The development of a provincial pediatric epilepsy program: an analysis of early multidimensional outcomes
Bibliographic record
Abstract
Introduction Access to epilepsy surgery is improving across Canada, but the province of Manitoba, with a population of approximately 1.37 million, has - until recently - lacked the local infrastructure to deliver surgical epilepsy care. This thesis aims to describe the change in care provided to pediatric epilepsy patients in Manitoba since the formation of a comprehensive Pediatric Epilepsy Program, provide an early analysis of local outcomes, and present a framework for program development. Methods Data was collected retrospectively from medical records on patients who previously had epilepsy surgery in Manitoba, and prospectively on new, incoming patients. Caregivers were asked to complete questionnaires on quality of life and satisfaction with the Program. An online database was created to capture demographic information, seizure and neuropsychological outcomes, patient and caregiver quality of life, and caregiver satisfaction. Descriptive statistics were used to describe these outcomes. Results Prior to the formation of the Pediatric Epilepsy Program, 16 patients underwent vagal nerve stimulator (VNS) insertions. Mean time to surgery was 5.5 +/- 2.92 years. At a follow-up of 1-5 years, 1 patient (6.25%) achieved Engel class I outcome, 12 patients (75%) achieved Engel class III outcome, and 3 patients (12.5%) achieved Engel class IV outcome. After formation of the Pediatric Epilepsy Program, 14 patients underwent a variety of epilepsy surgeries, including 11 resective procedures and 3 VNS insertions. Mean time to surgery was 5.49 +/- 2.99 years. At a follow-up of 3-12 months, 11 patients (78.6%) achieved Engel class I outcome, 2 patients (14.3%) achieved Engel class III outcome, and 1 (7.1%) patient achieved Engel class IV outcome. Neuropsychological testing remained stable in the 2 patients it was completed on. The average QOLCE-55 score measuring patient quality of life was (59.7 +/- 23.2)/100. The average CarerQol-7D score measuring caregiver quality of life was (78.3 +/- 18.6)/100. Caregiver satisfaction was high with an average rating of (9.4 +/- 0.8)/10. Conclusion Access to epilepsy surgery has improved for children in Manitoba with favorable multidimensional outcomes. Structural organization, funding and multidisciplinary engagement are necessary for program sustainability. A longitudinal database is recommended for continuous quality assessment and improvement.
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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 | 0.004 |
| 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 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".