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Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Care delivery and self-management strategies for children with epilepsy
Nigel Fleeman1, Peter M Bradley
1Liverpool Reviews & Implementation Group, University of Liverpool, 2nd Floor, Sherrington Buildings, Ashton Street, Liverpool, UK, L69 3GE.
Insights
Specialized interventions for childhood epilepsy show some benefits but have significant methodological flaws. More research is needed to determine the most effective programs for improving well-being in children with epilepsy.
Area of Science:
- Pediatric Neurology
- Clinical Psychology
- Health Services Research
Background:
- Epilepsy care for children has faced criticism for limited impact.
- Healthcare professionals and administrators have developed new service models and strategies to improve pediatric epilepsy care.
- These efforts aim to address perceived inadequacies in current treatment approaches.
Purpose of the Study:
- To assess the effects of specialized or dedicated interventions for epilepsy compared to usual care in children with epilepsy and their families.
- The study aimed to evaluate the impact of targeted programs on the well-being of pediatric epilepsy patients.
Main Methods:
- A comprehensive literature search was conducted across multiple databases including Cochrane Epilepsy Group Specialized Register, CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL Plus.
- Included study designs were randomized controlled trials (RCTs), cohort studies, or other prospective studies with a control group, and time series studies.
- Standard Cochrane methodological procedures were used for data collection and analysis.
Main Results:
- Six interventions from seven studies were reviewed, with five being RCTs.
- Education and counseling programs for children, adolescents, and their parents showed some benefits for well-being.
- All reviewed programs had methodological flaws, lacked independent evaluation across diverse samples, and were too heterogeneous for meta-analysis.
Conclusions:
- While reviewed programs offered some benefits to children with epilepsy, their impacts were highly variable.
- No single program demonstrated benefits across all outcome measures.
- Major methodological problems in the studies limit the evidence, indicating insufficient support for any single program at this time.
Background:
In response to criticism that epilepsy care for children has little impact, healthcare professionals and administrators have developed various service models and strategies to address perceived inadequacies.
Objectives:
To assess the effects of any specialised or dedicated intervention for epilepsy versus usual care in children with epilepsy and in their families.
Search Methods:
We searched the Cochrane Epilepsy Group Specialized Register (27 September 2016), the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 9) in the Cochrane Library, MEDLINE (1946 to 27 September 2016), Embase (1974 to 27 September 2016), PsycINFO (1887 to 27 September 2016) and CINAHL Plus (1937 to 27 September 2016). In addition, we also searched clinical trials registries for ongoing or recently completed trials, contacted experts in the field to seek information on unpublished and ongoing studies, checked the websites of epilepsy organisations and checked the reference lists of included studies.
Selection Criteria:
We included randomised controlled trials (RCTs), cohort studies or other prospective studies with a (matched or unmatched) control group (controlled before-and-after studies), or time series studies.
Data Collection And Analysis:
We used standard methodological procedures expected by Cochrane.
Main Results:
Our review included six interventions reported through seven studies (of which five studies were designed as RCTs). They reported on different education and counselling programmes for children and parents; teenagers and parents; or children, adolescents and their parents. Each programme showed some benefits for the well-being of children with epilepsy, but all had methodological flaws (e.g. in one of the studies designed as an RCT, randomisation failed), no single programme was independently evaluated with different study samples and no interventions were sufficiently homogeneous enough to be included in a meta-analysis,.
Authors' Conclusions:
While each of the programmes in this review showed some benefit to children with epilepsy, their impacts were extremely variable. No programme showed benefits across the full range of outcomes, and all studies had major methodological problems. At present there is insufficient evidence in favour of any single programme.
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