American Epilepsy Society (AES): Annual Meeting

SAN DIEGO – The Institute of Medicine’s report, "Epilepsy Across the Spectrum," has led to several new epilepsy initiatives at the U.S. Department of Health and Human Services, according to Assistant Secretary for Health Howard Koh.

"I want to assure you that since the day this report came out we have been meeting regularly to review what our department has done and what we can do [to] make these recommendations come alive," Dr. Koh said at the annual meeting of the American Epilepsy Society.

Several HHS agencies have already made progress. For instance, in November the Centers for Disease Control and Prevention (CDC) updated its epilepsy epidemiology statistics for the first time since 1994, a "direct result" of the Institute of Medicine’s call for further research, he said.

The new analysis estimated that about 4.1 million U.S. children and adults suffer from the condition, and that only about half of adults with active disease have seen a neurologist or epileptologist in the preceding year – an indication, perhaps, of inadequate care.

"CDC is going to take these [measurements] on a regular basis over the next decade. These data help us compare health status, comorbidities, and risk factors [with] the general public, [which] is absolutely vital," Dr. Koh said.

The CDC also partnered with the Epilepsy Foundation to launch the "Now I Know" national epilepsy media awareness campaign which, among other things, invites patients to share their experiences and advice on Facebook.

Also, "we are trying to advance the concept of self-management for people with epilepsy," which is a major IOM theme, Dr. Koh said. The CDC is working with several universities on the issue and has also helped launch a free self-management program on the Epilepsy Foundation’s website called Web-Ease.

The Food and Drug Administration is fully engaged in collaborative efforts, too, Dr. Koh said, including working with several groups to identify risk factors for Sudden Unexplained Death in Epilepsy (SUDEP), to explore if adult epilepsy drug outcomes can be extrapolated to children to speed pediatric drug development, and to establish protocols for head-to-head bioequivalency testing of generic and branded epilepsy drugs, including lamotrigine.

The IOM report – published in March 2012 – also emphasized the need to improve pediatric epilepsy care in rural and underserved settings. That task has fallen to the Health Resources and Services Administration (HRSA), which has been working on the issue since 2003, Dr. Koh said.

HRSA’s Project Access tracks epilepsy outcomes for children in underserved areas and helps ensure that they have proper insurance coverage, community services organization, referral agreements, and adult-care transfers when needed.

Telemedicine has been a major theme, especially in demonstration projects in Michigan and Nebraska. "Preliminary data" from those efforts "indicate families are spending less time traveling to reach specialty care [and that their] average wait for neurology visits has decreased from 4-6 months to 2-4 weeks," Dr. Koh said.

The National Institute of Neurological Disorders and Strokes, one of the National Institutes of Health, is on board too, issuing grants to study the effects of diet on epilepsy and whether or not it’s safe to take epilepsy drugs during pregnancy, among other research concerns, Dr. Koh said.

SAN DIEGO – The Institute of Medicine’s report, "Epilepsy Across the Spectrum," has led to several new epilepsy initiatives at the U.S. Department of Health and Human Services, according to Assistant Secretary for Health Howard Koh.

"I want to assure you that since the day this report came out we have been meeting regularly to review what our department has done and what we can do [to] make these recommendations come alive," Dr. Koh said at the annual meeting of the American Epilepsy Society.

Several HHS agencies have already made progress. For instance, in November the Centers for Disease Control and Prevention (CDC) updated its epilepsy epidemiology statistics for the first time since 1994, a "direct result" of the Institute of Medicine’s call for further research, he said.

The new analysis estimated that about 4.1 million U.S. children and adults suffer from the condition, and that only about half of adults with active disease have seen a neurologist or epileptologist in the preceding year – an indication, perhaps, of inadequate care.

"CDC is going to take these [measurements] on a regular basis over the next decade. These data help us compare health status, comorbidities, and risk factors [with] the general public, [which] is absolutely vital," Dr. Koh said.

The CDC also partnered with the Epilepsy Foundation to launch the "Now I Know" national epilepsy media awareness campaign which, among other things, invites patients to share their experiences and advice on Facebook.

Also, "we are trying to advance the concept of self-management for people with epilepsy," which is a major IOM theme, Dr. Koh said. The CDC is working with several universities on the issue and has also helped launch a free self-management program on the Epilepsy Foundation’s website called Web-Ease.

The Food and Drug Administration is fully engaged in collaborative efforts, too, Dr. Koh said, including working with several groups to identify risk factors for Sudden Unexplained Death in Epilepsy (SUDEP), to explore if adult epilepsy drug outcomes can be extrapolated to children to speed pediatric drug development, and to establish protocols for head-to-head bioequivalency testing of generic and branded epilepsy drugs, including lamotrigine.

The IOM report – published in March 2012 – also emphasized the need to improve pediatric epilepsy care in rural and underserved settings. That task has fallen to the Health Resources and Services Administration (HRSA), which has been working on the issue since 2003, Dr. Koh said.

HRSA’s Project Access tracks epilepsy outcomes for children in underserved areas and helps ensure that they have proper insurance coverage, community services organization, referral agreements, and adult-care transfers when needed.

Telemedicine has been a major theme, especially in demonstration projects in Michigan and Nebraska. "Preliminary data" from those efforts "indicate families are spending less time traveling to reach specialty care [and that their] average wait for neurology visits has decreased from 4-6 months to 2-4 weeks," Dr. Koh said.

The National Institute of Neurological Disorders and Strokes, one of the National Institutes of Health, is on board too, issuing grants to study the effects of diet on epilepsy and whether or not it’s safe to take epilepsy drugs during pregnancy, among other research concerns, Dr. Koh said.

SAN DIEGO – The Institute of Medicine’s report, "Epilepsy Across the Spectrum," has led to several new epilepsy initiatives at the U.S. Department of Health and Human Services, according to Assistant Secretary for Health Howard Koh.

"I want to assure you that since the day this report came out we have been meeting regularly to review what our department has done and what we can do [to] make these recommendations come alive," Dr. Koh said at the annual meeting of the American Epilepsy Society.

Several HHS agencies have already made progress. For instance, in November the Centers for Disease Control and Prevention (CDC) updated its epilepsy epidemiology statistics for the first time since 1994, a "direct result" of the Institute of Medicine’s call for further research, he said.

The new analysis estimated that about 4.1 million U.S. children and adults suffer from the condition, and that only about half of adults with active disease have seen a neurologist or epileptologist in the preceding year – an indication, perhaps, of inadequate care.

"CDC is going to take these [measurements] on a regular basis over the next decade. These data help us compare health status, comorbidities, and risk factors [with] the general public, [which] is absolutely vital," Dr. Koh said.

The CDC also partnered with the Epilepsy Foundation to launch the "Now I Know" national epilepsy media awareness campaign which, among other things, invites patients to share their experiences and advice on Facebook.

Also, "we are trying to advance the concept of self-management for people with epilepsy," which is a major IOM theme, Dr. Koh said. The CDC is working with several universities on the issue and has also helped launch a free self-management program on the Epilepsy Foundation’s website called Web-Ease.

The Food and Drug Administration is fully engaged in collaborative efforts, too, Dr. Koh said, including working with several groups to identify risk factors for Sudden Unexplained Death in Epilepsy (SUDEP), to explore if adult epilepsy drug outcomes can be extrapolated to children to speed pediatric drug development, and to establish protocols for head-to-head bioequivalency testing of generic and branded epilepsy drugs, including lamotrigine.

The IOM report – published in March 2012 – also emphasized the need to improve pediatric epilepsy care in rural and underserved settings. That task has fallen to the Health Resources and Services Administration (HRSA), which has been working on the issue since 2003, Dr. Koh said.

HRSA’s Project Access tracks epilepsy outcomes for children in underserved areas and helps ensure that they have proper insurance coverage, community services organization, referral agreements, and adult-care transfers when needed.

Telemedicine has been a major theme, especially in demonstration projects in Michigan and Nebraska. "Preliminary data" from those efforts "indicate families are spending less time traveling to reach specialty care [and that their] average wait for neurology visits has decreased from 4-6 months to 2-4 weeks," Dr. Koh said.

The National Institute of Neurological Disorders and Strokes, one of the National Institutes of Health, is on board too, issuing grants to study the effects of diet on epilepsy and whether or not it’s safe to take epilepsy drugs during pregnancy, among other research concerns, Dr. Koh said.

SAN DIEGO  – There are no discernible differences in the efficacy of the two most common antiepileptic drugs used in children with new-onset focal epilepsy, results from a retrospective cohort study found.

The drugs – levetiracetam and oxcarbazepine – had never been compared in a pediatric population before, Dr. Jenny L. Wilson said in an interview during a poster session at the annual meeting of the American Epilepsy Society.

"This is not a randomized, controlled trial, but it’s still a very good measure of effectiveness of two very commonly used antiepileptic drugs for pediatric epilepsy," said Dr. Wilson, a child neurology resident at the Children’s Hospital of Philadelphia. "We’re showing that the retention rates are similar, and that efficacy is comparable to studies of older antiepileptic drugs. Retention rate is a practical outcome measure which takes into account the efficacy and tolerability of an antiepileptic medication. It’s some initial data for clinicians to consider when they’re making decisions about a first-line antiepileptic drug."

Dr. Wilson and her colleague, Dr. Sudha Kilaru Kessler, at the university reviewed the medical records of 221 children aged 1-17 years whose epilepsy was diagnosed within 3 months of their first visit to Children’s Hospital between January 2008 and June 2010. They excluded patients with status epilepticus, those who were hospitalized for more than 2 days at presentation, and those who had less than 6 months of follow-up data available, and used Kaplan-Meier methods to estimate the rates of drug failure, which was defined as discontinuation of the first antiepileptic drug (AED) or addition of a second AED.

Of the 221 patients, the median age at first seizure was 5.7 years, and the median age at initiation of AED therapy was 6.5 years.

The researchers reported findings from 1,435 person-months for levetiracetam and 2,137 person-months for oxcarbazepine. The rate of AED failure was 2.8/100 person-months in the levetiracetam group and 1.7/100 person-months in the oxcarbazepine group, a difference that did not reach statistical significance (hazard ratio, 0.7; P = .11). Among all children, the probability of remaining on the first AED was 76% at 6 months and 58% at 40 months, and drug failures due to lack of tolerability occurred sooner than failures due to a lack of efficacy (a median of 1.7 months vs. 4.56 months).

Univariate analysis revealed the following reasons for failure: lack of efficacy (12.4/100 person-months), tolerability (26.2/100 person-months), and both (17.8/100 person-months). "In my experience, kids with behavioral problems tend to fail levetiracetam a little bit more because of behavioral side effects," Dr. Wilson commented. "We did not see significant differences in that regard. The failure rates were very similar."

She concluded that the overall study results suggest that levetiracetam and oxcarbazepine "are very good first-line agents for new diagnosis of focal epilepsy in children" and emphasized that a randomized trial is warranted to confirm the findings.

The study was funded by the National Institutes of Health. The researchers stated that they had no relevant financial disclosures.

SAN DIEGO  – There are no discernible differences in the efficacy of the two most common antiepileptic drugs used in children with new-onset focal epilepsy, results from a retrospective cohort study found.

The drugs – levetiracetam and oxcarbazepine – had never been compared in a pediatric population before, Dr. Jenny L. Wilson said in an interview during a poster session at the annual meeting of the American Epilepsy Society.

"This is not a randomized, controlled trial, but it’s still a very good measure of effectiveness of two very commonly used antiepileptic drugs for pediatric epilepsy," said Dr. Wilson, a child neurology resident at the Children’s Hospital of Philadelphia. "We’re showing that the retention rates are similar, and that efficacy is comparable to studies of older antiepileptic drugs. Retention rate is a practical outcome measure which takes into account the efficacy and tolerability of an antiepileptic medication. It’s some initial data for clinicians to consider when they’re making decisions about a first-line antiepileptic drug."

Dr. Wilson and her colleague, Dr. Sudha Kilaru Kessler, at the university reviewed the medical records of 221 children aged 1-17 years whose epilepsy was diagnosed within 3 months of their first visit to Children’s Hospital between January 2008 and June 2010. They excluded patients with status epilepticus, those who were hospitalized for more than 2 days at presentation, and those who had less than 6 months of follow-up data available, and used Kaplan-Meier methods to estimate the rates of drug failure, which was defined as discontinuation of the first antiepileptic drug (AED) or addition of a second AED.

Of the 221 patients, the median age at first seizure was 5.7 years, and the median age at initiation of AED therapy was 6.5 years.

The researchers reported findings from 1,435 person-months for levetiracetam and 2,137 person-months for oxcarbazepine. The rate of AED failure was 2.8/100 person-months in the levetiracetam group and 1.7/100 person-months in the oxcarbazepine group, a difference that did not reach statistical significance (hazard ratio, 0.7; P = .11). Among all children, the probability of remaining on the first AED was 76% at 6 months and 58% at 40 months, and drug failures due to lack of tolerability occurred sooner than failures due to a lack of efficacy (a median of 1.7 months vs. 4.56 months).

Univariate analysis revealed the following reasons for failure: lack of efficacy (12.4/100 person-months), tolerability (26.2/100 person-months), and both (17.8/100 person-months). "In my experience, kids with behavioral problems tend to fail levetiracetam a little bit more because of behavioral side effects," Dr. Wilson commented. "We did not see significant differences in that regard. The failure rates were very similar."

She concluded that the overall study results suggest that levetiracetam and oxcarbazepine "are very good first-line agents for new diagnosis of focal epilepsy in children" and emphasized that a randomized trial is warranted to confirm the findings.

The study was funded by the National Institutes of Health. The researchers stated that they had no relevant financial disclosures.

SAN DIEGO  – There are no discernible differences in the efficacy of the two most common antiepileptic drugs used in children with new-onset focal epilepsy, results from a retrospective cohort study found.

The drugs – levetiracetam and oxcarbazepine – had never been compared in a pediatric population before, Dr. Jenny L. Wilson said in an interview during a poster session at the annual meeting of the American Epilepsy Society.

"This is not a randomized, controlled trial, but it’s still a very good measure of effectiveness of two very commonly used antiepileptic drugs for pediatric epilepsy," said Dr. Wilson, a child neurology resident at the Children’s Hospital of Philadelphia. "We’re showing that the retention rates are similar, and that efficacy is comparable to studies of older antiepileptic drugs. Retention rate is a practical outcome measure which takes into account the efficacy and tolerability of an antiepileptic medication. It’s some initial data for clinicians to consider when they’re making decisions about a first-line antiepileptic drug."

Dr. Wilson and her colleague, Dr. Sudha Kilaru Kessler, at the university reviewed the medical records of 221 children aged 1-17 years whose epilepsy was diagnosed within 3 months of their first visit to Children’s Hospital between January 2008 and June 2010. They excluded patients with status epilepticus, those who were hospitalized for more than 2 days at presentation, and those who had less than 6 months of follow-up data available, and used Kaplan-Meier methods to estimate the rates of drug failure, which was defined as discontinuation of the first antiepileptic drug (AED) or addition of a second AED.

Of the 221 patients, the median age at first seizure was 5.7 years, and the median age at initiation of AED therapy was 6.5 years.

The researchers reported findings from 1,435 person-months for levetiracetam and 2,137 person-months for oxcarbazepine. The rate of AED failure was 2.8/100 person-months in the levetiracetam group and 1.7/100 person-months in the oxcarbazepine group, a difference that did not reach statistical significance (hazard ratio, 0.7; P = .11). Among all children, the probability of remaining on the first AED was 76% at 6 months and 58% at 40 months, and drug failures due to lack of tolerability occurred sooner than failures due to a lack of efficacy (a median of 1.7 months vs. 4.56 months).

Univariate analysis revealed the following reasons for failure: lack of efficacy (12.4/100 person-months), tolerability (26.2/100 person-months), and both (17.8/100 person-months). "In my experience, kids with behavioral problems tend to fail levetiracetam a little bit more because of behavioral side effects," Dr. Wilson commented. "We did not see significant differences in that regard. The failure rates were very similar."

She concluded that the overall study results suggest that levetiracetam and oxcarbazepine "are very good first-line agents for new diagnosis of focal epilepsy in children" and emphasized that a randomized trial is warranted to confirm the findings.

The study was funded by the National Institutes of Health. The researchers stated that they had no relevant financial disclosures.

SAN DIEGO – High-dose prednisolone appears to be an effective alternative to adrenocorticotropic hormone for infantile spasms, according to a small prospective study from the University of California, Los Angeles.

Sixty percent of infants (18 of 30) with the potentially devastating childhood epilepsy for a median of 4.5 months were cured following 2 weeks of high-dose oral prednisolone, 8 mg/kg per day. Five of the 12 (42%) who failed prednisolone were cured with a subsequent 2 weeks of intramuscular adrenocorticotropic hormone (ACTH), 150 IU/m² per day.

Lead investigator and neurologist Dr. Shaun Hussain, a UCLA clinical assistant professor of pediatrics, said he did the study because "there’s no agreement about which agent is best and which dosage is best." Previous studies have shown superiority for ACTH, but only against doses of prednisolone lower than 2 mg/kg per day; more recent work suggests high-dose prednisolone works as well as ACTH (Epilepsy Behav. 2009;14:674-6).

ACTH is also far more expensive than prednisolone, about $125,000 per treatment course instead of $200.

A large multicenter randomized comparison trial is needed to settle the debate; Dr. Hussain said he hopes to organize one. In the meantime, institutions like UCLA are leaning toward high-dose prednisolone, others lean toward ACTH, and some have abandoned ACTH altogether, he said.

For now, "I don’t think ACTH should be abandoned. I say that because five patients ended up responding to ACTH after they failed prednisolone. I believe instead of abandoning ACTH, it should simply be reserved for those patients who fail high-dose prednisolone," Dr. Hussain said at the annual meeting of the American Epilepsy Society.

Spasm onset in the 30 infants came at a median of 6.5 months, and study entry at a median of 11 months. Most of the children were boys, most were symptomatic, and most had an identifiable cause of the problem, including prenatal stroke and focal cortical dysplasia.

The children had failed prior treatments, contributing to the delay in trial entry. "We think in general [the delay] contributed to intractability," and that the cumulative response rate of "77% [23 of 30] is pretty good given our refractory population." Had the protocol been applied to a less-refractory group, it’s possible the results would have rivaled the 90% or so ACTH cure rates reported with more tractable patients, Dr. Hussain said.

That some patients who failed high-dose prednisolone responded to ACTH may mean that ACTH is better, or that prednisolone should have been continued a week or two longer, he noted.

Twenty patients (67%) had hypsarrhythmia at baseline, confirmed by overnight video EEGs. A second overnight video EEG assessed cure rates – a complete absence of spasms and hypsarrhythmia – following 2 weeks of prednisolone. The 12 infants who did not respond were immediately switched to ACTH.

Two of the 18 prednisolone responders (11%) relapsed within 5 months; one responded to additional high-dose prednisolone. Two of the five ACTH responders (40%) relapsed.

Dr. Hussain is an adviser to Questcor, the maker of ACTH (Acthar Gel), and has a research grant from Lundbeck.

SAN DIEGO – High-dose prednisolone appears to be an effective alternative to adrenocorticotropic hormone for infantile spasms, according to a small prospective study from the University of California, Los Angeles.

Sixty percent of infants (18 of 30) with the potentially devastating childhood epilepsy for a median of 4.5 months were cured following 2 weeks of high-dose oral prednisolone, 8 mg/kg per day. Five of the 12 (42%) who failed prednisolone were cured with a subsequent 2 weeks of intramuscular adrenocorticotropic hormone (ACTH), 150 IU/m² per day.

Lead investigator and neurologist Dr. Shaun Hussain, a UCLA clinical assistant professor of pediatrics, said he did the study because "there’s no agreement about which agent is best and which dosage is best." Previous studies have shown superiority for ACTH, but only against doses of prednisolone lower than 2 mg/kg per day; more recent work suggests high-dose prednisolone works as well as ACTH (Epilepsy Behav. 2009;14:674-6).

ACTH is also far more expensive than prednisolone, about $125,000 per treatment course instead of $200.

A large multicenter randomized comparison trial is needed to settle the debate; Dr. Hussain said he hopes to organize one. In the meantime, institutions like UCLA are leaning toward high-dose prednisolone, others lean toward ACTH, and some have abandoned ACTH altogether, he said.

For now, "I don’t think ACTH should be abandoned. I say that because five patients ended up responding to ACTH after they failed prednisolone. I believe instead of abandoning ACTH, it should simply be reserved for those patients who fail high-dose prednisolone," Dr. Hussain said at the annual meeting of the American Epilepsy Society.

Spasm onset in the 30 infants came at a median of 6.5 months, and study entry at a median of 11 months. Most of the children were boys, most were symptomatic, and most had an identifiable cause of the problem, including prenatal stroke and focal cortical dysplasia.

The children had failed prior treatments, contributing to the delay in trial entry. "We think in general [the delay] contributed to intractability," and that the cumulative response rate of "77% [23 of 30] is pretty good given our refractory population." Had the protocol been applied to a less-refractory group, it’s possible the results would have rivaled the 90% or so ACTH cure rates reported with more tractable patients, Dr. Hussain said.

That some patients who failed high-dose prednisolone responded to ACTH may mean that ACTH is better, or that prednisolone should have been continued a week or two longer, he noted.

Twenty patients (67%) had hypsarrhythmia at baseline, confirmed by overnight video EEGs. A second overnight video EEG assessed cure rates – a complete absence of spasms and hypsarrhythmia – following 2 weeks of prednisolone. The 12 infants who did not respond were immediately switched to ACTH.

Two of the 18 prednisolone responders (11%) relapsed within 5 months; one responded to additional high-dose prednisolone. Two of the five ACTH responders (40%) relapsed.

Dr. Hussain is an adviser to Questcor, the maker of ACTH (Acthar Gel), and has a research grant from Lundbeck.

SAN DIEGO – High-dose prednisolone appears to be an effective alternative to adrenocorticotropic hormone for infantile spasms, according to a small prospective study from the University of California, Los Angeles.

Sixty percent of infants (18 of 30) with the potentially devastating childhood epilepsy for a median of 4.5 months were cured following 2 weeks of high-dose oral prednisolone, 8 mg/kg per day. Five of the 12 (42%) who failed prednisolone were cured with a subsequent 2 weeks of intramuscular adrenocorticotropic hormone (ACTH), 150 IU/m² per day.

Lead investigator and neurologist Dr. Shaun Hussain, a UCLA clinical assistant professor of pediatrics, said he did the study because "there’s no agreement about which agent is best and which dosage is best." Previous studies have shown superiority for ACTH, but only against doses of prednisolone lower than 2 mg/kg per day; more recent work suggests high-dose prednisolone works as well as ACTH (Epilepsy Behav. 2009;14:674-6).

ACTH is also far more expensive than prednisolone, about $125,000 per treatment course instead of $200.

A large multicenter randomized comparison trial is needed to settle the debate; Dr. Hussain said he hopes to organize one. In the meantime, institutions like UCLA are leaning toward high-dose prednisolone, others lean toward ACTH, and some have abandoned ACTH altogether, he said.

For now, "I don’t think ACTH should be abandoned. I say that because five patients ended up responding to ACTH after they failed prednisolone. I believe instead of abandoning ACTH, it should simply be reserved for those patients who fail high-dose prednisolone," Dr. Hussain said at the annual meeting of the American Epilepsy Society.

Spasm onset in the 30 infants came at a median of 6.5 months, and study entry at a median of 11 months. Most of the children were boys, most were symptomatic, and most had an identifiable cause of the problem, including prenatal stroke and focal cortical dysplasia.

The children had failed prior treatments, contributing to the delay in trial entry. "We think in general [the delay] contributed to intractability," and that the cumulative response rate of "77% [23 of 30] is pretty good given our refractory population." Had the protocol been applied to a less-refractory group, it’s possible the results would have rivaled the 90% or so ACTH cure rates reported with more tractable patients, Dr. Hussain said.

That some patients who failed high-dose prednisolone responded to ACTH may mean that ACTH is better, or that prednisolone should have been continued a week or two longer, he noted.

Twenty patients (67%) had hypsarrhythmia at baseline, confirmed by overnight video EEGs. A second overnight video EEG assessed cure rates – a complete absence of spasms and hypsarrhythmia – following 2 weeks of prednisolone. The 12 infants who did not respond were immediately switched to ACTH.

Two of the 18 prednisolone responders (11%) relapsed within 5 months; one responded to additional high-dose prednisolone. Two of the five ACTH responders (40%) relapsed.

Dr. Hussain is an adviser to Questcor, the maker of ACTH (Acthar Gel), and has a research grant from Lundbeck.

SAN DIEGO – Behavioral health professionals who work in a school or hospital had better attitudes and felt more comfortable managing psychopathology in children with epilepsy, compared with their counterparts who provided treatment in the community.

However, no statistically significant differences were observed in the attitude, knowledge, or comfort in managing psychopathology among providers in the various disciplines who care for this patient population. The findings come from an online survey of 146 psychologists, clinical counselors, clinical social workers, physicians, and other health care professionals.

"For the past several years there have been many articles coming out regarding the comorbidities in epilepsy, [including] depression, anxiety, cognitive difficulties, issues with memory and learning," Jayne Pacheco-Phillips said during a press briefing at annual meeting of the American Epilepsy Society. "Everyone has started to talk about referring these children early for services. However, no one has looked at what the people who are providing the services know or believe about epilepsy."

Ms. Pacheco-Phillips, a licensed independent social worker in the division of child neurology at Nationwide Children’s Hospital, Columbus, Ohio, and her associates sent a link to an online questionnaire to the clinical directors of nine government-funded agencies that primarily provide services to children and youth in Franklin County, Ohio. Clinical directors then distributed the link to an estimated 500 behavioral health care professionals. The survey included 21 questions based on a Likert scale and was intended to assess the knowledge, attitudes, and the comfort of behavioral health professionals in terms of managing psychopathology in children with epilepsy.

Ms. Pacheco-Phillips reported findings from 146 providers who completed the entire survey, including psychologists, clinical counselors, clinical social workers, physicians, nurses, and those in unlicensed/other roles. Of the 146 respondents, 70 said that they did not know someone with epilepsy while the remaining 76 said they did.

Respondents who provided services in an institution, such as a school or hospital, possessed better attitudes (P = .003) and more comfort in managing psychopathology in children with epilepsy (P = .002), compared with those who provided treatment in the community, such as in families’ homes or in mental health agencies. Respondents who reported having witnessed a seizure had a higher comfort level in managing psychopathology in children (P = .001). Similarly, those who know someone with epilepsy indicated a better attitude (P = .003) and are more comfortable managing psychopathology (P = .007).

"Within the disciplines, we did not find a statistically significant difference in attitudes," Ms. Pacheco-Phillips added. "We were surprised by this. The physicians [surveyed] included psychiatrists and developmental pediatricians. Another interesting point was that 84% of the providers overall indicated that they would be interested in receiving additional education about psychopathology in epilepsy."

One of her coauthors, Dr. Lorie D. Hamiwka, characterized the study findings as important for all epilepsy providers, "because when families come to the clinic, a lot of these comorbidities that we see are more debilitating for children and families than the seizures are themselves," said Dr. Hamiwka, a neurologist at Nationwide Children’s. "They’re often a bigger burden."

Ms. Pacheco-Phillips said that she had no relevant financial conflicts to disclose.

SAN DIEGO – Behavioral health professionals who work in a school or hospital had better attitudes and felt more comfortable managing psychopathology in children with epilepsy, compared with their counterparts who provided treatment in the community.

However, no statistically significant differences were observed in the attitude, knowledge, or comfort in managing psychopathology among providers in the various disciplines who care for this patient population. The findings come from an online survey of 146 psychologists, clinical counselors, clinical social workers, physicians, and other health care professionals.

"For the past several years there have been many articles coming out regarding the comorbidities in epilepsy, [including] depression, anxiety, cognitive difficulties, issues with memory and learning," Jayne Pacheco-Phillips said during a press briefing at annual meeting of the American Epilepsy Society. "Everyone has started to talk about referring these children early for services. However, no one has looked at what the people who are providing the services know or believe about epilepsy."

Ms. Pacheco-Phillips, a licensed independent social worker in the division of child neurology at Nationwide Children’s Hospital, Columbus, Ohio, and her associates sent a link to an online questionnaire to the clinical directors of nine government-funded agencies that primarily provide services to children and youth in Franklin County, Ohio. Clinical directors then distributed the link to an estimated 500 behavioral health care professionals. The survey included 21 questions based on a Likert scale and was intended to assess the knowledge, attitudes, and the comfort of behavioral health professionals in terms of managing psychopathology in children with epilepsy.

Ms. Pacheco-Phillips reported findings from 146 providers who completed the entire survey, including psychologists, clinical counselors, clinical social workers, physicians, nurses, and those in unlicensed/other roles. Of the 146 respondents, 70 said that they did not know someone with epilepsy while the remaining 76 said they did.

Respondents who provided services in an institution, such as a school or hospital, possessed better attitudes (P = .003) and more comfort in managing psychopathology in children with epilepsy (P = .002), compared with those who provided treatment in the community, such as in families’ homes or in mental health agencies. Respondents who reported having witnessed a seizure had a higher comfort level in managing psychopathology in children (P = .001). Similarly, those who know someone with epilepsy indicated a better attitude (P = .003) and are more comfortable managing psychopathology (P = .007).

"Within the disciplines, we did not find a statistically significant difference in attitudes," Ms. Pacheco-Phillips added. "We were surprised by this. The physicians [surveyed] included psychiatrists and developmental pediatricians. Another interesting point was that 84% of the providers overall indicated that they would be interested in receiving additional education about psychopathology in epilepsy."

One of her coauthors, Dr. Lorie D. Hamiwka, characterized the study findings as important for all epilepsy providers, "because when families come to the clinic, a lot of these comorbidities that we see are more debilitating for children and families than the seizures are themselves," said Dr. Hamiwka, a neurologist at Nationwide Children’s. "They’re often a bigger burden."

Ms. Pacheco-Phillips said that she had no relevant financial conflicts to disclose.

SAN DIEGO – Behavioral health professionals who work in a school or hospital had better attitudes and felt more comfortable managing psychopathology in children with epilepsy, compared with their counterparts who provided treatment in the community.

However, no statistically significant differences were observed in the attitude, knowledge, or comfort in managing psychopathology among providers in the various disciplines who care for this patient population. The findings come from an online survey of 146 psychologists, clinical counselors, clinical social workers, physicians, and other health care professionals.

"For the past several years there have been many articles coming out regarding the comorbidities in epilepsy, [including] depression, anxiety, cognitive difficulties, issues with memory and learning," Jayne Pacheco-Phillips said during a press briefing at annual meeting of the American Epilepsy Society. "Everyone has started to talk about referring these children early for services. However, no one has looked at what the people who are providing the services know or believe about epilepsy."

Ms. Pacheco-Phillips, a licensed independent social worker in the division of child neurology at Nationwide Children’s Hospital, Columbus, Ohio, and her associates sent a link to an online questionnaire to the clinical directors of nine government-funded agencies that primarily provide services to children and youth in Franklin County, Ohio. Clinical directors then distributed the link to an estimated 500 behavioral health care professionals. The survey included 21 questions based on a Likert scale and was intended to assess the knowledge, attitudes, and the comfort of behavioral health professionals in terms of managing psychopathology in children with epilepsy.

Ms. Pacheco-Phillips reported findings from 146 providers who completed the entire survey, including psychologists, clinical counselors, clinical social workers, physicians, nurses, and those in unlicensed/other roles. Of the 146 respondents, 70 said that they did not know someone with epilepsy while the remaining 76 said they did.

Respondents who provided services in an institution, such as a school or hospital, possessed better attitudes (P = .003) and more comfort in managing psychopathology in children with epilepsy (P = .002), compared with those who provided treatment in the community, such as in families’ homes or in mental health agencies. Respondents who reported having witnessed a seizure had a higher comfort level in managing psychopathology in children (P = .001). Similarly, those who know someone with epilepsy indicated a better attitude (P = .003) and are more comfortable managing psychopathology (P = .007).

"Within the disciplines, we did not find a statistically significant difference in attitudes," Ms. Pacheco-Phillips added. "We were surprised by this. The physicians [surveyed] included psychiatrists and developmental pediatricians. Another interesting point was that 84% of the providers overall indicated that they would be interested in receiving additional education about psychopathology in epilepsy."

One of her coauthors, Dr. Lorie D. Hamiwka, characterized the study findings as important for all epilepsy providers, "because when families come to the clinic, a lot of these comorbidities that we see are more debilitating for children and families than the seizures are themselves," said Dr. Hamiwka, a neurologist at Nationwide Children’s. "They’re often a bigger burden."

Ms. Pacheco-Phillips said that she had no relevant financial conflicts to disclose.

SAN DIEGO – Nearly one-third of children with epilepsy had neurodevelopmental problems at the onset of unprovoked seizures, results from a large registry study found.

The finding supports the notion that seizures "often appear as part of a broader neurological problem, and that in most cases comorbidities should not be considered consequences of the seizure disorder," researchers led by Dr. Eva Andell wrote in a poster presented at the annual meeting of the American Epilepsy Society.

Dr. Andell, a pediatrician at Karolinska University, Stockholm, and her associates analyzed data from the Stockholm Incidence Register of Epilepsy, a surveillance system established in 2001 with the intent to identify incident cases of first unprovoked seizures and epilepsy among residents of Northern Stockholm.

The researchers limited their analysis to medical records from the time of first unprovoked seizure and the following 6 months among 766 children aged 0-18 years who were followed through Dec. 31, 2006, and set out to identify potential comorbidities that included developmental delay, language problems, mental retardation, cerebral palsy, autism spectrum disorders, attention-deficit/hyperactivity disorder (ADHD), and psychiatric diagnoses.

"Comorbidities were considered to be present when a relevant defined diagnosis appeared in the medical records or when the records included a clear problem description highly suggestive of a comorbidity," the researchers explained in their abstract.

Of the 766 children, 247 (32%) had one or two of the defined comorbidities at the time of the first recognized seizure or in the following 6 months. Of these, 87 (11%) were diagnosed with, or suspected to have two or more of the following diagnoses: mental retardation, cerebral palsy, autism spectrum disorders, ADHD, and psychiatric diagnoses.

The prevalence of all studied comorbidities was more common in the seizure cohort compared with reported rates in the general pediatric population, especially mental retardation (16% vs. 3%, respectively), cerebral palsy (9% vs. 0.2%), autism spectrum disorders (7% vs. 1%), and ADHD (6% vs. 5%).

In an interview, Dr. Andell advised clinicians to "not to forget to look into whether children with epilepsy have a comorbidity, and to treat the comorbidity as well."

Dr. Andell said she had no relevant financial conflicts to disclose.

SAN DIEGO – Nearly one-third of children with epilepsy had neurodevelopmental problems at the onset of unprovoked seizures, results from a large registry study found.

The finding supports the notion that seizures "often appear as part of a broader neurological problem, and that in most cases comorbidities should not be considered consequences of the seizure disorder," researchers led by Dr. Eva Andell wrote in a poster presented at the annual meeting of the American Epilepsy Society.

Dr. Andell, a pediatrician at Karolinska University, Stockholm, and her associates analyzed data from the Stockholm Incidence Register of Epilepsy, a surveillance system established in 2001 with the intent to identify incident cases of first unprovoked seizures and epilepsy among residents of Northern Stockholm.

The researchers limited their analysis to medical records from the time of first unprovoked seizure and the following 6 months among 766 children aged 0-18 years who were followed through Dec. 31, 2006, and set out to identify potential comorbidities that included developmental delay, language problems, mental retardation, cerebral palsy, autism spectrum disorders, attention-deficit/hyperactivity disorder (ADHD), and psychiatric diagnoses.

"Comorbidities were considered to be present when a relevant defined diagnosis appeared in the medical records or when the records included a clear problem description highly suggestive of a comorbidity," the researchers explained in their abstract.

Of the 766 children, 247 (32%) had one or two of the defined comorbidities at the time of the first recognized seizure or in the following 6 months. Of these, 87 (11%) were diagnosed with, or suspected to have two or more of the following diagnoses: mental retardation, cerebral palsy, autism spectrum disorders, ADHD, and psychiatric diagnoses.

The prevalence of all studied comorbidities was more common in the seizure cohort compared with reported rates in the general pediatric population, especially mental retardation (16% vs. 3%, respectively), cerebral palsy (9% vs. 0.2%), autism spectrum disorders (7% vs. 1%), and ADHD (6% vs. 5%).

In an interview, Dr. Andell advised clinicians to "not to forget to look into whether children with epilepsy have a comorbidity, and to treat the comorbidity as well."

Dr. Andell said she had no relevant financial conflicts to disclose.

SAN DIEGO – Nearly one-third of children with epilepsy had neurodevelopmental problems at the onset of unprovoked seizures, results from a large registry study found.

The finding supports the notion that seizures "often appear as part of a broader neurological problem, and that in most cases comorbidities should not be considered consequences of the seizure disorder," researchers led by Dr. Eva Andell wrote in a poster presented at the annual meeting of the American Epilepsy Society.

Dr. Andell, a pediatrician at Karolinska University, Stockholm, and her associates analyzed data from the Stockholm Incidence Register of Epilepsy, a surveillance system established in 2001 with the intent to identify incident cases of first unprovoked seizures and epilepsy among residents of Northern Stockholm.

The researchers limited their analysis to medical records from the time of first unprovoked seizure and the following 6 months among 766 children aged 0-18 years who were followed through Dec. 31, 2006, and set out to identify potential comorbidities that included developmental delay, language problems, mental retardation, cerebral palsy, autism spectrum disorders, attention-deficit/hyperactivity disorder (ADHD), and psychiatric diagnoses.

"Comorbidities were considered to be present when a relevant defined diagnosis appeared in the medical records or when the records included a clear problem description highly suggestive of a comorbidity," the researchers explained in their abstract.

Of the 766 children, 247 (32%) had one or two of the defined comorbidities at the time of the first recognized seizure or in the following 6 months. Of these, 87 (11%) were diagnosed with, or suspected to have two or more of the following diagnoses: mental retardation, cerebral palsy, autism spectrum disorders, ADHD, and psychiatric diagnoses.

The prevalence of all studied comorbidities was more common in the seizure cohort compared with reported rates in the general pediatric population, especially mental retardation (16% vs. 3%, respectively), cerebral palsy (9% vs. 0.2%), autism spectrum disorders (7% vs. 1%), and ADHD (6% vs. 5%).

In an interview, Dr. Andell advised clinicians to "not to forget to look into whether children with epilepsy have a comorbidity, and to treat the comorbidity as well."

Dr. Andell said she had no relevant financial conflicts to disclose.

SAN DIEGO – Selective serotonin reuptake inhibitor and serotonin-norepinephrine reuptake inhibitor antidepressants did not increase seizure frequency in a retrospective series of epilepsy patients seen at Rush University Medical Center in Chicago.

The researchers investigated how 84 adult epilepsy patients fared after being put on the drugs for 6 months. None had an increase – and some actually had a decrease – in seizure frequency, and almost all had improvements in their baseline depression and anxiety.

"There’s a long-held misconception that antidepressants have proconvulsive properties," probably because a few older tricyclic antidepressants and bupropion do, said lead investigator Dr. Ramses Ribot, a neurophysiology fellow at Rush.

That concern has carried over to SSRIs and SNRIs, for which there is no evidence of a proseizure effect. As a result, neurologists "are very hesitant to" prescribe the newer agents to epilepsy patients, and depression and anxiety – both common in epilepsy – remain "definitely undertreated," Dr. Ribot said at the annual meeting of the American Epilepsy Society.

Seventy-nine patients in the study were on SSRIs, most commonly escitalopram (Lexapro); the remaining five were taking SNRIs.

Among the 44 who entered the study with fewer than one seizure per month, seizure frequency did not change during antidepressant therapy.

Among the 40 patients who entered with 1-12 seizures per month, seizure frequency was reduced to fewer than one per month in 11 (27.5%) and did not change in 27 (68%). Seizures increased from one per month to two or three in two patients. Overall, 16 (40%) of the 40 patients had a greater than 50% reduction in seizure frequency.

The findings suggest that "these medications could have an anticonvulsant effect" – something that’s been suggested in previous research as well, Dr. Ribot said (Neurology 1995;45:1926-7).

Sixty-one of the 71 patients (86%) for whom psychiatric evaluations were available had improvements or remissions of depression and anxiety symptoms while on antidepressants, a finding that appeared to be independent of seizure frequency.

There were no procedural interventions or changes to antiepileptic drug regimens during the study and the 3 months leading up to it. The patients were over 18 years old, about evenly split between men and women, and clinically diagnosed with depression or anxiety disorders at baseline.

The researchers said that they have no disclosures.

SAN DIEGO – Selective serotonin reuptake inhibitor and serotonin-norepinephrine reuptake inhibitor antidepressants did not increase seizure frequency in a retrospective series of epilepsy patients seen at Rush University Medical Center in Chicago.

The researchers investigated how 84 adult epilepsy patients fared after being put on the drugs for 6 months. None had an increase – and some actually had a decrease – in seizure frequency, and almost all had improvements in their baseline depression and anxiety.

"There’s a long-held misconception that antidepressants have proconvulsive properties," probably because a few older tricyclic antidepressants and bupropion do, said lead investigator Dr. Ramses Ribot, a neurophysiology fellow at Rush.

That concern has carried over to SSRIs and SNRIs, for which there is no evidence of a proseizure effect. As a result, neurologists "are very hesitant to" prescribe the newer agents to epilepsy patients, and depression and anxiety – both common in epilepsy – remain "definitely undertreated," Dr. Ribot said at the annual meeting of the American Epilepsy Society.

Seventy-nine patients in the study were on SSRIs, most commonly escitalopram (Lexapro); the remaining five were taking SNRIs.

Among the 44 who entered the study with fewer than one seizure per month, seizure frequency did not change during antidepressant therapy.

Among the 40 patients who entered with 1-12 seizures per month, seizure frequency was reduced to fewer than one per month in 11 (27.5%) and did not change in 27 (68%). Seizures increased from one per month to two or three in two patients. Overall, 16 (40%) of the 40 patients had a greater than 50% reduction in seizure frequency.

The findings suggest that "these medications could have an anticonvulsant effect" – something that’s been suggested in previous research as well, Dr. Ribot said (Neurology 1995;45:1926-7).

Sixty-one of the 71 patients (86%) for whom psychiatric evaluations were available had improvements or remissions of depression and anxiety symptoms while on antidepressants, a finding that appeared to be independent of seizure frequency.

There were no procedural interventions or changes to antiepileptic drug regimens during the study and the 3 months leading up to it. The patients were over 18 years old, about evenly split between men and women, and clinically diagnosed with depression or anxiety disorders at baseline.

The researchers said that they have no disclosures.

SAN DIEGO – Selective serotonin reuptake inhibitor and serotonin-norepinephrine reuptake inhibitor antidepressants did not increase seizure frequency in a retrospective series of epilepsy patients seen at Rush University Medical Center in Chicago.

The researchers investigated how 84 adult epilepsy patients fared after being put on the drugs for 6 months. None had an increase – and some actually had a decrease – in seizure frequency, and almost all had improvements in their baseline depression and anxiety.

"There’s a long-held misconception that antidepressants have proconvulsive properties," probably because a few older tricyclic antidepressants and bupropion do, said lead investigator Dr. Ramses Ribot, a neurophysiology fellow at Rush.

That concern has carried over to SSRIs and SNRIs, for which there is no evidence of a proseizure effect. As a result, neurologists "are very hesitant to" prescribe the newer agents to epilepsy patients, and depression and anxiety – both common in epilepsy – remain "definitely undertreated," Dr. Ribot said at the annual meeting of the American Epilepsy Society.

Seventy-nine patients in the study were on SSRIs, most commonly escitalopram (Lexapro); the remaining five were taking SNRIs.

Among the 44 who entered the study with fewer than one seizure per month, seizure frequency did not change during antidepressant therapy.

Among the 40 patients who entered with 1-12 seizures per month, seizure frequency was reduced to fewer than one per month in 11 (27.5%) and did not change in 27 (68%). Seizures increased from one per month to two or three in two patients. Overall, 16 (40%) of the 40 patients had a greater than 50% reduction in seizure frequency.

The findings suggest that "these medications could have an anticonvulsant effect" – something that’s been suggested in previous research as well, Dr. Ribot said (Neurology 1995;45:1926-7).

Sixty-one of the 71 patients (86%) for whom psychiatric evaluations were available had improvements or remissions of depression and anxiety symptoms while on antidepressants, a finding that appeared to be independent of seizure frequency.

There were no procedural interventions or changes to antiepileptic drug regimens during the study and the 3 months leading up to it. The patients were over 18 years old, about evenly split between men and women, and clinically diagnosed with depression or anxiety disorders at baseline.

The researchers said that they have no disclosures.

SAN DIEGO – Bilateral stimulation of the anterior nuclei of the thalamus led to a median reduction in partial-onset seizure frequency of 69% after a follow-up period of 5 years in the ongoing multicenter, double-blind, randomized SANTE trial.

"We were surprised that these patients still showed improvement, despite the fact that they had failed so many other treatments, including surgery," Dr. Vicenta Salanova said during a press briefing at the annual meeting of the American Epilepsy Society. "We were happy to see that."

Based on SANTE (Stimulation of the Anterior Nucleus of Thalamus for Epilepsy) trial results to date, deep brain stimulation (DBS) therapy for medically refractory partial and secondarily generalized seizures has been approved in Europe and in Canada, but it remains investigational in the United States. In 2010, the SANTE trial’s sponsor, Medtronic, submitted a premarket approval application for DBS therapy in epilepsy with the Food and Drug Administration, but both parties "are still in discussions," said Dr. Salanova, professor of neurology and director of the Indiana University School of Medicine Comprehensive Epilepsy Program in Indianapolis. "We hope that, based on the results we have shown, this will eventually be approved in the United States."

The researchers reported on 110 participants aged 18-65 years with at least six partial or secondarily generalized seizures per month who had failed treatment with at least three antiepileptic drugs. Patients with an IQ of less than 70 and those who were unable to complete neuropsychological testing or had progressive neurologic lesions were excluded from the analysis. After a baseline period of 3 months, the researchers used a stereotactic technique to implant DBS electrodes in the anterior nuclei of the thalamus bilaterally. One month after implantation, study participants were randomized to stimulation at 5 V or to no stimulation. After 3 months of blinded treatment, all patients received stimulation. Long-term follow-up began at 13 months with stimulation parameters adjusted at the investigators’ discretion. Primary analysis was performed on patients with at least 70 days of seizure diary data.

Dr. Salanova reported that by the end of the blinded treatment phase, the median seizure frequency reduction was 40% in patients who underwent DBS, compared with 14.5% in controls. Over time, patients in the DBS group demonstrated stepwise improvements in the median percent reduction of seizures from baseline, to 41% at 1 year, 56% at 2 years, and 69% at 5 years. Responder rates, defined as a 50% or greater reduction in seizure frequency, also progressively improved over time to 43% at 1 year, 54% at 2 years, and 69% at 5 years.

The researchers also found that over the entire study period 16% of patients were seizure-free for at least 6 months. They observed no unanticipated adverse device effects or symptomatic intracranial hemorrhages. Both the Liverpool Seizure Severity Scale and Quality of Life in Epilepsy-31 inventory also showed statistically significant improvement over baseline by 1 year, which continued to be significant at 5 years (P less than .001).

Medtronic sponsored the study. Dr. Salanova said that she had no relevant financial conflicts to disclose.

SAN DIEGO – Bilateral stimulation of the anterior nuclei of the thalamus led to a median reduction in partial-onset seizure frequency of 69% after a follow-up period of 5 years in the ongoing multicenter, double-blind, randomized SANTE trial.

"We were surprised that these patients still showed improvement, despite the fact that they had failed so many other treatments, including surgery," Dr. Vicenta Salanova said during a press briefing at the annual meeting of the American Epilepsy Society. "We were happy to see that."

Based on SANTE (Stimulation of the Anterior Nucleus of Thalamus for Epilepsy) trial results to date, deep brain stimulation (DBS) therapy for medically refractory partial and secondarily generalized seizures has been approved in Europe and in Canada, but it remains investigational in the United States. In 2010, the SANTE trial’s sponsor, Medtronic, submitted a premarket approval application for DBS therapy in epilepsy with the Food and Drug Administration, but both parties "are still in discussions," said Dr. Salanova, professor of neurology and director of the Indiana University School of Medicine Comprehensive Epilepsy Program in Indianapolis. "We hope that, based on the results we have shown, this will eventually be approved in the United States."

The researchers reported on 110 participants aged 18-65 years with at least six partial or secondarily generalized seizures per month who had failed treatment with at least three antiepileptic drugs. Patients with an IQ of less than 70 and those who were unable to complete neuropsychological testing or had progressive neurologic lesions were excluded from the analysis. After a baseline period of 3 months, the researchers used a stereotactic technique to implant DBS electrodes in the anterior nuclei of the thalamus bilaterally. One month after implantation, study participants were randomized to stimulation at 5 V or to no stimulation. After 3 months of blinded treatment, all patients received stimulation. Long-term follow-up began at 13 months with stimulation parameters adjusted at the investigators’ discretion. Primary analysis was performed on patients with at least 70 days of seizure diary data.

Dr. Salanova reported that by the end of the blinded treatment phase, the median seizure frequency reduction was 40% in patients who underwent DBS, compared with 14.5% in controls. Over time, patients in the DBS group demonstrated stepwise improvements in the median percent reduction of seizures from baseline, to 41% at 1 year, 56% at 2 years, and 69% at 5 years. Responder rates, defined as a 50% or greater reduction in seizure frequency, also progressively improved over time to 43% at 1 year, 54% at 2 years, and 69% at 5 years.

The researchers also found that over the entire study period 16% of patients were seizure-free for at least 6 months. They observed no unanticipated adverse device effects or symptomatic intracranial hemorrhages. Both the Liverpool Seizure Severity Scale and Quality of Life in Epilepsy-31 inventory also showed statistically significant improvement over baseline by 1 year, which continued to be significant at 5 years (P less than .001).

Medtronic sponsored the study. Dr. Salanova said that she had no relevant financial conflicts to disclose.

SAN DIEGO – Bilateral stimulation of the anterior nuclei of the thalamus led to a median reduction in partial-onset seizure frequency of 69% after a follow-up period of 5 years in the ongoing multicenter, double-blind, randomized SANTE trial.

"We were surprised that these patients still showed improvement, despite the fact that they had failed so many other treatments, including surgery," Dr. Vicenta Salanova said during a press briefing at the annual meeting of the American Epilepsy Society. "We were happy to see that."

Based on SANTE (Stimulation of the Anterior Nucleus of Thalamus for Epilepsy) trial results to date, deep brain stimulation (DBS) therapy for medically refractory partial and secondarily generalized seizures has been approved in Europe and in Canada, but it remains investigational in the United States. In 2010, the SANTE trial’s sponsor, Medtronic, submitted a premarket approval application for DBS therapy in epilepsy with the Food and Drug Administration, but both parties "are still in discussions," said Dr. Salanova, professor of neurology and director of the Indiana University School of Medicine Comprehensive Epilepsy Program in Indianapolis. "We hope that, based on the results we have shown, this will eventually be approved in the United States."

The researchers reported on 110 participants aged 18-65 years with at least six partial or secondarily generalized seizures per month who had failed treatment with at least three antiepileptic drugs. Patients with an IQ of less than 70 and those who were unable to complete neuropsychological testing or had progressive neurologic lesions were excluded from the analysis. After a baseline period of 3 months, the researchers used a stereotactic technique to implant DBS electrodes in the anterior nuclei of the thalamus bilaterally. One month after implantation, study participants were randomized to stimulation at 5 V or to no stimulation. After 3 months of blinded treatment, all patients received stimulation. Long-term follow-up began at 13 months with stimulation parameters adjusted at the investigators’ discretion. Primary analysis was performed on patients with at least 70 days of seizure diary data.

Dr. Salanova reported that by the end of the blinded treatment phase, the median seizure frequency reduction was 40% in patients who underwent DBS, compared with 14.5% in controls. Over time, patients in the DBS group demonstrated stepwise improvements in the median percent reduction of seizures from baseline, to 41% at 1 year, 56% at 2 years, and 69% at 5 years. Responder rates, defined as a 50% or greater reduction in seizure frequency, also progressively improved over time to 43% at 1 year, 54% at 2 years, and 69% at 5 years.

The researchers also found that over the entire study period 16% of patients were seizure-free for at least 6 months. They observed no unanticipated adverse device effects or symptomatic intracranial hemorrhages. Both the Liverpool Seizure Severity Scale and Quality of Life in Epilepsy-31 inventory also showed statistically significant improvement over baseline by 1 year, which continued to be significant at 5 years (P less than .001).

Medtronic sponsored the study. Dr. Salanova said that she had no relevant financial conflicts to disclose.

SAN DIEGO – Patients who have been newly diagnosed with psychogenic nonepileptic seizures probably benefit from counseling and group therapy sessions before being referred to psychiatrists for treatment of their underlying mental health problem.

That’s what researchers from the Baylor College of Medicine in Houston found when they compared outcomes for 16 patients immediately referred to mental health services following diagnosis – the standard practice – with 19 others who had three educational group sessions beforehand where they learned about their condition and shared coping strategies.

Following their sessions, support group patients were more likely than were control group patients to agree that "my attacks do not really bother me or affect my life that much anymore" (P less than .001) and that "I have some control over my attacks" (P = .003). Perhaps most tellingly, patients in the treatment group were significantly less likely to return to the emergency department 3 months later (7% vs. 22%, P = .018).

"Clearly what we are seeing is that these patients need significant follow-up, perhaps with a neurologist rather than simply a mental health professional. Psychiatrists don’t feel comfortable addressing this issue; having a team approach with both a neurologist and a psychiatrist probably gives the best outcomes," lead investigator Dr. Atul Maheshwari of the department of neurology at Baylor said at the annual meeting of the American Epilepsy Society.

The patients in the randomized study were adults, mostly male, and had at least one seizure per week. They were diagnosed with psychogenic nonepileptic events (PNEE) in the epilepsy monitoring unit of Houston Veterans Affairs Medical Center, where the study was conducted. Psychiatric problems included depression, posttraumatic stress disorder, and childhood abuse.

The diagnosis of PNEE is often a hard blow to patients convinced that they have epilepsy or a brain tumor and feel like doctors aren’t taking them seriously; accepting that their seizures are caused by underlying psychiatric stress is difficult, Dr. Maheshwari said.

A nurse practitioner led the group sessions with talking points and instructions from a neurologist. "The first session helped [patients] understand [that] PNEE are nonpathologic, don’t cause the brain to be fried or cause long-term brain damage, but still require treatment. They were also shown videos of what PNEE look like and what epileptic seizures look like so they could better understand what’s going on. [Ultimately,] the goal was to take away the negative associations people have with the diagnosis," Dr. Maheshwari said.

"Subsequent sessions focused on finding constructive channels for stress release, focusing on the idea that [PNEE] are manifestations of inner-stress. Patients were allowed to discuss what strategies they found helpful. Peer-to-peer acceptance and evaluation helps," Dr. Maheshwari said.

Identification of triggers, including those for PTSD, was key, Dr. Maheshwari said. "For some people, [that means] identifying the aura so they can use stress-release strategies to avoid the seizure. It’s helpful to share those things with other people who have the same symptoms so they can appreciate they are not alone."

He cautioned that research is ongoing and the trial’s results are preliminary. Also, more people in the treatment group were married. Dr. Maheshwari noted that "we didn’t help out with the frequency and intensity of events, but there were significant improvements in patients’ perceptions of the problem" and quality of life.

Dr. Maheshwari said that he had no relevant disclosures.

SAN DIEGO – Patients who have been newly diagnosed with psychogenic nonepileptic seizures probably benefit from counseling and group therapy sessions before being referred to psychiatrists for treatment of their underlying mental health problem.

That’s what researchers from the Baylor College of Medicine in Houston found when they compared outcomes for 16 patients immediately referred to mental health services following diagnosis – the standard practice – with 19 others who had three educational group sessions beforehand where they learned about their condition and shared coping strategies.

Following their sessions, support group patients were more likely than were control group patients to agree that "my attacks do not really bother me or affect my life that much anymore" (P less than .001) and that "I have some control over my attacks" (P = .003). Perhaps most tellingly, patients in the treatment group were significantly less likely to return to the emergency department 3 months later (7% vs. 22%, P = .018).

"Clearly what we are seeing is that these patients need significant follow-up, perhaps with a neurologist rather than simply a mental health professional. Psychiatrists don’t feel comfortable addressing this issue; having a team approach with both a neurologist and a psychiatrist probably gives the best outcomes," lead investigator Dr. Atul Maheshwari of the department of neurology at Baylor said at the annual meeting of the American Epilepsy Society.

The patients in the randomized study were adults, mostly male, and had at least one seizure per week. They were diagnosed with psychogenic nonepileptic events (PNEE) in the epilepsy monitoring unit of Houston Veterans Affairs Medical Center, where the study was conducted. Psychiatric problems included depression, posttraumatic stress disorder, and childhood abuse.

The diagnosis of PNEE is often a hard blow to patients convinced that they have epilepsy or a brain tumor and feel like doctors aren’t taking them seriously; accepting that their seizures are caused by underlying psychiatric stress is difficult, Dr. Maheshwari said.

A nurse practitioner led the group sessions with talking points and instructions from a neurologist. "The first session helped [patients] understand [that] PNEE are nonpathologic, don’t cause the brain to be fried or cause long-term brain damage, but still require treatment. They were also shown videos of what PNEE look like and what epileptic seizures look like so they could better understand what’s going on. [Ultimately,] the goal was to take away the negative associations people have with the diagnosis," Dr. Maheshwari said.

"Subsequent sessions focused on finding constructive channels for stress release, focusing on the idea that [PNEE] are manifestations of inner-stress. Patients were allowed to discuss what strategies they found helpful. Peer-to-peer acceptance and evaluation helps," Dr. Maheshwari said.

Identification of triggers, including those for PTSD, was key, Dr. Maheshwari said. "For some people, [that means] identifying the aura so they can use stress-release strategies to avoid the seizure. It’s helpful to share those things with other people who have the same symptoms so they can appreciate they are not alone."

He cautioned that research is ongoing and the trial’s results are preliminary. Also, more people in the treatment group were married. Dr. Maheshwari noted that "we didn’t help out with the frequency and intensity of events, but there were significant improvements in patients’ perceptions of the problem" and quality of life.

Dr. Maheshwari said that he had no relevant disclosures.

SAN DIEGO – Patients who have been newly diagnosed with psychogenic nonepileptic seizures probably benefit from counseling and group therapy sessions before being referred to psychiatrists for treatment of their underlying mental health problem.

That’s what researchers from the Baylor College of Medicine in Houston found when they compared outcomes for 16 patients immediately referred to mental health services following diagnosis – the standard practice – with 19 others who had three educational group sessions beforehand where they learned about their condition and shared coping strategies.

Following their sessions, support group patients were more likely than were control group patients to agree that "my attacks do not really bother me or affect my life that much anymore" (P less than .001) and that "I have some control over my attacks" (P = .003). Perhaps most tellingly, patients in the treatment group were significantly less likely to return to the emergency department 3 months later (7% vs. 22%, P = .018).

"Clearly what we are seeing is that these patients need significant follow-up, perhaps with a neurologist rather than simply a mental health professional. Psychiatrists don’t feel comfortable addressing this issue; having a team approach with both a neurologist and a psychiatrist probably gives the best outcomes," lead investigator Dr. Atul Maheshwari of the department of neurology at Baylor said at the annual meeting of the American Epilepsy Society.

The patients in the randomized study were adults, mostly male, and had at least one seizure per week. They were diagnosed with psychogenic nonepileptic events (PNEE) in the epilepsy monitoring unit of Houston Veterans Affairs Medical Center, where the study was conducted. Psychiatric problems included depression, posttraumatic stress disorder, and childhood abuse.

The diagnosis of PNEE is often a hard blow to patients convinced that they have epilepsy or a brain tumor and feel like doctors aren’t taking them seriously; accepting that their seizures are caused by underlying psychiatric stress is difficult, Dr. Maheshwari said.

A nurse practitioner led the group sessions with talking points and instructions from a neurologist. "The first session helped [patients] understand [that] PNEE are nonpathologic, don’t cause the brain to be fried or cause long-term brain damage, but still require treatment. They were also shown videos of what PNEE look like and what epileptic seizures look like so they could better understand what’s going on. [Ultimately,] the goal was to take away the negative associations people have with the diagnosis," Dr. Maheshwari said.

"Subsequent sessions focused on finding constructive channels for stress release, focusing on the idea that [PNEE] are manifestations of inner-stress. Patients were allowed to discuss what strategies they found helpful. Peer-to-peer acceptance and evaluation helps," Dr. Maheshwari said.

Identification of triggers, including those for PTSD, was key, Dr. Maheshwari said. "For some people, [that means] identifying the aura so they can use stress-release strategies to avoid the seizure. It’s helpful to share those things with other people who have the same symptoms so they can appreciate they are not alone."

He cautioned that research is ongoing and the trial’s results are preliminary. Also, more people in the treatment group were married. Dr. Maheshwari noted that "we didn’t help out with the frequency and intensity of events, but there were significant improvements in patients’ perceptions of the problem" and quality of life.

Dr. Maheshwari said that he had no relevant disclosures.

SAN DIEGO – The women who were most likely to be on older antiepileptic drugs were the least likely to be counseled about the dangers those drugs pose to bone health in a retrospective study of 756 women with epilepsy.

Being uninsured or having Medicaid coverage was associated with about 50% lower odds for receiving counseling for bone health among women on phenytoin, carbamazepine, or phenobarbital – older antiepileptic drugs that are known to increase bone turnover and cause other bone issues that are especially problematic for women – investigator and second-year medical student Katie Paniszyn reported at the annual meeting of the American Epilepsy Society.

"This is a big problem. You have this huge discrepancy between who’s being prescribed these medications and who’s being counseled. Privately insured patients were less likely to be on these drugs, but more likely to get proper counseling when they were," said Ms. Paniszyn of Brown University, Providence, R.I.

She and her colleagues identified 756 female patients with epilepsy aged 11-60 years who were seen in 2010 at the outpatient academic neurology clinics affiliated with Hasbro Children’s Hospital and Rhode Island Hospital. They analyzed the patients’ clinical notes from 2005 to 2010.

The older antiepileptic drugs were more commonly used in uninsured patients (39 of 59, 66%) and those on Medicaid (52 of 103, 50%) and Medicare (42 of 85, 49%), compared with privately insured women (147 of 509, 29%). That’s not surprising because, as generics, they are more affordable to people with limited income.

What was surprising, however, was that uninsured and Medicaid patients were about half as likely to be encouraged to do weight-bearing exercises, have regular bone density scans, and take vitamin D and calcium supplements while taking the drugs. Bone health counseling was noted in the charts of 64% of Medicare (27 of 42) and 62% of privately insured patients (91 of 147), but in only 31% of Medicaid (16 of 52) and 36% of uninsured patients (14 of 39) (P less than .001). Epilepsy specialists were more likely to provide bone-health counseling than were general neurologists.

The reason for the discrepancy isn’t clear, but could have something to do with the fact that uninsured and Medicaid patients made fewer visits to the neurology clinic so that there were fewer opportunities to counsel them. Advice about compliance and more immediate side effects may have taken precedence, she said.

Whatever the reason is for the discrepancy, the investigators plan to add a flag to their electronic medical record system to remind clinicians about bone health counseling when they prescribe phenytoin, carbamazepine, or phenobarbital. Even "if someone only comes in once or twice, hopefully that will trigger counseling," she said.

While more than half of the women in the study spoke English, many spoke other languages. Because of that, the investigators also plan to print bone health brochures for epilepsy patients in several languages.

Ms. Paniszyn said she had no relevant financial disclosures.

SAN DIEGO – The women who were most likely to be on older antiepileptic drugs were the least likely to be counseled about the dangers those drugs pose to bone health in a retrospective study of 756 women with epilepsy.

Being uninsured or having Medicaid coverage was associated with about 50% lower odds for receiving counseling for bone health among women on phenytoin, carbamazepine, or phenobarbital – older antiepileptic drugs that are known to increase bone turnover and cause other bone issues that are especially problematic for women – investigator and second-year medical student Katie Paniszyn reported at the annual meeting of the American Epilepsy Society.

"This is a big problem. You have this huge discrepancy between who’s being prescribed these medications and who’s being counseled. Privately insured patients were less likely to be on these drugs, but more likely to get proper counseling when they were," said Ms. Paniszyn of Brown University, Providence, R.I.

She and her colleagues identified 756 female patients with epilepsy aged 11-60 years who were seen in 2010 at the outpatient academic neurology clinics affiliated with Hasbro Children’s Hospital and Rhode Island Hospital. They analyzed the patients’ clinical notes from 2005 to 2010.

The older antiepileptic drugs were more commonly used in uninsured patients (39 of 59, 66%) and those on Medicaid (52 of 103, 50%) and Medicare (42 of 85, 49%), compared with privately insured women (147 of 509, 29%). That’s not surprising because, as generics, they are more affordable to people with limited income.

What was surprising, however, was that uninsured and Medicaid patients were about half as likely to be encouraged to do weight-bearing exercises, have regular bone density scans, and take vitamin D and calcium supplements while taking the drugs. Bone health counseling was noted in the charts of 64% of Medicare (27 of 42) and 62% of privately insured patients (91 of 147), but in only 31% of Medicaid (16 of 52) and 36% of uninsured patients (14 of 39) (P less than .001). Epilepsy specialists were more likely to provide bone-health counseling than were general neurologists.

The reason for the discrepancy isn’t clear, but could have something to do with the fact that uninsured and Medicaid patients made fewer visits to the neurology clinic so that there were fewer opportunities to counsel them. Advice about compliance and more immediate side effects may have taken precedence, she said.

Whatever the reason is for the discrepancy, the investigators plan to add a flag to their electronic medical record system to remind clinicians about bone health counseling when they prescribe phenytoin, carbamazepine, or phenobarbital. Even "if someone only comes in once or twice, hopefully that will trigger counseling," she said.

While more than half of the women in the study spoke English, many spoke other languages. Because of that, the investigators also plan to print bone health brochures for epilepsy patients in several languages.

Ms. Paniszyn said she had no relevant financial disclosures.

SAN DIEGO – The women who were most likely to be on older antiepileptic drugs were the least likely to be counseled about the dangers those drugs pose to bone health in a retrospective study of 756 women with epilepsy.

Being uninsured or having Medicaid coverage was associated with about 50% lower odds for receiving counseling for bone health among women on phenytoin, carbamazepine, or phenobarbital – older antiepileptic drugs that are known to increase bone turnover and cause other bone issues that are especially problematic for women – investigator and second-year medical student Katie Paniszyn reported at the annual meeting of the American Epilepsy Society.

"This is a big problem. You have this huge discrepancy between who’s being prescribed these medications and who’s being counseled. Privately insured patients were less likely to be on these drugs, but more likely to get proper counseling when they were," said Ms. Paniszyn of Brown University, Providence, R.I.

She and her colleagues identified 756 female patients with epilepsy aged 11-60 years who were seen in 2010 at the outpatient academic neurology clinics affiliated with Hasbro Children’s Hospital and Rhode Island Hospital. They analyzed the patients’ clinical notes from 2005 to 2010.

The older antiepileptic drugs were more commonly used in uninsured patients (39 of 59, 66%) and those on Medicaid (52 of 103, 50%) and Medicare (42 of 85, 49%), compared with privately insured women (147 of 509, 29%). That’s not surprising because, as generics, they are more affordable to people with limited income.

What was surprising, however, was that uninsured and Medicaid patients were about half as likely to be encouraged to do weight-bearing exercises, have regular bone density scans, and take vitamin D and calcium supplements while taking the drugs. Bone health counseling was noted in the charts of 64% of Medicare (27 of 42) and 62% of privately insured patients (91 of 147), but in only 31% of Medicaid (16 of 52) and 36% of uninsured patients (14 of 39) (P less than .001). Epilepsy specialists were more likely to provide bone-health counseling than were general neurologists.

The reason for the discrepancy isn’t clear, but could have something to do with the fact that uninsured and Medicaid patients made fewer visits to the neurology clinic so that there were fewer opportunities to counsel them. Advice about compliance and more immediate side effects may have taken precedence, she said.

Whatever the reason is for the discrepancy, the investigators plan to add a flag to their electronic medical record system to remind clinicians about bone health counseling when they prescribe phenytoin, carbamazepine, or phenobarbital. Even "if someone only comes in once or twice, hopefully that will trigger counseling," she said.

While more than half of the women in the study spoke English, many spoke other languages. Because of that, the investigators also plan to print bone health brochures for epilepsy patients in several languages.

Ms. Paniszyn said she had no relevant financial disclosures.

SAN DIEGO – People with epilepsy who lacked health insurance were less likely to receive specialized epilepsy care in the form of video EEG monitoring and surgery, as were those on Medicaid or who were elderly, black, Hispanic, or had comorbidities, a study of nearly 200,000 adults in California demonstrated.

"Specialized epilepsy care can provide proper diagnosis and therapeutic interventions to control seizures and improve quality of life," Nicholas K. Schiltz said in an interview in advance of the annual meeting of the American Epilepsy Society, where the work was presented. "Previous studies have found evidence of disparities in access to epilepsy specialists among persons with low socioeconomic status and among racial and ethnic minorities. Other studies have found patients with Medicaid have difficulty accessing specialty care. This is the first report that explores the impact of both individual and community characteristics on disparities in access to specialized epilepsy care in persons with epilepsy."

For the study, Mr. Schiltz, a PhD candidate in the department of epidemiology and biostatistics at Case Western Reserve University, Cleveland, and his associates performed a cross-sectional analysis using data between 2005 and 2009 from the California State Inpatient Sample, the State Ambulatory Surgery Database, and the State Emergency Department Database, which provided information on all hospital discharges, ambulatory surgeries, and emergency department visits. The researchers linked these datasets to a 2009 Area Resource File, which provided health resource information and socioeconomic characteristics at the county level, and used a two-level hierarchical logistic regression model to determine the probability that an individual would receive video EEG monitoring or surgery. Individual-level predictors included insurance status, age, race/ethnicity, gender, and comorbidities, while county level predictors included proximity to a comprehensive epilepsy center and social and economic characteristics.

Of the 195,166 adults with epilepsy who were included in the study, 4,707 had video EEG monitoring and 779 underwent surgery during the study period. Mr. Schiltz reported that uninsured individuals were less likely to have video EEG monitoring (adjusted odds ratio [AOR] 0.16) or surgery (AOR 0.05). Similarly, those on Medicaid had significantly lower odds of receiving video EEG monitoring (AOR 0.65) and surgery (AOR 0.38), compared with individuals who had private insurance.

Other individual characteristics significantly associated with a low likelihood of having video EEG monitoring including being black (AOR 0.56), Hispanic (AOR 0.81), older (AOR 0.51), and having comorbid conditions (AOR 0.62).

Other individual characteristics associated with a low likelihood of having surgery including being black (AOR 0.22), older (AOR 0.44), and having comorbid conditions (AOR 0.47).

The researchers also found that adults who routinely received their services in an area where epilepsy centers are located were more likely to undergo video EEG monitoring (AOR 1.61) and surgery (AOR 2.64) than were those who had a regular source of care elsewhere.

This effect size "was surprising to us as it shows that receiving care in the area proximate to an epilepsy center is as important a factor as individual factors in determining access to specialty care," Mr. Schiltz said. "It is possible that neurologists or physicians who are in the area close to epilepsy centers are more aware and therefore refer patients to the epilepsy centers. We were also surprised that other community-level characteristics such as the poverty and employment rate were not significant predictors of access, as studies in other areas of clinical and health services research have found this to be the case."

The study’s overall findings, he added, make continued emphasis on highlighting awareness of epilepsy management among general neurologists and primary care physicians "as important as ever, as they serve as the main gatekeepers for patients to access specialized epilepsy care."

Mr. Schiltz acknowledged certain limitations of the study, including the fact that it relied on hospital billing records, which "do not contain detailed clinical information," he said. "In addition, we only identify specialized epilepsy centers based on the data from the National Association of Epilepsy Centers (NAEC). Some of the hospitals that provide specialized epilepsy care might not be a member of the NAEC. We looked at geographic factors at the county level, which may be somewhat crude in a state like California with diverse populations within counties."

Support for the study was provided by the Epilepsy Foundation, a training grant from the Agency for Healthcare Research and Quality, and a grant from the National Center for Research Resources. Mr. Schiltz received support for travel to the meeting from his receipt of an American Epilepsy Society Young Investigator Award.

Mr. Schiltz said that he had no relevant financial conflicts to disclose.

SAN DIEGO – People with epilepsy who lacked health insurance were less likely to receive specialized epilepsy care in the form of video EEG monitoring and surgery, as were those on Medicaid or who were elderly, black, Hispanic, or had comorbidities, a study of nearly 200,000 adults in California demonstrated.

"Specialized epilepsy care can provide proper diagnosis and therapeutic interventions to control seizures and improve quality of life," Nicholas K. Schiltz said in an interview in advance of the annual meeting of the American Epilepsy Society, where the work was presented. "Previous studies have found evidence of disparities in access to epilepsy specialists among persons with low socioeconomic status and among racial and ethnic minorities. Other studies have found patients with Medicaid have difficulty accessing specialty care. This is the first report that explores the impact of both individual and community characteristics on disparities in access to specialized epilepsy care in persons with epilepsy."

For the study, Mr. Schiltz, a PhD candidate in the department of epidemiology and biostatistics at Case Western Reserve University, Cleveland, and his associates performed a cross-sectional analysis using data between 2005 and 2009 from the California State Inpatient Sample, the State Ambulatory Surgery Database, and the State Emergency Department Database, which provided information on all hospital discharges, ambulatory surgeries, and emergency department visits. The researchers linked these datasets to a 2009 Area Resource File, which provided health resource information and socioeconomic characteristics at the county level, and used a two-level hierarchical logistic regression model to determine the probability that an individual would receive video EEG monitoring or surgery. Individual-level predictors included insurance status, age, race/ethnicity, gender, and comorbidities, while county level predictors included proximity to a comprehensive epilepsy center and social and economic characteristics.

Of the 195,166 adults with epilepsy who were included in the study, 4,707 had video EEG monitoring and 779 underwent surgery during the study period. Mr. Schiltz reported that uninsured individuals were less likely to have video EEG monitoring (adjusted odds ratio [AOR] 0.16) or surgery (AOR 0.05). Similarly, those on Medicaid had significantly lower odds of receiving video EEG monitoring (AOR 0.65) and surgery (AOR 0.38), compared with individuals who had private insurance.

Other individual characteristics significantly associated with a low likelihood of having video EEG monitoring including being black (AOR 0.56), Hispanic (AOR 0.81), older (AOR 0.51), and having comorbid conditions (AOR 0.62).

Other individual characteristics associated with a low likelihood of having surgery including being black (AOR 0.22), older (AOR 0.44), and having comorbid conditions (AOR 0.47).

The researchers also found that adults who routinely received their services in an area where epilepsy centers are located were more likely to undergo video EEG monitoring (AOR 1.61) and surgery (AOR 2.64) than were those who had a regular source of care elsewhere.

This effect size "was surprising to us as it shows that receiving care in the area proximate to an epilepsy center is as important a factor as individual factors in determining access to specialty care," Mr. Schiltz said. "It is possible that neurologists or physicians who are in the area close to epilepsy centers are more aware and therefore refer patients to the epilepsy centers. We were also surprised that other community-level characteristics such as the poverty and employment rate were not significant predictors of access, as studies in other areas of clinical and health services research have found this to be the case."

The study’s overall findings, he added, make continued emphasis on highlighting awareness of epilepsy management among general neurologists and primary care physicians "as important as ever, as they serve as the main gatekeepers for patients to access specialized epilepsy care."

Mr. Schiltz acknowledged certain limitations of the study, including the fact that it relied on hospital billing records, which "do not contain detailed clinical information," he said. "In addition, we only identify specialized epilepsy centers based on the data from the National Association of Epilepsy Centers (NAEC). Some of the hospitals that provide specialized epilepsy care might not be a member of the NAEC. We looked at geographic factors at the county level, which may be somewhat crude in a state like California with diverse populations within counties."

Support for the study was provided by the Epilepsy Foundation, a training grant from the Agency for Healthcare Research and Quality, and a grant from the National Center for Research Resources. Mr. Schiltz received support for travel to the meeting from his receipt of an American Epilepsy Society Young Investigator Award.

Mr. Schiltz said that he had no relevant financial conflicts to disclose.

SAN DIEGO – People with epilepsy who lacked health insurance were less likely to receive specialized epilepsy care in the form of video EEG monitoring and surgery, as were those on Medicaid or who were elderly, black, Hispanic, or had comorbidities, a study of nearly 200,000 adults in California demonstrated.

"Specialized epilepsy care can provide proper diagnosis and therapeutic interventions to control seizures and improve quality of life," Nicholas K. Schiltz said in an interview in advance of the annual meeting of the American Epilepsy Society, where the work was presented. "Previous studies have found evidence of disparities in access to epilepsy specialists among persons with low socioeconomic status and among racial and ethnic minorities. Other studies have found patients with Medicaid have difficulty accessing specialty care. This is the first report that explores the impact of both individual and community characteristics on disparities in access to specialized epilepsy care in persons with epilepsy."

For the study, Mr. Schiltz, a PhD candidate in the department of epidemiology and biostatistics at Case Western Reserve University, Cleveland, and his associates performed a cross-sectional analysis using data between 2005 and 2009 from the California State Inpatient Sample, the State Ambulatory Surgery Database, and the State Emergency Department Database, which provided information on all hospital discharges, ambulatory surgeries, and emergency department visits. The researchers linked these datasets to a 2009 Area Resource File, which provided health resource information and socioeconomic characteristics at the county level, and used a two-level hierarchical logistic regression model to determine the probability that an individual would receive video EEG monitoring or surgery. Individual-level predictors included insurance status, age, race/ethnicity, gender, and comorbidities, while county level predictors included proximity to a comprehensive epilepsy center and social and economic characteristics.

Of the 195,166 adults with epilepsy who were included in the study, 4,707 had video EEG monitoring and 779 underwent surgery during the study period. Mr. Schiltz reported that uninsured individuals were less likely to have video EEG monitoring (adjusted odds ratio [AOR] 0.16) or surgery (AOR 0.05). Similarly, those on Medicaid had significantly lower odds of receiving video EEG monitoring (AOR 0.65) and surgery (AOR 0.38), compared with individuals who had private insurance.

Other individual characteristics significantly associated with a low likelihood of having video EEG monitoring including being black (AOR 0.56), Hispanic (AOR 0.81), older (AOR 0.51), and having comorbid conditions (AOR 0.62).

Other individual characteristics associated with a low likelihood of having surgery including being black (AOR 0.22), older (AOR 0.44), and having comorbid conditions (AOR 0.47).

The researchers also found that adults who routinely received their services in an area where epilepsy centers are located were more likely to undergo video EEG monitoring (AOR 1.61) and surgery (AOR 2.64) than were those who had a regular source of care elsewhere.

This effect size "was surprising to us as it shows that receiving care in the area proximate to an epilepsy center is as important a factor as individual factors in determining access to specialty care," Mr. Schiltz said. "It is possible that neurologists or physicians who are in the area close to epilepsy centers are more aware and therefore refer patients to the epilepsy centers. We were also surprised that other community-level characteristics such as the poverty and employment rate were not significant predictors of access, as studies in other areas of clinical and health services research have found this to be the case."

The study’s overall findings, he added, make continued emphasis on highlighting awareness of epilepsy management among general neurologists and primary care physicians "as important as ever, as they serve as the main gatekeepers for patients to access specialized epilepsy care."

Mr. Schiltz acknowledged certain limitations of the study, including the fact that it relied on hospital billing records, which "do not contain detailed clinical information," he said. "In addition, we only identify specialized epilepsy centers based on the data from the National Association of Epilepsy Centers (NAEC). Some of the hospitals that provide specialized epilepsy care might not be a member of the NAEC. We looked at geographic factors at the county level, which may be somewhat crude in a state like California with diverse populations within counties."

Support for the study was provided by the Epilepsy Foundation, a training grant from the Agency for Healthcare Research and Quality, and a grant from the National Center for Research Resources. Mr. Schiltz received support for travel to the meeting from his receipt of an American Epilepsy Society Young Investigator Award.

Mr. Schiltz said that he had no relevant financial conflicts to disclose.