Barriers to the Management of Patients with Surgically Remediable Intractable Epilepsy

CNS Spectrums ◽  
2004 ◽  
Vol 9 (2) ◽  
pp. 146-152 ◽  
Author(s):  
Kari Swarztrauber
Keyword(s):  
Surgical Treatment ◽  
Vulnerable Populations ◽  
Small Proportion ◽  
Scientific Evidence ◽  
Healthcare Providers ◽  
Intractable Epilepsy ◽  
Minority Populations ◽  
Recommended Care ◽  
Patients With Epilepsy ◽  
Specific Barriers

AbstractIt is estimated that only a small proportion of patients with surgically remediable intractable epilepsy receive surgical treatment. There are multiple reasons why this is the case. Patients with intractable epilepsy are sometimes severely disabled and disability can create barriers to getting recommended care. Patients with epilepsy are not well informed about their condition and the available treatments. The incidence of epilepsy is similar in minority populations, and surgically remediable epilepsy frequently presents in adolescence. Nevertheless, these vulnerable populations have specific barriers to receiving epilepsy care, which are often not addressed. In addition, despite scientific evidence for the benefits of the surgical treatment of epilepsy, many healthcare providers do not recommend or adequately discuss surgery with patients. Solutions to these barriers will require interventions that result in informed and capable patients who actively participate in their care and healthcare providers who practice culturally sensitive, recommended care.

scholarly journals Selective Amygdalohippocampectomy: Indications and Follow-up

1991 ◽  
Vol 18 (S4) ◽  
pp. 617-627 ◽  
Author(s):  
Heinz Gregor Wieser
Keyword(s):  
Surgical Treatment ◽  
Small Proportion ◽  
A Priori ◽  
Temporal Lobectomy ◽  
Anterior Temporal Lobectomy ◽  
Surgical Interventions ◽  
Selective Amygdalohippocampectomy ◽  
Patients With Epilepsy ◽  
Real Chance

ABSTRACT:Selective amygdalohippocampectomy (AHE) offers a real chance of cure only in patients with welldefined, precisely localized “epileptogenic area”, i.e. seizure focus. Therefore, a priori only a small proportion of all patients with epilepsy can meet the criteria for selective surgical interventions. From the evidence in patients meeting the criteria for AHE, we conclude that this technique is to be preferred to the “standard” anterior temporal lobectomy and represents a more selective but still effective surgical treatment of epilepsy.

Psychiatric and psychosocial morbidity 1 year after epilepsy surgery

2020 ◽  
pp. 1-8
Author(s):  
S. Patel ◽  
M. Clancy ◽  
H. Barry ◽  
N. Quigley ◽  
M. Clarke ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Epilepsy Surgery ◽  
Refractory Epilepsy ◽  
Post Surgery ◽  
Axis I ◽  
Patients With Epilepsy ◽  
The Impact

Abstract Objectives: There is a high rate of psychiatric comorbidity in patients with epilepsy. However, the impact of surgical treatment of refractory epilepsy on psychopathology remains under investigation. We aimed to examine the impact of epilepsy surgery on psychopathology and quality of life at 1-year post-surgery in a population of patients with epilepsy refractory to medication. Methods: This study initially assessed 48 patients with refractory epilepsy using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Hospital Anxiety and Depression Scale (HADS) and the Quality of Life in Epilepsy Inventory 89 (QOLIE-89) on admission to an Epilepsy Monitoring Unit (EMU) as part of their pre-surgical assessment. These patients were again assessed using the SCID-I, QOLIE-89 and HADS at 1-year follow-up post-surgery. Results: There was a significant reduction in psychopathology, particularly psychosis, following surgery at 1-year follow-up (p < 0.021). There were no new cases of de novo psychosis and surgery was also associated with a significant improvement in the quality of life scores (p < 0.001). Conclusions: This study demonstrates the impact of epilepsy surgery on psychopathology and quality of life in a patient population with refractory surgery. The presence of a psychiatric illness should not be a barrier to access surgical treatment.

Measurement of Barriers, Attitudes, and Expectations for Sitting Less in Pregnancy

2021 ◽  
Vol 45 (6) ◽  
pp. 956-970
Author(s):  
Bethany Barone Gibbs ◽  
Melissa A. Jones ◽  
Kara M. Whitaker ◽  
Sharon Taverno Ross ◽  
Kelliann K. Davis
Keyword(s):  
Pregnant Women ◽  
Sedentary Time ◽  
Healthcare Providers ◽  
Outcome Expectations ◽  
Physical Symptoms ◽  
Third Trimester ◽  
Household Chores ◽  
Prenatal Interventions ◽  
Specific Barriers ◽  
In Pregnancy

Objective: Our objective was to develop, validate, and describe findings from an instrument to measure barriers, attitudes, and outcome expectations of sitting less in pregnant women. Methods: This validation (sub-study 1) and descriptive study (sub-study 2) evaluated a new questionnaire measuring sedentary time in pregnant women (N=131) in each trimester. Results: In sub-study 1, construct validity was supported by associations between device-measured sedentary time and questionnaire scores. An optimized questionnaire removed infrequently reported and non-correlated items. The original and optimized questionnaires with scoring instructions are provided. In sub-study 2, physical symptoms and work were most commonly reported as major reasons for sitting in pregnancy, followed by leisure, family, and social activities. Some women reported limiting sitting due to boredom/restlessness, to improve energy or health, and to control weight. In the third trimester, some women reported sitting more/less due to pain and encouragement from family, friends, and co-workers. Few women reported household chores or pregnancy risks as reasons to sit, felt sitting was healthy or necessary during pregnancy, or were encouraged to sit by healthcare providers. Conclusions: The developed questionnaire demonstrated validity and identified barriers to and expectations of sitting less during pregnancy. Prenatal interventions to reduce sitting should address general and pregnancy-specific barriers.

Craniosynostosis following hemispherectomy in a 2.5-month-old boy with intractable epilepsy

2011 ◽  
Vol 8 (5) ◽  
pp. 450-454 ◽  
Author(s):  
Mohammad-Ali Jazayeri ◽  
John N. Jensen ◽  
Sean M. Lew
Keyword(s):  
Surgical Treatment ◽  
Brain Volume ◽  
Intractable Epilepsy ◽  
Infantile Spasms ◽  
Cranial Vault ◽  
Volume Loss ◽  
Brain Volume Loss ◽  
Course Of Action ◽  
Cranial Vault Remodeling

The authors report on the case of a 6-week-old boy who presented with infantile spasms. At 2.5 months of age, the patient underwent a right hemispherectomy. Approximately 3 months postoperatively, the patient presented with left coronal craniosynostosis. Subsequent cranial vault remodeling resulted in satisfactory cosmesis. Four years after surgery, the patient remains seizure free without the need for anticonvulsant medications. The authors believe this to be the first reported case of iatrogenic craniosynostosis due to hemispherectomy, and they describe 2 potential mechanisms for its development. This case suggests that, in the surgical treatment of infants with intractable epilepsy, minimization of brain volume loss through disconnection techniques should be considered, among other factors, when determining the best course of action.

scholarly journals Imaging of intractable paediatric epilepsy

2015 ◽  
Vol 19 (2) ◽  
Author(s):  
Sanjay Prabhu ◽  
Nasreen Mahomed
Keyword(s):  
Imaging Techniques ◽  
Intractable Epilepsy ◽  
Imaging Features ◽  
Imaging Studies ◽  
Non Invasive ◽  
Multidisciplinary Meetings ◽  
Interdisciplinary Approaches ◽  
Structural Lesion ◽  
Patients With Epilepsy ◽  
Epileptogenic Foci

Approximately 20% of paediatric patients with epilepsy are refractory to medical therapies. In this subgroup of patients, neuroimaging plays an important role in identifying an epileptogenic focus. Successful identification of a structural lesion results in a better outcome following epilepsy surgery. Advances in imaging technologies, methods of epileptogenic region localisation and refinement of clinical evaluation of this group of patients in epilepsy centres have helped to widen the spectrum of children who could potentially benefit from surgical treatment. In this review, we discuss ways to optimise imaging techniques, list typical imaging features of common pathologies that can cause epilepsy, and potential pitfalls to be aware of whilst reviewing imaging studies in this challenging group of patients. The importance of multidisciplinary meetings to analyse and synthesise all the non-invasive data is emphasised. Our objectives are: to describe the four phases of evaluation of children with drug-resistant localisation-related epilepsy; to describe optimal imaging techniques that can help maximise detection of epileptogenic foci; to describe a systematic approach to reviewing magnetic resonance imaging of children with intractable epilepsy; to describe the features of common epileptogenic substrates; to list potential pitfalls whilst reviewing imaging studies in these patients; and to highlight the value of multimodality and interdisciplinary approaches to the management of this group of children.

scholarly journals Usefulness of magnetic motor evoked potentials in the surgical treatment of hemiplegic patients with intractable epilepsy

Seizure ◽  
2003 ◽  
Vol 12 (6) ◽  
pp. 373-378 ◽  
Author(s):  
TOHRU KAMIDA ◽  
HIROSHI BABA ◽  
KENJI ONO ◽  
MASATO YONEKURA ◽  
MINORU FUJIKI ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Evoked Potentials ◽  
Motor Evoked Potentials ◽  
Intractable Epilepsy

Ethical Issues in Qualitative Data Collection Among Vulnerable Populations in Healthcare Setting

2018 ◽  
pp. 80-97
Author(s):  
Seng Fah Tong ◽  
Wen Ting Tong ◽  
Wah Yun Low
Keyword(s):  
Data Collection ◽  
Therapeutic Relationship ◽  
Vulnerable Populations ◽  
Qualitative Data ◽  
Ethical Issues ◽  
Healthcare Providers ◽  
Healthcare Setting ◽  
Future Patient ◽  
Qualitative Data Collection

The chapter aims to highlight the ethical issues in qualitative data collection among vulnerable populations. Among the ethical issues are the conflict role of interviewers, adverse impact on future patient-therapist relationship, and emotional trauma both during and after data collection. The interviewers, usually healthcare providers, may subconsciously assume the role as a therapist during the interviews. Furthermore, the interviewers may encounter the participants (patients) in future clinical consultations; hence, information exchanges during the interviews could influence the therapeutic relationship. Recollection of experiences with an illness during the interviews can be a painful experience for patients. These ethical dilemmas can be addressed with appropriate sampling of participants and constant awareness of the researcher roles and relationships with the participants. Debriefing the participants with support is important to handle emotional upheavals.

Introduction

ESC CardioMed ◽  
2018 ◽  
pp. 1927-1928
Author(s):  
Giuseppe Boriani
Keyword(s):  
Clinical Skills ◽  
Care Delivery ◽  
Scientific Evidence ◽  
Healthcare Providers ◽  
Cardiac Pacing ◽  
Daily Practice ◽  
Specific Patient ◽  
Current Prevalence ◽  
History Of ◽  
The Impact

The history of pacing for bradycardia started more than 50 years ago and in these five decades the technologically driven evolution of devices and tools has been complemented by the acquisition of important scientific evidence of benefit in specific patient settings. The current prevalence of bradyarrhythmias requiring permanent cardiac pacing therapy is not precisely known, but the progressive ageing of the population makes it necessary to improve knowledge of the impact of bradycardia on patients’ health, as well as to improve the implementation in daily practice of the most appropriate and evidence-based device treatments, with an adequate reorganization of care. Moreover, the impressive technological evolution that occurred in this field, as a result of extensive cooperation between physicians, scientists, engineers, manufacturers, regulatory agencies, and healthcare providers, led to the appearance of new requirements such as improved clinical skills, the need for continuous education on rapidly evolving technology, the assessment of treatment costs, the need for consensus guidelines, and the need for reorganization of care delivery including telemedicine for device follow-up.

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