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Pellinen J, Foster EC, Wilmshurst JM, Zuberi SM, French J. Improving epilepsy diagnosis across the lifespan: approaches and innovations. Lancet Neurol 2024; 23:511-521. [PMID: 38631767 DOI: 10.1016/s1474-4422(24)00079-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/11/2024] [Accepted: 02/16/2024] [Indexed: 04/19/2024]
Abstract
Epilepsy diagnosis is often delayed or inaccurate, exposing people to ongoing seizures and their substantial consequences until effective treatment is initiated. Important factors contributing to this problem include delayed recognition of seizure symptoms by patients and eyewitnesses; cultural, geographical, and financial barriers to seeking health care; and missed or delayed diagnosis by health-care providers. Epilepsy diagnosis involves several steps. The first step is recognition of epileptic seizures; next is classification of epilepsy type and whether an epilepsy syndrome is present; finally, the underlying epilepsy-associated comorbidities and potential causes must be identified, which differ across the lifespan. Clinical history, elicited from patients and eyewitnesses, is a fundamental component of the diagnostic pathway. Recent technological advances, including smartphone videography and genetic testing, are increasingly used in routine practice. Innovations in technology, such as artificial intelligence, could provide new possibilities for directly and indirectly detecting epilepsy and might make valuable contributions to diagnostic algorithms in the future.
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Affiliation(s)
- Jacob Pellinen
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Emma C Foster
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jo M Wilmshurst
- Red Cross War Memorial Children's Hospital and University of Cape Town Neuroscience Institute, Cape Town, South Africa
| | - Sameer M Zuberi
- Royal Hospital for Children and University of Glasgow School of Health & Wellbeing, Glasgow, UK
| | - Jacqueline French
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, NY, USA
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D'Onofrio G, Ramachandran Nair R, Reid AY, Kobayashi E, Jones K, Bui E, Fantaneanu TA, Appendino JP. Fostering Education in Epilepsy: A Canadian League Against Epilepsy Teaching Initiative. Can J Neurol Sci 2024:1-6. [PMID: 38523490 DOI: 10.1017/cjn.2024.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
The Canadian League Against Epilepsy initiated a virtual epilepsy education program, conducting 29 webinars from March 2021 to September 2023. We report our experience, with the goal to inspire other groups to develop inclusive, equitable, and free educational spaces with a worldwide reach. Monthly sessions drew a median attendance of 118 participants, predominantly Canadian but also international, including physicians (58.9%) and trainees (22.8%). Post-webinar surveys (average 40% response rate) noted high satisfaction, a strong inclination to recommend the sessions, and an interest in clinical case-based topics. We plan to consider integrating a self-assessment section evaluating knowledge gained after each seminar.
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Affiliation(s)
- Gianluca D'Onofrio
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Università degli Studi di Genova, Genova, Italy
- Department of Neurosciences, Division of Pediatric Neurology, CHU Sainte-Justine, Montreal, QC, Canada
| | | | - Aylin Y Reid
- University Health Network, Krembil Research Institute, Toronto, ON, Canada
- Division of Neurology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Eliane Kobayashi
- Neurology and Neurosurgery Department, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Kevin Jones
- Division of Neurology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Esther Bui
- Division of Neurology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tadeu A Fantaneanu
- Division of Neurology, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
| | - Juan Pablo Appendino
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Villalpando-Vargas FV, Alonso-Vanegas M, Guerrero-Aranda A. Advancing epilepsy care: A novel educational paradigm for primary healthcare providers. Epileptic Disord 2024; 26:169-171. [PMID: 38108506 DOI: 10.1002/epd2.20189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/09/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Fridha V Villalpando-Vargas
- University Center "Los Valles", University of Guadalajara, Ameca, Mexico
- Epilepsy Clinic, Hospital "Country 2000", Guadalajara, Mexico
| | - Mario Alonso-Vanegas
- International Center for Epilepsy Surgery, HMG Coyoacán, Ciudad de Mexico, Mexico
| | - Alioth Guerrero-Aranda
- University Center "Los Valles", University of Guadalajara, Ameca, Mexico
- Epilepsy Clinic, Hospital "Country 2000", Guadalajara, Mexico
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Gifford A, Griffiths MJ, Rodie P, Wilmshurst J, Ball J, Dunkley C, McLellan A, O'Callaghan F, Kirkpatrick M. Reducing epilepsy diagnostic and treatment gaps: Standardized paediatric epilepsy training courses for health care professionals. Dev Med Child Neurol 2024. [PMID: 38297494 DOI: 10.1111/dmcn.15864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 02/02/2024]
Abstract
AIM To evaluate improvement in knowledge and clinical behaviour among healthcare professionals after attendance at paediatric epilepsy training (PET) courses. METHOD Since 2005, 1-day PET courses have taught evidence-based paediatric epilepsy management to doctors and nurses in low-, middle-, and high-income countries. A cohort study was performed of 7528 participants attending 252 1-day PET courses between 2005 and 2020 in 17 low-, middle-, and high-income countries, and which gathered data from participants immediately after the course and then 6 months later. Training outcomes were measured prospectively in three domains (reaction, learning, and behaviour) using a mixed-methods approach involving a feedback questionnaire, a knowledge quiz before and after the course, and a 6-month survey. RESULTS Ninety-eight per cent (7217 of 7395) of participants rated the course as excellent or good. Participants demonstrated knowledge gain, answering a significantly higher proportion of questions correctly after the course compared to before the course (88% [47 883 of 54 196], correct answers/all quiz answers, vs 75% [40 424 of 54 196]; p < 0.001). Most survey responders reported that the course had improved their epilepsy diagnosis and management (73% [311 of 425]), clinical service (68% [290 of 427]), and local epilepsy training (68% [290 of 427]). INTERPRETATION This was the largest evaluation of a global epilepsy training course. Participants reported high course satisfaction, showed knowledge gain, and described improvements in clinical behaviour 6 months later. PET supports the global reduction in the epilepsy 'treatment gap' as promoted by the World Health Organization.
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Affiliation(s)
| | - Michael J Griffiths
- Paediatric Neuroscience, Alder Hey Children's NHS Foundation Trust, University of Liverpool, Liverpool, UK
| | | | - Jo Wilmshurst
- Paediatric Neurology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Jessica Ball
- British Paediatric Neurology Association, London, UK
| | - Colin Dunkley
- Paediatric Department, Sherwood Forest Hospitals NHS Foundation Trust, UK
| | - Ailsa McLellan
- Department of Paediatric Neurosciences, Royal Hospital for Children and Young People, Edinburgh, UK
| | - Finbar O'Callaghan
- Department of Neuroscience, Great Ormond Street Hospital for Children, UCL Great Ormond Street Institute of Child Health, London, UK
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Çelik Ö, Apaydın Kaya Ç. Challenges and needs of epilepsy management in primary care (from the perspective of family physicians/general practitioners): A cross-sectional study. Epileptic Disord 2023; 25:739-748. [PMID: 37584561 DOI: 10.1002/epd2.20145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/20/2023] [Accepted: 07/30/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE Family physicians are expected to have sufficient knowledge and skills in epilepsy management due to frequent encountering with epileptic patients for prescribing antiepileptics, providing preventive services such as vaccination, pre-conceptional counseling, or managing acute health problems of the patients. This study aimed to determine family physicians' challenges and needs regarding managing epilepsy in primary care. METHODS This cross-sectional study was carried out with the family physicians working in Family Health Centers representing the four districts of Istanbul in 2020. After enrolling sociodemographic characteristics, epilepsy knowledge, and self-efficacy questionnaire were filled out by the physicians themselves, and the difficulties and needs in the follow-up of the patients with epilepsy were evaluated with open-ended questions. RESULTS Two hundred and twenty-eight physicians participated in the study (48.7% F; mean age: 43.06 ± 8.82). Most of the physicians reported that they feel incompetent and hesitated while providing health reports (driving [83.3%], sport [95.5%] or work [70.2%]), and prescribing antiepileptics, especially during pregnancy (38.2%) and breastfeeding (31.2%). Despite their high awareness of psychosocial problems in epileptic patients, only 25% of physicians stated that they could make psychosocial assessments. There was no correlation between Epilepsy Knowledge and Self-efficacy scores and physicians' age, graduation period, and family medicine experience (p > .05). Most frequently encountered difficulties were reported as epilepsy-specific (follow-up of pregnant or pediatric patients, lack of information about epilepsy and antiepileptics). Most physicians (82.6%) wanted training in epilepsy management. SIGNIFICANCE The findings of our study suggest that family physicians need knowledge and training in epilepsy management. The main limitation of the present study is its cross-sectional design, which does not allow for causal or directional inferences.
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Affiliation(s)
- Özla Çelik
- Department of Family Medicine, Marmara University School of Medicine, İstanbul, Turkey
| | - Çiğdem Apaydın Kaya
- Department of Family Medicine, Marmara University School of Medicine, İstanbul, Turkey
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Singh G, Singh MB, Ding D, Maulik P, Sander JW. Implementing WHO's Intersectoral Global Action Plan for epilepsy and other neurological disorders in Southeast Asia: a proposal. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 10:100135. [PMID: 37197018 PMCID: PMC7614540 DOI: 10.1016/j.lansea.2022.100135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/25/2022] [Accepted: 12/16/2022] [Indexed: 05/19/2023]
Abstract
The World Health Assembly approved the Intersectoral Global Action Plan for epilepsy and neurological disorders. Member states, including those in Southeast Asia, must now prepare to achieve IGAP's strategic targets by embracing novel approaches and strengthening existing policies and practices. We propose and present evidence to support four such processes. The opening course should engage all stakeholders to develop people-centric instead of outcome-centric approaches. Rather than caring for convulsive epilepsy alone, as currently done, primary care providers should also be skilled in diagnosing and treating focal and non-motor seizures. This could reduce the diagnostic gap as over half of epilepsies present with focal seizures. Currently, primary care providers lack knowledge and skills to manage focal seizures. Technology-enabled aids can help overcome this limitation. Lastly, there is need to add newer "easy to use" epilepsy medicines to Essential Medicines lists in light of emerging evidence for better tolerability, safety and user-friendliness.
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Affiliation(s)
- Gagandeep Singh
- Department of Neurology, Dayanand Medical College & Hospital, Ludhiana, India
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Mamta B. Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ding Ding
- Institute of Neurology, Fudan University Hospital, Shanghai, China
| | - Pallab Maulik
- George Institute for Global Health, New Delhi, India
| | - Josemir W. Sander
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede 2103 SW, the Netherlands
- Neurology Department, West of China Hospital, Sichuan University, Chengdu 61004, China
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Goel P, Singh G, Bansal V, Sharma S, Kumar P, Chaudhry R, Bansal N, Chaudhary A, Sharma S, Sander JW. Psychiatric comorbidities among people with epilepsy: A population-based assessment in disadvantaged communities. Epilepsy Behav 2022; 137:108965. [PMID: 36343531 DOI: 10.1016/j.yebeh.2022.108965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
UNLABELLED Psychiatric disorders are frequent among people with epilepsy but often under-recognized. The diagnosis and treatment of these disorders in low- and low-middle-income countries (LMICs) are challenging. METHODS This cross-sectional survey included people recruited during a community epilepsy screening program involving 59,509 individuals from poor communities in Ludhiana in Northwest India. Adults (age ≥18 years) with confirmed epilepsy on antiseizure medications were screened for depression and anxiety using the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and Generalized Anxiety Disorder-7 (GAD-7) twice over two years of follow-up. They were later interviewed for symptoms using the Brief Psychiatric Rating Scale, which was then confirmed by assessments by an experienced psychiatrist. RESULTS Of the 240 people with confirmed epilepsy, 167 (70%) were adults, of whom, 116 (70%) eventually participated in the study. The NDDI-E with a cut-off of 15 identified depression in 14 (12%) of 116 people after one year of follow-up and 17 (15%) at two years. The GAD-7 using a cut-off of 6 identified 22 (19%) at one year and 32 (28%) with anxiety at two years. The area under the curves for NDDI-E was estimated as 0.62 (95%CI, 0.51-0.73; SE: 0.06; p = 0.04) and for GAD-7 as 0.62 (95%CI, 0.46-0.78; SE: 0.08; p = 0.12). Brief Psychiatric Rating Scale identified 63 (54%) people with psychiatric symptoms, for whom, a psychiatric diagnosis was confirmed in 60 (52%). A psychiatric diagnosis was associated with education below high school [Odds Ratio (OR): 2.59, 95%CI, 1.12-5.1; p = 0.03], later age of seizure onset (OR, 1.05, 95%CI: 1.0-1.10; p = 0.04), seizure frequency of at least one/year at enrolment (OR, 2.36, 95%CI: 1.0-5.58; p = 0.05) and the use of clobazam (OR, 5.09, 95%CI, 1.40-18.42; p = 0.01). CONCLUSION Depression and anxiety are common in people with epilepsy. Our findings underscore the low yields of screening instruments, NDDI-E and GAD-7, and comparatively better professionally-administered diagnostic assessments in resource-limited settings in LMICs. Moreover, previously established cut-offs do not apply to the community studied.
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Affiliation(s)
- Parveen Goel
- Research & Development Unit, Dayanand Medical College, Ludhiana, India; Department of Neurology, Dayanand Medical College, Ludhiana, India
| | - Gagandeep Singh
- Research & Development Unit, Dayanand Medical College, Ludhiana, India; Department of Neurology, Dayanand Medical College, Ludhiana, India; UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom.
| | - Vasu Bansal
- Department of Medicine, Dayanand Medical College, Ludhiana, India
| | - Suman Sharma
- Research & Development Unit, Dayanand Medical College, Ludhiana, India
| | - Pankaj Kumar
- Department of Psychiatry, Dayanand Medical College, Ludhiana, India
| | - Rupesh Chaudhry
- Department of Psychiatry, Dayanand Medical College, Ludhiana, India
| | - Namita Bansal
- Research & Development Unit, Dayanand Medical College, Ludhiana, India
| | - Anurag Chaudhary
- Department of Social & Preventive Medicine, Dayanand Medical College, Ludhiana, India
| | - Sarit Sharma
- Department of Social & Preventive Medicine, Dayanand Medical College, Ludhiana, India
| | - Josemir W Sander
- UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede 2103 SW, The Netherlands; Neurology Department, West of China Hospital, Sichuan University, Chengdu 61004, China.
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