Defining the epilepsy management gap in a prospective cohort in Bhutan (P2.326)
Bibliographic record
Abstract
OBJECTIVE:To introduce the epilepsy “management gap” concept and demonstrate how it may improve upon the epilepsy “treatment gap” to identify subpopulations requiring neurological care in resource-limited settings. BACKGROUND: The epilepsy “treatment gap” describes the proportion of people with epilepsy (PWE) who require but do not receive anti-epileptic drugs (AEDs); however, outcomes are often poor in resource-limited settings even when AEDs are received. DESIGN/METHODS: We recruited a prospective cohort of PWE or suspected seizures at the JDW National Referral Hospital in Bhutan. Each participant completed an English or Dzhongka clinical questionnaire, quality of life in epilepsy-31 (QOLIE-31) survey, and a 20-minute EEG interpreted by a board-certified epileptologist. We defined the management gap as: (1) patients not taking an AED who had (i) seizure in the past month, and/or (ii) epileptiform abnormalities on EEG, (2) patients who had seizure-related injuries and (i) and/or (ii), (3) QOLIE-31 score <50 and (i) and/or (ii), (4) patients with suboptimal AED management, including (a) patients with staring spells on carbamazepine, (b) adults on phenobarbital, and (c) women of childbearing age (14-40 years) on sodium valproate. RESULTS: Among the 106 participants (47[percnt]female, 49[percnt]<18 years), the epilepsy management gap criteria were met by 57[percnt](n=60) of the cohort, whereas only 9[percnt](n=10) were included by the treatment gap definition. 80[percnt](8/10) of untreated patients met (i) and/or (ii), 92[percnt](24/26) of those with seizure-related injuries met (i) and/or (ii), 81[percnt](22/27) of patients with QOLIE-31 scores <50 met (i) and/or (ii), 67[percnt](10/15) of AED-treated patients with staring spells were on carbamazepine, 21[percnt](11/52) AED-treated adults were on phenobarbital, 34[percnt](11/32) of AED-treated women of childbearing age were on sodium valproate. CONCLUSIONS: The proposed “management gap” is a clinically relevant extension of the treatment gap, important for policymakers incorporating epilepsy management into global disease care programs. Study Supported by: Grand Challenges Canada & Thrasher Research Foundation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".