Direct and indirect costs associated with stereotactic radiosurgery or open surgery for medial temporal lobe epilepsy: Results from the ROSE trial

Objective To determine whether a less-invasive approach to surgery for medically refractory temporal lobe epilepsy is associated with lower health care costs and costs of lost productivity over time, compared to open surgery. Methods We compared direct medical costs and indirect productivity costs associated with treatment with stereotactic radiosurgery (SRS) or anterior temporal lobectomy (ATL) in the ROSE (Radiosurgery or Open Surgery for Epilepsy) trial. Health care use was abstracted from hospital bills, the study database, and diaries in which participants recorded health care use and time lost from work while seeking care. Costs of use were calculated using a Medicare costing approach used in a prior study of the costs of ATL. The power of many analyses was limited by the sample size and data skewing. Results Combined treatment and follow-up costs (in thousands of US dollars) did not differ between SRS (n = 20, mean = $76.6, 95$79.0, 95% CI = 60.09-103.8). Indirect costs also did not differ. More ATL than SRS participants were free of consciousness-impairing seizures in each year of follow-up (all P < 0.05). Costs declined following ATL (P = 0.005). Costs tended to increase over the first 18 months following SRS (P = 0.17) and declined thereafter (P = 0.06). This mostly reflected hospitalizations for SRS-related adverse events in the second year of follow-up. Significance Lower initial costs of SRS for medial temporal lobe epilepsy were largely offset by hospitalization costs related to adverse events later in the course of follow-up. Future studies of less-invasive alternatives to ATL will need to assess adverse events and major costs systematically and prospectively to understand the economic implications of adopting these technologies

Uloga socio-demografskih i iskustvenih čimbenika u formiranju stavova i socijalne distance prema epilepsiji i oboljelima [The role of socio-demographic and empiric factors in the formation of attitudes and social distance towards epilesy and people with epilepsy]

Public knowledge, perception and attitude of Croatian citizens towards epilepsy were studied on a random sample of 1000 inhabitants older than 15 years of age who answered 12 questions in a dedicated questionnaire [Croatian Epilepsy Questionnaire (CEQ)-12 (CEQ12)]. Face-to-face interviews were conducted in participants' households by Ipsos PULS, market and public opinion research agency (Zagreb) in 2004 and 2009. Standard methods of descriptive and analytical statistics were utilized in data analysis. Over ninety percent (92.3%) knew about epilepsy, 47.1% knew a person with epilepsy, 38.6% witnessed an epileptic seizure, 3.1% believed epilepsy was a form of insanity, 80.6% could list at least one symptom, and 45.9% at least one cause of epilepsy. The respondents considered seizures (29.6%), injuries during attacks (22.6%), and fear of seizures (18.9%) the worst aspects of epilepsy for the patient. Epilepsy (5.3/8) ranked sixth out of eight studied diseases based on severity (lung cancer, AIDS, stroke, heart attack, schizophrenia, epilepsy, depression, andpeptic ulcer). Only 7.8% respondents would object to having their child socialize with a child with epilepsy, while 77.8% believed that a child with epilepsy can succeed equally in life as its healthy counterpart. Almost half (45.9%) of participants would approach and help a seizing person, while 36.2% would approach a seizing person and call the Emergency Medical System (EMS) without direct involvement. Of the eight diseases compared, the average expressed distance towards epilepsy was 2.6 on a 1 to 6 scale (1. Spouse, 2. Friend, 3. Coworker/neighbor, 4. Sharing the city, 5. Sharing the country, 6. Avoid at all costs) and closest to collegiality (3. Coworker/neighbor). Researched attitudes towards epilepsy and persons who suffer from it did not change significantly between the surveys in 2004 and 2009. General familiarity with epilepsy in Croatia was at the level of most developed countries, explicit attitudes towards this disease among the most progressive in Europe, and implicit attitudes revealed openness at the level of most developed societies. A moderate distance towards epilepsy and persons with 106 Bagić A. (2011) Uloga socio-demografskih i iskustvenih čimbenika u formiranju stavova i socijalne distance prema epilepsiji i oboljelima. epilepsy was expressed along with, to a large extent, readiness to help a seizing person. Along with the stability of attitudes, the study confirmed that empiric factors (knowing a person with epilepsy, having witnessed an epileptic seizure) were correlated more consistently and stronger with more positive attitudes towards epilepsy and smaller social distance towards persons with epilepsy than demographic characteristics, and that attitude and distance towards epilepsy is an expression of general attitude and disposition towards stigmatizing diseases or diseased persons, and not of specific disposition towards this population. This study indicates a new and more economical approach for the possibility of accomplishing bigger and farther reaching changes in public attitudes using social marketing

Editorial: Magnetoencephalography: Methodological innovation paves the way for scientific discoveries and new clinical applications

Non peer reviewe

An Emerging Screening Method for Interrogating Human Brain Function: Tutorial

Cognitive decline can be observed due to a myriad of causes. Clinicians would benefit from a noninvasive quantitative tool to screen and monitor brain function based on direct measures of neural features. In this study, we used neuroimaging data from magnetoencephalography (with a whole-head Elekta Neuromag 306 sensor system) to derive a set of features that strongly correlate with brain function. We propose that simple signal characteristics related to peak variability, timing, and abundance can be used by clinicians as a screening tool to investigate cognitive function in at-risk individuals. Using a minimalistic set of features, we were able to perfectly distinguish between participants with normative and nonnormative brain function, and we were also able to successfully predict participants’ Mini-Mental Test score (r=0.99; P<.001; mean absolute error=0.413). This set of features can be easily visualized in an analog fashion, providing clinicians with several graded measurements (in comparison to a single binary diagnostic tool) that can be used for screening and monitoring cognitive decline

Decoding Brain States Based on Magnetoencephalography From Prespecified Cortical Regions

Brain state decoding based on whole-head MEG has been extensively studied over the past decade. Recent MEG applications pose an emerging need of decoding brain states based on MEG signals originating from prespecified cortical regions. Toward this goal, we propose a novel region-of-interest-constrained discriminant analysis algorithm (RDA) in this paper. RDA integrates linear classification and beamspace transformation into a unified framework by formulating a constrained optimization problem. Our experimental results based on human subjects demonstrate that RDA can efficiently extract the discriminant pattern from prespecified cortical regions to accurately distinguish different brain states