Abstract:
OBJECTIVE:Among children with epilepsy, to develop and evaluate a model to predict emergency department (ED) use, an indicator of poor disease control and/or poor access to care. METHODS:We used electronic health record data from 2013 to predict ED use in 2014 at 2 centers, benchmarking predictive performance against machine learning algorithms. We evaluated algorithms by calculating the expected yearly ED visits among the 5% highest risk individuals. We estimated the breakeven cost per patient per year for an intervention that reduced ED visits by 10%. We estimated uncertainty via cross-validation and bootstrapping. RESULTS:Bivariate analyses showed multiple potential predictors of ED use (demographics, social determinants of health, comorbidities, insurance, disease severity, and prior health care utilization). A 3-variable model (prior ED use, insurance, number of antiepileptic drugs [AEDs]) performed as well as the best machine learning algorithm at one center (N = 2730; ED visits among top 5% highest risk, 3-variable model, mean = 2.9, interquartile range [IQR] = 2.7-3.1 vs Random Forest, mean = 2.9, IQR = 2.7-3.1), and superior at the second (N = 784; mean = 2.5, IQR = 2.2-2.9 vs mean = 1.9, IQR = 1.6-2.5). The per-patient-per-year breakeven point using this model to identify high-risk individuals was $958 (95% confidence interval [CI] = $568-$1390) at one center and $1086 (95% CI = $886-$1320) at the second. SIGNIFICANCE:Prior ED use, insurance status, and number of AEDs, taken together, predict future ED use for children with epilepsy. Our estimates suggest a program targeting high-risk children with epilepsy that reduced ED visits by 10% could spend approximately $1000 per patient per year and break even. Further work is indicated to develop and evaluate such programs.
journal_name
Epilepsiajournal_title
Epilepsiaauthors
Grinspan ZM,Patel AD,Hafeez B,Abramson EL,Kern LMdoi
10.1111/epi.13948subject
Has Abstractpub_date
2018-01-01 00:00:00pages
155-169issue
1eissn
0013-9580issn
1528-1167journal_volume
59pub_type
杂志文章,多中心研究相关文献
EPILEPSIA文献大全abstract:OBJECTIVE:Depression is a common comorbidity of epilepsy, and its timely identification in persons with epilepsy is essential. The use of screening tools to detect depression is common in epilepsy, but some scales in current use have not been validated using a gold standard in this population. The present study aims to...
journal_title:Epilepsia
pub_type: 杂志文章
doi:10.1111/epi.12754
更新日期:2014-10-01 00:00:00
abstract::Epilepsy-prone and epilepsy-resistant substrains were selectively bred from a strain of BALB/c mice; audiogenic-sensitive epilepsy-prone animals showed enhanced sensitivity to chemical convulsants. Treatment with pyridoxine (100 mg/L in drinking water) initiated at mating and continued throughout pregnancy and the lif...
journal_title:Epilepsia
pub_type: 杂志文章
doi:10.1111/j.1528-1157.1993.tb02373.x
更新日期:1993-01-01 00:00:00
abstract:PURPOSE:We determined the prevalence of oral disorders and the dental treatment needs of outpatients with epilepsy. METHODS:A questionnaire was administered to 56 consecutive patients (35 males, 21 females) presenting to an outpatient clinic. All patients underwent dental examinations. The clinical and diagnostic feat...
journal_title:Epilepsia
pub_type: 杂志文章
doi:10.1111/j.1528-1157.1998.tb01426.x
更新日期:1998-06-01 00:00:00
abstract:OBJECTIVE:There are limited data on the indications for the use of chronic invasive electroencephalography (EEG) monitoring (IEM) for pediatric epilepsy surgery. METHODS:We retrospectively studied 102 children who underwent intracranial monitoring to map critical cortex, localize the epileptogenic region, or resolve d...
journal_title:Epilepsia
pub_type: 杂志文章
doi:10.1111/epi.12983
更新日期:2015-07-01 00:00:00
abstract:PURPOSE:The possibility that a recent seizure or a recent change in antiepileptic medication might produce an occult change in neuropsychological performance is of interest, and especially so in the context of evaluation for epilepsy surgery. Such an evaluation is often done in a setting of video-EEG monitoring where a...
journal_title:Epilepsia
pub_type: 杂志文章
doi:10.1111/j.1528-1167.2007.01140.x
更新日期:2007-10-01 00:00:00
abstract::We examined postoperative changes in the memory function of 68 people with unilateral hippocampal sclerosis (HS) who underwent epilepsy surgery and had no previous clinical memory impairments. One in four with right HS (RHS) and one in five with left HS (LHS) in our sample of 323 people with unilateral HS performed wi...
journal_title:Epilepsia
pub_type: 杂志文章
doi:10.1111/epi.12319
更新日期:2013-09-01 00:00:00
abstract::Fetal heart rate (FHR) characteristics of fetuses exposed and not exposed to antiepileptic drugs (AEDs) were studied. FHR is considered to reflect central nervous system (CNS) integrity. Three intervals during pregnancy were investigated: 20, 32, and 38 weeks. At 32 and 38 weeks, FHR was studied in relation to quiet (...
journal_title:Epilepsia
pub_type: 杂志文章
doi:10.1111/j.1528-1157.1992.tb02353.x
更新日期:1992-07-01 00:00:00
abstract::In order to evaluate immediate recall and learning in epileptic patients, four tests were chosen: Wechsler's memory span for digits, graphic reproduction of geometric figures from the Wechsler Memory Scale, learning of a list of words from the Rey Memory Scale, and recognition of these words. These tests were performe...
journal_title:Epilepsia
pub_type: 杂志文章
doi:10.1111/j.1528-1157.1983.tb04878.x
更新日期:1983-04-01 00:00:00
abstract::Amygdala kindling, the progressive development of seizures following repeated electrical stimulation, has been used as a model of epileptogenesis, neural memory, and the development of behavioral alterations. In an attempt to interfere with the kindling process, electroconvulsive seizures (ECS) were administered 6 h p...
journal_title:Epilepsia
pub_type: 杂志文章
doi:10.1111/j.1528-1157.1984.tb04181.x
更新日期:1984-04-01 00:00:00
abstract::Ketogenic diets (KDs) are effective treatments for epilepsy. The mechanisms of action are poorly understood. In some experimental seizure models, calorie restriction and hypoglycemia may augment the antiseizure effects of KDs. In addition, inhibiting glycolysis or diverting glucose from the glycolytic pathway inhibits...
journal_title:Epilepsia
pub_type: 杂志文章,评审
doi:10.1111/j.1528-1167.2008.01847.x
更新日期:2008-11-01 00:00:00
abstract::Neurotrophic factors are involved in the survival of neurons as well as in the proliferation and differentiation of neuronal precursors. Therefore, modulating their levels in lesion areas may exert favorable effects on seizure-induced damage. However, it is unclear if damage limitation or repair may prevent epileptoge...
journal_title:Epilepsia
pub_type: 杂志文章
doi:10.1111/j.1528-1167.2010.02609.x
更新日期:2010-07-01 00:00:00
abstract:OBJECTIVE:The need for alternative pharmacologic strategies in treatment of epilepsies is pressing for about 30% of patients with epilepsy who do not experience satisfactory seizure control with present treatments. In temporal lobe epilepsy (TLE) even up to 80% of patients are pharmacoresistant, and surgical resection ...
journal_title:Epilepsia
pub_type: 杂志文章
doi:10.1111/epi.13360
更新日期:2016-05-01 00:00:00
abstract::Genomic findings are emerging rapidly in 2 large, closely related epilepsy research consortia: the Epilepsy Phenome/Genome Project and Epi4K. Disclosure of individual results to participants in genomic research is increasingly viewed as an ethical obligation, but strategies for return of results were not included in t...
journal_title:Epilepsia
pub_type: 杂志文章
doi:10.1111/epi.14530
更新日期:2018-09-01 00:00:00
abstract::We conducted a systematic review to determine which noninvasive technologies should be used in the workup for epilepsy surgery to identify structural or functional abnormalities to help locate the site of seizure onset. The review focused on patients where there was insufficient confidence, in either the decision to g...
journal_title:Epilepsia
pub_type: 杂志文章,评审
doi:10.1111/j.1528-1167.2012.03534.x
更新日期:2012-08-01 00:00:00
abstract::Five-hundred twelve epileptic children were followed longitudinally for several years. The 2- and 4-year remission statuses at the latest examination were 50.6 and 44.2%, respectively. Dividing our sample into groups showing onset of seizures in infancy or at 2-3, 4-7, 8-10, or 11-14 years, the remission rates were as...
journal_title:Epilepsia
pub_type: 杂志文章
doi:10.1111/j.1528-1157.1982.tb05053.x
更新日期:1982-02-01 00:00:00
abstract:PURPOSE:Temporal lobe epilepsy is associated with the inflammatory process related to the basic mechanisms that lead to seizure susceptibility and brain damage. Platelet-activating factor (PAF), a potent, short-lived phospholipid mediator of inflammation, participates in physiologic signaling in the brain. However, aft...
journal_title:Epilepsia
pub_type: 杂志文章
doi:10.1111/j.1528-1167.2010.02920.x
更新日期:2011-03-01 00:00:00
abstract:OBJECTIVE:Diazepam buccal film (DBF) is in development for treatment of patients experiencing bouts of increased seizure activity. We assessed safety, tolerability, and usability of self- or caregiver-administered DBF in the outpatient setting. METHODS:Patients aged 2-65 years needing treatment with a rescue benzodiaz...
journal_title:Epilepsia
pub_type: 杂志文章
doi:10.1111/epi.16696
更新日期:2020-11-01 00:00:00
abstract::The antiepileptic drug sodium valproate (VPA) can provoke a thrombocytopenia or platelet dysfunction, with or without hemorrhages. These unwanted side effects are probably infrequent or, at least, have little clinical importance except in patients undergoing surgery. Thromboelastography appears to be a reliable screen...
journal_title:Epilepsia
pub_type: 杂志文章,评审
doi:10.1111/j.1528-1157.1981.tb04094.x
更新日期:1981-04-01 00:00:00
abstract:PURPOSE:The antiepileptic effects of clobazam, a 1,5-benzodiazepine, have been well documented in animal experiments and clinical trials. However, the drug's mechanisms of antiepileptic actions are still undetermined. The purpose of this study was to learn how clobazam and its active metabolite modulate gamma-aminobuty...
journal_title:Epilepsia
pub_type: 杂志文章
doi:10.1111/j.1528-1157.1996.tb00643.x
更新日期:1996-08-01 00:00:00
abstract::An understanding of the basic principles of human inheritance patterns is necessary to appreciate the variety and complexity of genetic influences in the epilepsies. The various modes of human inheritance include single gene (mendelian), chromosomal, mitochondrial, and multifactorial/polygenic. Recent insights regardi...
journal_title:Epilepsia
pub_type: 杂志文章
doi:10.1111/j.1528-1157.1994.tb05924.x
更新日期:1994-01-01 00:00:00
abstract:PURPOSE:To determine prevalence of active epilepsy in school children in a defined area and assess the usefulness of International League Against Epilepsy classification of seizures and epileptic syndromes, with special emphasis on frequency, additional handicaps, and therapeutic problems of severe cases. METHODS:The ...
journal_title:Epilepsia
pub_type: 杂志文章
doi:10.1111/j.1528-1157.2000.tb00246.x
更新日期:2000-07-01 00:00:00
abstract:OBJECTIVE:To assess the ability of functional MRI (fMRI) to predict postoperative language decline compared to direct cortical stimulation (DCS) in epilepsy surgery patients. METHODS:In this prospective case series, 17 patients with drug-resistant epilepsy had intracranial monitoring and resection from 2012 to 2016 wi...
journal_title:Epilepsia
pub_type: 杂志文章
doi:10.1111/epi.14666
更新日期:2019-03-01 00:00:00
abstract::Androgen deficiency is unusually common among men with epilepsy. It may contribute to reproductive and sexual dysfunction and possibly exacerbate seizure frequency. The most important androgen is testosterone. it exists in the serum in a free form or bound to albumin or sex hormone-binding globulin (SHBG). Free testos...
journal_title:Epilepsia
pub_type: 杂志文章,评审
doi:10.1111/j.1528-1157.1991.tb05890.x
更新日期:1991-01-01 00:00:00
abstract:OBJECTIVE:Recent reports define temporal lobe epilepsy with amygdala enlargement (TLE-AE) as a distinct electroclinical syndrome comparable to TLE with hippocampal sclerosis. In this retrospective observational study, we present the largest consecutive series of patients with new-onset TLE-AE to date and describe clini...
journal_title:Epilepsia
pub_type: 杂志文章
doi:10.1111/epi.13471
更新日期:2016-09-01 00:00:00
abstract:OBJECTIVE:Many antiseizure drugs (ASDs) act on voltage-dependent sodium channels, and the molecular basis of these effects is well established. In contrast, how ASDs act on the level of neuronal networks is much less understood. METHODS:In the present study, we determined the effects of eslicarbazepine (S-Lic) on diff...
journal_title:Epilepsia
pub_type: 杂志文章
doi:10.1111/epi.16808
更新日期:2021-01-16 00:00:00
abstract::Lennox-Gastaut syndrome (LGS) is a rare epileptic encephalopathy with a peak age of onset of 3-5 years of age. Reported prevalence rates for LGS vary widely from 1-10% of all childhood epilepsies. Incidence rates are much lower. LGS is characterized by intractable, multiple, generalized seizure types and an interictal...
journal_title:Epilepsia
pub_type: 杂志文章
doi:10.1111/j.1528-1167.2011.03177.x
更新日期:2011-08-01 00:00:00
abstract::Recent clinical trials indicate that cannabidiol (CBD) may reduce seizure frequency in pediatric patients with certain forms of treatment-resistant epilepsy. Many of these patients experience significant impairments in quality of life (QOL) in physical, mental, and social dimensions of health. In this study, we measur...
journal_title:Epilepsia
pub_type: 杂志文章
doi:10.1111/epi.13815
更新日期:2017-08-01 00:00:00
abstract::The intracarotid amobarbital procedure (IAP) is frequently used to determine hemispheric language dominance and memory competence in individuals with intractable epilepsy before surgical intervention. The present study focused on outcome results concerning use of this technique in children. The IAP was an effective to...
journal_title:Epilepsia
pub_type: 杂志文章
doi:10.1111/j.1528-1157.1992.tb01755.x
更新日期:1992-11-01 00:00:00
abstract::We aimed to determine whether analysis of EEG envelope trend aids bedside detection of neonatal seizures. Five neonatal EEGs with multiple seizures were used to determine optimal trend parameters for seizure detection. Using these parameters, envelope trends were generated on eight additional EEGs, evaluated by experi...
journal_title:Epilepsia
pub_type: 杂志文章
doi:10.1111/j.1528-1167.2007.01425.x
更新日期:2008-02-01 00:00:00
abstract:PURPOSE:The main objective of this research is the development of automated video processing and analysis procedures aimed at the recognition and characterization of the types of neonatal seizures. The long-term goal of this research is the integration of these computational procedures into the development of a stand-a...
journal_title:Epilepsia
pub_type: 杂志文章
doi:10.1111/j.1528-1167.2005.56504.x
更新日期:2005-06-01 00:00:00