and significantly decrease the length of hospital stay. Ultimately, this will shorten the long waiting list for EMU admission created by the COVID-19 pandemic.
Collapse
|
19
|
Ricciardi D, Casagrande S, Iodice F, Orlando B, Trojsi F, Cirillo G, Clerico M, Bozzali M, Leocani L, Abbadessa G, Miele G, Tedeschi G, Bonavita S, Lavorgna L; Digital Technologies, Web, Social Media Study Group of the Italian Society of Neurology. Myasthenia gravis and telemedicine: a lesson from COVID-19 pandemic. Neurol Sci 2021. [PMID: 34436726 DOI: 10.1007/s10072-021-05566-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/12/2021] [Indexed: 01/09/2023]
Abstract
COVID-19 pandemic has induced an urgent reorganization of the healthcare system to ensure continuity of care for patients affected by chronic neurological diseases including myasthenia gravis (MG). Due to the fluctuating nature of the disease, early detection of disease worsening, adverse events, and possibly life-threatening complications is mandatory. This work analyzes the main unresolved issues in the management of the myasthenic patient, the possibilities offered so far by digital technologies, and proposes an online evaluation protocol based on 4 simple tests to improve MG management. Telemedicine and Digital Technology might help neurologists in the clinical decision-making process of MG management, avoiding unnecessary in presence consultations and allowing a rational use of the time and space reduced by the pandemic.
Collapse
|
20
|
Brigo F, Ponzano M, Sormani MP, Clerico M, Abbadessa G, Cossu G, Trojsi F, Colucci F, Tortorella C, Miele G, Spina E, Artusi CA, Carmisciano L, Servillo G, Bozzali M, Sparaco M, Leocani L, Lanzillo R, Tedeschi G, Bonavita S, Lavorgna L. Digital work engagement among Italian neurologists. Ther Adv Chronic Dis 2021; 12:20406223211029616. [PMID: 34367544 PMCID: PMC8299881 DOI: 10.1177/20406223211029616] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/15/2021] [Indexed: 12/21/2022] Open
Abstract
Background Digital health, including telemedicine, is increasingly recommended for the management of chronic neurological disorders, and it has changed the roles of patients and clinicians. Methods In this cross-sectional study we aimed to investigate the digital work engagement of Italian neurologists through a survey collected between September 2020 and January 2021. Questionnaires were anonymous and collected demographic characteristics, attitudes towards digital devices and social media, and details about the clinician-patient relationship. We used logistic-regression models to identify characteristics associated with the propensity to communicate with patients using social media. Results Among the 553 neurologists who participated to the study, smartphones and computers were widely preferred compared with tablets; wearable devices were not common, although some neurologists desired them. A total of 48% of participants reported communicating with patients using social media but only a few were in favor of social friendship with patients; WhatsApp was the social media most popular for professional (86%) and personal (98%) purposes. Propensity to communicate with social media was significantly higher among those who were older (p < 0.001) and lived in regions outside northern Italy (center: p = 0.006; south and the islands: p < 0.001). For 58% of responders, social media improved their relationship with patients, but 72% usually warned patients about unreliable websites. Conclusions The preferred social media were those which were rapid and which safeguard privacy more effectively; neurologists made many efforts to disprove fake news circulating online, providing help to patients in various ways. This analysis can help direct future interventions for the management of chronic neurological disorders.
Collapse
Affiliation(s)
- Francesco Brigo
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Marta Ponzano
- Department of Health Sciences (DISSAL), University of Genoa, Via Antonio Pastore, 1, Genova 16126, Italy
| | - Maria Pia Sormani
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Marinella Clerico
- Clinical and Biological Sciences Department, University of Torino, Torino, Italy
| | - Gianmarco Abbadessa
- Department of Advanced Medical and Surgical Sciences, II Clinic of Neurology, University of Campania 'Luigi Vanvitelli,' Caserta, Italy
| | | | - Francesca Trojsi
- Department of Advanced Medical and Surgical Sciences, II Clinic of Neurology, University of Campania 'Luigi Vanvitelli,' Caserta, Italy
| | - Fabiana Colucci
- Clinical and Biological Sciences Department, University of Torino, Torino, Italy
| | - Carla Tortorella
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Giuseppina Miele
- Department of Advanced Medical and Surgical Sciences, II Clinic of Neurology, University of Campania 'Luigi Vanvitelli,' Caserta, Italy
| | - Emanuele Spina
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | | | - Luca Carmisciano
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | | | - Marco Bozzali
- Department of Neuroscience, University of Torino, Torino, Italy
| | - Maddalena Sparaco
- Department of Advanced Medical and Surgical Sciences, II Clinic of Neurology, University of Campania 'Luigi Vanvitelli,' Caserta, Italy
| | - Letizia Leocani
- Institute of Experimental Neurology, Ospedale San Raffaele, and Department of Neurology, Vita-Salute San Raffaele University, Milano, Italy
| | - Roberta Lanzillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, II Clinic of Neurology, University of Campania 'Luigi Vanvitelli,' Caserta, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, II Clinic of Neurology, University of Campania 'Luigi Vanvitelli,' Caserta, Italy
| | - Luigi Lavorgna
- Department of Advanced Medical and Surgical Sciences, II Clinic of Neurology, University of Campania 'Luigi Vanvitelli,' Caserta, Italy
| |
Collapse
|
21
|
Benson A, Shahwan A. Monitoring the frequency and duration of epileptic seizures: "A journey through time". Eur J Paediatr Neurol 2021; 33:168-178. [PMID: 34120833 DOI: 10.1016/j.ejpn.2021.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/19/2021] [Accepted: 05/25/2021] [Indexed: 11/28/2022]
Abstract
Seizure monitoring plays an undeniably important role in diagnosing and managing epileptic seizures. Establishing the frequency and duration of seizures is crucial for assessing the burden of this chronic neurological disease, selecting treatment methods, determining how frequently these methods are applied, and informing short and long-term therapeutic decisions. Over the years, seizure monitoring tools and methods have evolved and become increasingly sophisticated; from home seizure diaries to EEG monitoring to cutting-edge responsive neurostimulation systems. In this article, the various methods of seizure monitoring are reviewed.
Collapse
Affiliation(s)
- Ailbhe Benson
- Department of Clinical Neurophysiology & Neurology, CHI at Temple Street, Dublin, Ireland.
| | - Amre Shahwan
- Department of Clinical Neurophysiology & Neurology, CHI at Temple Street, Dublin, Ireland.
| |
Collapse
|
22
|
Zahid Hussain. Paradigm of technological convergence and digital transformation: The challenges of CH sectors in the global COVID-19 pandemic and commencing resilience-based structure for the post-COVID-19 era. Digital Applications in Archaeology and Cultural Heritage 2021; 21. [ DOI: 10.1016/j.daach.2021.e00182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Technology and digitalization are vital for helping organizations to survive in the competitive marketplace. The global COVID-19 pandemic has fixated attention on the cultural heritage sectors. This study presents technological convergence and new digital platforms that require business societies to transform into new sustainable meanings. The concept of technological convergence to the autonomous ecosystem is supported by cutting-edge technologies, a distinctive life cycle for value-added creation. This study is based on a five-part conceptual context to examine the impact of pandemic on the cultural heritage sectors. The major impacts like institutional issues, financial limitations, data access policies, and stakeholders diverging views are fully addressed. An additional impression of this study is that it has comprehensively expressed the opportunities and capabilities of technological convergence in terms of competence, integration, impound and novelty for higher value creation most related to the cultural heritage sectors in the current and post COVID-19 pandemic era.
Collapse
|
23
|
Shaarani I, Ghanem A, Jounblat M, Jounblat H, Mansour R, Taleb R. Utilization of Telemedicine by the Lebanese Physicians During Time of Pandemic. Telemed J E Health 2021; 28:219-226. [PMID: 33999731 DOI: 10.1089/tmj.2021.0090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The use of technology in the medical field has been rising rapidly and offering, in many cases, an alternative to traditional ways of practicing medicine, especially when remote medical services are required. This background has laid the foundation for telemedicine to play a role in controlling the current coronavirus disease 2019 (COVID-19) pandemic. Telemedicine has the potential to allow the facilitation of providing the necessary medical care to patients without exposing them to contact with other patients or the general population. Objective: The aim of this study was to investigate the utilization of telemedicine by the Lebanese physicians during the COVID-19 pandemic. Methods: This cross-sectional online study was conducted using LimeSurvey® through an e-mail-based questionnaire sent to physicians currently enrolled in both Beirut and Tripoli Lebanese Order of Physicians. Results: Four hundred one physicians completed the survey resulting in a response rate of 5.85%. Most of the respondents (N = 401, 75.8%) reported using telemedicine to provide health care services to patients without in-person visits during the pandemic. Among those using telemedicine (N = 304), around 40% reported that they started using it during COVID-19 pandemic. Discussion: Literature states that the average time of an in-person clinic consultation is more than 15 min. This implies that telemedicine can play a role in saving physicians' time; this conclusion is supported by other studies that consider telemedicine a time-saving method of providing health care services. Conclusions: Our study indicated that telemedicine is used by the majority of Lebanese physicians and that this use has been accelerated by the COVID-19 pandemic. Our results showed that telemedicine does have a potential that can allow it to be integrated in the health care system and implemented on a national organized level.
Collapse
Affiliation(s)
- Issam Shaarani
- Faculty of Medicine, Department of Clinical Sciences, Beirut Arab University, Beirut, Lebanon
| | - Ali Ghanem
- Faculty of Medicine, Department of Clinical Sciences, Beirut Arab University, Beirut, Lebanon
| | - Mohammad Jounblat
- Faculty of Medicine, Department of Clinical Sciences, Beirut Arab University, Beirut, Lebanon
| | - Hadi Jounblat
- Faculty of Medicine, Department of Clinical Sciences, Beirut Arab University, Beirut, Lebanon
| | - Reem Mansour
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Rim Taleb
- Faculty of Medicine, Department of Clinical Sciences, Beirut Arab University, Beirut, Lebanon
| |
Collapse
|
24
|
Azmy A, Abushady EM, Abu Shady MM. Online Health Survey on Epileptic Children during Coronavirus Disease-2019 Pandemic. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Coronavirus disease 2019 (COVID-19) is a novel infectious disease caused by severe acute respiratory syndrome coronavirus 2, and the outbreak is now rapidly spreading globally. The current administrative measures of lock-down, social distancing, and self-isolation are intended at reducing the spread of the viral infection, minimizing contacts between potentially infected individuals and healthy subjects. However, they can complicate the management of children with neurological illnesses by instigating or worsening concomitant anxiety and depression, hindering the interactions with physicians, and leading to shortages or inconsistent supply of medicines.
OBJECTIVE: The current study aims to provide information on the medical care and wellbeing of children with epilepsy during COVID-19 pandemic and provide the best possible care for those children while avoiding visits to urgent care facilities and hospitalizations during the pandemic.
METHODS: The current study was an observational cross-section survey study. One hundred twenty children with epilepsy following in the epilepsy clinic of Medical Research Center of Excellence, and epilepsy clinic at Neurology Department, Faculty of Medicine, Ain Shams University aged above 4 years were recruited. The authors designed a 22-items questionnaire to address impact of COVID-19 crisis on the care, seizure outcome, behavior of children, and concerns of their parents. The study was conducted during the period from May 2020 to November 2020.
RESULTS: The study included 120 epileptic children, 47 males and 73 females, with age ranged from 4 to 17 years with mean age 8.34 ± 3.877 years. Before COVID pandemic, 18.3% of care providers had worries about epilepsy, while during the pandemic, 78.3% of them had the same worries. Twenty percent of the studied patients showed worsened sleep during the pandemic. Medical follow-up difficulties and drug access difficulties were found in 18.3% and 50% of the patients, respectively, during the pandemic. Child anxiety was 20% before the pandemic and 97.5% during the pandemic. Of the care providers, 95.8% were worried about their children of getting COVID 19. Thirty percent showed a need for psychological support, 76.7% for medical support, and 75% for information support about epilepsy. Medical support by phone or online during the pandemic was accepted by 80.8% of the caregivers. The study also showed that epileptic children with age ≤12 years needed more psychological support than those >12 years. All children without anxiety before the COVID-19 pandemic had anxiety during COVID-19 pandemic, while 87.5% of those with anxiety before COVID still had anxiety during the pandemic, signifying that COVID 19 pandemic increased the anxiety of the epileptic children significantly.
CONCLUSION: The present study found no increase in seizure exacerbation during the outbreak of COVID-19. During the pandemic, worries of the care providers about progression of the frequency of seizure and epileptic children anxiety increased significantly. Physicians should offer health care facilities including medications and information as much as possible at home to keep children with epilepsy in good psychological and mental status as well as minimizing of risk of seizure exacerbation through adherence. Effective telemedicine tools will prove useful for the long-term management of these patients.
Collapse
|
25
|
Stipa G, Gabbrielli F, Rabbito C, Di Lazzaro V, Amantini A, Grippo A, Carrai R, Pasqui R, Barloscio D, Olivi D, Lori S. The Italian technical/administrative recommendations for telemedicine in clinical neurophysiology. Neurol Sci 2021; 42:1923-1931. [PMID: 32974797 PMCID: PMC7514225 DOI: 10.1007/s10072-020-04732-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/15/2020] [Indexed: 12/18/2022]
Abstract
Recent advances in technology, information technology, Internet networks, and, more recently, fiber optics in industrialized countries allow the exchange of a huge amount of data, in real time, across the globe. The acquisition of increasingly sophisticated technologies has made it possible to develop telemedicine, by which the specialist's evaluation can be carried out on the patient even remotely. In Italy, this very useful tool, although possible from a technological and information technology point of view, has not been developed because of the lack of clear and univocal rules and of major administrative obstacles related to the Italian Public Health System. To promote telemedicine implementation in Italy, the Italian Society of Clinical Neurophysiology and the Italian Society of Telemedicine together with the National Centre for Telemedicine and New Assistive Technologies of the Italian Higher Institute of Health prepared these inter-society recommendations. Because of potential forensic value of these recommendations, they were prepared considering the current regulations and the General Data Protection Regulation and will provide the basis for a Consensus Conference planned to discuss and prepare National Telemedicine Guidelines.
Collapse
Affiliation(s)
- G Stipa
- Neurophysiology Unit, Neuroscience Department, Terni Hospital - A.O. S. Maria, Terni, Italy.
- Italian Society of Clinical Neurophysiology - SINC, Rome, Italy.
- Italian Society of Telemedicine and Healthcare - SIT, Rome, Italy.
| | - F Gabbrielli
- Italian Society of Telemedicine and Healthcare - SIT, Rome, Italy
- National Center for Telemedicine, Italian National Institute for Health - ISS, Rome, Italy
| | - C Rabbito
- Italian Society of Telemedicine and Healthcare - SIT, Rome, Italy
| | - V Di Lazzaro
- Italian Society of Clinical Neurophysiology - SINC, Rome, Italy
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Campus Bio-Medico of Rome University, Rome, Italy
| | - A Amantini
- Italian Society of Clinical Neurophysiology - SINC, Rome, Italy
- Neurophysiology Unit, Neuro-Muscular-Skeletal Department, Careggi Hospital, University of Florence, Florence, Italy
| | - A Grippo
- Italian Society of Clinical Neurophysiology - SINC, Rome, Italy
- Italian Society of Telemedicine and Healthcare - SIT, Rome, Italy
- Neurophysiology Unit, Neuro-Muscular-Skeletal Department, Careggi Hospital, University of Florence, Florence, Italy
| | - R Carrai
- Italian Society of Clinical Neurophysiology - SINC, Rome, Italy
- Neurophysiology Unit, Neuro-Muscular-Skeletal Department, Careggi Hospital, University of Florence, Florence, Italy
| | - R Pasqui
- Italian Society of Telemedicine and Healthcare - SIT, Rome, Italy
| | - D Barloscio
- Neurophysiology Unit, Neuroscience Department, Terni Hospital - A.O. S. Maria, Terni, Italy
| | - D Olivi
- Neurophysiology Unit, Neuroscience Department, Terni Hospital - A.O. S. Maria, Terni, Italy
| | - S Lori
- Italian Society of Clinical Neurophysiology - SINC, Rome, Italy
- Italian Society of Telemedicine and Healthcare - SIT, Rome, Italy
- Neurophysiology Unit, Neuro-Muscular-Skeletal Department, Careggi Hospital, University of Florence, Florence, Italy
| |
Collapse
|
26
|
Rosellini I, Vianello M, Ghazaryan A, Guidoni SV, Palmieri A, Giopato F, Vitaliani R, Fuccaro M, Terrin A, Rigoni MT, Pietrobon F, Bonifati DM. Virtual visits for chronic neurologic disorders during COVID-19 pandemic. Neurol Sci 2021; 42:2607-10. [PMID: 33774762 DOI: 10.1007/s10072-021-05212-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/20/2021] [Indexed: 12/26/2022]
Abstract
Background COVID-19 pandemic has boosted telemedicine in medical clinical practice. Experiences in the management of chronic neurological disorders are limited and scattered. The aim of the study was to evaluate feasibility and efficacy of virtual visit for chronic neurological disorders during COVID-19 pandemic. Methods All patients scheduled for a visit during the lockdown period were contacted. The patients fell into four categories: (1) long-term follow-up, the patient was re-scheduled; (2) visit was necessary, teleconsultation was accepted; (3) problem was solved by phone call; and (4) visit was necessary and teleconsultation was not feasible, then visit was maintained. Google Meet was used. During the virtual visit, neurological examination was performed, and demographic and clinical characteristics were recorded. Results At the end of May 2020, 184 virtual visits for 178 patients were performed for the following diseases: myasthenia gravis (47 patients), multiple sclerosis (79), epilepsy (12), headache (6), and parkinsonism (34). The patients were 70 males and 108 females with a mean age of 53.5 years (range 13–90). During virtual visit, we were able to obtain a satisfactory neurological examination. Conclusions We demonstrated feasibility and effectiveness of virtual visit in the management of a large group of patients with common chronic neurological disorders.
Collapse
|
27
|
Friedrich L, Sruk A, Bielen I. Responses of people with epilepsy to the COVID-19 pandemic in the time of national lockdown. Epilepsy Behav 2021; 116:107790. [PMID: 33548913 PMCID: PMC7805410 DOI: 10.1016/j.yebeh.2021.107790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/20/2020] [Accepted: 01/02/2021] [Indexed: 12/17/2022]
Abstract
The aim of our study was to gather information on how people with epilepsy (PwE) responded to the COVID-19 pandemic during the national lockdown. An online questionnaire was therefore offered to the visitors of the Croatian Association for Epilepsy's website. The 22-items questionnaire was designed to acquire information from adults with epilepsy living in Croatia on demographic data, cognitive, emotional and behavioral responses to the pandemic, and communication problems between patients and their neurologists during the lockdown. Perceived anxiety and fears were expressed with the Likert scale (1-5) and the results of specific fears added to make the Total Fear Score. Results: Out of 186 respondents in total, only 2.8% did not comply with the lockdown measures, and all of those respondents stated that they did not feel any anxiety related to COVID-19. A canceled neurologist examination during the lockdown was significantly associated with pandemic-related anxiety (2.9 ± 1.28 vs. 2.3 ± 1.19, U = 3039, p = 0.001) and fears (Total Fear Score 31.4 ± 9.70 vs. 28.4 ± 9.79, U = 3341, p = 0.036), and 87.4% of respondents expressed the wish to communicate with their neurologist, either by phone/video call (53.0%) or email (34.4%). Conclusion: We think the results of our survey show that the responses from PwE point to a social responsibility appropriate for the existing situation. During future pandemics, telemedicine could have an important role in tackling the fears and anxieties caused by the cancelation of examinations, which corresponds to the wishes expressed by the great majority of our respondents.
Collapse
Affiliation(s)
- Latica Friedrich
- Department of Neurology, "Sveti Duh" University Hospital, School of Medicine Josip Juraj Strossmayer, University of Osijek, Sveti Duh 64, Zagreb, Croatia.
| | | | | |
Collapse
|
28
|
Kendzerska T, Zhu DT, Gershon AS, Edwards JD, Peixoto C, Robillard R, Kendall CE. The Effects of the Health System Response to the COVID-19 Pandemic on Chronic Disease Management: A Narrative Review. Risk Manag Healthc Policy 2021; 14:575-584. [PMID: 33623448 PMCID: PMC7894869 DOI: 10.2147/rmhp.s293471] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/18/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Individuals with chronic conditions require ongoing disease management to reduce risks of adverse health outcomes. During the COVID-19 pandemic, health care for non-COVID-19 cases was affected due to the reallocation of resources towards urgent care for COVID-19 patients, resulting in inadequate ongoing care for chronic conditions. METHODS A keyword search was conducted in PubMed, Google Scholar, Science Direct, and Scopus for English language articles published between January 2020 and January 2021. FINDINGS During the COVID-19 pandemic, in-person care for individuals with chronic conditions have decreased due to government restriction of elective and non-urgent healthcare visits, greater instilled fear over potential COVID-19 exposure during in-person visits, and higher utilization rates of telemedicine compared to the pre-COVID-19 period. Potential benefits of a virtual-care framework during the pandemic include more effective routine disease monitoring, improved patient satisfaction, and increased treatment compliance and follow-up rates. However, more needs to be done to ensure timely and effective access to telemedicine, particularly for individuals with lower digital literacy. Capitation primary care models have been proposed as a more financially-robust approach during the COVID-19 pandemic than fee-for-service primary care models; however, the interplay between different primary models and the health outcomes is still poorly understood and warrants further investigation. Shortages of medication used to manage chronic conditions were also observed at the beginning of the COVID-19 pandemic due to global supply chain disruptions. Finally, patients with chronic conditions faced lifestyle disruptions due to the COVID-19 pandemic, specifically in physical activity, sleep, stress, and mental health, which need to be better addressed. INTERPRETATION Overall, this review elucidates the disproportionately greater barriers to primary and specialty care that patients with chronic diseases face during the COVID-19 pandemic and emphasizes the urgent need for better chronic disease management strategies moving forward.
Collapse
Affiliation(s)
- Tetyana Kendzerska
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - David T Zhu
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada
- Faculty of Science, Western University, London, Ontario, Canada
| | - Andrea S Gershon
- Department of Medicine, Sunnybrook Health Sciences Centre/University of Toronto, Toronto, Ontario, Canada
| | - Jodi D Edwards
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Cayden Peixoto
- The Institut Du Savoir Montfort, Ottawa, Ontario, Canada
| | - Rebecca Robillard
- The Royal’s Institute of Mental Health Research/University of Ottawa, Ottawa, Ontario, Canada
| | - Claire E Kendall
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada
- The Institut Du Savoir Montfort, Ottawa, Ontario, Canada
- C.T. Lamont Primary Health Care Research Group, Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
29
|
Puteikis K, Jasionis A, Mameniškienė R. Recalling the COVID-19 lockdown: Insights from patients with epilepsy. Epilepsy Behav 2021; 115:107573. [PMID: 33268021 PMCID: PMC7700727 DOI: 10.1016/j.yebeh.2020.107573] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/09/2020] [Accepted: 10/17/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of our study was to explore health changes among people with epilepsy (PWE) during a national COVID-19 lockdown in the context of patients' clinical characteristics and their experience of receiving epilepsy-related medical services. METHODS A questionnaire was distributed for adult PWE both online and at a tertiary epilepsy center after the end of a national lockdown in Lithuania. PWE were asked to evaluate their health status during the lockdown and estimate changes in their seizure patterns. Additional questions concerned the accessibility and quality of epilepsy-related consultations. RESULTS The study sample consisted of 143 PWE (59 [41.3%] male, mean age 35.1 ± 13.4 years), 94 (65.7%) completed the survey in person, 49 (34.3%) - online. A deterioration in reported physical and mental health during lockdown was observed (Z = -4.604, p < 0.0001 and Z = -4.253, p < 0.0001, respectively) and 22 (15.4%) PWE reported seizure exacerbation. In an ordinal logistic regression model (analysis of data from all participants), baseline seizure frequency (b = 0.413, p = 0.031), reported physical health before lockdown (b = -0.462, p = 0.031) and the ease of proper antiepileptic drug (AED) use during the imposed restrictions (b = -0.535, p = 0.006) were statistically significant variables associated with changes in seizure frequency. The latter were not affected by modifications in AED use (Mann-Whitney U = 1127.0, p = 0.307) irrespective of the data collection method. With teleconsultations being predominant during the lockdown, an overall decline in the quality of epilepsy-related consultations was observed (Z = -2.895, p = 0.004). Among all participants, 46 (32.2%) lost an epilepsy-related consultation or medical service because of the lockdown. This loss was found to be associated with seizure exacerbation (Mann-Whitney U = 1622.5, p = 0.046). CONCLUSION Our study indicates that a national COVID-19 lockdown may have led to worse seizure control and health status in some PWE. Easy access to AEDs and their appropriate use may be especially useful to prevent seizure exacerbation during strict COVID-19 restrictions. The quality and accessibility of remote epilepsy-related consultations was suboptimal and may require further improvement during disruption of in-person services.
Collapse
|
30
|
Iodice F, Romoli M, Giometto B, Clerico M, Tedeschi G, Bonavita S, Leocani L, Lavorgna L. Stroke and digital technology: a wake-up call from COVID-19 pandemic. Neurol Sci 2021; 42:805-809. [PMID: 33433756 PMCID: PMC7801773 DOI: 10.1007/s10072-020-04993-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/11/2020] [Indexed: 12/23/2022]
Abstract
Introduction The pandemic has implemented the need for new digital technologies as useful tools during the emergency and the long recovery phase that will follow. SARS-CoV-2 has strongly impacted stroke care with significant contraction in a number of patients treated. Methods This mini-review is an initiative of the “Digital Technologies, Web and Social Media Study Group” of the Italian Society of Neurology and briefly discusses digital tools for managing the acute phase and the rehabilitation after stroke, even considering the new apps that will improve the process of remote monitoring of patients after discharge at home. Results Telemedicine and digital technologies could play a role in each of the three stroke-belt stages: hyperacute treatment and reperfusion, acute care, etiological classification and secondary prevention and rehabilitation. Conclusion The global emergency represented by the COVID-19 pandemic can be the stimulus to accelerate the digitalization process in the field of stroke for the use of new methods on a large scale.
Collapse
Affiliation(s)
- Francesco Iodice
- Institute of Neurology, Fondazione Policlinico Gemelli, IRCCS, Rome, Italy. .,Department of Neuroscience and Neurorehabilitation, San Raffaele Pisana IRCCS, Rome, Italy. .,Digital Technologies, Web and Social Media Study Group of the Italian Society of Neurology Francesco Iodice (Member), Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Michele Romoli
- Department of Neurology and Metropolitan Stroke Center, IRCCS Istituto delle Scienze Neurologiche di Bologna, "C.A. Pizzardi" Maggiore Hospital, Bologna, Italy.,Neurology Clinic, University of Perugia, Perugia, Italy
| | - Bruno Giometto
- Department of Neurology, "Santa Chiara" Hospital APSS, Trento, Italy
| | - Marinella Clerico
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Letizia Leocani
- Department of Neurorehabilitation and INSPE-Institute of Experimental Neurology, IRCCS San Raffaele Hospital and University Vita-Salute, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Luigi Lavorgna
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | |
Collapse
|
31
|
Pajo AT, Espiritu AI, Jamora RDG. Impact and Challenges of the COVID-19 Pandemic on Patients Requiring Botulinum Toxin A Treatment. J Mov Disord 2021; 14:29-33. [PMID: 33423433 PMCID: PMC7840245 DOI: 10.14802/jmd.20088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/02/2020] [Indexed: 12/23/2022] Open
Affiliation(s)
- Azalea Tenerife Pajo
- Department of Neurosciences, College of Medicine - Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Adrian Isidoro Espiritu
- Department of Neurosciences, College of Medicine - Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.,Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Roland Dominic Go Jamora
- Department of Neurosciences, College of Medicine - Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.,Movement Disorders Service and Section of Neurology, Institute for Neurosciences, St. Luke's Medical Center, Quezon City and Global City, Philippines
| |
Collapse
|
32
|
Reilly C, Muggeridge A, Cross JH. The perceived impact of COVID-19 and associated restrictions on young people with epilepsy in the UK: Young people and caregiver survey. Seizure 2021; 85:111-114. [PMID: 33453591 PMCID: PMC7791316 DOI: 10.1016/j.seizure.2020.12.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/14/2020] [Accepted: 12/31/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose To garner the views of young people with epilepsy and caregivers regarding the impact of COVID-19 and subsequent restrictions in the UK. Mehods An online survey was used to explore the views of young people with epilepsy (n = 71) and caregivers (n = 130) in June 2020. It included questions on the impact of the pandemic and associated restrictions on the child’s epilepsy and on child and parental wellbeing. Results One in three young people and 29 % of caregivers reported that the young person’s seizures had increased during the pandemic (only 10 % of young people and 8% of caregivers reported a decrease). Half of young people reported that they were more reluctant to go to hospital. Thirty-one percent of young people and 20 % of parents reported difficulties getting epilepsy medication whilst a significant minority of young people (18 %) and caregivers (25 %) reported that the young person had investigations/assessments cancelled by their hospital. The majority of young people reported their sleep (72 %), mood (64 %) and levels of physical activity (53 %) had deteriorated. Caregivers experienced increases in stress (55 %) and anxiety (52 %). Epilepsy nurses were seen as the most helpful support Conclusions Results indicate that the pandemic and associated restrictions have had a negative impact on young people with epilepsy. Perceived increases in seizures, reluctance to go to hospital and cancelled investigations are likely to impact on epilepsy management. The wider psychosocial impact is also likely to be significant with increases in child and caregiver mental health problems in an already vulnerable group.
Collapse
Affiliation(s)
- Colin Reilly
- Research Department, Young Epilepsy, Lingfield, Surrey, RH7 6PW, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street London WC1N 1EH UK.
| | - Amy Muggeridge
- Research Department, Young Epilepsy, Lingfield, Surrey, RH7 6PW, UK
| | - J Helen Cross
- Research Department, Young Epilepsy, Lingfield, Surrey, RH7 6PW, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street London WC1N 1EH UK; Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK
| |
Collapse
|
33
|
Affiliation(s)
| | - Emily K Acton
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, University of Pennsylvania, Philadelphia
| |
Collapse
|
34
|
Spina E, Trojsi F, Tozza S, Iovino A, Iodice R, Passaniti C, Abbadessa G, Bonavita S, Leocani L, Tedeschi G, Manganelli F, Lavorgna L; Digital Technologies, Web and Social Media Study Group of the Italian Society of Neurology (SIN). How to manage with telemedicine people with neuromuscular diseases? Neurol Sci 2021; 42:3553-9. [PMID: 34173087 DOI: 10.1007/s10072-021-05396-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/08/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION COVID-19 pandemic radically transformed our daily clinical practice, raising the need not to lose close contact with patients without being able to see them face-to-face. These issues are even more felt and evident in fragile patients, as those affected by neuromuscular disease. An important help came from new digital technologies that allow clinicians to remotely monitor health status and any deterioration of chronically ill patients. METHODS In this mini-review, an initiative of the "Digital Technologies, Web and Social Media Study Group" of the Italian Society of Neurology, we propose to analyze the approach to neuromuscular patients by looking over raising evidence on the main cornerstones of Telemedicine (TM): clinician-patient interaction, remote clinical assessment, remote monitoring, and digital therapeutics. In particular, we explored the strategies developed by researchers and their impact on the physical and emotional status of the patients, with particular focusing on their adherence to the program of virtual monitoring. RESULTS TM plays an important role in each of four stages of approach to neuromuscular disease, having demonstrated validity in keep close clinical patient interaction, clinical assessment, remote monitoring, and telerehabilitation. Nevertheless, there is no remote alternative to electrophysiological testing neither validate tools to assess disability. CONCLUSION The role of TM in neuromuscular care is yet underestimated but is crucial, beyond the pandemic era. Further development of TM is advisable, through making specific apps, remotely controlled by clinicians, and making more engaging clinicians-patients interaction. Last, it is necessary to ensure adequate internet access to everyone.
Collapse
|
35
|
Kristoffersen ES, Sandset EC, Winsvold BS, Faiz KW, Storstein AM. Experiences of telemedicine in neurological out-patient clinics during the COVID-19 pandemic. Ann Clin Transl Neurol 2020; 8:440-447. [PMID: 33377609 PMCID: PMC7886029 DOI: 10.1002/acn3.51293] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/03/2020] [Accepted: 12/11/2020] [Indexed: 12/28/2022] Open
Abstract
Objective The COVID‐19 pandemic has led to rapid changes in the delivery of medical care worldwide. The main objective of this survey was to investigate the initial experiences of neurologists with the use of telemedicine for different neurological conditions during the first phase of the COVID‐19. Methods All hospital‐based neurologists in Norway (n = 400) were invited to a questionnaire survey by e‐mail in April 2020. The study focused on telemedicine and all questions were answered with regard to the first weeks of the pandemic lockdown in Norway. Results One‐hundred and thirty‐five neurologists responded. Overall, 87% reported a shift toward more telemedicine, with significantly more use of telephone than video consultations for both new referrals (54% vs. 30%, P < 0.001) and follow‐ups (99% vs. 50%, P < 0.001). Respondents deemed it much more professionally satisfactory to conduct follow‐up consultations by telephone, than to carry out consultations with new patients by telephone (85% vs. 13%, P < 0.001). Teleconsultations were better suited for headache and epilepsy patients as compared to multiple sclerosis and movement disorder patients. There was no significant difference between residents and senior consultants regarding how they experienced teleconsultations. Female neurologists found telemedicine better and more effective than male neurologists. Interpretation Telemedicine was rapidly implemented in Norwegian neurological departments during the first weeks of the COVID‐19 pandemic. Teleconsultations were better suited for follow‐ups than for new referrals, and better for headache and epilepsy patients as compared to multiple sclerosis and movement disorder patients.
Collapse
Affiliation(s)
- Espen Saxhaug Kristoffersen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway.,Department of General Practice, University of Oslo, Oslo, Norway
| | - Else Charlotte Sandset
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,The Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Bendik Slagsvold Winsvold
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Division of Clinical Neuroscience, Department of Research, Innovation and Education, Oslo University Hospital, Oslo, Norway
| | - Kashif Waqar Faiz
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | | |
Collapse
|
36
|
Smith M, Nakamoto M, Crocker J, Tiffany Morden F, Liu K, Ma E, Chong A, Van N, Vajjala V, Carrazana E, Viereck J, Liow K. Early impact of the COVID-19 pandemic on outpatient migraine care in Hawaii: Results of a quality improvement survey. Headache 2020; 61:149-156. [PMID: 33316097 DOI: 10.1111/head.14030] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/30/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE A survey was implemented for early assessment of pandemic-related practice processes and quality improvement (QI). BACKGROUND In response to the public health measures in Hawaii to curtail the coronavirus 2019 pandemic, Hawaii Pacific Neuroscience (HPN) adapted their patient care to ensure continuity of neurological treatment. METHODS The telephone survey was conducted on patients seen at HPN during the period of April 22, 2020-May 18, 2020 to address four areas related to patients' outpatient experience: delivery of care, general well-being, experience with telemedicine, and disease-specific questions. RESULTS A total of 928 patients were contacted of which 429 (46.2%) patients responded and 367 (85.5%) agreed to participate. A total of 133 patients with migraine and 234 patients with other neurological conditions provided responses. Our migraine patients' survey responses suggest that their well-being was disproportionately negatively affected by the pandemic. Survey respondents with migraine were significantly more likely than their non-migraine peers to report worsening anxiety and sleep problems [62/132 (47.0%) vs. 78/234 (33.3%), χ2 = 6.64, p = 0.010, and 64/132 (48.5%) vs. 73/234 (31.2%), χ2 = 10.77, p = 0.001]; migraine patients also reported worsening of depression as a result of the pandemic more than patients with other diagnoses, though this was not statistically significant [44/132 (33.3%) vs. 57/234 (24.4%), χ2 = 3.40, p = 0.065]. In regard to access to healthcare, significantly more migraine patients reported running out of medications than those with other diagnoses [20/133 (15.0%) vs. 18/234 (7.7%), χ2 = 4.93, p = 0.026]. More avoided seeking medical help for new health problems because of the pandemic [30/133 (22.6%) vs. 30/234 (12.8%), χ2 = 5.88, p = 0.015]. Migraine patients were also significantly impacted economically by the pandemic; 43/132 (32.4%) of migraine patients reported losing their jobs as the result of the pandemic versus 34/234 (14.5%) of their peers (χ2 = 11.20, p < 0.001). An increase in headache severity or frequency was reported in 39/118 (33.1%) of respondents and 19/118 (16.1%) reported to using more abortive therapy than usual. Telemedicine was well received by almost all patients who took advantage of the option. Most of those patients found telemedicine to be easy to use and as valuable as an in-person visit. Migraine patients indicated with more frequency that without the telemedicine option, they would have missed their medical appointments [37/68 (54.4%) vs. 56/144 (38.6%), χ2 = 4.31, p = 0.038]; a majority would prefer or consider telemedicine for future appointments over in-person visits. CONCLUSIONS Insights gained from this QI survey to the practice's new pandemic-related processes include stressing lifestyle modification, optimizing treatment plans, and continuing the option of telemedicine.
Collapse
Affiliation(s)
- Maiya Smith
- John Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Max Nakamoto
- John Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Julie Crocker
- John Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | | | - Keke Liu
- John Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Enze Ma
- John Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Ariel Chong
- Undergraduate Education, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Nicholas Van
- Undergraduate Education, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Vimala Vajjala
- Headache & Facial Pain Center, Hawaii Pacific Neuroscience, Honolulu, HI, USA
| | - Enrique Carrazana
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawaii Pacific Neuroscience, Honolulu, HI, USA
| | - Jason Viereck
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawaii Pacific Neuroscience, Honolulu, HI, USA
| | - Kore Liow
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawaii Pacific Neuroscience, Honolulu, HI, USA
| |
Collapse
|
37
|
Abstract
Industry 5.0, the fifth industrial revolution, consists of smart digital information and manufacturing technologies. This industrial revolution generates effective processes and makes rapid improvement in industries and healthcare. Solutions to challenges posed by COVID-19 pandemic can be identified with the deployment of Industry 5.0-based technologies. It helps to provide personalized therapy and treatment processes to the COVID-19 patients if a detailed patient’s information is available. The aim of Industry 5.0 technologies is to create a smart healthcare environment with real-time capabilities. During the COVID-19 pandemic, these technologies can provide a remote monitoring system in healthcare. This paper identifies and studies major technologies of Industry 5.0 helpful for the COVID-19 pandemic. The supportive features of Industry 5.0 for the COVID-19 pandemic are discussed diagrammatically. Finally, we identified and studied significant challenges faced in the context of Industry 5.0 technologies for the COVID-19 pandemic. The literature revealed that this technological innovation allows a high personalization level to fulfill personal specific demands of the patient and doctors. These technologies play a significant role in making the life of doctors better. Further, doctors can use this technology to focus on critically infected patients and provide proper appropriate information regarding their better treatment. Moreover, Industry 5.0 technologies can help doctors and medical students for required medical training during this COVID-19 outbreak.
Collapse
Affiliation(s)
- Mohd Javaid
- Department of Mechanical Engineering, Jamia Millia Islamia, New Delhi, India
| | - Abid Haleem
- Department of Mechanical Engineering, Jamia Millia Islamia, New Delhi, India
| | - Ravi Pratap Singh
- Department of Industrial and Production Engineering, Dr B R Ambedkar National Institute of Technology, Jalandhar, Punjab, India
| | - Mir Irfan Ul Haq
- School of Mechanical Engineering, Shri Mata Vaishno Devi University, Katra, Jammu and Kashmir, India
| | - Ankush Raina
- School of Mechanical Engineering, Shri Mata Vaishno Devi University, Katra, Jammu and Kashmir, India
| | - Rajiv Suman
- Department of Industrial & Production Engineering, G. B. Pant University of Agriculture & Technology, Pantnagar, Uttarakhand, India
| |
Collapse
|
38
|
Semprino M, Fasulo L, Fortini S, Martorell Molina CI, González L, Ramos PA, Martínez C, Caraballo R. Telemedicine, drug-resistant epilepsy, and ketogenic dietary therapies: A patient survey of a pediatric remote-care program during the COVID-19 pandemic. Epilepsy Behav 2020; 112:107493. [PMID: 33181913 PMCID: PMC7532773 DOI: 10.1016/j.yebeh.2020.107493] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The purpose of this study was to assess parent satisfaction with the management of ketogenic diet therapies (KDTs) through telemedicine using WhatsApp as the main tool. METHODS Parent satisfaction was longitudinally evaluated through questionnaires. The survey was developed with Google Questionnaire forms and sent via WhatsApp. The questionnaire consisted of 13 items concerning the management of KDTs using telemedicine in the context of the coronavirus disease 2019 (COVID-19) pandemic. Our population of patients has limited financial resources and low levels of education. Given that many families did not have either computers or WIFI, or any other access to information or communication technology, WhatsApp was chosen as a tool as it was available on the cell phones of all families and the professionals. RESULTS Our survey showed that 96.3% of the parents were satisfied with the management of KDTs through telemedicine. The main benefits observed were the possibility of continuing treatment during the COVID-19 pandemic and the ease of accessing the professional team from the comfort of their home. Overall, 72.2% of the families would recommend using telemedicine for KDTs in any situation regardless of the pandemic. None of the families reported that they would recommend against treatment by telemedicine. The availability of a social support network (parents WhatsApp group) coordinated by professionals from the KDT team was considered to be useful by most respondents (90%). CONCLUSIONS Our study suggests that management of children with DRE on KDTs through telemedicine is feasible, well accepted by the families, and probably as safe as conventional medicine. WhatsApp may be an interesting telemedicine tool to start and maintain KDTs.
Collapse
Affiliation(s)
- Marcos Semprino
- Department of Neurology, Clínica San Lucas, Neuquén, Argentina,Department of Nutrition, Clínica San Lucas, Neuquén, Argentina
| | - Lorena Fasulo
- Department of Neurology, Clínica San Lucas, Neuquén, Argentina,Department of Nutrition, Clínica San Lucas, Neuquén, Argentina
| | - Sebastian Fortini
- Department of Neurology, Hospital de Pediatría Niño Jesús, Tucumán, Argentina
| | | | - Lara González
- Department of Neurology, Hospital de Pediatría Niño Jesús, Tucumán, Argentina
| | | | - Carolina Martínez
- Department of Nutrition, Hospital de Pediatría Niño Jesús, Tucumán, Argentina
| | - Roberto Caraballo
- Department of Neurology, Hospital de Pediatría "Prof. Dr. Juan P Garrahan", Buenos Aires, Argentina.
| |
Collapse
|
39
|
Willems LM, Balcik Y, Noda AH, Siebenbrodt K, Leimeister S, McCoy J, Kienitz R, Kiyose M, Reinecke R, Schäfer JH, Zöllner JP, Bauer S, Rosenow F, Strzelczyk A. SARS-CoV-2-related rapid reorganization of an epilepsy outpatient clinic from personal appointments to telemedicine services: A German single-center experience. Epilepsy Behav 2020; 112:107483. [PMID: 33181898 PMCID: PMC7537633 DOI: 10.1016/j.yebeh.2020.107483] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION When the SARS-CoV-2 pandemic reached Europe in 2020, a German governmental order forced clinics to immediately suspend elective care, causing a problem for patients with chronic illnesses such as epilepsy. Here, we report the experience of one clinic that converted its outpatient care from personal appointments to telemedicine services. METHODS Documentations of telephone contacts and telemedicine consultations at the Epilepsy Center Frankfurt Rhine-Main were recorded in detail between March and May 2020 and analyzed for acceptance, feasibility, and satisfaction of the conversion from personal to telemedicine appointments from both patients' and medical professionals' perspectives. RESULTS Telephone contacts for 272 patients (mean age: 38.7 years, range: 17-79 years, 55.5% female) were analyzed. Patient-rated medical needs were either very urgent (6.6%, n = 18), urgent (23.5%, n = 64), less urgent (29.8%, n = 81), or nonurgent (39.3%, n = 107). Outpatient service cancelations resulted in a lack of understanding (9.6%, n = 26) or anger and aggression (2.9%, n = 8) in a minority of patients, while 88.6% (n = 241) reacted with understanding, or relief (3.3%, n = 9). Telemedicine consultations rather than a postponed face-to-face visit were requested by 109 patients (40.1%), and these requests were significantly associated with subjective threat by SARS-CoV-2 (p = 0.004), urgent or very urgent medical needs (p = 0.004), and female gender (p = 0.024). Telemedicine satisfaction by patients and physicians was high. Overall, 9.2% (n = 10) of patients reported general supply problems due to SARS-CoV-2, and 28.4% (n = 31) reported epilepsy-specific problems, most frequently related to prescriptions, or supply problems for antiseizure drugs (ASDs; 22.9%, n = 25). CONCLUSION Understanding and acceptance of elective ambulatory visit cancelations and the conversion to telemedicine consultations was high during the coronavirus disease 2019 (COVID-19) lockdown. Patients who engaged in telemedicine consultations were highly satisfied, supporting the feasibility and potential of telemedicine during the COVID-19 pandemic and beyond.
Collapse
Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Yunus Balcik
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Anna H Noda
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Kai Siebenbrodt
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Sina Leimeister
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jeannie McCoy
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ricardo Kienitz
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Makoto Kiyose
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Raphael Reinecke
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jan-Hendrik Schäfer
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Johann Philipp Zöllner
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Sebastian Bauer
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany.
| |
Collapse
|
40
|
Saleem T, Sheikh N, Abbasi MH, Javed I, Khawar MB. COVID-19 containment and its unrestrained impact on epilepsy management in resource-limited areas of Pakistan. Epilepsy Behav 2020; 112:107476. [PMID: 33181895 PMCID: PMC7518832 DOI: 10.1016/j.yebeh.2020.107476] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/04/2020] [Accepted: 09/06/2020] [Indexed: 12/14/2022]
Abstract
The current pandemic of coronavirus disease 2019 (COVID-19) that led to an unprecedented crisis with significant health, social, and economic repercussions presented more serious concerns for those living with some chronic conditions such as epilepsy. This study was aimed to find out impact of the COVID-19 pandemic on management of epilepsy. A cross-sectional study was conducted through telephone interviews, targeting 213 caregivers of pediatric patients with epilepsy, belonging to underserved areas of Faisalabad, Punjab, Pakistan. A simple questionnaire was designed to record the responses of participants relevant to the direct and indirect effects of COVID-19 pandemic and their knowledge about possible ways that can be accessed for the management of epilepsy during an ongoing pandemic. The current study, which holds 77% of the respondents from rural areas and 23% from urban settings, showed that partial measures of lockdown taken to stop or slow the spread of COVID-19 resulted in adverse economic and health outcomes in the said population including cancelation of follow-up visits, worsening of seizures, job loss, burden of antiepileptic drugs (AEDs) costs, and discontinuation of medicines. Furthermore, knowledge about alternative ways to access health facilities was found very poor among caregivers. Income sources of poor people disrupted by lockdown can lead to unintentional nonadherence to medication, which is a clear picture of inequitable distribution of resources. This study highlights the major issues faced by the caregivers during this ongoing pandemic of COVID-19.
Collapse
Affiliation(s)
- Tayyaba Saleem
- Cell and Molecular Biology Laboratory, Department of Zoology, University of the Punjab, Lahore 54590, Pakistan
| | - Nadeem Sheikh
- Cell and Molecular Biology Laboratory, Department of Zoology, University of the Punjab, Lahore 54590, Pakistan.
| | | | - Iram Javed
- Department of Pediatric Neurology Children Hospital & Institute of Child Health Faisalabad, 38000, Pakistan
| | - Muhammad Babar Khawar
- Cell and Molecular Biology Laboratory, Department of Zoology, University of the Punjab, Lahore 54590, Pakistan; State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing 100049, China
| |
Collapse
|
41
|
Affiliation(s)
- Naoto Kuroda
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA.
| |
Collapse
|
42
|
Panda PK, Dawman L, Panda P, Sharawat IK. Feasibility and effectiveness of teleconsultation in children with epilepsy amidst the ongoing COVID-19 pandemic in a resource-limited country. Seizure 2020; 81:29-35. [PMID: 32712376 PMCID: PMC7368411 DOI: 10.1016/j.seizure.2020.07.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/11/2020] [Accepted: 07/15/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION The ongoing COVID-19 pandemic and the lockdown measures employed by the government have forced neurologists across the world to look upon telemedicine as the only feasible and practical option to continue providing health care towards children with epilepsy in home isolation. Children with epilepsy are challenging for teleconsultation as direct information from the patient is missing, regarding seizures and adverse effects, especially behavioral and psychological side effects. METHODS Clinical and epilepsy-related details of telephonic consultations for children 1 month-18 years, performed between 26th March and 17th May 2020 in a tertiary care teaching hospital in Uttarakhand (a state of India known for hilly terrains with low per capita income) were recorded. Suitable changes in the dose/commercial brand of antiepileptic drug (AED) regimen were performed, along with the addition of new AED and referral to local practitioners for immediate hospitalization, when urgent health care issues were detected. Voice call, text message, picture/video message, and all other possible measures were employed to accumulate maximum clinical information in real-time. RESULTS A total of 153 children(95 males [62 %], 9.45 ± 3.24 years, 140 lower/middle socioeconomic status) were enrolled after screening 237 children with various neurological disorders, whose caregivers contacted for teleconsultation. A total of 278 telephone consultations performed for these 153 children (1-5 telephone calls per patient). Hundred-thirteen children were identified to have a total of 152 significant clinical events (breakthrough seizure/uncontrolled epilepsy (108), AED related (13), and unrelated systemic adverse effects (24), worsening of associated co-morbidities (7). In rest of the patients, the query of the caregiver included unavailability of AED/prescribed commercial brand in the locality, query related to the dose of drugs, proxy for a scheduled routine visit (no active issues), and concern regarding COVID-19 related symptoms and effect of COVID-19 and lockdown in children with epilepsy. Ninety-three (60 %) patients required hiking up of AED dose, whereas 29 (17 %) patients required the addition of a new AED/commercial brand. Five children were advised immediate admission to a nearby hospital. Overall, 147 (96 %) caregivers were satisfied with the quality of medical advice. CONCLUSION Teleconsultation is one of the few feasible options with good effectiveness for providing medical advice to children with epilepsy during pandemic times.
Collapse
Affiliation(s)
- Prateek Kumar Panda
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Lesa Dawman
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Pragnya Panda
- Department of Medicine, SCB Medical College, Cuttack, Odisha, India
| | - Indar Kumar Sharawat
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
| |
Collapse
|
43
|
Brigo F, Lattanzi S, Giussani G, Tassi L, Pietrafusa N, Galimberti CA, Bragazzi NL, Mecarelli O. A cross-sectional survey among physicians on internet use for epilepsy-related information. Epilepsy Res 2020; 165:106393. [PMID: 32544785 DOI: 10.1016/j.eplepsyres.2020.106393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/29/2020] [Accepted: 06/05/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We investigated views towards the Internet in a sample of Italian healthcare specialists involved in epilepsy field, to identify factors associated with the attitude of being influenced by information found on the Internet. METHODS This study was a self-administered survey conducted in a group of members of the Italian Chapter of the International League Against Epilepsy (ILAE) in January 2018. RESULTS 184 questionnaires were analyzed. 97.8 % of responders reported to seek online information on epilepsy. The Internet was most frequently searched to obtain new information (69.9 %) or to confirm a diagnostic or therapeutic decision (37.3 %). The influence of consulting the Internet on clinical practice was associated with registration to social network(s) (OR: 2.94; 95 %CI: 1.28-6.76; p = 0.011), higher frequency of Internet use (OR: 3.66; 95 %CI: 1.56-9.21; p = 0.006) and higher confidence in reliability of online information (OR: 2.61; 95 %CI: 1.09-6.26; p = 0.031). No association was found with age, sex, years in epilepsy practice or easiness to find online information. CONCLUSION Internet is frequently used among healthcare professionals involved in the epilepsy to obtain information about this disease. The attitude of being influenced by the Internet for diagnostic and/or therapeutic decisions in epilepsy is independent on age and years of experience in epilepsy, and probably reflects an individual approach towards the Web.
Collapse
Affiliation(s)
- F Brigo
- Hospital Franz Tappeiner, Department of Neurology, Merano, Italy.
| | - S Lattanzi
- Marche Polytechnic University, Neurological Clinic, Department of Experimental and Clinical Medicine, Ancona, Italy
| | - G Giussani
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Laboratory of Neurological Disorders, Department of Neuroscience, Milan, Italy
| | - L Tassi
- Niguarda Hospital, 'Claudio Munari' Epilepsy Surgery Centre, Milan, Italy
| | - N Pietrafusa
- Bambino Gesù Children's Hospital, IRCCS, Department of Neuroscience, Rome, Italy
| | - C A Galimberti
- IRCCS C. Mondino National Neurological Institute, Epilepsy Centre, Pavia, Italy
| | - N L Bragazzi
- School of Public Health, University of Genoa, Department of Health Sciences (DISSAL), Genoa, Italy
| | - O Mecarelli
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| |
Collapse
|