EpiNet as a way of involving more physicians and patients in epilepsy research: Validation study and accreditation process

open185siObjective: EpiNet was established to encourage epilepsy research. EpiNet is used for multicenter cohort studies and investigator-led trials. Physicians must be accredited to recruit patients into trials. Here, we describe the accreditation process for the EpiNet-First trials. Methods: Physicians with an interest in epilepsy were invited to assess 30 case scenarios to determine the following: whether patients have epilepsy; the nature of the seizures (generalized, focal); and the etiology. Information was presented in two steps for 23 cases. The EpiNet steering committee determined that 21 cases had epilepsy. The steering committee determined by consensus which responses were acceptable for each case. We chose a subset of 18 cases to accredit investigators for the EpiNet-First trials. We initially focused on 12 cases; to be accredited, investigators could not diagnose epilepsy in any case that the steering committee determined did not have epilepsy. If investigators were not accredited after assessing 12 cases, 6 further cases were considered. When assessing the 18 cases, investigators could be accredited if they diagnosed one of six nonepilepsy patients as having possible epilepsy but could make no other false-positive errors and could make only one error regarding seizure classification. Results: Between December 2013 and December 2014, 189 physicians assessed the 30 cases. Agreement with the steering committee regarding the diagnosis at step 1 ranged from 47% to 100%, and improved when information regarding tests was provided at step 2. One hundred five of the 189 physicians (55%) were accredited for the EpiNet-First trials. The kappa value for diagnosis of epilepsy across all 30 cases for accredited physicians was 0.70. Significance: We have established criteria for accrediting physicians using EpiNet. New investigators can be accredited by assessing 18 case scenarios. We encourage physicians with an interest in epilepsy to become EpiNet-accredited and to participate in these investigator-led clinical trials.openBergin P.S.; Beghi E.; Sadleir L.G.; Brockington A.; Tripathi M.; Richardson M.P.; Bianchi E.; Srivastava K.; Jayabal J.; Legros B.; Ossemann M.; McGrath N.; Verrotti A.; Tan H.J.; Beretta S.; Frith R.; Iniesta I.; Whitham E.; Wanigasinghe J.; Ezeala-Adikaibe B.; Striano P.; Rosemergy I.; Walker E.B.; Alkhidze M.; Rodriguez-Leyva I.; Ramirez Gonzalez J.A.; D'Souza W.J.; Calle A.; Palacios C.; Cairns A.; Carney P.; Craig D.; Gill D.; Gupta S.; Lander C.; Laue-Gizzi H.; Hitchens N.; Kiley M.; Lawn N.; Reyneke E.; Riney K.; Tan M.; Tan M.; Thieban M.; Wong C.; van Rijckevorsel G.; Ferrari Strang A.G.; Gifoni A.; Helio L.; Monnerat B.; Brna P.; Donner E.; Jacques S.; Jette N.; McLachlan R.; Mohamed I.; Tran T.P.Y.; Bo X.; Fan S.; Guang Y.; Li M.; Wang K.; Zhang S.; Ladino L.; Christensen J.; Kӧlmel M.S.; Nikanorova M.; Uusitalo A.; Vieira P.; Auvin S.; Ediberidze T.; Gogatishvili N.; Jishkariani T.; Dennig D.; Grimmer A.; Michaelis R.; Schubert-Bast S.; Stephani C.; Stodieck S.; Vollbrandt M.; Zellner A.; Zafeiriou D.; Fogarasi A.; Halasz P.; Chaurasia R.N.; Jain S.; Nair R.; Passi P.; Rajadhyaksha S.; Sattaluri S.J.; Shah H.; Udani V.; Costello D.; Aguglia U.; Bartocci A.; Benna P.; Ferlazzo E.; Laino D.; Spalice A.; Zanchi C.; Ali A.; Lim K.S.; Ramirez A.; Anderson N.; Barber A.; Cariga P.; Cleland J.; Child N.; Davis S.; Dayal V.; Dickson C.; Doran J.; Duncan R.; Giri P.; Herd M.; Hutchinson D.; Jones B.; Kao J.; Kilfoyle D.; Mottershead J.; Muir C.; Nolan M.; Pereira J.; Ranta A.; Sadani S.; Simpson M.; Spooner C.; Timmings P.; Walker E.; Wei D.; Willoughby E.; Wong E.; Wu T.; Olusola T.; Mahmud H.; Mogul Z.; Espinoza J.; Vizarreta J.H.; Baeta E.M.; Teotonio R.; Jocic-Jakubi B.; Lukic S.; Korosec M.; Zgur T.; Eguilaz M.G.; Asztely F.; Sithinamsuwan P.; Anderson J.; Auce P.; Desurkar A.; Hamandi K.; Kelso A.; Sanchez V.; Sidra A.; Smith P.; Wehner T.; Winston G.; Andrade E.; Bensalem-Owen M.; Boudreau M.; Caller T.; Chapman K.; Chari G.; Davis K.; Droker B.; El-Hagrassy M.; Eliashiv D.; Eze C.; Heck C.; Kabir A.; Kolesnik D.; Lam A.; Lopez J.; Maamoon T.; Cohen J.M.; Maganti R.; Nwankwo C.; Park K.; Proteasa S.; Sandok E.; Seinfield S.; Toub J.; Wirrell E.; Arbildi M.; Thien T.T.Bergin, P. S.; Beghi, E.; Sadleir, L. G.; Brockington, A.; Tripathi, M.; Richardson, M. P.; Bianchi, E.; Srivastava, K.; Jayabal, J.; Legros, B.; Ossemann, M.; Mcgrath, N.; Verrotti, A.; Tan, H. J.; Beretta, S.; Frith, R.; Iniesta, I.; Whitham, E.; Wanigasinghe, J.; Ezeala-Adikaibe, B.; Striano, P.; Rosemergy, I.; Walker, E. B.; Alkhidze, M.; Rodriguez-Leyva, I.; Ramirez Gonzalez, J. A.; D'Souza, W. J.; Calle, A.; Palacios, C.; Cairns, A.; Carney, P.; Craig, D.; Gill, D.; Gupta, S.; Lander, C.; Laue-Gizzi, H.; Hitchens, N.; Kiley, M.; Lawn, N.; Reyneke, E.; Riney, K.; Tan, M.; Tan, M.; Thieban, M.; Wong, C.; van Rijckevorsel, G.; Ferrari Strang, A. G.; Gifoni, A.; Helio, L.; Monnerat, B.; Brna, P.; Donner, E.; Jacques, S.; Jette, N.; Mclachlan, R.; Mohamed, I.; Tran, T. P. Y.; Bo, X.; Fan, S.; Guang, Y.; Li, M.; Wang, K.; Zhang, S.; Ladino, L.; Christensen, J.; Kӧlmel, M. S.; Nikanorova, M.; Uusitalo, A.; Vieira, P.; Auvin, S.; Ediberidze, T.; Gogatishvili, N.; Jishkariani, T.; Dennig, D.; Grimmer, A.; Michaelis, R.; Schubert-Bast, S.; Stephani, C.; Stodieck, S.; Vollbrandt, M.; Zellner, A.; Zafeiriou, D.; Fogarasi, A.; Halasz, P.; Chaurasia, R. N.; Jain, S.; Nair, R.; Passi, P.; Rajadhyaksha, S.; Sattaluri, S. J.; Shah, H.; Udani, V.; Costello, D.; Aguglia, U.; Bartocci, A.; Benna, P.; Ferlazzo, E.; Laino, D.; Spalice, A.; Zanchi, C.; Ali, A.; Lim, K. S.; Ramirez, A.; Anderson, N.; Barber, A.; Cariga, P.; Cleland, J.; Child, N.; Davis, S.; Dayal, V.; Dickson, C.; Doran, J.; Duncan, R.; Giri, P.; Herd, M.; Hutchinson, D.; Jones, B.; Kao, J.; Kilfoyle, D.; Mottershead, J.; Muir, C.; Nolan, M.; Pereira, J.; Ranta, A.; Sadani, S.; Simpson, M.; Spooner, C.; Timmings, P.; Walker, E.; Wei, D.; Willoughby, E.; Wong, E.; Wu, T.; Olusola, T.; Mahmud, H.; Mogul, Z.; Espinoza, J.; Vizarreta, J. H.; Baeta, E. M.; Teotonio, R.; Jocic-Jakubi, B.; Lukic, S.; Korosec, M.; Zgur, T.; Eguilaz, M. G.; Asztely, F.; Sithinamsuwan, P.; Anderson, J.; Auce, P.; Desurkar, A.; Hamandi, K.; Kelso, A.; Sanchez, V.; Sidra, A.; Smith, P.; Wehner, T.; Winston, G.; Andrade, E.; Bensalem-Owen, M.; Boudreau, M.; Caller, T.; Chapman, K.; Chari, G.; Davis, K.; Droker, B.; El-Hagrassy, M.; Eliashiv, D.; Eze, C.; Heck, C.; Kabir, A.; Kolesnik, D.; Lam, A.; Lopez, J.; Maamoon, T.; Cohen, J. M.; Maganti, R.; Nwankwo, C.; Park, K.; Proteasa, S.; Sandok, E.; Seinfield, S.; Toub, J.; Wirrell, E.; Arbildi, M.; Thien, T. T

Cerebral ischemic events in patients with mitral valve prolapse.

All patients 20 years old or older referred for echocardiographic examination and found to have mitral valve prolapse during the period January 1975 through December 1979 were included in the study. Of the 1,138 patients, two-thirds were women and one-third were men. Their average age was 48.4 years. Forty patients (3.5%) had histories of prior focal cerebrovascular ischemic events. In 26 of the 40 patients, no responsible mechanism other than mitra valve prolapse was identified, and in 4, the ischemic event occurred during an episode of bacterial endocarditis, a known complication of mitral valve prolapse. In 10 of the 26 patients, there was clinical information to suggest an embolic mechanism for the ischemic. A conservative estimate of the prevalence rate for cerebral infarction in this group of patients is four times greater than the rate expected in a normal population. This difference is likely due to the contribution of mitral valve prolapse in the pathogenesis of cerebral infarction.</jats:p

Fatal cerebral embolism following aorto-coronary bypass graft surgery.

In a case of fatal cerebral embolic infarction following aorto-coronary bypass graft (ACBG) surgery, postmortem examination revealed thrombosis of the vein grafts to the left circumflex and left anterior descending coronary arteries. Continguous with the thrombus in the graft to the circumflex artery was thrombotic material adherent to the aortic sutures and extending several millimeters into the lumen of the aorta. A nonadherent thrombus of similar histologic character was found in the right middle cerebral artery, associated with localized brain infarction. In addition to the risks of cerebral complication associated with other types of open-heart surgery, the location of the vein grafts in patients undergoing ACBG operations seems to offer a unique mechansim for the occurrence of systemic and cerebral embolism, which may be operational in other cases.</jats:p

Effects of anticoagulants in an animal model of septic cerebral embolization.

The effect of anticoagulation on lesions caused by cerebral emboli of different types was studied in 57 dogs. The resultant arterial and parenchymal lesions were assessed by pathologic and angiographic studies. Embolization with emboli that caused little or no inflammatory response in the artery (12 dogs) was not associated with hemorrhagic infarcts or with subdural or subarachnoid hemorrhage; furthermore, treatment with anticoagulants (9 dogs) did not change the character of the lesions. Embolization with emboli that caused arteritis, that is, bacterial contamination or presence of lead chromate in the embolus (21 dogs), was associated with hemorrhagic infarcts, focal subarachnoid hemorrhage, and increased incidence of acute subdural hemorrhage. Treatment with anticoagulants (16 dogs) was associated with a further increase in the incidence of subdural hemorrhage.</jats:p