5^th International Conference on Epilepsy & Treatment August 29-30, 2019 Vienna, Austria

Dagmar Amtmann is a psychologist and UW research associate professor with the Department of Rehabilitation Medicine. Dr. Amtmann's research interests include improving measures of patient reported outcomes such as pain, fatigue, and participation using modern measurement theories; statistical analytic approaches using multilevel and latent variable modeling; and instructional, information, and assistive technology for individuals with cognitive disabilities (with a particular focus on reading and writing technology for both children and adults).

Rationale: Caregivers of a child with health care needs often experience both challenges and benefits related to this caregiving. It is important to identify caregivers who are overwhelmed by caregiving and may need additional support. It is also important to study the benefits in caregiving as they are associated with better coping and lower levels of depression. The University of Washington Caregiver Stress Scale (UWCSS) and Benefit Scale (UWCBS) were developed using patient-centered and modern psychometric methodology including item response theory (IRT). Short forms (SF) were developed to provide scores sufficiently reliable to be used in clinical trials. Methods: The items for the SFs were selected by a panel of experts from a larger pool of IRT calibrated items. Scores are on the T-score metric (M=50, SD=10) and the mean of 50 represents stress and benefits reported by the community sample of caregivers. Higher score indicates more stress and more benefit, respectively. The pool of items was developed with feedback by pediatric neurologists and caregivers of children with epileptic encephalopathy in the US and EU. Items were administered to caregivers of children (N=722) (age <18) with Epileptic Encephalopathies, Down syndrome, Muscular Dystrophy and a community sample through an online survey. Test-retest data were collected 40 to 80 hours after the initial administration (n=133) and test-retest reliability was evaluated using the Intraclass correlation (ICC). Results: The panel of experts selected 8 and 10 items for the SFs assessing caregiving benefit and stress, respectively, which both maximize reliability and ensure inclusion of topics most important to caregivers. Both SFs evidenced good reliability (>.80) across a wide range of scores (i.e., 2SD below to 1.5SD above the mean for UWCSS and 3SD below to 1SD above the mean for UWCBS. Test-retest reliability was high for both SFs (ICC(2,1)>.95). SFs can be scored by summing items and converting to T-scores using conversion tables, and recommendations for scoring with missing data are available. Conclusions: The UWCSS and UWCBS SFs are brief and reliable measures of caregiver stress and benefits suitable for use in clinical trials, research and clinical practice. SFs can be administered by a computer or on paper. Scores based on the SFs are directly comparable to the scores based on the full item bank that can also be administered by Computerized Adaptive Testing.

Anmar Hatem is a board-certified and experienced consultant neurologist providing patients at Neurology sector of Baghdad Teaching Hospital care for a wide range of conditions. He joined Neurological Specialties in 2005 with a special expertise in the field of Epilepsy, Multiple Sclerosis, and botulinum toxin therapy. He graduated from Medical College at the University of Basra and completed his internship and neurology residency at Baghdad Teaching Hospital .He continued his training and got The Board degree at the Iraqi Board of medical specialization in neurology. Now Dr Anmar is Secretory general for Iraqi neurology society since 2017 and a trainer in both Iraqi board of neurology and Arabian board of medicine.

Background: Despite the introduction of new antiepileptic drugs (AEDs) and advances in the surgical treatment of epilepsy, an important group of patients still remains uncontrolled by any of these methods. Vagus nerve stimulation (VNS) is an adjunctive treatment for those with drug resistant epilepsy. In addition to the reduction in seizure frequency, there is other variables need to be assessed for better determination of VNS efficacy like quality of life (QOL) improvement. Aims of the Study: Evaluate the effectiveness of VNS, for Iraqi patients with drug resistant epilepsy, in reducing seizure frequency and improving QOL of these patients. Method and Patients: Forty-six patients of drug resistant epilepsy were retrospectively examined. They underwent implantation of a stimulator in Baghdad medical city during 2015, and with a follow-up of one year. They were 25 male and 21 females, and their ages at VNS implantation was ≥18 year old for 28 patients and between11-17 year old for 18 patients. Analysis of seizure reduction (using McHugh classification) with the effect of demographic and clinical variables on it, and assessment of QOL (using QOLIE-35 and QOLIE-AD 48 scales) were done in this study. SSPS v.22 was used for the statistical analysis. Results: The total well response rate (including class I and II and equal to reduction in seizure frequency ≥ 50%) was 58.7 % (27/46 patients), 6 cases became seizure free, and 6 cases reported no improvement, we also found that the factors of gender, age and predominant seizure type had clinical outcome effects. The mean seizure frequency and number of AEDs that used by the patients reduced. The mean of all domains and overall score of QOL scales improved and some domains had statistically significant improvement. Conclusion: VNS is a safe, well-tolerated and effective treatment in reducing seizure frequency and improving QOL for patients with drug resistant epilepsy.