Economic burden and influencing factor analysis of outpatients with epilepsy: A cross-sectional study in Shanghai,Shanxi and Sichuan

Objective: To better understand the economic burden of patients with epilepsy receiving outpatient services in China and to analyze potential factors influencing epileptic economic burden through a cross-sectional study. Methods: Using a self-designed questionnaire, we collected information retrospectively from 754 patients with epilepsy evaluated in neurology clinics in Shanghai Municipality, Shanxi Province and Sichuan Province. Descriptive analyses were used after cost variables were presented as logarithms, and multiple linear regressions were performed to explore influencing factors. Results: Fifty percent of the investigated patients experienced an epilepsy attack before the age of 15, and 51.3% had suffered from epilepsy for more than five years. In the past year, 87.9% of patients had visited different hospitals multiple times for evaluation(40.3%) and maintenance treatment(40.7%). The total economic burden of epilepsy was US$ 1143.2. The average direct economic burden and indirect economic burden were US$ 939.0 and US$ 110.2, respectively. Multiple linear regressions showed that patients had to bear greater economic burden if they were hospitalized,using multiple antiepileptic drugs, experiencing illness for less than 5 years, in severe seizure index or active epilepsy with drug resistance, which was statistically significant. Totally only14.3% of patients could get reimbursement in outpatient services. Conclusions: Patients with epilepsy must present to hospitals regularly for satisfactory prognosis, which results in economic burden. Patients bear greater economic burden, especially direct medical costs, if they are newly diagnosed, experience severe seizures, or undergo multiple drug treatments that require more frequent monitoring. However, current insurance policy for outpatient services do not help reduce economic burden of patients efficiently.

Management of people with epilepsy during the COVID-19 pandemic:a national survey among epileptologists in China

Background:Compared to the healthy people,people with comorbid medical conditions are more vulnerable in the context of the coronavirus disease 2019(COVID-19)pandemic,including the people with epilepsy.Besides a consensus recommendation by multi-national epilepsy specialists,the situation of the epilepsy management during the pandemic has seldom been reported.Methods:The China Association Against Epilepsy carried out an online nationwide survey among its board members in April 2020.One hundred and thirty board members from 22 provinces,5 autonomous regions,and 4 municipalities across China responded to the questionnaires.They reported the situation of clinical practice and gave opinions on the management of people with epilepsy between January 13th and March 31st,2020,a time period concentrated with confirmed COVID-19 cases.Results:The proportions of patients consulting through telephone or online(88.4%)and of patients with regular case review(93.9%)were highest in the high-risk area,as reported by the responders.The patients in the high-risk area were more likely to have increased episodes of seizures(17.7%),aggravated psychological disorders(30.2%),and less accessibility to anti-seizure medications(ASMs)(77.2%).Regular ASMs supply(74.6%),medical consultation(69.2%),and psychological aids(29.2%)were urgently needed for people with epilepsy.Conclusions:This study demonstrated the most common dilemma faced by people with epilepsy in policy circumstances during the COVID-19 epidemic in China.The opinions raised by Chinese epileptologists may provide reference for epilepsy care in other countries.

Reevaluation of the effect of Dianxianning on seizure rate of refractory epilepsy as additive treatment in clinical practice

We observed the effect of Dianxianning,which was used as additive treatment to treat 206 epilepsy patients,on the epilepsy seizure rate.Based on a multicenter,prospective,randomized,and controlled clinical trial design,we used the seizure rate of epilepsy as the main index.For the treatment group comprising 137 patients,we combined Dianxianning with chemical medicine,which is the basic treatment.For the control group with 69 patients,we added placebo.The results showed that 1)Effect on seizure rate:After a three-month treatment,the seizure rate of the treatment group decreased by 37.84%on average,whereas that of the control group decreased by 13.18%on average.Statistically comparing the two groups,there was a significant difference between these groups(P<0.05).2)Effect on seizure frequency:As time passed,the frequency in each group gradually decreased.After a three-month treatment,there was a significant difference between the two groups(P<0.05).3)Comparison between the before and after treatment of each group:There was a very significant difference between the two groups(P<0.0001).The results indicated that,as an additive treatment,Dianxianning has a good effect on controlling the epilepsy seizure rate and frequency management.It is more effective than using chemical medicine alone.

Acta Epileptologica:for sharing research advances in epilepsy research

Why are we building a new journal for epilepsy research?It’s a question we kept thinking during the planning and preparation of Acta Epileptologica.First,we are faced with greater challenges caused by Epilepsy.An aging society with more various public health problems has come,among which epilepsy is one of the arising risks for health.The WHO has estimated that epilepsy affects more than 50 million people worldwide and one of the peak age of onset is over 65 years old.Therefore,more research on finding solutions is urgently needed.Acta Epileptologica(AE)offers a new option for publication and communication.

Strategies for epilepsy control in public health aspects

This article provides the authors’recommendations of strategies for epilepsy control in public health aspects.Besides a brief review of some collaborative epilepsy control activities in public health aspects by the International League against Epilepsy(ILAE),the International Bureau for Epilepsy(IBE)and the World Health Organization(WHO),recommendations for further developing strategies for epilepsy control in public health aspects to the ILAE,IBE,state governments and other international&regional governmental organizations and non-governmental organizations are described in the paper including public health strategies/actions in political and geographical aspects and in technological field.

Epilepsy control during an epidemic:emerging approaches and a new management framework

Epidemics are a big threat to world health.The ongoing pandemic of corona virus disease 2019(COVID-19)has caused a series of challenges to public health.One such challenge is the management of chronic diseases such as epilepsy during an epidemic event.Studies on this topic are rather limited and the related medical practice is full of uncertainty.Here we review recent development of potential approaches for epilepsy control during an epidemic and propose a new three-level management framework to address these challenges.

Arbovirus and seizures

The high prevalence and spread of arthropod-borne viruses(arboviruses)make them an important cause of viral encephalitis in humans.Most epidemic viral encephalitides have an etiology associated with arboviruses.Among various arboviruses,the Japanese encephalitis virus,West Nile virus,Zika virus,Dengue virus and Chikungunya virus can induce seizures.Arboviruses of the genus Flavivirus are usually transmitted by mosquitoes and other host animals.These vector-borne pathogens can cause epidemic viral encephalitis.Seizures may not be the major manifestation in these viral encephalitides,but may predict a poor prognosis.In this article,we discuss the relationships between these viruses and seizures from perspectives of clinical characteristics,pathogenesis,prognosis and treatments of each.

Correction to:Arbovirus and seizures

After publication of this article[1],it is noticed the article contains an error:the section below should be placed between the section headings of‘Pathogenesis’and‘Activated glia’on page 2.Tropism with the brain JEV’s neurotropism is a relevant factor of its pathogenesis.Neurotropism is not synonymous with neurovirulence,but they can be associated with each other in some cases.The JEV typically replicates before it spreads to local lymph nodes.Then the liver,heart,kidney and other organs the blood-brain barrier(Fig.2).To cross the barrier,JEV replicates in endothelial cells inflammatory cells that carry the virus(Fig.3).