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Strafford H, Lacey AS, Hollinghurst J, Akbari A, Watkins A, Paterson J, Jennings D, Lyons RA, Powell HR, Kerr MP, Chin RW, Pickrell WO. COVID-19 vaccination uptake in people with epilepsy in wales. Seizure 2023; 108:49-52. [PMID: 37080124 PMCID: PMC10076248 DOI: 10.1016/j.seizure.2023.04.006] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/09/2023] Open
Abstract
PURPOSE People with epilepsy (PWE) are at increased risk of severe COVID-19. Assessing COVID-19 vaccine uptake is therefore important. We compared COVID-19 vaccination uptake for PWE in Wales with a matched control cohort. METHODS We performed a retrospective, population, cohort study using linked, anonymised, Welsh electronic health records within the Secure Anonymised Information Linkage (SAIL) Databank (Welsh population=3.1 million).We identified PWE in Wales between 1st March 2020 and 31st December 2021 and created a control cohort using exact 5:1 matching (sex, age and socioeconomic status). We recorded 1st, 2nd and booster COVID-19 vaccinations. RESULTS There were 25,404 adults with epilepsy (127,020 controls). 23,454 (92.3%) had a first vaccination, 22,826 (89.9%) a second, and 17,797 (70.1%) a booster. Comparative figures for controls were: 112,334 (87.8%), 109,057 (85.2%) and 79,980 (62.4%).PWE had higher vaccination rates in all age, sex and socioeconomic subgroups apart from booster uptake in older subgroups. Vaccination rates were higher in older subgroups, women and less deprived areas for both cohorts. People with intellectual disability and epilepsy had higher vaccination rates when compared with controls with intellectual disability. CONCLUSIONS COVID-19 vaccination uptake for PWE in Wales was higher than that for a matched control group.
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Affiliation(s)
- H Strafford
- Neurology Research Group, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales SA2 8PP, UK.
| | - A S Lacey
- Neurology Research Group, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales SA2 8PP, UK
| | - J Hollinghurst
- Neurology Research Group, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales SA2 8PP, UK
| | - A Akbari
- Neurology Research Group, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales SA2 8PP, UK
| | - A Watkins
- Neurology Research Group, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales SA2 8PP, UK
| | - J Paterson
- Epilepsy Action, New Anstey House, Gate Way Drive, Yeadon, Leeds, England, UK
| | - D Jennings
- Epilepsy Action, New Anstey House, Gate Way Drive, Yeadon, Leeds, England, UK
| | - R A Lyons
- Neurology Research Group, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales SA2 8PP, UK
| | - H R Powell
- Neurology Research Group, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales SA2 8PP, UK; Morriston Hospital, Swansea Bay University Health Board, Swansea, Wales, UK
| | - M P Kerr
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, Wales, UK
| | - R W Chin
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences and Department of Child Life and Health, The University of Edinburgh, Scotland, UK; Royal Hospital for Children and Young People, Edinburgh, Scotland, UK
| | - W O Pickrell
- Neurology Research Group, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales SA2 8PP, UK; Morriston Hospital, Swansea Bay University Health Board, Swansea, Wales, UK
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Donovan B, Ashby S, Hanna J, Cowdry T, Thorpe J, Hughes E, Kerr MP, Thomas RH. "Untold Distress" - How did the COVID-19 pandemic affect those who had previously experienced an epilepsy-related bereavement? Epilepsy Behav 2023; 139:109071. [PMID: 36640482 PMCID: PMC9835558 DOI: 10.1016/j.yebeh.2022.109071] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE This study explores the impact of the COVID-19 pandemic and lockdown on people with lived experience of sudden bereavement as a consequence of an epilepsy-related death. METHOD We developed an online survey with fixed choice and open-ended response formats to collect data on grief symptoms and well-being during the pandemic. A total of 275 people bereaved by epilepsy-related deaths between 1980-2020 participated in this study: with 79 participants providing free-text responses for inductive thematic analysis. RESULTS In total, 84% of participants reported a bereavement following a sudden death of a person aged under 40, with 22% aged 19 and under. The majority (77% of participants) reported they had been thinking more about the person who died compared to before the COVID-19 outbreak and 54% had experienced more distressing flashbacks to the time of death. Additionally, 61% reported more difficulties falling asleep and staying asleep and 88% of participants reported that the outbreak and response measures had negatively impacted upon their mental health. Medication was being taken for a diagnosed mental health condition by 33% of participants at the time of the study. We categorized these negative experiences during COVID in to four main-themes - 'Family', 'Lifestyle', 'Personal Well-being' and 'Health Services and Shielding Populations'. The 'Personal Well-being' theme was inextricably linked to grief symptoms including 'reflection on the death', 're-exposure to feeling', 'grief', 'salience of sudden deaths in the media' and 'inability to commemorate anniversaries and rituals'. These findings were consistent for bereaved people irrespective of the recency of the death. CONCLUSION This study highlights the impact of the disruption caused by the pandemic on the grief-management of those bereaved by epilepsy-related death. Grief is not static and its management is connected to the psychosocial and formal support structures that were disrupted during the pandemic. The removal of these supports had an adverse effect upon the mental health and well-being of many bereaved. There is an urgent need for a system-wide transformation of epilepsy and mental health services to be inclusive of the needs and experiences of people impacted by sudden deaths in epilepsy and the contribution of the specialist service developed by families and clinicians to meet this gap.
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Affiliation(s)
- Ben Donovan
- SUDEP Action, 18, Newbury St., Wantage OX12 8DA, United Kingdom.
| | - Samantha Ashby
- SUDEP Action, 18, Newbury St., Wantage OX12 8DA, United Kingdom
| | - Jane Hanna
- SUDEP Action, 18, Newbury St., Wantage OX12 8DA, United Kingdom
| | - Tracy Cowdry
- SUDEP Action, 18, Newbury St., Wantage OX12 8DA, United Kingdom
| | - Jennifer Thorpe
- SUDEP Action, 18, Newbury St., Wantage OX12 8DA, United Kingdom
| | - Elaine Hughes
- King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, United Kingdom; Evelina Children's Hospital, Westminster Bridge Rd, St Thomas' Hospital, London SE1 7EH, United Kingdom
| | - Mike P Kerr
- Psychological Medicine and Clinical Neurosciences, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, United Kingdom
| | - Rhys H Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom; Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, United Kingdom
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Daniels H, Lacey AS, Akbari A, Fonferko-Shadrach B, Hollinghurst J, Rees MI, Sawhney IMS, Powell HR, Kerr MP, Owen Pickrell W. 146 Epilepsy, deprivation and mortality in Wales 2005–2017. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.177] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPublic Health England have recently reported that deaths associated with epilepsy are increasing and are associated with increased deprivation. We investigated comparable Welsh mortality trends and associations between epilepsy mortality and deprivation.MethodWe used routinely-collected health data within the Secure Anonymised Information Linkage (SAIL) Databank. We recorded deaths associated with epilepsy (DAE), epilepsy recorded on death certificates, and deaths in people with epilepsy (DPWE), people with diagnoses of epilepsy and epilepsy prescriptions before death. We compared death rates in different deprivation deciles adjusting for epilepsy prevalence.ResultsDuring 2005–2017 (41million patient-years) there were 2116 DAE and 7821 DPWE. DAE and DPWE increased from 4.3/100,000/yr and 17.2/100,000/yr in 2005–2007 to 5.7/100,000/yr and 20.9/100,000/yr in 2015–2017. The age-standardised mortality rates (ASMR) in 2006–2008 for DAE and DPWE were 5.3/100,000/yr and 20/100,000/yr respectively, in 2015–2017 they were 5.8/100,000/yr and 20/100,000/yr. DAE were not significantly associated with deprivation when adjusted for epilepsy prevalence.ConclusionWhen adjusting for age, deaths associated wtih epilepsy and deaths in people with epilepsy did not increase significantly in Wales between 2005–2007 and 2015–2017. The association between dep- rivation and deaths associated with epilepsy appears to be explained by higher epilepsy prevalence in areas of higher deprivation.w.o.pickrell@swansea.ac.uk
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Craig DP, Choi YY, Hughes E, Osland K, Hanna J, Kerr MP, Thomas RH. Paediatric sudden unexpected death in epilepsy: A parental report cohort. Acta Neurol Scand 2021; 143:509-513. [PMID: 33210735 DOI: 10.1111/ane.13378] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/01/2020] [Accepted: 11/12/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sudden unexpected death in epilepsy (SUDEP) accounts for a large percentage of deaths in children with epilepsy. Contributing factors to paediatric SUDEP are incompletely understood. AIMS OF STUDY The Epilepsy Deaths Register (EDR) is an anonymized register that compiles information on deaths related to epilepsy, across all ages and epilepsy classifications. Using the EDR, we sought to identify key risk factors for SUDEP in children to assist the development of preventive measures. METHODS All registrations between the ages of 1 and 16 years were reviewed to identify definite or probable SUDEP. These cases were analysed to identify common demographics, comorbidities, monitoring, treatments and circumstances near to the deaths. RESULTS We identified forty-six cases (27 males) of definite or probable SUDEP. Paediatric SUDEP is more common in a 12- to 16-year age group and in those with neuro-disability. Most paediatric SUDEP occurs during apparent sleep. There were four cases with a vagus nerve stimulator. SUDEP can occur early after the onset of seizures. CONCLUSIONS This is the largest single cohort of SUDEP reported in children. Reports from caregivers can augment population data. Surveillance in sleep is a priority area of development.
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Affiliation(s)
| | - Yun Young Choi
- Wonju College of Medicine Yonsei University Wonju South Korea
| | - Elaine Hughes
- Paediatric Neurosciences Evelina London Children’s Hospital London UK
| | | | | | - Mike P. Kerr
- Psychological Medicine and Clinical Neurosciences Cardiff University Cardiff UK
| | - Rhys H. Thomas
- Royal Victoria Infirmary Newcastle‐upon‐Tyne UK
- Translational and Clinical Research Institute Newcastle University Newcastle UK
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Lacey AS, Pickrell WO, Thomas RH, Kerr MP, White CP, Rees MI. Educational attainment of children born to mothers with epilepsy. J Neurol Neurosurg Psychiatry 2018; 89:736-740. [PMID: 29588327 DOI: 10.1136/jnnp-2017-317515] [Citation(s) in RCA: 8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/29/2018] [Accepted: 02/24/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Small prospective studies have identified that children exposed to valproate in utero have poorer scores on cognitive testing. We wanted to identify whether children exposed to antiepileptic drugs (AEDs) in utero have poorer school performance. METHODS We used anonymised, linked, routinely collected healthcare records to identify children born to mothers with epilepsy. We linked these children to their national attainment Key Stage 1 (KS1) tests in mathematics, language and science at the age of 7 and compared them with matched children born to mothers without epilepsy, and with the national KS1 results. We used the core subject indicator (CSI) as an outcome measure (the proportion of children achieving a minimum standard in all subjects) and the results in individual subjects. RESULTS We identified 440 children born to mothers with epilepsy with available KS1 results. Compared with a matched control group, fewer children with mothers being prescribed sodium valproate during pregnancy achieved the national minimum standard in CSI (-12.7% less than the control group), mathematics (-12.1%), language (-10.4%) and in science (-12.2%). Even fewer children with mothers being prescribed multiple AEDs during pregnancy achieved a national minimum standard: CSI (by -20.7% less than the control group), mathematics (-21.9%), language (-19.3%) and science (-19.4%). We did not observe any significant difference in children whose mothers were prescribed carbamazepine or were not taking an AED when compared with the control group. CONCLUSIONS In utero exposure to AEDs in combination, or sodium valproate alone, is associated with a significant decrease in attainment in national educational tests for 7-year-old children compared with both a matched control group and the all-Wales national average. These results give further support to the cognitive and developmental effects of in utero exposure to sodium valproate as well as multiple AEDs, which should be balanced against the need for effective seizure control for women during pregnancy.
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Affiliation(s)
- Arron S Lacey
- Wales Epilepsy Research Network, Swansea University Medical School, Swansea University, Swansea, UK.,Farr Institute, Swansea University Medical School, Swansea, UK
| | - William Owen Pickrell
- Wales Epilepsy Research Network, Swansea University Medical School, Swansea University, Swansea, UK
| | - Rhys H Thomas
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Mike P Kerr
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Cathy P White
- Morriston Hospital, Abertawe Bro-Morgannwg University Hospital Trust, Swansea, UK
| | - Mark I Rees
- Wales Epilepsy Research Network, Swansea University Medical School, Swansea University, Swansea, UK
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Fonferko-Shadrach B, Lacey AS, White CP, Powell HWR, Sawhney IMS, Lyons RA, Smith PEM, Kerr MP, Rees MI, Pickrell WO. Validating epilepsy diagnoses in routinely collected data. Seizure 2017; 52:195-198. [PMID: 29059611 PMCID: PMC5703030 DOI: 10.1016/j.seizure.2017.10.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [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: 08/11/2017] [Revised: 09/20/2017] [Accepted: 10/12/2017] [Indexed: 12/31/2022] Open
Abstract
Cases with and without epilepsy were linked with anonymised primary care data. Primary care diagnosis and drug codes accurately identify the cases with epilepsy. Drug codes alone can be used to identify children with epilepsy. Combining drug and diagnosis codes for adults and children increases accuracy.
Purpose Anonymised, routinely-collected healthcare data is increasingly being used for epilepsy research. We validated algorithms using general practitioner (GP) primary healthcare records to identify people with epilepsy from anonymised healthcare data within the Secure Anonymised Information Linkage (SAIL) databank in Wales, UK. Method A reference population of 150 people with definite epilepsy and 150 people without epilepsy was ascertained from hospital records and linked to records contained within SAIL (containing GP records for 2.4 million people). We used three different algorithms, using combinations of GP epilepsy diagnosis and anti-epileptic drug (AED) prescription codes, to identify the reference population. Results Combining diagnosis and AED prescription codes had a sensitivity of 84% (95% ci 77–90) and specificity of 98% (95–100) in identifying people with epilepsy; diagnosis codes alone had a sensitivity of 86% (80–91) and a specificity of 97% (92–99); and AED prescription codes alone achieved a sensitivity of 92% (70–83) and a specificity of 73% (65–80). Using AED codes only was more accurate in children achieving a sensitivity of 88% (75–95) and specificity of 98% (88–100). Conclusion GP epilepsy diagnosis and AED prescription codes can be confidently used to identify people with epilepsy using anonymised healthcare records in Wales, UK.
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Affiliation(s)
- Beata Fonferko-Shadrach
- Wales Epilepsy Research Network, Institute of Life Science, Swansea University, Swansea, UK; Morriston Hospital, Abertawe Bro Morgannwg University Health Board, Swansea, UK; Neurology and Molecular Neuroscience Research Group, Institute of Life Science, Swansea University Medical School, Swansea University, Swansea, UK
| | - Arron S Lacey
- Wales Epilepsy Research Network, Institute of Life Science, Swansea University, Swansea, UK; Neurology and Molecular Neuroscience Research Group, Institute of Life Science, Swansea University Medical School, Swansea University, Swansea, UK; Farr Institute, Swansea University Medical School, Swansea University, Swansea, UK
| | - Catharine P White
- Wales Epilepsy Research Network, Institute of Life Science, Swansea University, Swansea, UK; Morriston Hospital, Abertawe Bro Morgannwg University Health Board, Swansea, UK
| | - H W Rob Powell
- Wales Epilepsy Research Network, Institute of Life Science, Swansea University, Swansea, UK; Morriston Hospital, Abertawe Bro Morgannwg University Health Board, Swansea, UK
| | - Inder M S Sawhney
- Wales Epilepsy Research Network, Institute of Life Science, Swansea University, Swansea, UK; Morriston Hospital, Abertawe Bro Morgannwg University Health Board, Swansea, UK
| | - Ronan A Lyons
- Farr Institute, Swansea University Medical School, Swansea University, Swansea, UK
| | - Phil E M Smith
- Wales Epilepsy Research Network, Institute of Life Science, Swansea University, Swansea, UK; University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | - Mike P Kerr
- Wales Epilepsy Research Network, Institute of Life Science, Swansea University, Swansea, UK; Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Mark I Rees
- Wales Epilepsy Research Network, Institute of Life Science, Swansea University, Swansea, UK; Neurology and Molecular Neuroscience Research Group, Institute of Life Science, Swansea University Medical School, Swansea University, Swansea, UK
| | - W Owen Pickrell
- Wales Epilepsy Research Network, Institute of Life Science, Swansea University, Swansea, UK; Neurology and Molecular Neuroscience Research Group, Institute of Life Science, Swansea University Medical School, Swansea University, Swansea, UK; University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK.
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Lacey AS, Fonferko-Shadrach B, Lyons RA, Kerr MP, Ford DV, Rees MI, Pickrell OW. Obtaining structured clinical data from unstructured data using natural language processing software. Int J Popul Data Sci 2017. [PMCID: PMC9351290 DOI: 10.23889/ijpds.v1i1.381] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
ABSTRACT
BackgroundFree text documents in healthcare settings contain a wealth of information not captured in electronic healthcare records (EHRs). Epilepsy clinic letters are an example of an unstructured data source containing a large amount of intricate disease information. Extracting meaningful and contextually correct clinical information from free text sources, to enhance EHRs, remains a significant challenge. SCANR (Swansea University Collaborative in the Analysis of NLP Research) was set up to use natural language processing (NLP) technology to extract structured data from unstructured sources.
IBM Watson Content Analytics software (ICA) uses NLP technology. It enables users to define annotations based on dictionaries and language characteristics to create parsing rules that highlight relevant items. These include clinical details such as symptoms and diagnoses, medication and test results, as well as personal identifiers.
ApproachTo use ICA to build a pipeline to accurately extract detailed epilepsy information from clinic letters.
MethodsWe used ICA to retrieve important epilepsy information from 41 pseudo-anonymized unstructured epilepsy clinic letters. The 41 letters consisted of 13 ‘new’ and 28 ‘follow-up’ letters (for 15 different patients) written by 12 different doctors in different styles. We designed dictionaries and annotators to enable ICA to extract epilepsy type (focal, generalized or unclassified), epilepsy cause, age of onset, investigation results (EEG, CT and MRI), medication, and clinic date. Epilepsy clinicians assessed the accuracy of the pipeline.
ResultsThe accuracy (sensitivity, specificity) of each concept was: epilepsy diagnosis 98% (97%, 100%), focal epilepsy 100%, generalized epilepsy 98% (93%, 100%), medication 95% (93%, 100%), age of onset 100% and clinic date 95% (95%, 100%).
Precision and recall for each concept were respectively, 98% and 97% for epilepsy diagnosis, 100% each for focal epilepsy, 100% and 93% for generalized epilepsy, 100% each for age of onset, 100% and 93% for medication, 100% and 96% for EEG results, 100% and 83% for MRI scan results, and 100% and 95% for clinic date.
Conclusions ICA is capable of extracting detailed, structured epilepsy information from unstructured clinic letters to a high degree of accuracy. This data can be used to populate relational databases and be linked to EHRs. Researchers can build in custom rules to identify concepts of interest from letters and produce structured information. We plan to extend our work to hundreds and then thousands of clinic letters, to provide phenotypically rich epilepsy data to link with other anonymised, routinely collected data.
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Pickrell WO, Lacey AS, Bodger OG, Demmler JC, Thomas RH, Lyons RA, Smith PEM, Rees MI, Kerr MP. Epilepsy and deprivation, a data linkage study. Epilepsia 2015; 56:585-91. [PMID: 25873180 DOI: 10.1111/epi.12942] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate whether the link between epilepsy and deprivation is due to factors associated with deprivation (social causation) or factors associated with a diagnosis of epilepsy (social drift). METHODS We reviewed electronic primary health care records from 2004 to 2010, identifying prevalent and incident cases of epilepsy and recording linked deprivation scores. Logistic and Poisson regression models were used to calculate odds ratios and incidence rate ratios. The change in deprivation was measured 10 years after the initial diagnosis of epilepsy for a cohort of people. RESULTS Between 2004 and 2010, 8.1 million patient-years of records were reviewed. Epilepsy prevalence and incidence were significantly associated with deprivation. Epilepsy prevalence ranged from 1.13% (1.07-1.19%) in the most deprived decile to 0.49% (0.45-0.53%) in the least deprived decile (adjusted odds ratio 0.92, p < 0.001). Epilepsy incidence ranged from 40/100,000 per year in the most deprived decile to 19/100,000 per year in the least deprived decile (adjusted incidence rate ratio 0.94, p < 0.001). There was no statistically significant change in deprivation index decile 10 years after a new diagnosis of epilepsy (mean difference -0.04, p = 0.85). SIGNIFICANCE Epilepsy prevalence and incidence are strongly associated with deprivation; the deprivation score remains unchanged 10 years after a diagnosis of epilepsy. These findings suggest that increasing rates of epilepsy in deprived areas are more likely explained by social causation than by social drift. The nature of the association between incident epilepsy and social deprivation needs further exploration.
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Affiliation(s)
- William O Pickrell
- Wales Epilepsy Research Network, Neurology and Molecular Neuroscience Research Group, College of Medicine, Swansea University, Swansea, United Kingdom
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Kerr MP, Mensah S, Besag F, de Toffol B, Ettinger A, Kanemoto K, Kanner A, Kemp S, Krishnamoorthy E, LaFrance WC, Mula M, Schmitz B, van Elst LT, Trollor J, Wilson SJ. International consensus clinical practice statements for the treatment of neuropsychiatric conditions associated with epilepsy. Epilepsia 2011; 52:2133-8. [PMID: 21955156 DOI: 10.1111/j.1528-1167.2011.03276.x] [Citation(s) in RCA: 226] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In order to address the major impact on quality of life and epilepsy management caused by associated neuropsychiatric conditions, an international consensus group of epileptologists met with the aim of developing clear evidence-based and practice-based statements to provide guidance on the management of these conditions. Using a Delphi process, this group prioritized a list of key management areas. These included: depression, anxiety, psychotic disorders, nonepileptic seizures, cognitive dysfunction, antiepileptic drug (AED)-related neurobehavioral disorders, suicidality, disorders in children and adolescents, disorders in children with intellectual disability, and epilepsy surgery. Clinical practice statements were developed for each area and consensus reached among members of the group. The assessment and management of these conditions needs to combine knowledge of psychiatric disorders, knowledge of the impact of epilepsy and its treatment on psychopathology, and an ability to deliver care within epilepsy services. The aim of these statements is to provide guidance on quality care for people with epilepsy that have a range of neuropsychiatric disorders.
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Affiliation(s)
- Mike P Kerr
- Psychological Medicine, University of Wales College of Medicine, Cardiff, United Kingdom.
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Hammond CL, Thomas RH, Rees MI, Kerr MP, Rapport F. Implications for families of advances in understanding the genetic basis of epilepsy. Seizure 2010; 19:675-9. [DOI: 10.1016/j.seizure.2010.10.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Veenstra MY, Walsh PN, van Schrojenstein Lantman-de Valk HMJ, Haveman MJ, Linehan C, Kerr MP, Weber G, Salvador-Carulla L, Carmen-Cara A, Azema B, Buono S, Germanavicius A, Tossebro J, Maatta T, van Hove G, Moravec D. Sampling and ethical issues in a multicenter study on health of people with intellectual disabilities. J Clin Epidemiol 2010; 63:1091-100. [PMID: 20304607 DOI: 10.1016/j.jclinepi.2009.12.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Revised: 11/25/2009] [Accepted: 12/20/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To study health inequalities in persons with intellectual disabilities, representative and unbiased samples are needed. Little is known about sample recruitment in this vulnerable group. This study aimed to determine differences in ethical procedures and sample recruitment in a multicenter research on health of persons with intellectual disabilities. Study questions regarded the practical sampling procedure, how ethical consent was obtained in each country, and which person gave informed consent for each study participant. STUDY DESIGN AND SETTING Exploratory, as part of a multicenter study, in 14 European countries. After developing identical guidelines for all countries, partners collected data on health indicators by orally interviewing 1,269 persons with intellectual disabilities. Subsequently, semistructured interviews were carried out with partners and researchers. RESULTS Identification of sufficient study participants proved feasible. Sampling frames differed from nationally estimated proportions of persons with intellectual disabilities living with families or in residential settings. Sometimes, people with intellectual disabilities were hard to trace. Consent procedures and legal representation varied broadly. Nonresponse data proved unavailable. CONCLUSION To build representative unbiased samples of vulnerable groups with limited academic capacities, international consensus on respectful consent procedures and tailored patient information is necessary.
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Affiliation(s)
- Marja Y Veenstra
- Department of General Practice, CAPHRI Care and Public Health Research Institute, University of Maastricht
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Linehan C, Kerr MP, Walsh PN, Brady G, Kelleher C, Delanty N, Dawson F, Glynn M. Examining the prevalence of epilepsy and delivery of epilepsy care in Ireland. Epilepsia 2009; 51:845-52. [DOI: 10.1111/j.1528-1167.2009.02417.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Turky A, Beavis JM, Thapar AK, Kerr MP. Psychopathology in children and adolescents with epilepsy: an investigation of predictive variables. Epilepsy Behav 2008; 12:136-44. [PMID: 17959421 DOI: 10.1016/j.yebeh.2007.08.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Revised: 08/06/2007] [Accepted: 08/06/2007] [Indexed: 11/16/2022]
Abstract
This epidemiological study was aimed at determining the prevalence of behavioral and emotional problems in a UK community-based population of children and adolescents with epilepsy aged 4-17 using a postal questionnaire survey. The intent was to identify, through this survey, those epilepsy-related and demographic factors predictive of the presence of psychopathology and diminished health-related quality of life, and to distinguish whether such factors differ for differing types of psychopathology. Outcomes were measured using the Strengths and Difficulties Questionnaire (SDQ), Moods and Feelings Questionnaire (MFQ), Impact of Paediatric Epilepsy Scale (IPES), and Quality of Life in Epilepsy Inventory for Adolescents (QOLIE-AD-48). Information was obtained from main carers for 56 children (25 males and 31 females, mean age=12 years, SD=3 years 9 months, range=5-17). Parent report identified that 23 (47.9%, 95% confidence interval [CI] 34.5-61.7%) children met psychiatric caseness criteria and 32 (61.5%, 95% CI 48-73.5%) had chronic distress and social impairment. Regression analyses identified seizure severity as a risk factor for emotional problems and depression (odds ratio [OR]=1.09, P<0.05), whereas cognitive impairment was associated with behavioral problems, specifically conduct problems (OR=14.0, P<0.05), hyperactivity/inattention (OR=9.4, P<0.01), and peer problems (OR=28.5, P<0.01). Cognitive impairment and high seizure frequency were significantly related to increased IPES scores (R(2)=0.33, P<0.001) and diminished QOLIE-AD-48 scores (R(2)=0.39, P<0.01). In conclusion, children with epilepsy experience considerable psychopathology and reduced quality of life. Epilepsy-related factors appear more closely associated with emotional well-being, and cognitive factors with behavior problems.
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Mensah SA, Beavis JM, Thapar AK, Kerr MP. A community study of the presence of anxiety disorder in people with epilepsy. Epilepsy Behav 2007; 11:118-24. [PMID: 17532266 DOI: 10.1016/j.yebeh.2007.04.012] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Revised: 04/10/2007] [Accepted: 04/13/2007] [Indexed: 11/29/2022]
Abstract
Anxiety represents a major problem for people with epilepsy, and it is important to understand why it arises and how to reduce its potential debilitating and adverse effects. The aim of this study was to determine the prevalence of anxiety in a community-identified sample of people with epilepsy and to identify which demographic and clinical factors are most closely associated with anxiety and which factors predict the presence of anxiety among people with epilepsy. Adults with epilepsy in the community (n=515) were identified through primary care records and sent validated questionnaires, which included the Hospital Anxiety and Depression Scale (HADS). The mailout also included items on demographic and clinical variables. The prevalence of anxiety (HADS score >11) in this sample was 20.5% (95% CI: 16.9-24.1%) and was associated with a current history of depression, perceived side effects of antiepileptic medication, lower educational attainment, chronic ill health, female gender, and unemployment. It was not associated with the duration of epilepsy. The findings from this study suggest that anxiety disorders in a community population with epilepsy are most strongly predicted by factors independent of epilepsy-related variables, with the exception of patient-reported side effects. It is important to be aware of these factors when evaluating an individual with epilepsy.
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Affiliation(s)
- Seth A Mensah
- Academic Department of Neuropsychiatry, Whitchurch Hospital, Cardiff, Wales, UK
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15
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Williams J, Lawthom C, Dunstan FD, Dawson TP, Kerr MP, Wilson JF, Smith PEM. Variability of antiepileptic medication taking behaviour in sudden unexplained death in epilepsy: hair analysis at autopsy. J Neurol Neurosurg Psychiatry 2006; 77:481-4. [PMID: 16543526 PMCID: PMC2077527 DOI: 10.1136/jnnp.2005.067777] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [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: 03/15/2005] [Revised: 05/20/2005] [Accepted: 06/01/2005] [Indexed: 11/04/2022]
Abstract
BACKGROUND Variable compliance with antiepileptic drugs (AEDs) is a potentially preventable cause of sudden unexplained death in epilepsy (SUDEP). Hair AED concentrations provide a retrospective insight into AED intake variability. METHODS We compared hair AED concentration variability in patients with SUDEP (n = 16), non-SUDEP epilepsy related deaths (n = 9), epilepsy outpatients (n = 31), and epilepsy inpatients (n = 38). AED concentrations were measured in 1 cm hair segments using high performance liquid chromatography. Individual patient hair AED concentration profiles were corrected for "washout" using linear regression analysis. The coefficient of variation (CV) of the corrected mean hair AED concentration provided an index of variability of an individual's AED taking behaviour. Hair sample numbers varied between subjects, and so weighted regression estimates of the CV were derived for each group. RESULTS The CV regression estimates for each group were: SUDEP 20.5% (standard error 1.9), non-SUDEP 15.0% (3.9), outpatients 9.6% (1.4), and inpatients 6.2% (2.7). The SUDEP group therefore showed greater hair AED concentration variability than either the outpatient or the inpatient groups (p<0.0001). CONCLUSION Observed variability of hair AED concentrations, reflecting variable AED ingestion over time, is greater in patients dying from SUDEP than in either epilepsy outpatients or inpatients. SUDEP, at least in a proportion of cases, appears preventable.
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Affiliation(s)
- J Williams
- Department of Pharmacology, Therapeutics and Toxicology, Cardiff University, University Hospital of Wales, Cardiff, CF14 4XW, UK
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16
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Abstract
Behavioral disturbance is common in many individuals with mental retardation. Its presence in those with coexisting epilepsy provides a further challenge to the individual, caretakers, and family members. In particular, concerns that antiepileptic medication is causing such behavioral disturbances are often raised. For the clinician, assessment is crucial to minimize morbidity by appropriately identifying the cause of the behavioral disturbance. The assessment should aim to delineate whether the disturbance is due to a direct effect of epilepsy, its treatment, social impact, or factors unrelated to the epilepsy. However, before being able to make this differentiation, the clinician needs to understand the behavior itself. Assessing behavior in people with mental retardation requires a multifactorial approach. These factors include an objective and reliable description of the behavior and an assessment of its function. Detailed description requires a functional analysis of behavior. Such analysis may indicate the behavior is associated with epilepsy treatment or represents a seizure disorder in itself. In the majority of cases, though, it is likely that any disturbance seen is independent of epilepsy or its management.
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Affiliation(s)
- Mike P. Kerr
- Welsh Center for Learning Disabilities, Meridian Court, North Road, Cardiff, CF14 3BG, Wales, UK
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17
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Abstract
OBJECTIVES To examine the relation between social deprivation and the prevalence of epilepsy and associated morbidity using hospital activity data as a proxy. METHODS The study was conducted in the health district of South Glamorgan, United Kingdom (population 434 000). Routinely available hospital data (inpatient and outpatient), an epilepsy clinic database, and mortality data underwent a process of record linkage to identify records relating to the same patient and to identify patients with epilepsy. Each patient was allocated a Townsend index deprivation score on the basis of their ward of residence. Age standardised correlations were calculated between deprivation score and prevalence of epilepsy, inpatient admissions, and outpatient appointments. Standardised mortality ratios (SMR) were also calculated. All analyses were performed on two cohorts: (1) all patients with epilepsy and (2) those patients with epilepsy without any underlying psychiatric illness or learning disability. RESULTS The prevalence of epilepsy ranged between 2.0 and 13.4 per 1000 with a median of 6.7. There were positive correlations between social deprivation and prevalence in both populations: (1) r=0.75 (p<0.001) and (2) r=0.70 (p<0.001). After standardising for underlying prevalence there were also correlations for mean inpatient admissions: (1) r=0.62 (p<0.001), (2) r=0.59, (p<0.001) and for outpatient appointments: (1) r=0.53, (p=0.001) and (2) r=0. 51 (p=0.001). The SMR for those deprived was (1) 1.66 (95% confidence interval (95% CI) 1.27-2.05) and (2) 1.80 (95% CI 0.71-1. 67). For the population as a whole (with and without epilepsy) the SMR was 1.25 (95% CI 1.27-2.32). CONCLUSION This study shows a strong correlation between the prevalence of epilepsy and social deprivation and weaker correlations between social deprivation and mean hospital activity.
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Affiliation(s)
- C L Morgan
- Department of General Medicine, University Hospital of Wales, Heath Park, Cardiff, UK
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Morgan CL, Ahmed Z, Kerr MP. Health care provision for people with a learning disability. Record-linkage study of epidemiology and factors contributing to hospital care uptake. Br J Psychiatry 2000; 176:37-41. [PMID: 10789324 DOI: 10.1192/bjp.176.1.37] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND We know little about how people with a learning disability access secondary health care. AIMS To describe the epidemiology of learning disability, the influence of deprivation on prevalence and the pattern of secondary care uptake, including the effect of institutionalisation. METHOD A record-linkage study of secondary care contacts of 434,000 people between 1991 and 1997. A population with learning disability was identified; their secondary care contact was calculated and compared with the general population's. RESULTS The distribution of people with a learning disability (n = 1595) correlated significantly with deprivation. The presence of a learning disability hospital significantly affected care uptake. Place of residence also affected acute admission to the learning disability hospital. Former institution residents generated 212 admissions per 1000 patients; community patients generated 18 per 1000. The admission rate with any psychiatric diagnosis to any setting was 26.3 per 1000 people with a learning disability; 16.5% of such patients had a dual diagnosis. CONCLUSIONS Health provision for people with a learning disability is affected by institutional provision.
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Affiliation(s)
- C L Morgan
- Department of General Medicine, University Hospital of Wales, Cardiff
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Ahmed Z, Fraser W, Kerr MP, Kiernan C, Emerson E, Robertson J, Felce D, Allen D, Baxter H, Thomas J. Reducing antipsychotic medication in people with a learning disability. Br J Psychiatry 2000; 176:42-6. [PMID: 10789325 DOI: 10.1192/bjp.176.1.42] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The use of antipsychotic drugs in people with learning disabilities is currently receiving intensified scrutiny and attempts are being made to reduce it. AIMS A randomised controlled trial was designed to investigate factors influencing antipsychotic drug reduction among people with learning disabilities prescribed such medication for behavioural problems. METHOD Thirty-six participants randomly allocated to the experimental group underwent four, monthly 25% drug reduction stages. There were no planned drug changes for the control group (n = 20). RESULTS Twelve participants (33%) completed full withdrawal; a further seven (19%) achieved and maintained at least a 50% reduction. Drug reduction was associated with increased dyskinesia and higher activity engagement but not increased maladaptive behaviour. Some setting characteristics were associated with drug reinstatement. CONCLUSIONS A substantial proportion of people with learning disability prescribed antipsychotic medications for behavioural purposes rather than for treating psychotic illness can have their drugs reduced or withdrawn.
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Affiliation(s)
- Z Ahmed
- Welsh Centre for Learning Disabilities, University of Wales College of Medicine, Cardiff
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20
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Affiliation(s)
- P E Smith
- Epilepsy Unit, University Hospital of Wales, Cardiff, UK.
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21
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Kerr MP. Topiramate: uses in people with an intellectual disability who have epilepsy. J Intellect Disabil Res 1998; 42 Suppl 1:74-79. [PMID: 10030437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The novel anticonvulsant topiramate has been shown to have efficacy across a range of seizure types including both generalized and partial seizures in several well-designed randomized controlled trials. It has also been shown to be effective in atonic seizures associated with Lennox-Gastaut syndrome. Tolerability data show a tendency to neuropsychiatric side-effects, such as confusion and word finding difficulties, when topiramate is used in polytherapy; these side-effects are reduced in monotherapy usage. The efficacy and spectrum of seizures treated by topiramate suggests that it has an important role in managing epilepsy in people with intellectual disability. The predictable side-effects can be monitored in clinical practice and possibly reduced by slow dose increments. The data set of patients with intellectual disability is still too small to rule out idiosyncratic drug reaction.
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Affiliation(s)
- M P Kerr
- University of Wales College of Medicine, Cardiff, UK
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22
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Abstract
A survey of the prescription of the novel anticonvulsants lamotrigine, vigabatrin, gabapentin and topiramate was carried out in an outpatient setting to investigate the outcome of prescription and factors affecting response. One hundred and fifty randomly selected patient notes were analysed retrospectively. Drug continuation and seizure freedom were used as measures of response. Twenty-nine percent of patients had a brain lesion, 14% a psychiatric disorder, 7% neonatal seizures, 21% a family history of epilepsy and 15% a learning disability. On average at the moment of initiation of the novel anticonvulsant the patients had had a diagnosis of epilepsy for 18 years, were 33 years old, had 19 seizures per month and had previously used two drugs which failed to control their epilepsy. The first novel anticonvulsant was in 55% of cases lamotrigine, in 43% vigabatrin and in 1 % gabapentin. The overall percentage of patients who stayed on their first novel anticonvulsant was 55%, and 17% became seizure-free. No factors were found to influence the response in terms of drug continuation. For seizure freedom, the presence of a psychiatric disorder and partial seizures predicted a significantly poorer response. Length of seizure disorder, seizure frequency at initiation, the number of previously used failed drugs and the total number of drugs previously used were all significantly lower in the seizure-free group.
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Affiliation(s)
- R D Thijs
- University of Utrecht, The Netherlands
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24
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Jones RG, Kerr MP. A randomized control trial of an opportunistic health screening tool in primary care for people with intellectual disability. J Intellect Disabil Res 1997; 41 ( Pt 5):409-415. [PMID: 9373821 DOI: 10.1111/j.1365-2788.1997.tb00728.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
People with intellectual disability have an increased variety of health care problems compared with the general population. The transition of care for such people from institutions into the community places them in a primary care system already facing increasing demands for their services. There is a consensus that health screening is at its most useful in identifying functional disabilities. Therefore, an intervention which helps the general practitioner (GP) towards opportunistically checking those areas of health most often deficient in people with intellectual disability would appear of considerable benefit (especially if information directing the GP towards appropriate secondary care services is also provided). The present study was designed to evaluate the impact of such an intervention.
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Affiliation(s)
- R G Jones
- Cardiff Community Healthcare NHS Trust, Wales
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25
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Abstract
There is growing awareness of the importance of evidence-based medicine in guiding health care delivery. This paper reviews the evidence pertinent to the delivery of primary health care to people with an intellectual disability. Research concerning issues of health status, specialist knowledge of health care, and barriers and solutions to health care delivery for people with an intellectual disability is presented and discussed. Recommendations for future evidence-based research are made, including suggested areas of importance.
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Affiliation(s)
- N G Lennox
- University of Melbourne, Developmental Disability Unit, Public Health and Community Medicine, Carlton, Victoria, Australia
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26
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Abstract
A major component of the population of people who have epilepsy are people with a learning disability. As a group, such individuals often have complex epilepsy which is refractory to treatment. Current available measures to assess the outcomes of therapeutic interventions in epilepsy are based on seizure frequency, seizure severity and quality-of-life measures, but have not been validated in people with a learning disability. Thus, we do not know if such measures of outcome serve the needs of this group. This review examines how able we are to assess the efficacy of our interventions to control epilepsy in people with learning disability. It is suggested that a standard data set is necessary as the basis of the assessment of any therapeutic intervention. Central components of this data set would encompass a definition of important characteristics of an individual, a description of their epilepsy and an assessment of the impact of their condition on both their own and their carer's health. The approach to obtaining this information should employ a methodology which can allow for environmental influences.
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Affiliation(s)
- M P Kerr
- Welsh Centre for Learning Disabilities, Department of Psychological Medicine, University of Wales College of Medicine, Cardiff, UK
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27
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Ahmed Z, O'Brien G, Betts T, Kerr MP, Fraser WI. Learning disabilities: moving forward--a focus on epilepsy, Birmingham, England, 29 June 1996. J Intellect Disabil Res 1997; 41 ( Pt 4):355-360. [PMID: 9297614 DOI: 10.1111/j.1365-2788.1997.tb00720.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
On 29 June 1996 a conference was held in Birmingham to highlight the status of epilepsy in people with learning disabilities. The conference consisted both of seminars and workshops. Dr Tim Betts, Birmingham; Dr Greg O'Brien, Northumberland; and Dr Mike Kerr addressed issues of assessment, diagnosis and drug treatment of epilepsy in this population. This meeting report summarizes the proceedings of the conference.
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Affiliation(s)
- Z Ahmed
- Welsh Centre for Learning Disabilities, Cardiff, Wales
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28
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Kerr MP, Evans S, Nolan M, Fraser WI. Assessing clinicians' consultation with people with profound learning disability: producing a rating scale. J Intellect Disabil Res 1995; 39 ( Pt 3):187-190. [PMID: 7640487 DOI: 10.1111/j.1365-2788.1995.tb00499.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
This paper describes the development of a scale for assessing clinicians' communication with people with profound learning disability. Four psychiatrists and four nurses were assessed completing three simple non-invasive clinical procedures--blood pressure, pulse and axillary temperature--with people with profound learning disability. Videotaped assessment of consultations was performed by three experienced speech and language therapists using a previously designed scale for analysing encounters with people with mild learning disability. This led to the production of a new scale specifically for people with profound learning disability. A significant inter-rater reliability was found between the three speech therapists for total scores (rater a-b, corr = 0.654, P = 0.006; rater a-c, corr = 0.795, P = 0.0001: rater b-c, corr = 0.673, P = 0.004). Significant reliability between raters was also found for the subsections of verbal behaviour and non-verbal behaviour.
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Affiliation(s)
- M P Kerr
- Department of Psychological Medicine, Ely Hospital, Cardiff, Wales
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29
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Kerr MP. Antidepressant prescribing: a comparison between general practitioners and psychiatrists. Br J Gen Pract 1994; 44:275-6. [PMID: 7619096 PMCID: PMC1238901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The 'defeat depression' campaign emphasizes the importance of adequate prescribing of antidepressants in general practice. AIM A study was undertaken to investigate the prescribing habits of a group of general practitioners and psychiatrists. METHOD A postal questionnaire was sent to 123 general practitioners and 97 psychiatrists in south Wales. RESULTS The response rate among general practitioners was 60% and among psychiatrists it was 67%. As a group, the psychiatrists reported using significantly higher daily dosages of antidepressant medication for adult and for elderly patients over a longer period compared with general practitioners. Fifty two per cent of 68 general practitioners and 17% of 60 psychiatrists reported using lower than recommended daily treatment dosages for adult patients and 40% of 68 general practitioners and 7% of 62 psychiatrists used a shorter than recommended period of continuation therapy (less than four months). Both groups showed a wide variation in the use of maintenance therapy. CONCLUSION Educational efforts should be made to improve the prescribing habits of general practitioners and psychiatrists.
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Affiliation(s)
- M P Kerr
- Department of Psychological Medicihe, Ely Hospital, Cardiff
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Tekieli ME, Ruscello DM, Kerr MP, Moore RN. Speech changes following orthodontic treatment with the functional regulator. Br J Disord Commun 1983; 18:108-117. [PMID: 6626459 DOI: 10.3109/13682828309019828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Abstract
Nine cleft lip and palate children exhibiting collapse of maxillary segments and cross-bite were treated orthodontically with the functional regulator (FR) for periods ranging from 6 to 18 months. The purpose of this investigation was to evaluate quantitatively treatment of cleft palate patients with the functional regulator and to evaluate the effect of the appliance on their speech. Cleft palate patients typically have speech, nose, and lip defects which make patient cooperation and appliance acceptance more difficult. However, patient cooperation was considered good with an average mean of 12.7 hours per day of appliance wear and a range of 5.6 to 18.2 hours. Change in interimplant dimension was measured on frontal radiographs, and dental changes were measured of serial dental casts. The resulting data indicated no significant change in maxillary width or cross-bite relationship. The functional regulator was not clinically useful in this sample when the treatment objective was primary expansion of collapsed maxillary segments in the cleft palate patient. Good speech-production skills prior to treatment will minimize the adverse effect that the FR has on speech intelligibility. A significant amount of accommodation to the appliance occurs within 1 week after insertion, but maximum improvement in speech intelligibility occurs with full-time wear of the appliance for as many hours per day as possible.
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