Evidence map›Paper›PMID 31838172›Full record

ArticleEpilepsy research2020

Missed opportunities for epilepsy surgery referrals in Bhutan: A cohort study.

Andrew Siyoon Ham, Damber K Nirola, Neishay Ayub, Lhab Tshering, Ugyen Dem, Nathalie Jette, Chencho Dorji, Farrah J Mateen

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PubMed Full text at PMC Publisher
In one paragraph

Article in Epilepsy research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

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5 · Who and what money

Authors and funding

8 authors.

Andrew Siyoon HamHarvard University, Cambridge, MA, USA.
Damber K NirolaKhesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan.
Neishay AyubMassachusetts General Hospital, Boston, MA, USA.
Lhab TsheringJigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.
Ugyen DemKhesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan.
Nathalie JetteIcahn School of Medicine at Mount Sinai, New York, NY, USA.
Chencho DorjiJigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.
Farrah J MateenMassachusetts General Hospital, Boston, MA, USA. Electronic address: fmateen@partners.org.

Funding

The Epilepsy Bioinformatics Study for Antiepileptogenic Therapy (EpiBioS4Rx) Public Engagement CoreU54NS100064 · NINDS · UNIVERSITY OF SOUTHERN CALIFORNIA · PI TOGA, ARTHUR W · 2017 to 2021
$21.7M
Mount Sinai Network of Excellence in Neuroscience Clinical TrialsU24NS107201 · NINDS · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · PI JETTE, NATHALIE, MILLER, AARON · 2018 to 2022
$1.7M
CLINICAL UTILITY OF A SMARTPHONE-BASED EEG SYSTEM FOR PEOPLE WITH EPILEPSY IN BHUTANR21NS098886 · NINDS · MASSACHUSETTS GENERAL HOSPITAL · PI MATEEN, FARRAH JASMINE · 2017 to 2018
$396k
NINDS NIH HHS R21 NS098886NINDS NIH HHS U24 NS107201NINDS NIH HHS U54 NS100064
6 · The paper itself

Abstract

objectiveTo quantify the missed opportunities for epilepsy surgery referral and operationalize the Canadian Appropriateness of Epilepsy Surgery (CASES) tool for use in a lower income country without neurologists.

methodsPeople with epilepsy were recruited from the Jigme Dorji Wangchuck National Referral Hospital from 2014-2016. Each participant was clinically evaluated, underwent at least one standard EEG, and was invited to undergo a free 1.5 T brain MRI. Clinical variables required for CASES were operationalized for use in lower-income populations and entered into the free, anonymous website tool.

findingsThere were 209 eligible participants (mean age 28.4 years, 56 % female, 179 with brain MRI data). Of the 179 participants with brain MRI, 43 (24.0 %) were appropriate for an epilepsy surgery referral, 21 (11.7 %) were uncertain, and 115 (64.3 %) were inappropriate for referral. Among the 43 appropriate referral cases, 36 (83.7 %) were "very high" and 7 (16.3 %) were "high" priorities for referral. For every unit increase in surgical appropriateness, quality of life (QoL) dropped by 2.3 points (p-value <0.001). Among the 68 patients who took >1 antiepileptic drug prior to enrollment, 42 (61.8 %) were appropriate referrals, 14 (20.6 %) were uncertain, and 12 (17.6 %) were inappropriate.

conclusionApproximately a quarter of Bhutanese epilepsy patients who completed evaluation in this national referral-based hospital should have been evaluated for epilepsy surgery, sometimes urgently. Surgical services for epilepsy are an emerging priority for improving global epilepsy care and should be scaled up through international partnerships and clinician support algorithms like CASES to avoid missed opportunities.

Indexed as

Referral and ConsultationAdultBhutanBrainCohort StudiesEpilepsyFemaleHumansMagnetic Resonance ImagingMaleMental HealthMiddle AgedQuality of LifeSeizuresAsiaEpilepsyHealth servicesMental healthQuality of lifeSeizuresSurgical services

Identifiers

PMID31838172
PMCPMC6954951

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.