ABSTRACT
This article explores how contingency theories of leadership (pragmatic theories that note 'no one size fits all') can be used by multidisciplinary health-care teams to improve communication and patient care.
Subject(s)
Interdisciplinary Communication , Leadership , Practice Patterns, Physicians' , Humans , Patient Care Team , Quality ImprovementABSTRACT
Gabapentin (GAB) is a newer second-line antiepileptic drug (AED) used in children. This is a multi-centre retrospective observational study of the efficacy, tolerability and retention rate in 105 children, aged 0-17.5 years (mean 10.1) over a 14 year period. The median age of epilepsy onset was 2.5 years (range 0-14.6). 72% started GAB as at least the 3rd AED, with 43% having been withdrawn from at least 2 AEDs. 77% had focal and 52% symptomatic epilepsies. The maintenance doses for GAB ranged 6.0-87.3 mg/kg/day (mean 43.7). The study comprised 157 person-treatment years for GAB. GAB was well tolerated with 55% remaining on treatment beyond 1 year. No serious adverse events were reported whilst on GAB, but 39% reported possibly and probably related adverse events. Seizure improvement (<50% seizure frequency compared to baseline) at more than 12 months of treatment, was reported in 35% of patients starting GAB, including 6% who remained seizure free. The results demonstrated the efficacy and tolerability of GAB in children with difficult to treat epilepsies, and a good response to treatment beyond 12 months, in both focal and generalised epilepsies.
Subject(s)
Amines/therapeutic use , Anticonvulsants/therapeutic use , Cyclohexanecarboxylic Acids/therapeutic use , Epilepsy/drug therapy , gamma-Aminobutyric Acid/therapeutic use , Adolescent , Child , Child, Preschool , Female , Gabapentin , Humans , Infant , MaleABSTRACT
UNLABELLED: Clobazam (CLB), Topiramate (TOP) and Lamotrigine (LAM) are newer second-line antiepileptic drugs (AEDs) used in children. This is a single-centre retrospective observational study of the efficacy, tolerability and retention rate in 224 separate treatment episodes in 194 children, aged 0.1-16.7 years (median 9.4) over an 8 year period. The median age of epilepsy onset was 3.3 years (range 0-15.1). 79% started CLB, TOP or LAM as at least the 3rd AED, with 39% having been withdrawn from at least 2 AEDs. 53% had generalised and 37% idiopathic epilepsies. The maintenance doses for CLB ranged 0.12-3.50 mg/kg/day (mean 0.7); for TOP 0.45-32.0 mg/kg/day (mean 7.1) and for LAM 1.13-16.0 mg/kg/day (mean 5.6). The study comprised 75 person-treatment years for CLB, 56 for TOP, 124 for LAM. RESULTS: CLB, TOP and LAM were well tolerated with 51%, 37% and 69% remaining on treatment beyond 1 year respectfully. 1 serious adverse event for CLB (inducing seizures) and 2 for LAM (rashes) were reported, and 60%, 47% and 39% had possibly and probably related adverse events for CLB, TOP and LAM respectively. Beyond 12 months seizure improvement (< 50% seizure frequency compared to baseline) was reported in 43%, 35% and 44% on CLB, TOP and LAM, including 5% and 8% remaining seizure free on CLB and LAM respectively. CONCLUSION: Our results demonstrate the efficacy and tolerability of CLB, TOP and LAM in children with difficult to treat epilepsies and a good response in CLB and LAM, and a reasonable response in TOP beyond 12 months.
