Spatio-Temporal Correlation of Epileptic Seizures with The Electrocardiography Brain Perfusion Index

The Electrocardiography Brain Perfusion index (EBPi) is a novel electrocardiography (ECG)-based metric that may function as a proxy for cerebral blood flow (CBF). We investigated the spatio-temporal correlation between EBPi and epileptic seizure events. EBPi was computed retrospectively from clinical EEG and ECG data captured previously from 30 epilepsy patients during seizures. Significant EBPi changes were compared temporally with clinically defined ground-truth seizure onset and offset times. We also assessed the spatial correlation between EBPi metrics and clinically defined ground-truth seizure locations. A significant increase in EBPi was detected 10.5 s [-6, 53] (median [95% confidence interval (CI)]) after ground-truth seizure onset, and a significant decrease in EBPi was detected 5 s [-42, 74] (median [95% CI]) after ground-truth seizure offset. EBPi demonstrated a positive predictive value of 61.5% [33.3, 75] (median [95% CI]) and a sensitivity of 57.1% [38.5, 66.7] (median [95% CI]) for the detection of ground truth seizure locations. EBPi signals exhibited a temporal sensitivity to seizure events and in some cases were correlated spatially to the seizure location. Therefore, EBPi, which has been linked to CBF, appears to contain spatio-temporal information related to seizure activity and might have useful application in augmenting EEG data captured during seizures

Return to driving after a diagnosis of epilepsy: A prospective registry study

Summary Objective To determine the frequency and predictors of return to driving within 1 year after a diagnosis of epilepsy. Methods SEISMIC (the Sydney Epilepsy Incidence Study to Measure Illness Consequences) was a prospective, multicenter, community-wide study of people of all ages with newly diagnosed epilepsy in Sydney, Australia. Demographic, socioeconomic, and clinical characteristics and driving status were obtained as soon as possible after baseline registration with a diagnosis of epilepsy. Multivariate logistic regression was used to determine predictors of return to driving at 12-month follow-up. Results Among 181 (76%) adult participants (≥18 years old) who reported driving before an epilepsy diagnosis, 152 provided information on driving at 12 months, of whom 118 (78%) had returned to driving. Driving for reasons of getting to work or place of education (odds ratio [OR] = 4.70, 95% confidence intervals [CI] = 1.87-11.86), no seizure recurrence (OR = 5.15, 95% CI = 2.07-12.82), and being on no or a single antiepileptic drug (OR = 4.54, 95% CI = 1.45-14.22) were associated with return to driving (C statistic = 0.79). More than half of participants with recurrent seizures were driving at follow-up. Significance Early return to driving after a diagnosis of epilepsy is related to work/social imperatives and control of seizures, but many people with recurrent seizures continue to drive. Further efforts are required to implement driving restriction policies and to provide transport options for people with epilepsy

Course and impact of sleep disturbance in newly diagnosed epilepsy: A prospective registry study

Objective To determine the course of sleep distrurbance (insomnia symptoms and short sleep duration) after a diagnosis of epilepsy and their associations with seizure control, mood, disability, and quality of life. Patients and methods One hundred and sixty-nine adults were drawn from the Sydney Epilepsy Incidence Study to Measure Illness Consequences (SEISMIC), a prospective, multicenter, community-wide study in Sydney, Australia. Socio-demographic, psychosocial, clinical characteristics, and information on sleep disturbance were obtained early (median 48 [IQR15-113] days) after a diagnosis of epilepsy, and at 12 months. Logistic regression models were used to determine associations between patterns of sleep disturbance with outcomes at 12 months. Results Insomnia symptoms and/or short sleep duration were present in 18-23% of participants at both time points, with over half (54-61%) showing a chronic pattern. There was no association of sleep disturbance pattern with recurrent seizures, medication use or disability. Chronic insomnia symptoms and short sleep duration were strongly associated with worse mental health (aOR 3.76, 95% CI 1.28-11.06; and aOR 5.41, 95% CI 1.86-15.79) and poorer quality of life at 12 months (aOR 3.02, 95% CI 1.03-8.84; and aOR 3.11, 95% CI 1.10-8.82), after adjusting for clinical features of epilepsy and comorbidity. Those whose sleep disturbance remitted had no adverse outcomes. Conclusions Insomnia symptoms and short sleep duration are less common in people with recently-diagnosed than chronic epilepsy. The temporal association with poor psycholosocial outcomes supports specific interventions addressing sleep disturbance

Determining the role and responsibilities of the Australian epilepsy nurse in the management of epilepsy: a study protocol

Introduction Epilepsy is a common neurological condition affecting between 3% and 3.5% of the Australian population at some point in their lifetime. The effective management of chronic and complex conditions such as epilepsy requires person-centred and coordinated care across sectors, from primary to tertiary healthcare. Internationally, epilepsy nurse specialists are frequently identified as playing a vital role in improving the integration of epilepsy care and enhancing patient self-management. This workforce has not been the focus of research in Australia to date. Methods and analysis This multistage mixed-method study examines the role and responsibilities of epilepsy nurses, particularly in primary and community care settings, across Australia, including through the provision of a nurse helpline service. A nationwide sample of 30 epilepsy nurses will be purposively recruited via advertisements distributed by epilepsy organisations and through word-of-mouth snowball sampling. Two stages (1 and 3) consist of a demographic questionnaire and semistructured interviews (individual or group) with epilepsy nurse participants, with the thematic data analysis from this work informing the areas for focus in stage 3. Stage 2 comprises of a retrospective descriptive analysis of phone call data from Epilepsy Action Australia’s National Epilepsy Line service to identify types of users, their needs and reasons for using the service, and to characterise the range of activities undertaken by the nurse call takers. Ethics and dissemination Ethics approval for this study was granted by Macquarie University (HREC: 52020668117612). Findings of the study will be published through peer-reviewed journal articles and summary reports to key stakeholders, and disseminated through public forums and academic conference presentations. Study findings will also be communicated to people living with epilepsy and families

Determining the role and responsibilities of the community epilepsy nurse in the management of epilepsy

Aims and Objectives: The aim of this study is to enhance the understanding of the core elements and influencing factors on the community‐based epilepsy nurse's role and responsibilities. Background: Internationally, epilepsy nurse specialists play a key role in providing person‐centred care and management of epilepsy but there is a gap in understanding of their role in the community. Design: A national three‐stage, mixed‐method study was conducted. Methods: One‐on‐one, in‐depth semi‐structured qualitative interviews were conducted online with 12 community‐based epilepsy nurses (Stage 1); retrospective analysis of data collected from the National Epilepsy Line, a nurse‐led community helpline (Stage 2); and focus group conducted with four epilepsy nurses, to delve further into emerging findings (Stage 3). A thematic analysis was conducted in Stages 1 and 3, and a descriptive statistical analysis of Stage 2 data. Consolidated Criteria for Reporting Qualitative studies checklist was followed for reporting. Results: Three key themes emerged: (1) The epilepsy nurse career trajectory highlighted a lack of standardised qualifications, competencies, and career opportunities. (2) The key components of the epilepsy nurse role explored role diversity, responsibilities, and models of practice in the management of living with epilepsy, and experiences navigating complex fragmented systems and practices. (3) Shifting work practices detailed the adapting work practices, impacted by changing service demands, including COVID‐19 pandemic experiences, role boundaries, funding, and resource availability. Conclusion: Community epilepsy nurses play a pivotal role in providing holistic, person‐centred epilepsy management They contribute to identifying and addressing service gaps through innovating and implementing change in service design and delivery. Relevance to Clinical Practice: Epilepsy nurses' person‐centred approach to epilepsy management is influenced by the limited investment in epilepsy‐specific integrated care initiatives, and their perceived value is impacted by the lack of national standardisation of their role and scope of practice. No Patient or Public Contribution: Only epilepsy nurses' perspectives were sought