Antiseizure medication adherence trajectories in Medicare beneficiaries with newly treated epilepsy

Abstract

Objective

This study was undertaken to characterize trajectories of antiseizure medication (ASM) adherence in adults with newly treated epilepsy and to determine predictors of trajectories.

Methods

This was a retrospective cohort study using Medicare. We included beneficiaries with newly treated epilepsy (one or more ASM and none in the preceding 2 years, plus International Classification of Diseases codes) in 2010–2013. We calculated the proportion of days covered (proportion of total days with any ASM pill supply) for 8 quarters or until death. Group-based trajectory ...

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Carbon emission savings and short‐term health care impacts from telemedicine: An evaluation in epilepsy

Abstract

Objective

Health systems make a sizeable contribution to national emissions of greenhouse gases that contribute to global climate change. The UK National Health Service is committed to being a net zero emitter by 2040, and a potential contribution to this target could come from reductions in patient travel. Achieving this will require actions at many levels. We sought to determine potential savings and risks over the short term from telemedicine through virtual clinics.

Methods

During the severe acute respiratory syndrome coronavirus 2 (SARS-2-CoV) ...

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Cost‐effectiveness analysis of responsive neurostimulation for drug‐resistant focal onset epilepsy

Abstract

Objective

We evaluated the incremental cost-effectiveness of responsive neurostimulation (RNS) therapy for management of medically refractory focal onset seizures compared to pharmacotherapy alone.

Methods

We created and analyzed a decision model for treatment with RNS therapy versus pharmacotherapy using a semi-Markov process. We adopted a public payer perspective and used the maximum duration of 9 years in the RNS long-term follow-up study as the time horizon. We used seizure frequency data to model changes in quality of life and estimated the impact of RNS ...

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Long‐term outcome in a noninvasive rat model of birth asphyxia with neonatal seizures: Cognitive impairment, anxiety, epilepsy, and structural brain alterations

Abstract

Objective

Birth asphyxia is a major cause of hypoxic–ischemic encephalopathy (HIE) in neonates and often associated with mortality, neonatal seizures, brain damage, and later life motor, cognitive, and behavioral impairments and epilepsy. Preclinical studies on rodent models are needed to develop more effective therapies for preventing HIE and its consequences. Thus far, the most popular rodent models have used either exposure of intact animals to hypoxia-only, or a combination of hypoxia and carotid occlusion, for the induction of neonatal seizures and ...

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The relation of etiology based on the 2017 ILAE classification to the effectiveness of the ketogenic diet in drug‐resistant epilepsy in childhood

Abstract

Objective

To investigate the effectiveness and safety of the ketogenic diet (KD) in drug-resistant epilepsy in childhood in relation to the new 2017 International League Against Epilepsy (ILAE) classification of etiology.

Methods

A consecutive cohort of patients treated with the KD were categorized according to the ILAE classification into known (structural, genetic, metabolic, infectious, and immune-mediated) and unknown etiology. Primary outcome was the frequency of patients achieving seizure freedom with the KD at 3 months, secondary outcomes were seizure reduction >50% at 3 months, and ...

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Aberrant hippocampal mossy fibers in temporal lobe epilepsy target excitatory and inhibitory neurons

Summary

Objective

The pathoanatomical correlate of temporal lobe epilepsy is hippocampal sclerosis, characterized by selective neuronal death of mossy cells in the hilus and of pyramidal cells in cornu ammonis 1. Although granule cells survive, they lose mossy cells as a target and redirect their axons (mossy fibers) backward into the molecular cell layer. It has been assumed that this process results in excitatory circuits. We therefore examined whether sprouted mossy fibers form synaptic connection not only with excitatory granule cells but ...

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Wearable devices for seizure detection: Practical experiences and recommendations from the Wearables for Epilepsy And Research (WEAR) International Study Group

Abstract

The Wearables for Epilepsy And Research (WEAR) International Study Group identified a set of methodology standards to guide research on wearable devices for seizure detection. We formed an international consortium of experts from clinical research, engineering, computer science, and data analytics at the beginning of 2020. The study protocols and practical experience acquired during the development of wearable research studies were discussed and analyzed during bi-weekly virtual meetings to highlight commonalities, strengths, and weaknesses, and to formulate recommendations. Seven major ...

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A web‐based algorithm to rapidly classify seizures for the purpose of drug selection

Abstract

Objective

To develop and validate a pragmatic algorithm that classifies seizure types, to facilitate therapeutic decision-making.

Methods

Using a modified Delphi method, five experts developed a pragmatic classification of nine types of epileptic seizures or combinations of seizures that influence choice of medication, and constructed a simple algorithm, freely available on the internet. The algorithm consists of seven questions applicable to patients with seizure onset at the age of 10 years or older. Questions to screen for nonepileptic attacks were added. Junior physicians, nurses, ...

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Sudden unexpected death in epilepsy in persons younger than 50 years: A retrospective nationwide cohort study in Denmark

Abstract

Objective

Persons with epilepsy have an increased mortality including a high risk of sudden unexplained death (SUD), also referred to as sudden unexpected death in epilepsy (SUDEP). We aimed to evaluate the risk of SUDEP in comparison to other causes of death and the risk of SUD in persons with and without epilepsy.

Methods

We undertook a retrospective population-based cohort study of all Danish citizens with and without epilepsy aged 1–49 years during 2007–2009. All deaths in the population were evaluated, and all cases ...

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Anterior nucleus of the thalamus seizure detection in ambulatory humans

Abstract

There is a paucity of data to guide anterior nucleus of the thalamus (ANT) deep brain stimulation (DBS) with brain sensing. The clinical Medtronic Percept DBS device provides constrained brain sensing power within a frequency band (power-in-band [PIB]), recorded in 10-min averaged increments. Here, four patients with temporal lobe epilepsy were implanted with an investigational device providing full bandwidth chronic intracranial electroencephalogram (cEEG) from bilateral ANT and hippocampus (Hc). ANT PIB-based seizure detection was assessed. Detection parameters were cEEG PIB ...

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