scholarly journals P.094 Referral Practices for Epilepsy Surgery in Pediatric Patients: A North American Study

2021 ◽  
Vol 48 (s3) ◽  
pp. S46-S46
Author(s):  
SG Buttle ◽  
K Muir ◽  
S Dehnoei ◽  
R Webster ◽  
A Tu
Keyword(s):  
Epilepsy Surgery ◽  
North American ◽  
The United States ◽  
Modifiable Factors ◽  
Referral Practices ◽  
Surgical Evaluation ◽  
Prior Literature ◽  
Family Perceptions ◽  
Drug Resistant Epilepsy ◽  
International League

Background: The International League Against Epilepsy recommends patients with drug resistant epilepsy (DRE) be referred for surgical evaluation, however prior literature suggests this is an underutilized intervention. This study captures practices of North American pediatric neurologists regarding the management of DRE and factors which may promote or limit referrals for epilepsy surgical evaluation. Methods: A REDCap survey distributed via the Child Neurology Society mailing list to pediatric neurologists practicing in North America. “R” was used to conduct data analyses. Ethics approval from the CHEO REB was granted prior to the start of data collection. Results: 102 pediatric neurologists responded, 77% of whom currently practice in the United States. 73% of respondents reported they would refer a patient for surgical consultation after two failed medications. Of all potential predictors tested in a logistic regression model, low referral volume was the only predictor of whether participants refer patients after more than three failed medications. Conclusions: Pediatric neurologists demonstrate fair knowledge of formal recommendations to refer patients for surgical evaluation after two failed medication trials. Other modifiable factors reported, especially family perceptions of epilepsy surgery, should be prioritized when developing tools to enhance effective referrals and increase utilization of epilepsy surgery in the management of pediatric DRE.

Selection of children with drug resistant epilepsy who are candidates for epilepsy surgery: pre and post-operative evaluation

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Osama Salah Mohamed El Sharkawy ◽  
Zeinab Anwar El kabbany ◽  
Neveen Tawakol Younis ◽  
Khaled Aboulfotouh Ahmad ◽  
Ahmed Darwish Mahmoud ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Preoperative Evaluation ◽  
Drug Resistant ◽  
Surgery Outcome ◽  
Class 1 ◽  
Operative Evaluation ◽  
Drug Resistant Epilepsy ◽  
Stage 1 ◽  
International League ◽  
Selection Of

Abstract Objective To select patients with drug resistant epilepsy following up in Pediatrics Neurology Outpatient Clinic of Children's Hospital, Ain Shams University who are candidates for epilepsy surgery and to detect outcome of epilepsy surgery in such children as regards seizures control. Methods This prospective study was conducted over a period of 36 months and comprises of 3 stages. Stage 1 includes selection of candidates for epilepsy surgery and preoperative evaluation. Evaluation included clinical assessment, video EEG, MRI epilepsy protocol. Stage 2 include surgery phase where decision of surgery was made by a multidisciplinary team. Stage 3 includes post-operative evaluation as regards Seizures frequency, Seizures Severity using Chalfont score, Engel Epilepsy Surgery Outcome Scale and the International League Against Epilepsy (ILAE) outcome classification. Data was tabulated and analyzed with SSPS package for windows. Results 17 patients underwent epilepsy surgery. Results revealed significant decrease in seizures frequency and severity at 6 and 12 months after surgery. As regards Engel Epilepsy Surgery Outcome Scale 11 (64.7%) patients were class I at 12 months. As regards the ILAE outcome classification 10 (58.8%) patients are class 1 at 12 months. Conclusions epilepsy surgery can be a hope for patients with drug resistant epilepsy who are well selected and evaluated preoperatively. New studies on larger number and for longer duration are recommended.

scholarly journals The Cost-Effectiveness of Epilepsy Surgery and Surgical Evaluation in the United States

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Shehryar R Sheikh ◽  
Michael P Steinmetz ◽  
Michael W Kattan ◽  
Mendel Singer ◽  
Belinda Udeh ◽  
...  
Keyword(s):  
United States ◽  
Monte Carlo ◽  
Cost Effectiveness ◽  
Epilepsy Surgery ◽  
Medical Management ◽  
Cost Effective ◽  
The United States ◽  
Effective Strategies ◽  
Surgical Evaluation ◽  
The Cost

Abstract INTRODUCTION Surgery is an effective treatment for many pharmacoresistant temporal lobe epilepsy patients, but incurs considerable cost. It is unknown whether surgery and surgical evaluation are cost-effective strategies in the United States. We aim to evaluate whether 1) surgery is cost-effective for patients who have been deemed surgical candidates when compared to continued medical management, 2) surgical evaluation is cost-effective for patients who have drug-resistant temporal epilepsy and may or may not ultimately be deemed surgical candidates METHODS We use a Monte Carlo simulation method to assess the cost-effectiveness of surgery and surgical evaluation over a lifetime horizon. Patients transition between two health states (‘seizure free’ and ‘having seizures’) as part of a Markov process, based on literature estimates. We adopt both healthcare and societal perspectives, including direct healthcare costs and indirect costs such as lost earnings by patients and care providers. We estimate variability of model predictions using probabilistic and deterministic sensitivity analyses. RESULTS 1) Epilepsy surgery is cost effective in surgically eligible patients by virtue of being cost saving and more effective than medical management in the long run, with 95% of 10 000 Monte Carlo simulations favoring surgery. From a societal perspective, surgery becomes cost effective within 3 yr. At 5 yr, surgery has an incremental cost-effectiveness ratio (ICER) of $31,600, which is significantly below the societal willingness-to-pay (∼ $100,000/quality-adjusted life years (QALY)) and comparable to hip/knee arthroplasty. 2) Surgical evaluation is cost-effective in pharmacoresistant patients even if the probability of being deemed a surgical candidate is low (5%-10%). Even if the probability of surgical eligibility is only 10%, surgical referral has an ICER of $96,000/QALY, which is below societal willingness-to-pay. CONCLUSION Epilepsy surgery and surgical evaluation are both cost-effective strategies in the United States. Pharmacoresistant temporal lobe epilepsy patients should be referred for surgical evaluation without hesitation on cost-effectiveness grounds.

Referral practices for epilepsy surgery in pediatric patients: A North American Study

Epilepsia ◽  
2021 ◽  
Author(s):  
Sarah Grace Buttle ◽  
Katherine Muir ◽  
Sajjad Dehnoei ◽  
Richard Webster ◽  
Albert Tu
Keyword(s):  
Epilepsy Surgery ◽  
North American ◽  
Pediatric Patients ◽  
American Study ◽  
North American Study ◽  
Referral Practices

scholarly journals Establishment of epilepsy surgery in Peru

Neurology ◽  
2018 ◽  
Vol 91 (8) ◽  
pp. 368-370 ◽  
Author(s):  
David A. Steven ◽  
Carlos M. Vasquez ◽  
Jose C. Delgado ◽  
Willy Zapata-Luyo ◽  
Alicia Becerra ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Intractable Epilepsy ◽  
The United States ◽  
South American ◽  
The North ◽  
The World ◽  
Sporadic Cases ◽  
Surgery Center ◽  
International League

Epilepsy surgery is a well-established treatment for certain types of intractable epilepsy. While there is a relatively high number of epilepsy surgery centers in Canada and the United States, the same cannot be said about many other parts of the world, such as South America. Although there are notable exceptions, such as Brazil and Colombia, formal epilepsy surgery centers have been lacking in many South American countries, including Peru. Although sporadic cases have been performed in Peru, there was no formal epilepsy surgery center in the country as of 2011. Beginning in 2008, with the support of the Partnering Epilepsy Centers in America program of the North American Commission of the International League Against Epilepsy, the Epilepsy Program at Western University in London, Canada, was partnered with the Department of Epilepsy at the Instituto Nacional de Ciencias Neurologicas in Lima. This was the beginning of a long-term relationship that culminated in the establishment of the first 2 formal epilepsy surgery centers in Peru. The purpose of this communication is to briefly summarize the establishment of 2 independent epilepsy surgery programs in Peru and to document the methods with which this accomplishment was achieved.

Benjamin Henry Latrobe and the nomenclature of two North American fishes

1987 ◽  
Vol 14 (1) ◽  
pp. 85-88
Author(s):  
CHARLOTTE M PORTER
Keyword(s):  
United States ◽  
North American ◽  
The United States ◽  
American Shad ◽  
New Name ◽  
The Common ◽  
Fish Louse

A curious error affects the names of three North American clupeids—the Alewife, American Shad, and Menhaden. The Alewife was first described by the British-born American architect, Benjamin Henry Latrobe in 1799, just two years after what is generally acknowledged as the earliest description of any ichthyological species published in the United States. Latrobe also described the ‘fish louse’, the common isopod parasite of the Alewife, with the new name, Oniscus praegustator. Expressing an enthusiasm for American independence typical of his generation, Latrobe humorously proposed the name Clupea tyrannus for the Alewife because the fish, like all tyrants, had parasites or hangers-on.

scholarly journals Progress in Diagnosing Primary Ciliary Dyskinesia: The North American Perspective

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1278
Author(s):  
Michael Glenn O’Connor ◽  
Amjad Horani ◽  
Adam J. Shapiro
Keyword(s):  
Genetic Testing ◽  
North America ◽  
North American ◽  
Primary Ciliary Dyskinesia ◽  
Clinical Phenotype ◽  
The United States ◽  
Diagnostic Process ◽  
The North ◽  
Diagnostic Guideline ◽  
Ciliary Dyskinesia

Primary Ciliary Dyskinesia (PCD) is a rare, under-recognized disease that affects respiratory ciliary function, resulting in chronic oto-sino-pulmonary disease. The PCD clinical phenotype overlaps with other common respiratory conditions and no single diagnostic test detects all forms of PCD. In 2018, PCD experts collaborated with the American Thoracic Society (ATS) to create a clinical diagnostic guideline for patients across North America, specifically considering the local resources and limitations for PCD diagnosis in the United States and Canada. Nasal nitric oxide (nNO) testing is recommended for first-line testing in patients ≥5 years old with a compatible clinical phenotype; however, all low nNO values require confirmation with genetic testing or ciliary electron micrograph (EM) analysis. Furthermore, these guidelines recognize that not all North American patients have access to nNO testing and isolated genetic testing is appropriate in cases with strong clinical PCD phenotypes. For unresolved diagnostic cases, referral to a PCD Foundation accredited center is recommended. The purpose of this narrative review is to provide insight on the North American PCD diagnostic process, to enhance the understanding of and adherence to current guidelines, and to promote collaboration with diagnostic pathways used outside of North America.

scholarly journals “The Future of Archaeology Is Antiracist”: Archaeology in the Time of Black Lives Matter

2021 ◽  
pp. 1-20
Author(s):  
Ayana Omilade Flewellen ◽  
Justin P. Dunnavant ◽  
Alicia Odewale ◽  
Alexandra Jones ◽  
Tsione Wolde-Michael ◽  
...  
Keyword(s):  
United States ◽  
North American ◽  
The United States ◽  
Heritage Preservation ◽  
Social Unrest ◽  
Black Lives Matter ◽  
The North ◽  
Road Map ◽  
The Social ◽  
The Future

This forum builds on the discussion stimulated during an online salon in which the authors participated on June 25, 2020, entitled “Archaeology in the Time of Black Lives Matter,” and which was cosponsored by the Society of Black Archaeologists (SBA), the North American Theoretical Archaeology Group (TAG), and the Columbia Center for Archaeology. The online salon reflected on the social unrest that gripped the United States in the spring of 2020, gauged the history and conditions leading up to it, and considered its rippling throughout the disciplines of archaeology and heritage preservation. Within the forum, the authors go beyond reporting the generative conversation that took place in June by presenting a road map for an antiracist archaeology in which antiblackness is dismantled.

Notice of transfer of figured specimens of North American Devonian cyclocystoids

1993 ◽  
Vol 67 (1) ◽  
pp. 151-151
Author(s):  
R. William Orr ◽  
Richard H. Fluegeman
Keyword(s):  
United States ◽  
New York ◽  
North American ◽  
The United States ◽  
State University ◽  
Ball State University ◽  
Geological Museum ◽  
University College ◽  
University Of Cincinnati ◽  
The University

In 1990 (Fluegeman and Orr) the writers published a short study on known North American cyclocystoids. This enigmatic group is best represented in the United States Devonian by only two specimens, both illustrated in the 1990 report. Previously, the Cortland, New York, specimen initially described by Heaslip (1969) was housed at State University College at Cortland, New York, and the Logansport, Indiana, specimen was housed at Ball State University, Muncie, Indiana. Both institutions recognize the importance of permanently placing these rare specimens in a proper paleontologic repository with other cyclocystoids. Therefore, these two specimens have been transferred to the curated paleontologic collection at the University of Cincinnati Geological Museum where they can be readily studied by future workers in association with a good assemblage of Ordovician specimens of the Cyclocystoidea.

641 North American Practices for Facial Massage and Stretching Post Facial Burns

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S176-S177
Author(s):  
Alexa Barwick ◽  
Dana Y Nakamura ◽  
James H Holmes ◽  
Joseph Molnar
Keyword(s):  
North American ◽  
Service Providers ◽  
Multiple Choice ◽  
Scar Tissue ◽  
The United States ◽  
Burn Care ◽  
Speech Language Pathologist ◽  
Specific Protocol ◽  
Facial Burns ◽  
Therapy Interventions

Abstract Introduction Facial burns can be complicated by the development of scar tissue and contractures, resulting in decreased flexibility of the tissue involved in swallowing, facial expression, and verbal communication. Maximizing functional range of motion is an important preventative measure for improving functional outcomes for swallowing, communication, and for the prevention of microstomia. A range of therapy interventions including stretching, massage, compression, and use of appliances has been reported in the literature; however, there is limited to no information on current practice patterns amongst North American providers (MD, DO, PA, NP, etc.) or therapists (PT, OT, and SLP). Methods A RedCap survey was developed by a Speech-Language Pathologist and Occupational Therapist involved in burn care. The survey consisted of 18 total questions, with participants responding to between 12–13 questions due to branching logic. Questions were related to demographic and service provision related to facial massage and stretching. Survey questions were multiple choice, multiple answer multiple choice, or contained text boxes. The survey was distributed to Providers and Therapists from the United Stated of America and Canada who were members of the American Burn Association (ABA). Results A total of 69 surveys were collected, with 57 surveys meeting criteria for inclusion. Respondents consisted of therapists 68%, providers 23%, and other health professionals 9%. Forty-six ABA burn centers from across the United States and Canada were represented. The majority of respondents had over 10 years of experience working with burn patients. 91% of respondents reported that facial massage and stretching was used as a tool at their facility. Respondents, who report facial massage is utilized at their facility, report OT as being the primary discipline responsible for assessing (67%) and completing (65%) facial massage, with 85% reporting additional discipline(s) also participating in facial massage. 9% of respondents report that facial massage and stretching is not utilized at their facility following facial burns. Of those who responded that facial massage and stretching is not utilized following facial burns, 40% felt this would be beneficial to patients, while 60% were unsure. Conclusions Facial scar management is an important part of burn care, with the majority of respondents reporting completion of facial massage and stretching as part of the services provided to patients who have suffered facial burns. OTs are the primary service providers for facial massage and stretching post facial burn. Practices for facial massage varies greatly, with the majority of respondents reporting no specific protocol for facial massage and stretching is followed.

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