IMPACT OF SEIZURE CLUSTERING ON ADULT EPILESPY

这个应用程序是面向指导患者的RCDA （K23）。该候选人接受过临床神经病学和神经生理学方面的培训，目前在阿尔伯特·爱因斯坦医学院（AECOM）任教。候选人的主要兴趣是癫痫的神经生理学，流行病学和结果问题，特别关注癫痫发作模式和沉淀物。候选人的长期目标是发展研究的复杂性和技术，以便在癫痫或其他神经系统疾病领域进行高质量的临床研究。职业发展建议包括完成AECOM临床研究培训计划的理学硕士学位，随后设计，实施和分析在Montefiore医疗中心/AECOM的癫痫发作聚集的拟议研究项目，这是一个广泛，成功的临床研究场所，是候选人长期目标的理想场所。癫痫发作聚类可能影响癫痫的治疗和预后，但尚未得到广泛的研究。我们的目标是招募300名成人，主要是市中心的癫痫患者，并对他们进行为期数月的前瞻性随访。我们将癫痫发作集群定义为24小时内发生三次或更多癫痫发作。我们计划研究聚集性癫痫发作的发生率、危险因素和诱发因素，以及聚集性癫痫对各种癫痫结局的影响。我们假设聚类的发生率将会很高，癫痫发作聚类将与定位相关因素和癫痫持续状态（SE）的危险因素有关，并且俱乐部患者发生SE的风险会增加。识别有聚集性风险的患者可能会改善他们的治疗，特别是他们患SE的风险增加。此外，我们假设，我们将确定潜在的可修改的促发因素的癫痫集群，特别是癫痫集群，需要紧急干预。这可能会减少聚类的发生率，并减少由此产生的发病率。最后，我们检查了我们队列中癫痫的结局指标，包括对药物治疗的反应、生活质量和护理，并检查了癫痫发作聚类对这些结局指标的影响。如果有证据表明，群发性癫痫发作患者的癫痫预后更差，那么对这些患者制定专门的癫痫治疗方案，包括更积极的药物治疗和早期的社会心理干预，可能是合适的。我们期望这项研究既能明确癫痫发作聚类在成人癫痫中的作用，又能提高人们对癫痫在医疗、社会和经济方面的影响的认识。

This application is for a Mentored Patient-oriented RCDA (K23). The candidate is trained in clinical neurology and neurophysiology, and is currently on the faculty at the Albert Einstein College of Medicine (AECOM). The ma interests of the candidate are neurophysiologic, epidemiologic, and outcome issues in epilepsy, with a special f on seizure patterns and precipitants. The long term goals of the candidate are to develop the research sophistication and techniques to allow for high quality clinical research in the field of epilepsy or other neurologic disorders. career development proposal includes completion of a Masters of Science in the AECOM Clinical Research Training Program, followed by the design, implementation and analysis of the proposed research project on seizure clusting at Montefiore Medical Center/AECOM, which is a site of extensive, successful clinical research, and is ideally for the candidate's long term goals. Seizure clustering may affect treatment and outcome of epilepsy, but has not been widely studied. We aim recruit a cohort of 300 adult, predominantly inner-city patients with epilepsy, and follow them prospectively for months. We will define seizure clustering as three or more seizures occurring within 24 hours. We plan to examine the incidence, risk factors and precipitants for clustered seizures, as well as the impact of clustering on various epilepsy outcomes. We hypothesize that the incidence of clustering will be high ,that seizure clustering will be associated with localization-related factors and risk factors for status epilepticus (SE), and that patients with club will be at increased risk for SE. Identifying patients at risk for clustering may improve their treatment, especial they are at an increased risk of SE. Furthermore, we hypothesize that we will identify potentially modifiable precipitating factors for seizure clustering, and specifically, seizure clustering which requires emergency intervention. This may allow for a reduction in the incidence of clustering and a decrease in resultant morbidity. Finally, we examine outcome measures of epilepsy in our cohort,, including response to medical therapy, quality of life, an of care, and examine the impact of seizure clustering on these outcome measures. If outcome of epilepsy is demonstrated to be worse in patients with clustered seizures, development of a specialized epilepsy care program these patients, including more aggressive medical therapy and earlier psychosocial intervention, may be appropriate. We anticipate that this study will both define the role of seizure clustering in adult epilepsy, and increase o appreciation of the medical, social and financial impact of epilepsy in a large cohort of inner city adult patients.