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Article ; Online: What Do We Need to Know About Transition/Transfer Programs and What Sort of Research Will Answer the Questions?

Camfield, Peter / Camfield, Carol

2020 Volume 36, Page(s) 100858

Abstract: Despite an increasing literature, there are many unanswered questions about transition to adult care for youth with chronic disorders. This paper questions the definition and components of optimal transition programs, their effectiveness and costs. Few ... ...

Abstract	Despite an increasing literature, there are many unanswered questions about transition to adult care for youth with chronic disorders. This paper questions the definition and components of optimal transition programs, their effectiveness and costs. Few transition programs have been comprehensively evaluated and effectiveness studies are usually based on a historical control group. Transition clinics for neurological disorders are described but not evaluated. Studies in diabetes, renal transplant, and rheumatologic disorders provide the best available evidence, albeit limited, of the value of transition clinics/programs. A few studies have addressed the cost of transition clinics and suggest that the incremental costs of the clinic are recouped by reduced medical costs in adult care. There is room for a great deal more research about transition.
MeSH term(s)	Adolescent ; Adult ; Disease Progression ; Humans ; Nervous System Diseases/therapy ; Program Development/economics ; Program Development/standards ; Transition to Adult Care ; Young Adult
Language	English
Publishing date	2020-10-26
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1290000-x
ISSN	1558-0776 ; 1071-9091
ISSN (online)	1558-0776
ISSN	1071-9091
DOI	10.1016/j.spen.2020.100858
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Article: Can an epilepsy transfer clinic be sustained in the United States?

Hauser, W Allen / Camfield, Carol S / Camfield, Peter R

Neurology. Clinical practice

2020 Volume 10, Issue 4, Page(s) 274–276

Language	English
Publishing date	2020-09-15
Publishing country	United States
Document type	Editorial
ZDB-ID	2645818-4
ISSN	2163-0933 ; 2163-0402
ISSN (online)	2163-0933
ISSN	2163-0402
DOI	10.1212/CPJ.0000000000000785
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Article ; Online: Regression in children with epilepsy.

Camfield, Peter / Camfield, Carol

Neuroscience and biobehavioral reviews

2018 Volume 96, Page(s) 210–218

Abstract: Regression in children with epilepsy may involve loss of cognitive abilities, failure to progress or a slowing of developmental trajectory. A few seizures do not lead to regression. Large numbers of seizures may be associated with regression but the ... ...

Abstract	Regression in children with epilepsy may involve loss of cognitive abilities, failure to progress or a slowing of developmental trajectory. A few seizures do not lead to regression. Large numbers of seizures may be associated with regression but the cause is an important cofounder. Individual spike discharges on EEG are associated with transient cognitive impairment and continuous spike discharges with regression. Regression may be global in continuous spike wave in slow sleep (CSWS) or specific (auditory agnosia) in Landau Kleffner syndrome. Regression is mild and transient in Rolandic Epilepsy or profound and permanent in West Syndrome. Epilepsy syndromes grouped under "epileptic encephalopathies" may lead to regression, although proof of this concept is not strong for many syndromes. The absence of cognitive assessment before epilepsy onset, the contribution of the cause and complications of treatment make for difficult methodological problems. The large majority of children with epilepsy do not have regression. There is need for more longitudinal studies of children with epileptic encephalopathies and other epilepsies associated with regression.
MeSH term(s)	Animals ; Brain/physiopathology ; Child ; Epilepsy/physiopathology ; Epilepsy/psychology ; Humans
Language	English
Publishing date	2018-12-08
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	282464-4
ISSN	1873-7528 ; 0149-7634
ISSN (online)	1873-7528
ISSN	0149-7634
DOI	10.1016/j.neubiorev.2018.12.008
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Article ; Online: Nights and weekends: Two clinical epilepsy researchers with intertwined lives.

Camfield, Peter / Camfield, Carol

Epilepsy & behavior : E&B

2016 Volume 58, Page(s) 133–136

Language	English
Publishing date	2016-05
Publishing country	United States
Document type	Editorial
ZDB-ID	2010587-3
ISSN	1525-5069 ; 1525-5050
ISSN (online)	1525-5069
ISSN	1525-5050
DOI	10.1016/j.yebeh.2016.02.021
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Article ; Online: Cognitive Disabilities and Long-term Outcomes in Children with Epilepsy: A Tangled Tail.

Camfield, Carol / Camfield, Peter

Seminars in pediatric neurology

2017 Volume 24, Issue 4, Page(s) 243–250

Abstract: Cognitive problems ranging from mild specific learning problems to profound intellectual disability (ID) are very common in children with epilepsy. For most affected patients there is good evidence that the cognitive problems are present at the onset of ... ...

Abstract	Cognitive problems ranging from mild specific learning problems to profound intellectual disability (ID) are very common in children with epilepsy. For most affected patients there is good evidence that the cognitive problems are present at the onset of seizures and do not deteriorate over time. There is no evidence that a few seizures lead to cognitive deterioration. An exception may occur in children with epileptic encephalopathies, although this contention is not always easy to prove. ID is a strong predictor of intractable epilepsy, and the greater the degree of the ID the greater the risk of medication resistant epilepsy. It is not known if specific learning disorders are associated with more severe epilepsy. Rolandic epilepsy is unusual because possibly one-third of patients have transient cognitive and behavioral difficulties during the active phase but later have normal adult social outcome. More longitudinal studies with baseline and repeated cognitive assessments are needed to fully understand the relationship of cognitive problems to childhood onset epilepsy.
MeSH term(s)	Animals ; Child ; Cognition Disorders/etiology ; Cognition Disorders/physiopathology ; Epilepsy/complications ; Epilepsy/physiopathology ; Epilepsy/psychology ; Humans ; Intellectual Disability/etiology ; Intellectual Disability/physiopathology
Language	English
Publishing date	2017
Publishing country	United States
Document type	Journal Article
ZDB-ID	1290000-x
ISSN	1558-0776 ; 1071-9091
ISSN (online)	1558-0776
ISSN	1071-9091
DOI	10.1016/j.spen.2017.10.006
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Article ; Online: Intractable seizures after a lengthy remission in childhood-onset epilepsy.

Camfield, Peter R / Camfield, Carol S

Epilepsia

2017

Abstract: Objectives: To establish the risk of subsequent intractable epilepsy after ≥2, ≥5, and ≥10 years of remission in childhood-onset epilepsy.: Methods: From the Nova Scotia childhood-onset epilepsy population-based cohort patients with all types of ... ...

Abstract	Objectives: To establish the risk of subsequent intractable epilepsy after ≥2, ≥5, and ≥10 years of remission in childhood-onset epilepsy. Methods: From the Nova Scotia childhood-onset epilepsy population-based cohort patients with all types of epilepsy were selected with ≥20 years follow-up from seizure onset (incidence cases). Children with childhood absence epilepsy were excluded. The rate of subsequent intractable epilepsy was then studied for patients with ≥5 years remission on or off AED treatment and compared with the rate for those with ≥2 and ≥10 years of remission. Results: Three hundred eighty-eight eligible patients had ≥20 years follow-up (average 27.7 ± (standard deviation) 4 years) until they were an average of 34 ± 6.5 years of age. Overall, 297 (77%) had a period of ≥5 years of seizure freedom (average 21.2 ± 8 years), with 90% of these remissions continuing to the end of follow-up. Seizures recurred in 31 (10%) and were intractable in 7 (2%). For the 332 with a remission of ≥2 years seizure-free, 6.9% subsequently developed intractable epilepsy (p = 0.001). For the 260 with ≥10 years remission, 0.78% subsequently developed intractable epilepsy (p = 0.25 compared with ≥5 years remission). Significance: Even after ≥5 or ≥10 years of seizure freedom, childhood-onset epilepsy may reappear and be intractable. The risk is fortunately small, but for most patients it is not possible to guarantee a permanent remission.
Language	English
Publishing date	2017-10-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	216382-2
ISSN	1528-1167 ; 0013-9580
ISSN (online)	1528-1167
ISSN	0013-9580
DOI	10.1111/epi.13916
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Article: Incidence, prevalence and aetiology of seizures and epilepsy in children.

Camfield, Peter / Camfield, Carol

Epileptic disorders : international epilepsy journal with videotape

2015 Volume 17, Issue 2, Page(s) 117–123

Abstract: Aim: To (1) summarize published, peer-reviewed literature about the incidence and prevalence of epilepsy in children from developed and developing countries around the world, and (2) discuss problems in defining aetiologies of epilepsy in children, and ... ...

Abstract	Aim: To (1) summarize published, peer-reviewed literature about the incidence and prevalence of epilepsy in children from developed and developing countries around the world, and (2) discuss problems in defining aetiologies of epilepsy in children, and distinguish between seizures and epilepsy. Methods: Review of selected literature with particular attention to systematic reviews. Results: The incidence of epilepsy in children ranges from 41-187/100,000. Higher incidence is reported from underdeveloped countries, particularly from rural areas. The incidence is consistently reported to be highest in the first year of life and declines to adult levels by the end of the first decade. The prevalence of epilepsy in children is consistently higher than the incidence and ranges from 3.2-5.5/1,000 in developed countries and 3.6-44/1,000 in underdeveloped countries. Prevalence also seems highest in rural areas. The incidence and prevalence of specific seizure types and epilepsy syndromes is less well documented. In population-based studies, there is a slight, but consistent, predominance of focal seizures compared with generalized seizures. Only about one third of children with epilepsy can be assigned to a specific epilepsy syndrome, as defined by the most recently proposed system for organization of epilepsy syndromes. Conclusions: The incidence and prevalence of epilepsy in children appears to be lower in developed countries and highest in rural areas of underdeveloped countries. The reasons for these trends are not well established. Although focal seizures predominate, the incidence and prevalence of specific epilepsy syndromes is not well documented.
MeSH term(s)	Child ; Epilepsy/epidemiology ; Epilepsy/etiology ; Humans
Language	English
Publishing date	2015-06
Publishing country	France
Document type	Journal Article ; Review
ZDB-ID	2086797-9
ISSN	1950-6945 ; 1294-9361
ISSN (online)	1950-6945
ISSN	1294-9361
DOI	10.1684/epd.2015.0736
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Article: Febrile seizures and genetic epilepsy with febrile seizures plus (GEFS+).

Camfield, Peter / Camfield, Carol

Epileptic disorders : international epilepsy journal with videotape

2015 Volume 17, Issue 2, Page(s) 124–133

Abstract: To review the literature about febrile seizures and GEFS plus with special emphasis on management and outcome. Selected literature review. Febrile seizures are the most common convulsive event in humans, occurring in 2-6% of the population. The aetiology ...

Abstract	To review the literature about febrile seizures and GEFS plus with special emphasis on management and outcome. Selected literature review. Febrile seizures are the most common convulsive event in humans, occurring in 2-6% of the population. The aetiology is complex with strong evidence for a heterogeneous genetic predisposition interacting with fever of any cause, with certain viral infections having a greater effect. A large amount of literature has established that febrile seizures have no long-term consequences on cognition or behaviour. Unfortunately, about 40% of children with a first febrile seizure will have a recurrence. The strongest predictor of recurrence is age <14-16 months at the time of the first febrile seizure. Epilepsy follows febrile seizures in ∼3% cases, with the concepts of simple and complex febrile seizures providing relatively weak prediction. Very prolonged febrile seizures may lead to mesial temporal sclerosis and temporal lobe epilepsy although the degree of risk remains uncertain. Investigations beyond establishing the cause of the provoking fever are nearly always unnecessary. Treatment is mainly reassurance and there is some evidence that parents eventually "come to grips" with the fear that their children are dying during a febrile seizure. Antipyretic medications are remarkably ineffective to prevent recurrences. Daily and intermittent prophylactic medications are ineffective or have unacceptable side effects or risks. "Rescue" benzodiazepines may prevent prolonged recurrences for selected patients with a first prolonged febrile seizure although this has not been proven. Genetic epilepsy with febrile seizures plus (GEFS+) is a complex autosomal dominant disorder usually caused by mutations in SCN1A (a voltage-gated sodium channel). One third of patients have febrile seizures only; two thirds have a variety of epilepsy syndromes, both focal and generalized. Febrile seizures may distress parents but rarely have any long-term consequences. Reassurance is the only treatment for the vast majority. Identifying patients with GEFS plus may lead to further investigations and counselling.
MeSH term(s)	Child ; Epilepsy, Generalized/epidemiology ; Epilepsy, Generalized/etiology ; Epilepsy, Generalized/genetics ; Humans ; Seizures, Febrile/epidemiology ; Seizures, Febrile/etiology ; Seizures, Febrile/genetics
Keywords	covid19
Language	English
Publishing date	2015-06
Publishing country	France
Document type	Journal Article ; Review
ZDB-ID	2086797-9
ISSN	1950-6945 ; 1294-9361
ISSN (online)	1950-6945
ISSN	1294-9361
DOI	10.1684/epd.2015.0737
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Article ; Online: Injuries from seizures are a serious, persistent problem in childhood onset epilepsy: a population-based study.

Camfield, Carol / Camfield, Peter

Seizure

2015 Volume 27, Page(s) 80–83

Abstract: Purpose: Document the frequency, types and risk factors for injuries caused by seizures for people with childhood onset epilepsy.: Method: We contacted patients with all types of epilepsy except childhood absence from the Nova Scotia Childhood ... ...

Abstract	Purpose: Document the frequency, types and risk factors for injuries caused by seizures for people with childhood onset epilepsy. Method: We contacted patients with all types of epilepsy except childhood absence from the Nova Scotia Childhood Epilepsy population-based cohort. Seizure onset was between 1977 and 1985. Patients and parents were asked about serious injuries resulting from a seizure, defined as severe enough for an urgent physician or dentist visit. Results: Of 595 eligible patients, we contacted 472 (79%). During an average follow up of 23.9 ± 8 years, 52 (11%) experienced ≥1 serious injury for a total of 81 injuries. Of all injuries, 24 (30%) were lacerations requiring sutures, 15 (19%) fractures, 11 (14%) broken teeth, 8 (10%) concussions, 4 (5%) burns, and 20 (25%) other. "Other" included 1 fatal drowning, 2 near-drownings, 3 shoulder dislocations and 1 severe eye injury. Four injuries occurred with the first seizure; all others after a long gap from seizure onset (range 1.5-30 years). Injuries occurred in all epilepsy syndromes, most commonly with symptomatic generalized epilepsy (17% vs. 11% p = 0.03) and intractable epilepsy (28% vs. 8% p<0.0001). Most injuries occurred during normal daily activities and were judged not to be easily preventable. Conclusions: During ∼24 years of follow up 1 out of 10 patients with childhood onset epilepsy had a serious injury as the result of a seizure. Most injuries occurred years after the initial diagnosis and were more common when seizures were more frequent. The only practical solution to injury prevention is better seizure control.
MeSH term(s)	Adolescent ; Adult ; Brain Concussion/etiology ; Brain Injuries/etiology ; Child ; Cohort Studies ; Community Health Planning ; Female ; Fractures, Bone/etiology ; Humans ; Male ; Seizures/complications ; Time Factors ; Tooth Injuries/etiology ; Young Adult
Language	English
Publishing date	2015-04
Publishing country	England
Document type	Journal Article
ZDB-ID	1137610-7
ISSN	1532-2688 ; 1059-1311
ISSN (online)	1532-2688
ISSN	1059-1311
DOI	10.1016/j.seizure.2015.02.031
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Zs.A 3573: Show issues

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Article ; Online: Are febrile seizures an indication for intermittent benzodiazepine treatment, and if so, in which cases?

Camfield, Peter / Camfield, Carol

Epileptic disorders : international epilepsy journal with videotape

2014 Volume 16, Issue Spec No 1, Page(s) S84–88

Abstract: Febrile seizures occur in ∼4% of children. After a first febrile seizure, the risk of recurrence is ∼40%, but excellent studies document that febrile seizures do not cause brain damage or deficits in cognition or behaviour. The risk of subsequent ... ...

Abstract	Febrile seizures occur in ∼4% of children. After a first febrile seizure, the risk of recurrence is ∼40%, but excellent studies document that febrile seizures do not cause brain damage or deficits in cognition or behaviour. The risk of subsequent epilepsy is 2-4%. Prolonged febrile seizures are of concern because a child may later develop mesial temporal sclerosis and intractable epilepsy in rare cases. Most prolonged febrile seizures represent the first febrile seizure and cannot be anticipated. A first prolonged febrile seizure does not increase the risk of recurrence, but if there is a recurrence, it is more likely to be prolonged. Prevention of recurrent febrile seizures is difficult. Antipyretics are ineffective. Daily AED treatment is not often justified. Intermittent oral diazepam at the time of illness is not very successful and has significant side effects. The most optimistic study found that the number of subjects required to treat in order to prevent one recurrence was 14. Intermittent clobazam has fewer side effects than diazepam and may be somewhat effective. Rescue benzodiazepines given outside health care facilities may be effective in selected patients to prevent prolonged recurrences, although this has not been proven with rectal diazepam which has been more extensively studied than buccal or nasal midazolam. Currently, we suggest that, for children with febrile seizures, candidates for consideration for rescue benzodiazepines are those with a prolonged febrile seizure or poor access to medical care. It is possible that the use of a rescue benzodiazepine may alleviate severe parental anxiety, but this remains to be established.
Language	English
Publishing date	2014-10-09
Publishing country	France
Document type	Journal Article
ZDB-ID	2086797-9
ISSN	1950-6945 ; 1294-9361
ISSN (online)	1950-6945
ISSN	1294-9361
DOI	10.1684/epd.2014.0683
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