Epilepsy outcomes

Mesial temporal lobe epilepsy (MTLE) A type of epilepsy that consists of partial seizures arising from the mesial temporal lobe of the brain. Often this type of epilepsy is associated with an anatomic change described as hippocampal sclerosis. Patients with this type of epilepsy often have excellent outcomes with surgery for epilepsy. 

The ultimate outcome goal for any patient with epilepsy is elimination of all seizures without any adverse effects of the treatment. An effective treatment plan would allow the patient to pursue a normal lifestyle with complete control of seizures. Specifically, the treatment should enable the patient to drive, perform well in school, hold a reasonable job, and function effectively in the family and community. However, due to the intractability of the seizures or sensitivity to antiepileptic drugs (AEDs), many patients are not able to achieve these outcomes. In these cases, the goal of therapy is to provide a tolerable balance between reduced seizure severity and/or frequency and medication adverse effects that optimizes the individual s ability to have a lifestyle as nearly normal as possible. 

A native of England, Roy Bolbery, forty-two when interviewed, was ill throughout his childhood in London. At age six he had a severe adverse reaction to penicillin. His sleep frequently was interrupted by night terrors. And during the day he would suddenly feel ill for no apparent reason. The outcome of many medical tests was a diagnosis of mild epilepsy. His sister died in childhood of leukemia. His father suffered with tuberculosis. 

Lack of access to medicines and inappropriate doses result in serious morbidity and mortality, particularly for childhood infections and chronic diseases, such as hypertension, diabetes, epilepsy and mental disorders. Inappropriate use and over-use of medicines waste resources - often out-of-pocket payments by patients - and result in significant patient harm in terms of poor patient outcomes and adverse drug reactions. Furthermore, over-use of antimicrobials is leading to increased antimicrobial resistance and non-sterile injections to the transmission of hepatitis, HIV/AIDS and other blood-borne diseases. Finally, irrational over-use of medicines can stimulate inappropriate patient demand, and lead to reduced access and attendance rates due to medicine stock-outs and loss of patient confidence in the health system. 

Gilliam F. Optimizing health outcomes in active epilepsy. Neurology 2002 58(8 suppl 5) S9-20. 

Cost-effectiveness is an economic evaluation in which both the costs and the consequences of treatments are examined. The denominator of the cost-effectiveness ratio can be an intermediate outcome, such as a delay in the progression of a disease, or a final outcome, such as life-years saved. Once the outcome is measured, the costs associated with attaining this outcome form the numerator of the ratio. For example, suppose our interest is determining the relative value of drug therapy for epilepsy versus epilepsy... 

A neonatal form of hepatic failure has a rapidly fatal course and frequently includes severe hypotonia, myoclonus epilepsy, and psychomotor retardation [39]. Another type (found in children aged 2-18 months) has a milder clinical course with infrequent fatal outcome [11]. Abnormal histology (steatosis, micro and macro-nodular cirrhosis) and elevated plasma or cerebrospinal fluid (CSF) lactate are consistent features of the disease, regardless of the clinical subtype. The brain is often involved in these presentations, but other organs could also be involved. Dwarfism... 

A large number of epidemiology and case-control studies have examined the potential association between oral aluminum exposure and Alzheimer s disease. A number of these studies have been criticized for flawed patient selection, poor comparability of exposed and control groups, poor exposure assessment, poor assessment of health outcomes, and weak statistical correlations (Nieboer et al. 1995 Schupf et al. 1989). Studies conducted by Martyn et al. (1989), McLachlan et al. (1996), and Michel et al. (1990) have found an association between oral exposure to aluminum and an increased risk of Alzheimer s disease. In a survey study conducted by Martyn et al. (1989), the incidence of Alzheimer s disease in individuals under the age of 70 was estimated from computerized tomographic (CT) records. The 1,203 subjects lived in 88 county districts within England and Wales. Data on aluminum concentrations in the municipal water over a 10-year period were obtained from water authorities and water companies. The subjects were classified as having probable Alzheimer s disease, possible Alzheimer s disease, other causes of dementia, or epilepsy. The relative risks of Alzheimer s disease were elevated in the subjects living in districts with aluminum water concentrations of >0.01 mg/L. However, the relative risk exceeded unity only in the subjects with aluminum water concentrations of >0.11 mg/L (relative risk of 1.5, 95% confidence interval of 1.1-2.2). 

Outcomes in Elderly Patients With Newly Diagnosed and Treated Epilepsy Martin J. Brodie and Linda J. Stephen... 

Health Disparities in Epilepsy How Patient-Oriented Outcomes in Women Differ from Men Frank Gilliam... 

Gillham R, Kane K, Bryant-Comstock L, Brodie MJ. A double-blind comparison of lamotrigine and carbamazepine in newly diagnosed epilepsy with health-related quality of fife as an outcome measure. Seizure 2000 9(6) 375-9. 

Steegers-Theunissen RP, Renter WO, Borm GF, Thomas CM, Merkus HM, Op de Coul DA, De Jong PA, van Geijn HP, Wouters M, Eskes TK. Factors influencing the risk of abnormal pregnancy outcome in epileptic women a multi-centre prospective study. Epilepsy Res 1994 18(3) 261-9. 

Phenjdoin can aggravate symptoms and worsen outcome in patients with Baltic myoclonic epilepsy (SED-13, 140) (18) and susceptibility to neurological comphcations can be increased in patients with organic brain disorders. 

A study to document the outcomes of epilepsy treatment, conducted by Hirsch and Van Den Eeden (1997), illustrates some of the challenges associated with collecting burden of illness data. The traditional clinical measure of seizure frequency is no longer considered appropriate as the sole measure of outcome of treatment or surgical intervention. The additional variables to document the burden of illness that were found illustrate the gap between the type of data desired and what is available. Hitherto, QOL had been assessed in epilepsy patients using no fewer than 12 different... 

Hirsch JD, Van Den Eeden SK. 1997. Epilepsy searching for outcomes data beyond seizure frequency in a managed care organization. J. Outcomes Manage. 4(1) 9-11, 14-17, 23. 

Very few examples of outcomes research in neurological pharmacy exist. However, one historical control study determined that the implementation of a pharmacokinetics consultation service in an epilepsy clinic decreased seizure frequency and number of adverse effects compared with the baseline frequency in the 4 months prior to offering the service.A second study conducted in the pediatric epilepsy population described the effect of establishment of a specialty pediatric epilepsy clinic with clinical pharmacy services. Compared with patients seen before the beginning of the clinic, patients seen in the specialty clinic had decreased numbers of antiepileptic drugs and decreased doses of these medications. Frequency of seizures was not examined in this report. 

Baker GA, Smith DF, Dewey M, et al. The initial development of a health-related quality of life model as an outcome measure in epilepsy. Epilepsy Res 1993 16 65-81. 

Smith D, Baker G, Davies G, et al. Outcomes of assessing treatment with lamotiigine in partial epilepsy. Epilepsia 1993 34 312-22. 

HIV/AIDS human immunodeficiency virus/acquired immunodeficiency syndrome HUI Health Utilities Index HYEs healthy-year equivalents ICC intraclass correlation coefficient KDQOL Kidney Disease Quality of Life instrument MCS mental component summary scale of the SF-36 MOS-HTV Medical Outcomes Study HIV Health Survey MOT Medical Outcomes Trust MSQOL Migraine Specific Quality of Life NHP Nottingham Health Profile PCS physical component summary scale of the SF-36 QALY quahty-adjusted hfe year QOL quahty of life QOLIE Quality of Life in Epilepsy QWB Quality of WeU-Being scale SF-36 MOS 36-Item Short-Form Health Survey SIP Sickness Impact Profile VAS visual analog scale WY well year YHL years of healthy life... 

Benbadis S, Chelune GJ, Stanford LD, et al. Outcome and complications of epilepsy sugery. In Wylhe E, ed. The Treatment of Epilepsy, 3d ed. Philadelphia, Lippincott Williams Wilkins, 2001 1197-1211. 

Smith DF, Hutton JL, Sandemann D, et al. The prognosis of primary intracerebral tumours presenting with epilepsy The outcome of medical and surgical management. J Neurol Neurosurg Psychiatry. 1991 54 915-920. 

---