Global Health and Epilepsy: Update and Future Directions

Spiciarich, Mary C.; Gaudecker, Jane R. von; Jurasek, Laura; Burneo, Jorge G.; Vidaurre, Jorge

doi:10.1007/s11910-019-0947-6

Cited by 23 publications

(16 citation statements)

References 82 publications

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“…Epilepsy is one of the most common neurological disorders with high prevalence and affects approximately 0.5–1% of the general population worldwide ( 1 ). Although many patients with epilepsy are able to achieve seizure control with anti-epileptic drugs (AEDs) treatment, 20–30% of these patients not only continue to suffer from ongoing seizures and but also experience adverse effects from the treatment ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

Clinical Efficacy and Safety of Lacosamide as an Adjunctive Treatment in Adults With Refractory Epilepsy

et al. 2021

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Background: Lacosamide (LCM), a novel AED (antiepileptic drug), was used as an adjunctive treatment in patients with partial-onset seizures or without secondary generalization. However, no meta-analysis was performed to evaluate the efficacy of LCM as an adjunctive treatment in post-marketing clinical studies.Aims: To assess the safety and efficacy of LCM as an adjunctive treatment in adults with refractory epilepsy, a systematic review and meta-analysis of randomized controlled trials (RCTs) and real-world studies were performed.Methods: All studies were identified from electronic databases. Both RCTs and observational prospective studies were included. Primary outcomes included responder rate, adverse effects (AEs) and withdraw rate. The pooled rates (PR) with their corresponding 95% confidence intervals (CI) were calculated. Publication bias was assessed with Begg's or Egger's tests.Results: Total 16 studies (3,191 patients) including 5 RCTs and 11 real-word studies were enrolled. The pooled 50% responder rate and seizure-free rate were 48% (95% CI: 0.42, 0.54) and 9% (95% CI: 0.06, 0.11) in all studies, respectively. Subgroup analysis showed that the pooled 50% responder rate were 53% (95% CI: 0.44, 0.62) from observational studies and 38% (95% CI: 0.35, 0.42) from RCTs, respectively; the pooled seizure-free rate were 13% (95% CI: 0.09, 0.18) from observational studies and 4% (95% CI: 0.06, 0.11) from RCTs, respectively. Similar incidence of AEs were reported in real-world studies (0.57, 95% CI: 0.43, 0.72) and RCTs (0.59, 95% CI: 0.42–0.76). Finally, a total of 13% (95%CI: 0.09, 0.16) and 13% (95% CI: 0.08, 0.16) of all patients prescribed with LCM was withdrawn in RCTs and real-world studies, respectively, due to the occurrence of AEs. Furthermore, similar to the 50% responder rate, seizure-free rate, incidence of AEs and withdraw rate were reported at 6-month or at least 12-month of LCM adjunction. Publication bias was not detected in these studies.Conclusions: Our results revealed that LCM adjunctive therapy even with long-term treatment was efficacious and well tolerated in adults with refractory epilepsy.

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Section: Introductionmentioning

confidence: 99%

Clinical Efficacy and Safety of Lacosamide as an Adjunctive Treatment in Adults With Refractory Epilepsy

et al. 2021

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“…It accounts for 0•5% of the world's disease burden [2] . Epilepsy directly affects an estimated 50–70 million people worldwide and involves an additional 500 million people as family members and caregivers of people living with epilepsy (PwE) [ 3 , 4 ] PwE have an increased risk of premature death, loss of work productivity, and increased healthcare needs and expenditure [ 5 , 6 ]. Nearly 90% of the global burden of epilepsy occurs in the populations of low- and middle-income countries (LMICs) [7] .…”

Section: Introductionmentioning

confidence: 99%

The competence of village clinicians in the diagnosis and management of childhood epilepsy in Southwestern China and its determinants: A cross-sectional study

Liu

Wang

et al. 2020

The Lancet Regional Health - Western Pacific

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Background: Due to lack of neurologists in low-and middle-income countries, communities of patients living with epilepsy are calling for task-shifting of diagnosis and management from physicians to paramedical providers in the primary health care systems to narrow the huge treatment gap. Evidence to guide this work has been limited. This study assesses the competence of village clinicians (VC)-mostly paramedical providers-in the diagnosis and management of a presumptive case of childhood epilepsy and its determinants. Methods:A cross-sectional study was conducted in rural areas of a province in Southwestern China from July 2017 to January 2018. We randomly selected 370 VCs who practiced Western medicine and assumed the main responsibility of providing medical services in his/her clinic. A standardized clinical vignette based on national clinical practice guidelines was used to evaluate clinicians' competence in three domains: number and proportion of recommended (and essential) checklist (questions, examinations, and tests) completed, correctness of diagnosis, and correctness of case management.Findings: Though VCs completed 14 • 3% (IQR 9 • 5%-19 • 1%) of the recommended checklist, 63 • 2% (234/370, 95%CI 58 • 2%-68 • 0%) provided a correct diagnosis. Only 1 • 6% of VCs (6/370, 95%CI 0 • 7%-3 • 5%) gave correct management with both correct medication and referral, however 90 • 3% (334/370, 95%CI 86 • 8%-92 • 9%) provided partially correct management by referring patients to upper-level health facilities (89 • 5%, 331/370, 95%CI 85 • 9%-92 • 2%) or prescribing anti-epileptic drugs (AEDs) correctly (0 • 8%, 3/370, 95%CI 0 • 3%-2 • 4%). Around 1/4 VCs referred patients to Township Health Centers which usually were not staffed with pediatric neurologists. Fewer provided helpful medical advice to patients for daily management. The heuristic process was found to be negatively associated with the proportion of the recommended checklist that VCs completed, which is positively associated with correctness of diagnosis.Interpretation: Most VCs could diagnose and refer childhood epilepsy patients correctly; however, they lacked competence when it came to assuming the responsibility of primary care providers, referring efficiently, refilling AEDs, as well as supervising and instructing daily management of patients.Funding: HY received the funding for this study from the "Health and Hope Fund " of the Business Development Center of the RCSC (Beijing) and UCB (Belgium). UCB provided support in the form of a salary for author DET.

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“…Sergantieji epilepsija pažymi, kad išgirdę diagnozę tiesiog išklausė gydytoją, tikėjosi ligos atsitraukimo, išgyveno ligos neigimo fazę. Ligos neigimo metu siekiama "būti normaliu", laukiama, gal išnyks priepuoliai ir bus galima gyventi "įprastinį, normalų" gyvenimą, tačiau priepuoliams kartojantis, pradedama ieškoti informacijos: "Tai tada ieškojau informacijos, klausinėjau taip ir giminių, gal ką žino apie tą ligą" (10). Pirmą kartą diagnozavus epilepsiją, pacientai patiria nerimą dėl neapibrėžtumo, nes nėra supažindinti su diagnostiniais tyrimais, gydymo būdais: "pradžioje eidavau taip su nerimu, nes nežinai ką išgirsi.…”

Section: Tyrimo Rezultataiunclassified

“…Rekonstruojant praeities įvykius, pastebimi pozityvūs elgesio modeliai, kurie padeda atpažinti veiksnius, sukeliančus priepuolius, todėl pradedama pasitikėti savimi: "kad reikia išlikti ramiai ir jeigu bandysiu išlikti ramiau -tada pasveiksiu, paskui atsimenu pradėjau labai pasitikėt savim" (10). Atsivėrimas sau apibūdinamas kaip pripažinimas to, kas neišvengiama, t.y.…”

Section: Tyrimo Rezultataiunclassified

Gydytojo − Paciento Sąveika: Tapsmas Epilepsija Sergančiu Pacientu

Tuitaitė¹

2021

Health Sciences

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Epilepsija – nenuspėjama liga. Sunku numatyti priepuolio laiką ir pasekmes, todėl pacientui, gydytojo kabinete išgirdusiam šią diagnozę, nelengva suprasti, kaip pasikeis jo gyvenimas. Susitikimų su gydytojais metu pacientas mokosi pažinti šią ligą, nuolat reflektuojant apie kūno pokyčius ir gydymo eigą. Naujausi epilepsija sergančių asmenų gyvenimo kokybės tyrimai rodo bendravimo ir bendradarbiavimo su sveikatos priežiūros specialistų komanda svarbą. Tyrimo tikslas − atskleisti, kaip epilepsija sergantys žmonės mokosi gyventi su liga gydytojo-paciento sąveikos kontekste. Pasirinkta konstruktyvistinės grindžiamosios teorijos koncepcija, taikant K. Charmaz versiją [4]. Atliktas kokybinis tyrimas. Taikytas teorinės imties sudarymo principas. Tyrimui atrinkti epilepsija sergantys suaugusieji, kuriems šis susirgimas diagnozuotas ne anksčiau nei prieš penkerius metus, neturintys pažintinių funkcijų sutrikimų. Duomenų rinkimo metodas − pusiau struktūruotas interviu. Interviu duomenys transkribuoti ir koduoti, formuotos kategorijos. Tyrimo metu rašytos atmintinės, naudotos duomenų analizės metu. Apklausta 10 epilepsija sergančių asmenų. Tyrimas atskleidė, kad pacientams ligos pradžioje sunku suprasti epilepsijos priepuolių priežastis, diagnostikos ir gydymo priemones dėl išgyvenamo nerimo ir ligos neigimo. Pacientams susitaikius su epilepsijos diagnoze, pradedamas ugdyti diadinis pasitikėjimo gydytoju jausmas, sergantieji motyvuojami išgirsti gydytojo nurodymus ir juos vykdyti, mokomi atpažinti veiksnius, skatinančius priepuolių atsiradimą. Kuriant pasitikėjimu ir atsakomybe grįstus diadinius gydytojo ir paciento santykius, pacientas tampa aktyviu, nuolat besimokančiu asmeniu. Tyrimo metu konstruota grindžiamoji teorija, paaiškinanti paciento mokymosi gyventi su liga proceso etapus, kurią sudaro trys centrinės kategorijos: 1) „Aš“ − susipažinimas su epilepsija, siekiant suprasti paciento patirtį, tik diagnozavus epilepsiją; 2) „Aš“ − atsivėrimas sau, siekiant rekonstruoti paciento išgyvenimus, pradėjus mokytis gyventi su liga; 3) „Aš“ − atsivėrimas kitam, siekiant susitikimų su gydytoju metu suprasti paciento vaidmenį ligos gydymo procese.

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Global Health and Epilepsy: Update and Future Directions

Cited by 23 publications

References 82 publications

Clinical Efficacy and Safety of Lacosamide as an Adjunctive Treatment in Adults With Refractory Epilepsy

Clinical Efficacy and Safety of Lacosamide as an Adjunctive Treatment in Adults With Refractory Epilepsy

The competence of village clinicians in the diagnosis and management of childhood epilepsy in Southwestern China and its determinants: A cross-sectional study

Gydytojo − Paciento Sąveika: Tapsmas Epilepsija Sergančiu Pacientu

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