Physical activity interventions for young people with increased risk of problematic substance use: a systematic review including different intervention formats

Objective: This systematic review investigates physical activity (PA) interventions for (1) reducing substance use and associated outcomes, (2) increasing physical activity, and (3) improving mental health in young people aged 12–25 years at increased risk for problematic substance use. Method: Four databases (PsycINFO, CINAHL, SPORTDiscus, and Medline) and grey literature, including hand searches, were searched (2021–2022). Non-randomized controlled or randomized controlled trials of a) multimodal or unimodal, short or long-term physical activity interventions in young people at increased risk of problematic substance use that b) investigated substance use outcomes were included. PA and mental health outcomes were explored where possible. Results: Sixty-one percent of the studies (k = 17/28) reported a significant improvement in outcomes related to tobacco (e.g., abstinence, cravings, withdrawal symptoms, smoking pattern), alcohol (e.g., quantity, frequency), or other substance use (e.g., frequency, quantity, recent use). Eight studies reported an increase in PA participation; two reported a beneficial effect on depression symptoms. The certainty of the evidence, i.e., the confidence in the reported effect estimates, was downgraded based on the risk of bias assessment. Findings should therefore be interpreted cautiously. Conclusions: A range of physical activity intervention formats and modalities may decrease substance use and associated outcomes and increase physical activity participation among people at risk for problematic substance use. Future research is warranted to better establish efficacy and investigate the effectiveness of implementing physical activity as part of treatment for substance use in young people

Behaviour change techniques in physical activity-focused interventions for young people at risk of problematic substance use: a systematic review and meta-analysis.

Aim This systematic review investigates behaviour change techniques in interventions promoting physical activity for young people aged 12-25 years at heightened risk of problematic substance use, and the effect of these techniques on physical activity participation and substance use outcomes. Methods Four databases (PsycINFO, CINAHL, SPORTDiscus and Medline) were searched between November 2020 and November 2022 for randomized and non-randomized controlled studies according to inclusion criteria. Meta-analyses were calculated using weighted, standardized averages of effect sizes (Hedges' g). Results Twenty-eight studies were included, 14 studies in the meta-analysis (intervention n = 1328; control n = 845). Reported BCTs included behavioural instructions, social comparison and goal setting. There was a significant effect of behaviour change techniques on combined substance use outcomes, such as cravings and consumption, for interventions reporting multiple behaviour change techniques (g = -0.33, p < .001, 95% CI [-0.50,-0.16]) or one single behaviour change technique (g = -1.84, p < .001, 95% CI [-2.89,-0.8]). Limitations include unexplained variance and limited reporting of relevant behaviour change technique data in the included studies. Conclusion The results indicate that using behaviour change techniques in interventions that promote physical activity for young people has an effect on substance use. Further research needs to be completed comparing the impact of the number and type of behaviour change technique, and improved reporting of intervention content is required

Intracranial EEG recording in autoimmune epilepsy dataset

The appearance of seizures in autoimmune epilepsy on intracranial recordings has not been previously demonstrated. The following data shows a multifocal epilepsy in a patient with seronegative autoimmune epilepsy (reported here; “Electroclinical Insights into Autoimmune Epilepsy”, Gillinder, 2019). Independent seizures were seen to arise from 5 separate foci. These all began with slow repetitive spiking in a highly restricted area. Only after many minutes would this activity spread to other regions. Despite arising from different locations, all foci affected the posterior insula resulting in clinical symptoms

The use of virtual reality simulation to determine potential for endoscopic surgery skill acquisition

Background: Efficient acquisition of endoscopic technique is essential for high-level care in surgical practice. In contrast to similar substantial risk industries, there is no standard instrument capable of detecting the potential of surgical residency candidates to develop such skills. Material and methods: We used the Simbionix "Lapmentor" Virtual reality simulator basic skills tasks 1, 5 and 6 to establish baseline performance of 17 subjects lacking surgical experience, then divided them into two groups. One group trained on the Lapmentor, a validated trainer. The second group trained on a video box trainer using 3 FLS tasks, which correlate with real OR performance. After completing the training program, each group was tested on its training modality and correlations were sought between performance in the screening tasks and final scores in both groups. Results: Time in Lapmentor task 1 showed significant correlations with total FLS scores (R 0.807 P 0.015), in addition to other benchmark parameters. With the Lapmentor group, time on task 5 demonstrated correlation with itself on the final scores (R 0.794 P 0.011). Conclusions: Time in the Lapmentor task 1 demonstrates correlations with FLS scores, which translate to better OR performance. The Lapmentor thus shows potential to be used as a screening test for surgical talent

Electroclinical insights into autoimmune epilepsy

Purpose: Chronic autoimmune epilepsy is an increasingly recognised entity however its clinical and electrographic features remain poorly understood. We present a case undergoing diagnostic Stereo-electro-encephalography implantation that was found to have a multifocal perisylvian epilepsy with unique electrographic features and is now seizure free with immunotherapy.Methods: The patient had antibody negative refractory perisylvian epilepsy and underwent implantation of the perisylvian-temporal networks. Immunomodulatory treatment was administered during SEEG.Results: SEEG demonstrated a multifocal perisylvian epilepsy with strong involvement of the posterior insula. There was almost continuous spiking seen interictally from multiple foci within the right hemisphere and independent seizures were generated from 5 locations. After treatment with intravenous methylprednisone and immunoglobulin during SEEG, spiking and seizures terminated while still off anti-seizure medications. The patient remains seizure free on immunotherapy.Conclusion: This case highlights the importance of considering autoimmunity in the differential diagnosis of refractory epilepsy, especially perisylvian epilepsy. It also highlights the need to define a clinical phenotype associated with autoantibodies in epilepsy, as there are likely many cases who are not positive for one of the commercially available tests. This case also provides insights into the possible features of an electroclinical syndrome associated with autoimmunity

Short burst Clobazam dosing at discharge from VEEG evaluation reduces re-presentation with seizures

Purpose: Recurrent seizures and status epilepticus after medication reduction for inpatient Video Electroencephalograph (VEEG) monitoring is a well-known complication of this investigation. In the literature this is reported to occur at a rate of approximately 3–7%. We review the use of short burst Clobazam dosing on discharge from the Epilepsy monitoring unit (EMU) to determine if this might reduce rates of representation with seizures. Methods: We performed a retrospective review of all cases admitted to the EMU. Their medication reduction, number of seizures, seizure severity and demographics were collected. Representations to hospital were considered if they occurred within 14 days of discharge from the unit. Results: 264 cases were included, and 146 patients received 5 days of Clobazam 10 mg PO BD upon discharge after VEEG and 118 did not. There were significantly fewer patients re-presenting to hospital for seizures in the 14 days following discharge in those who were administered short-burst Clobazam compared to those who were not (0% and 4.23% respectively). There was also a trend towards fewer re-admissions for non-seizure indications including mental health issues or non-epileptic seizures and AED side effects. There were no definite adverse reactions to Clobazam recorded. Conclusion: Short burst Clobazam appears to be a safe and effective means to reduce representation with seizures after medication reduction during VEEG recording. This obviously benefits patients but it may also be a cost-effective means to reduce unnecessary health expenditure

Treatment outcomes after the introduction of a new seizure management protocol

Background/Aim: The present study aims to determine qualitative outcomes of presentations with acute recurrent seizures or status epilepticus to the emergency department of our institution after the introduction of a new seizure management protocol.Methods: We performed a retrospective analysis on two cohorts of patients for all presentations to the emergency department of our institution. Presentations were reviewed from January to July pre-protocol introduction and the same period post-protocol. Patients were included if they were treated for acute recurrent seizures or status epilepticus. The protocol applied a strict treatment regimen and used levetiracetam, valproate and phenobarbitone in place of phenytoin.Results: A total of 77 patients was included from the pre-protocol cohort and 72 from the post-protocol group. There was a significant reduction in intensive care unit (ICU) admission (seven patients in cohort 1 and 0 patients in cohort 2) and adverse drug reactions (18 patients in cohort 1 and four patients in cohort 2). There was a trend towards fewer deaths.Conclusion: The introduction of the new seizure management protocol assessed in this study has resulted in fewer ICU admissions, adverse drug reactions and most importantly fewer patient deaths. This is likely attributable to a combination of improved efficacy of the newer antiepileptic agents and a clearly defined protocol directed therapy