Browsing by Author "Husain, Aatif M"
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Item Open Access Barriers and facilitators to implementation of epilepsy self-management programs: a systematic review using qualitative evidence synthesis methods.(Systematic reviews, 2020-04-25) Lewinski, Allison A; Shapiro, Abigail; Gierisch, Jennifer M; Goldstein, Karen M; Blalock, Dan V; Luedke, Matthew W; Gordon, Adelaide M; Bosworth, Hayden B; Drake, Connor; Lewis, Jeffrey D; Sinha, Saurabh R; Husain, Aatif M; Tran, Tung T; Van Noord, Megan G; Williams, John WBackground
Epilepsy affects nearly 50 million people worldwide. Self-management is critical for individuals with epilepsy in order to maintain optimal physical, cognitive, and emotional health. Implementing and adopting a self-management program requires considering many factors at the person, program, and systems levels. We conducted a systematic review of qualitative and mixed-methods studies to identify facilitators and barriers that impact implementation and adoption of self-management programs for adults with epilepsy.Methods
We used established systematic review methodologies for qualitative and mixed-methods studies. We included studies addressing facilitators (i.e., factors that aided) or barriers (i.e., factors that impeded) to implementation and adoption of self-management interventions for adults with epilepsy. We conducted a narrative thematic synthesis to identify facilitators and barriers.Results
The literature search identified 2700 citations; 13 studies met eligibility criteria. Our synthesis identified five themes that categorize facilitators and barriers to successful implementation epilepsy self-management: (1) relevance, intervention content that facilitates acquisition of self-management skills; (2) personalization, intervention components that account for the individual's social, physical, and environmental characteristics; (3) intervention components, components and dosing of the intervention; (4) technology considerations, considerations that account for individual's use, familiarity with, and ownership of technology; and (5) clinician interventionist, role and preparation of the individual who leads intervention. We identified facilitators in 11 of the 13 studies and barriers in 11 of the 13 studies and classified these by social-ecological level (i.e., patient/caregiver, program, site/system).Conclusion
Identification of facilitators and barriers at multiple levels provides insight into disease-specific factors that influence implementation and adoption of self-management programs for individuals with epilepsy. Our findings indicate that involving individuals with epilepsy and their caregivers in intervention development, and then tailoring intervention content during the intervention, can help ensure the content is relevant to intervention participants. Our findings also indicate the role of the clinician (i.e., the individual who provides self-management education) is important to intervention implementation, and key issues with clinicians were identified as barriers and opportunities for improvement. Overall, our findings have practical value for those seeking to implement and adopt self-management interventions for epilepsy and other chronic illnesses.Systematic review registration
PROSPERO registration number is CRD42018098604.Item Open Access Baseline EEG pattern on continuous ICU EEG monitoring and incidence of seizures(Journal of Clinical Neurophysiology, 2015-01-01) Swisher, Christa B; Shah, Dharmen; Sinha, Saurabh R; Husain, Aatif M© 2015 by the American Clinical Neurophysiology Society..Purpose: To identify the probability of detecting nonconvulsive seizures based on the initial pattern seen in the first 30 minutes of continuous EEG (cEEG) monitoring. Methods: Continuous EEG monitoring reports from 243 adult patients were reviewed, assessing the baseline cEEG monitoring pattern and the presence of seizures during the entire monitoring period. The baseline EEG patterns were classified into nine categories: seizures, lateralized periodic discharges, generalized periodic discharges, focal epileptiform discharges, burst suppression, asymmetric background, generalized slowing, generalized periodic discharges with triphasic morphology, and normal. Results: Overall, 51 patients (21%) had nonconvulsive seizures at any time during cEEG monitoring. Notably, 112 patients had generalized slowing as the initial EEG pattern, and none of these patients were noted to have seizures. Seizure rates among the types of baseline EEG findings were as follows: lateralized periodic discharges (56%, n = 9), burst suppression (50%, n = 10), generalized periodic discharges (50%, n = 2), normal (33%, n = 3), focal epileptiform discharges (31%, n = 35), and asymmetric background (11%, n = 46). Conclusions: Patients with only generalized slowing seen on the baseline EEG recording are unlikely to develop seizures on subsequent cEEG monitoring. Depending on the clinical circumstance, the standard duration of cEEG recording (24-48 hours) may be unnecessary in patients with generalized slowing as their only cEEG abnormalityItem Open Access Diagnostic Accuracy of Electrographic Seizure Detection by Neurophysiologists and Non-Neurophysiologists in the Adult ICU Using a Panel of Quantitative EEG Trends.(J Clin Neurophysiol, 2015-08) Swisher, Christa B; White, Corey R; Mace, Brian E; Dombrowski, Keith E; Husain, Aatif M; Kolls, Bradley J; Radtke, Rodney R; Tran, Tung T; Sinha, Saurabh RPURPOSE: To evaluate the sensitivity and specificity of a panel of quantitative EEG (qEEG) trends for seizure detection in adult intensive care unit (ICU) patients when reviewed by neurophysiologists and non-neurophysiologists. METHODS: One hour qEEG panels (n = 180) were collected retrospectively from 45 ICU patients and were distributed to 5 neurophysiologists, 7 EEG technologists, and 5 Neuroscience ICU nurses for evaluation of seizures. Each panel consisted of the following qEEG tools, displayed separately for left and right hemisphere electrodes: rhythmicity spectrogram (rhythmic run detection and display; Persyst Inc), color density spectral array, EEG asymmetry index, and amplitude integrated EEG. The reviewers did not have access to the raw EEG data. RESULTS: For the reviewer's ability to detect the presence of seizures on qEEG panels when compared with the gold standard of independent raw EEG review, the sensitivities and specificities are as follows: neurophysiologists 0.87 and 0.61, EEG technologists 0.80 and 0.80, and Neuroscience ICU nurses 0.87 and 0.61, respectively. There was no statistical difference among the three groups regarding sensitivity. CONCLUSIONS: Quantitative EEG display panels are a promising tool to aid detection of seizures by non-neurophysiologists as well as by neurophysiologists. However, even when used as a panel, qEEG trends do not appear to be adequate as the sole method for reviewing continuous EEG data.Item Open Access Self-management of Epilepsy: A Systematic Review.(Annals of internal medicine, 2019-07) Luedke, Matthew W; Blalock, Dan V; Goldstein, Karen M; Kosinski, Andrzej S; Sinha, Saurabh R; Drake, Connor; Lewis, Jeffrey D; Husain, Aatif M; Lewinski, Allison A; Shapiro, Abigail; Gierisch, Jennifer M; Tran, Tung T; Gordon, Adelaide M; Van Noord, Megan G; Bosworth, Hayden B; Williams, John WBackground:Although self-management is recommended for persons with epilepsy, its optimal strategies and effects are uncertain. Purpose:To evaluate the components and efficacy of self-management interventions in the treatment of epilepsy in community-dwelling persons. Data Sources:English-language searches of MEDLINE, Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL in April 2018; the MEDLINE search was updated in March 2019. Study Selection:Randomized and nonrandomized comparative studies of self-management interventions for adults with epilepsy. Data Extraction:An investigator assessed study characteristics; intervention details, including 6 components of self-management; and outcomes, which were verified by a second reviewer. Risk of bias (ROB) was assessed independently by 2 investigators. Data Synthesis:13 randomized and 2 nonrandomized studies (2514 patients) evaluated self-management interventions. Interventions were delivered primarily in group settings, used a median of 4 components, and followed 2 general strategies: 1 based on education and the other on psychosocial therapy. Education-based approaches improved self-management behaviors (standardized mean difference, 0.52 [95% CI, 0.0 to 1.04]), and psychosocial therapy-based approaches improved quality of life (mean difference, 6.64 [CI, 2.51 to 10.77]). Overall, self-management interventions did not reduce seizure rates, but 1 educational intervention decreased a composite of seizures, emergency department visits, and hospitalizations. Limitation:High ROB in most studies, incomplete intervention descriptions, and studies limited to English-language publications. Conclusion:There is limited evidence that self-management strategies modestly improve some patient outcomes that are important to persons with epilepsy. Overall, self-management research in epilepsy is limited by the range of interventions tested, the small number of studies using self-monitoring technology, and uncertainty about components and strategies associated with benefit. Primary Funding Source:U.S. Department of Veterans Affairs. (PROSPERO: CRD42018098604).Item Open Access Use of pregabalin for nonconvulsive seizures and nonconvulsive status epilepticus.(Seizure, 2013-03) Swisher, Christa B; Doreswamy, Meghana; Husain, Aatif MPURPOSE: To determine the efficacy of pregabalin (PGB) in treatment of frequent nonconvulsive seizures (NCS) and nonconvulsive status epilepticus (NCSE) in critically ill patients. METHODS: In this retrospective study, 21 patients were identified as having received pregabalin for the treatment of NCS as determined by continuous electroencephalographic monitoring. The patients were considered to be responders if their seizures were terminated within 24h of initiation of PGB without the addition of another antiepileptic agent. RESULTS: Of the 21 patients who received PGB for treatment of NCS or NCSE, 11 (52%) were responders. PGB was administered via a nasogastric tube or orally and was the 2nd to 4th agent used. The average initial dose and total daily dose of PGB was similar in the responders and non-responders (342mg vs. 360mg, respectively). PGB was more effective in aborting NCS (9 patients, 82%) than NCSE (2 patients, 18%). Of the 9 brain tumor patients, PGB resulted in seizure cessation in 67% (6 patients). In contrast, all patients with hypoxic injury (4) did not respond to PGB. The responders were noted to have better clinical outcome (64% vs. 9% discharged home). Most of the patients tolerated the medication without any significant short term adverse effects, except two patients who were noted to have dizziness and sedation. CONCLUSIONS: Pregabalin may be safe option for add-on treatment for nonconvulsive seizures in critically ill patients when conventional therapy fails.