Publications by authors named "Marina Gainza-Lein"
Article Synopsis
- The study retrospectively analyzed the use and costs of antiseizure medications (ASM) in the U.S. from 2006 to 2021, tracking 347,158 patients with epilepsy.
- Initially, the most prescribed ASMs were valproate and phenytoin, but by 2021, levetiracetam and lamotrigine became the most common for both pediatric and adult cases, while generic ASM usage surged from 23% to 83%.
- The average wholesale price of ASM per person-year doubled, with brand-name drugs seeing a 419% increase and generic drugs a 462% increase, although patients' out-of-pocket expenses for generics dropped significantly, by 37%.
Background And Objectives: The objective of this study was to determine patient-specific factors known proximate to the presentation to emergency care associated with the development of refractory convulsive status epilepticus (RSE) in children.
Methods: An observational case-control study was conducted comparing pediatric patients (1 month-21 years) with convulsive SE whose seizures stopped after benzodiazepine (BZD) and a single second-line antiseizure medication (ASM) (responsive established status epilepticus [rESE]) with patients requiring more than a BZD and a single second-line ASM to stop their seizures (RSE). These subpopulations were obtained from the pediatric Status Epilepticus Research Group study cohort.
Article Synopsis
- - This study examines the trends in costs and usage of three main treatments for infantile epileptic spasms syndrome (IESS) between 2006 and 2020, specifically focusing on adrenocorticotropic hormone (ACTH), oral prednisolone, and vigabatrin.
- - A total of 1,131 patients were analyzed, showing that while the cost of ACTH skyrocketed by about 2700%, oral prednisolone’s price dropped by 50%, and vigabatrin’s cost increased by 340% during the same period.
- - The use of ACTH as a treatment significantly declined from 78% to just 18%, indicating a shift towards more cost-effective options as
Objective: To describe the demographics of epilepsy surgery utilization and its impact on health care resource use.
Methods: Retrospective descriptive study using the MarketScan commercial claims database. We studied children and adults who underwent epilepsy surgery in the USA in the period 2006-2019.
Article Synopsis
- Seizure clusters, defined as two or more seizures in a six-hour period, are prevalent in pediatric epilepsy patients, with about one-third of participants experiencing them during a year-long study.
- The study classified patients into high, intermediate, and low-risk groups based on their seizure history, finding that those with more frequent seizures were more likely to experience clusters.
- Despite identifying at-risk factors and the use of rescue medications, these medications were underutilized, suggesting a need for future research on their effectiveness in managing seizure clusters and preventing related complications.
Article Synopsis
- * Out of 293 children studied, many received multiple doses of BZDs, especially if seizures started outside of the hospital and if they delayed treatment — with 57.3% receiving BZDs beyond 30 minutes after the onset.
- * The findings suggest that more timely escalation from BZDs to non-BZD ASMs is needed, particularly for patients whose seizures began before they arrived at the hospital.
Article Synopsis
- The study aimed to examine long-term outcomes in pediatric patients experiencing refractory status epilepticus (RSE) and to identify factors linked to new neurological deficits following RSE.
- Data from 276 patients showed a 4% in-hospital mortality rate, with 62.9% of patients later developing unprovoked seizures and 39.3% of those with normal development before RSE acquiring new neurological deficits.
- Longer durations of electroclinical RSE were associated with higher risks of new deficits, and the study highlights that about one-third of previously seizure-free patients experienced recurrent seizures post-RSE.
Objective: We aimed to characterize the clinical profile and outcomes of new onset refractory status epilepticus (NORSE) in children, and investigated the relationship between fever onset and status epilepticus (SE).
Methods: Patients with refractory SE (RSE) between June 1, 2011 and October 1, 2016 were prospectively enrolled in the pSERG (Pediatric Status Epilepticus Research Group) cohort. Cases meeting the definition of NORSE were classified as "NORSE of known etiology" or "NORSE of unknown etiology.
Article Synopsis
- Pediatric patients with refractory status epilepticus experience delays in treatment, which varies depending on the day of the week or whether it's a holiday.
- A study analyzing 329 patients found that time to the first benzodiazepine (BZD) was longer during weekdays compared to weekends/holidays, with significant differences in time for non-BZD antiseizure medications, especially for cases that began in the hospital.
- Findings suggest that improving the response time for treatments during weekdays may enhance patient outcomes, highlighting the need for policies addressing treatment disparities based on the day of the week.
Objective: To describe the epidemiology and health resource utilization for convulsive status epilepticus (SE) in the emergency department (ED).
Methods: Retrospective descriptive study in the Nationwide Emergency Department Sample (NEDS). Primary SE and secondary SE (SE in a case who visited the ED for other primary reason) were compared with non-SE seizures.
Objective: To compare the effectiveness and cost-effectiveness of adrenocorticotropic hormone (ACTH) and oral steroids as first-line treatment for infantile spasm resolution, we performed a systematic review, meta-analysis, and cost-effectiveness study.
Methods: A decision analysis model was populated with effectiveness data from a systematic review and meta-analysis of existing literature and cost data from publicly available prices. Effectiveness was defined as the probability of clinical spasm resolution 14 days after treatment initiation.
Introduction: In Chile, Down syndrome has a prevalence of 2.5 in 1,000 live births. These patients present more congenital anomalies and comorbidities than the general population, increasing their hospitaliza tion rate.
View Article and Find Full Text PDFObjective: Treatments for convulsive status epilepticus (SE) have a wide range of effectiveness. The estimated effectiveness of non-intravenous benzodiazepines (non-IV BZDs) ranges from approximately 70% to 90% and the estimated effectiveness of non-benzodiazepine antiseizure medications (non-BZD ASMs) ranges from approximately 50% to 80%. This study aimed to quantify the clinical and economic burden of decisional uncertainty in the treatment of SE.
View Article and Find Full Text PDFArticle Synopsis
- The study aimed to identify reasons for low dosing of benzodiazepines (BZD) in children with refractory status epilepticus (RSE) and examine how this variability affects seizure cessation.
- Data from a retrospective analysis of 289 pediatric RSE patients revealed that 57.9% received a low initial BZD dose, with contributing factors being male sex, older age, no previous epilepsy diagnosis, and delayed treatment.
- Low total BZD dosing was found to significantly decrease the chances of achieving seizure cessation, indicating the need for more consistent dosing practices in both emergency and hospital settings.
Objective: To determine whether publication of evidence on delays in time to treatment shortens time to treatment in pediatric refractory convulsive status epilepticus (rSE), we compared time to treatment before (2011-2014) and after (2015-2019) publication of evidence of delays in treatment of rSE in the Pediatric Status Epilepticus Research Group (pSERG) as assessed by patient interviews and record review.
Methods: We performed a retrospective analysis of a prospectively collected dataset from June 2011 to September 2019 on pediatric patients (1 month-21 years of age) with rSE.
Results: We studied 328 patients (56% male) with median (25th-75th percentile [p-p]) age of 3.
Purpose: To evaluate whether the onset of pediatric refractory status epilepticus (rSE) is related to time of day.
Method: We analyzed the time of day for the onset of rSE in this prospective observational study performed from June 2011 to May 2019 in pediatric patients (1 month to 21 years of age). We evaluated the temporal distribution of pediatric rSE utilizing a cosinor analysis.
Electroencephalographic Reporting for Refractory Status Epilepticus.
J Clin Neurophysiol
September 2019
Purpose: We aimed to determine whether clinical EEG reports obtained from children in the intensive care unit with refractory status epilepticus could provide data for comparative effectiveness research studies.
Methods: We conducted a retrospective descriptive study to assess the documentation of key variables within clinical continuous EEG monitoring reports based on the American Clinical Neurophysiology Society's standardized EEG terminology for children with refractory status epilepticus from 10 academic centers. Two pediatric electroencephalographers reviewed the EEG reports.
Objective: To 1) describe clinical characteristics of adult patients in Chile with severe acute respiratory infections (SARI) associated with influenza viruses, and 2) analyze virus subtypes identified in specimens collected from those patients, hospital resources used in clinical management, clinical evolution, and risk factors associated with a fatal outcome, using observational data from the SARI surveillance network (SARInet).
Methods: Adults hospitalized from 1 July 2011 to 31 December 2015 with influenza-associated SARI at a SARI sentinel surveillance hospital in Santiago were identified and the presence of influenza in all cases confirmed by reverse transcription polymerase chain reaction (RT-PCR), using respiratory samples.
Results: A total of 221 patients (mean age: 74.
Objective: Compare the cost and effectiveness of nonbenzodiazepine antiepileptic drugs (non-BZD AEDs) for treatment of BZD-resistant convulsive status epilepticus (SE).
Methods: Decision analysis model populated with effectiveness data from a systematic review and meta-analysis of the literature, and cost data from publicly available prices. The primary outcome was cost per seizure stopped ($/SS).
Article Synopsis
- The study aimed to evaluate the cost-effectiveness of various genetic testing strategies for patients with epilepsy when the cause is unknown, comparing chromosomal microarray (CMA), epilepsy panel (EP), and whole-exome sequencing (WES).
- Results indicated that WES had the highest diagnostic yield (45%), making it the most cost-effective test initially, though after accounting for publication bias, EP emerged as slightly more cost-effective.
- The overall findings recommend beginning with WES or EP for genetic testing in unexplained epilepsy cases, as CMA proved to be the least effective option in terms of both yield and cost-effectiveness.
We reviewed 37 studies reporting long-term outcomes after a status epilepticus (SE) episode in pediatric and adult populations. Study design, length of follow-up, outcome measures, domains investigated (mortality, SE recurrence, subsequent epilepsy, cognitive outcome, functional outcome, or quality of life), and predictors of long-term outcomes are summarized. Despite heterogeneity in the design of prior studies, overall risk of poor long-term outcome after SE is high in both children and adults.
View Article and Find Full Text PDFObjective: We aimed to evaluate and compare the status epilepticus treatment pathways used by pediatric status epilepticus research group (pSERG) hospitals in the United States and the American Epilepsy Society (AES) status epilepticus guideline.
Methods: We undertook a descriptive analysis of recommended timing, dosing, and medication choices in 10 pSERG hospitals' status epilepticus treatment pathways.
Results: One pathway matched the timeline in the AES guideline; nine pathways described more rapid timings.
Objective: Describe basic science, animal models and clinical data related to timing of treatment in status epilepticus (SE).
Methods: We summarized the results of 15 studies that reported time to treatment in SE, and reviewed basic and clinical literature.
Results: SE is a life-threatening and time-sensitive emergency that requires immediate treatment.
Article Synopsis
- The text outlines the definitions, prevalence, risk factors, consequences, and acute management strategies for seizure clusters using rescue medications.
- Research indicates varying clinical definitions for seizure clusters, typically involving multiple seizures within a defined timeframe, and highlights that patients with severe epilepsy are at greater risk.
- Rescue medications, particularly benzodiazepines like rectal diazepam gel, can effectively manage seizures and reduce emergency visits, though these medications remain underused; education on their use could improve outcomes for high-risk patients.
Article Synopsis
- The study assessed how well different machine learning models could predict in-hospital mortality for critically ill children undergoing continuous EEG monitoring in the ICU.
- The best-performing model, using stepwise selection, achieved an AUC of 0.82, while other models like LASSO and support vector machine had lower AUCs of 0.79 and 0.71, respectively.
- Traditional explanatory models performed poorly, with AUCs of only 0.63 and 0.45, highlighting that machine learning approaches can enhance mortality predictions using limited patient data.