David M Labiner

Interests

No activities entered.

Courses

Scholarly Contributions

Journals/Publications

• Labiner, D. M., & Labiner, D. M. (2021). Accreditation of Epilepsy Centers.. Epilepsy currents, 21(2), 132-133. doi:10.1177/1535759721991568
  More info

  In 2012, the Institute of Medicine recommended that a formal process be developed for the accreditation of epilepsy centers in the United States. This article provides some of the background and processes that led to the criteria by which epilepsy centers are now accredited.
• Fishman, J., Martin, M., Labiner, D. M., Lew, C. R., & Johnson, B. H. (2019). Healthcare resource utilization and costs before and after lacosamide initiation as adjunctive therapy among patients with epilepsy in the United States. Epilepsy & behavior : E&B, 99, 106331.
  More info

  The objective of this study was to evaluate all-cause and epilepsy-specific healthcare resource utilization and costs following lacosamide (LCM) initiation as adjunctive therapy for the treatment of epilepsy.
• Hammer, M. F., Sprissler, R., Bina, R. W., Lau, B., Johnstone, L., Walter, C. M., Labiner, D. M., & Weinand, M. E. (2019). Altered expression of signaling pathways regulating neuronal excitability in hippocampal tissue of temporal lobe epilepsy patients with low and high seizure frequency. Epilepsy research, 155, 106145.
  More info

  Despite recent advances in our understanding of synaptic transmission associated with epileptogenesis, the molecular mechanisms that control seizure frequency in patients with temporal lobe epilepsy (TLE) remain obscure. RNA-Seq was performed on hippocampal tissue resected from 12 medically intractable TLE patients with pre-surgery seizure frequencies ranging from 0.33 to 120 seizures per month. Differential expression (DE) analysis of individuals with low (LSF, mean = 4 seizure/month) versus high (HSF, mean = 60 seizures/month) seizure frequency identified 979 genes with ≥2-fold change in transcript abundance (FDR-adjusted p-value ö0.05). Comparisons with post-mortem controls revealed a large number of downregulated genes in the HSF (1676) versus LSF (399) groups. More than 50 signaling pathways were inferred to be deactivated or activated, with Signal Transduction as the central hub in the pathway network. While neuroinflammation pathways were activated in both groups, key neuronal system pathways were systematically deactivated in the HSF group, including calcium, CREB and Opioid signaling. We also infer that enhanced expression of a signaling cascade promoting synaptic downscaling may have played a key role in maintaining a higher seizure threshold in the LSF cohort. These results suggest that therapeutic approaches targeting synaptic scaling pathways may aid in the treatment of seizures in TLE.
• Weinand, M. E., Hammer, M., Lau, B., Labiner, D. M., Walter, C. M., Bernas, M. J., Witte, M. H., Kasoff, W., Bina, R., & Sprissler, R. (2019). Leukocyte expression profiles reveal gene sets with prognostic value for seizure-free outcome following stereotactic laser amygdalohippocampotomy. Nature Scientific Reports.
• Ip, Q., Malone, D. C., Chong, J. W., Harris, R. B., & Labiner, D. M. (2018). An update on the prevalence and incidence of epilepsy among older adults. Epilepsy Research, 139, 107-112.
• Ip, Q., Malone, D. C., Chong, J., Harris, R. B., & Labiner, D. M. (2018). Economic impact of epilepsy and the cost of nonadherence to antiepileptic drugs in older Medicare beneficiaries. Epilepsy & behavior : E&B, 80, 208-214.
  More info

  Epilepsy is most prevalent among older individuals, and its economic impact is substantial. The development of economic burden estimates that account for known confounders, and using percent incremental costs may provide meaningful comparison across time and different health systems. The first objective of the current study was to estimate the percent incremental healthcare costs and the odds ratio (OR) for inpatient utilization for older Medicare beneficiaries with epilepsy and without epilepsy. The second objective was to estimate the percent incremental healthcare costs and the OR for inpatient utilization associated with antiepileptic drug (AED) nonadherence among Medicare beneficiaries with epilepsy. The OR of inpatient utilization for cases compared with controls (i.e., non-cases) were 2.4 (95% CI 2.3 to 2.6, p-value
• Joyce, N. R., Fishman, J., Green, S., Labiner, D. M., Wild, I., & Grabowski, D. C. (2018). Cost sharing for antiepileptic drugs: medication utilization and health plan costs. The American journal of managed care, 24(6), e183-e189.
  More info

  To examine the association between health plan out-of-pocket (OOP) costs for antiepileptic drugs and healthcare utilization (HCU) and overall plan spending among US-based commercial health plan beneficiaries with epilepsy.
• Shih, J. J., Fountain, N. B., Herman, S. T., Bagic, A., Lado, F., Arnold, S., Zupanc, M. L., Riker, E., & Labiner, D. M. (2018). Indications and methodology for video-electroencephalographic studies in the epilepsy monitoring unit. Epilepsia, 59(1), 27-36.
  More info

  Although the epilepsy and neurology communities have position papers on a number of topics pertaining to epilepsy diagnosis and management, no current paper exists for the rationale and appropriate indications for epilepsy monitoring unit (EMU) evaluation. General neurologists, hospital administrators, and insurers also have yet to fully understand the role this type of testing has in the diagnosis and management of individuals with paroxysmal neurologic symptoms. This review outlines the indications for long-term video-electroencephalography (VEEG) for typical elective admissions to a specialized inpatient setting. The common techniques used in EMUs to obtain diagnostic information are reviewed. The added benefit of safety measures and clinical testing above that available for routine or long-term ambulatory electroencephalography is also discussed. The indications for admission to the EMU include differential diagnosis of paroxysmal spells, characterization of seizure types, presurgical epilepsy evaluations, seizure quantification, monitoring medication adjustment in a safe setting, and differentiation between seizures and side effects. We conclude that the appropriate use of this specialized testing can lead to an early and correct diagnosis in a variety of clinical circumstances. The EMU evaluation is considered the gold standard test for the definitive diagnosis of epilepsy and seizure-like spells.
• Weinand, M. E., Weinand, M. E., Hammer, M., Hammer, M., Labiner, D. M., Labiner, D. M., Walter, C. M., Walter, C. M., Bernas, M. J., Bernas, M. J., Witte, M. H., Witte, M. H., Sprissler, R. S., Sprissler, R. S., Kasoff, W., Kasoff, W., Bina, R. W., & Bina, R. W. (2018). Leukocyte RNA expression: Prognostic value for seizure-free outcome following stereotactic laser amygdalohippocampotomy. Neurosurgery, 65(1), 94.
• Gallek, M. J., Skoch, J., Ansay, T., Behbahani, M., Mount, D., Manziello, A., Witte, M., Bernas, M., Labiner, D. M., & Weinand, M. E. (2016). Cortical gene expression: prognostic value for seizure outcome following temporal lobectomy and amygdalohippocampectomy. Neurogenetics, 17(4), 211-218.
  More info

  Whole genome analyses were performed to test the hypothesis that temporal cortical gene expression differs between epilepsy patients rendered seizure-free versus non-seizure-free following anterior temporal lobectomy with amygdalohippocampectomy (ATL/AH). Twenty four patients underwent ATL/AH to treat medically intractable seizures of temporal lobe origin (mean age 35.5 years, mean follow-up 42.2 months); they were then dichotomized into seizure-free and non-seizure-free groups. Tissue RNA was isolated from the lateral temporal cortex and gene expression analysis was performed. Whole genome data were analyzed for prognostic value for seizure-free outcome following ATL/AH by logistic regression. Genes that could distinguish seizure outcome groups were identified based on providing an accuracy of >0.90 judging by area under the receiver operating characteristic curve, AUC, with a P value of the slope coefficient of
• Manacheril, R., Faheem, U., Labiner, D. M., Drake, K. W., Chong, J. W., Manacheril, R., Faheem, U., Labiner, D. M., Drake, K. W., & Chong, J. W. (2016). Psychosocial Impact of Epilepsy in Older Adults. Healthcare.
• McCallum, A. P., Gallek, M. J., Ramey, W., Manziello, A., Witte, M. H., Bernas, M. J., Labiner, D. M., & Weinand, M. E. (2016). Cortical gene expression correlates of temporal lobe epileptogenicity. Pathophysiology : the official journal of the International Society for Pathophysiology, 23(3), 181-90.
  More info

  Despite being one of the most common neurological diseases, it is unknown whether there may be a genetic basis to temporal lobe epilepsy (TLE). Whole genome analyses were performed to test the hypothesis that temporal cortical gene expression differs between TLE patients with high vs. low baseline seizure frequency.
• Sleeth, C., Drake, K., Labiner, D. M., & Chong, J. (2016). Felt and enacted stigma in elderly persons with epilepsy: A qualitative approach. Epilepsy & behavior : E&B, 55, 108-112.
  More info

  Stigma is a common psychological consequence of chronic diseases, including epilepsy; however, little research has been done to determine the effect of stigma on persons with epilepsy, especially the elderly. We interviewed 57 older adults with epilepsy to discover the extent and consequences of, and reasons for, epilepsy-related stigma in their lives. Felt stigma was more frequently reported than enacted stigma, with over 70% having experienced this form of stigma. Participants described ignorance and fear of the disease as the foundation of epilepsy-related stigma. The most common response to stigmatizing events was a decrease in epilepsy disclosure to family or friends. Results from this study could inform interventions designed for elderly persons with epilepsy and their support networks, as well as educational campaigns for the general public.
• Kaiboriboon, K., Malkhachroum, A. M., Zrik, A., Daif, A., Schiltz, N. M., Labiner, D. M., & Lhatoo, S. D. (2015). Epilepsy surgery in the United States: Analysis of data from the National Association of Epilepsy Centers. Epilepsy research, 116, 105-9.
  More info

  To examine trends in epilepsy-related surgical procedures performed at major epilepsy centers in the US between 2003 and 2012, and in the service provision infrastructure of epilepsy centers over the same time period.
• Labiner, D. M. (2015). William A. Sibley, MD (1925–2015). Neurology, 85(12), 1016.
• Labiner, D. M., Chong, J. W., Tang, D. H., Malone, D. C., Warholak, T. L., Armstrong, E. P., Slack, M. K., & Hsu, C. H. (2015). Healthcare Resource Burden of Newly Diagnosed Epilepsy in the US Low-Income Elderly Population. European Geriatric Medicine, 6, 251-256.
• Lhatoo, S. D., Kaiboriboon, K., & Labiner, D. (2015). Response to "The persistent under-utilization of epilepsy surgery". Epilepsy research, 118, 70-1.
• Manacheril, R., Faheem, U., Labiner, D. M., Drake, K. W., & Chong, J. W. (2015). Psychosocial Impact of Epilepsy in Older Adults.. Healthcare.
• Nokes, B., Sim, Y., Gibson, B., Byreddy, S., Labiner, D. M., Coull, B., & Chong, J. (2015). Assessment of stroke risk in southern Arizona, the pairing of acculturation and stroke risk factor development. Journal of immigrant and minority health / Center for Minority Public Health, 17(2), 513-8.
  More info

  Stroke is a leading cause of mortality in the United States. Hispanics have the same incidence of stroke, but are more likely to have subsequent strokes than non-Hispanic whites. This difference in outcome may be attributable to differences in stroke risk factor awareness. Patients at a community health center in Tucson, AZ completed an anonymous survey regarding existing and perceived health issues. Patient responses were compared in terms of ethnicity and acculturation, as indicated by language preference. Patient responses (n = 301, Spanish: 150, English: 151) indicated that proportionately fewer non-acculturated Hispanics than acculturated Hispanic and non-Hispanic patients indicated that they were at risk for stroke. Acculturated Hispanics and non-Hispanics displayed similar morbidity trends, including increased obesity, hypertension, diabetes, heart problems, depression, and previous stroke. These findings suggest that Hispanics become less healthy and more at risk for stroke and stroke risk factors as they become acculturated.
• Tang, D. H., Malone, D. C., Warholak, T. L., Chong, J. W., Armstrong, E. P., Slack, M. K., Hsu, C. H., Labiner, D. M., Tang, D. H., Malone, D. C., Warholak, T. L., Chong, J. W., Armstrong, E. P., Slack, M. K., Hsu, C. H., & Labiner, D. M. (2015). Healthcare Resource Burden of Newly Diagnosed Epilepsy in the US Low-Income Elderly Population. European Geriatric Medicine.
• Tang, D. H., Malone, D. C., Warholak, T. L., Chong, J., Armstrong, E. P., Slack, M. K., Hsu, C. H., & Labiner, D. M. (2015). Prevalence and Incidence of Epilepsy in an Elderly and Low-Income Population in the United States. Journal of clinical neurology (Seoul, Korea), 11(3), 252-61.
  More info

  The purpose of this study was to estimate the incidence and prevalence of epilepsy among an elderly and poor population in the United States.
• Weinand, M. E., Hammer, M., Lau, B., Labiner, D. M., Walter, C. M., Bernas, M. J., Witte, M. H., Kasoff, W., Bina, R., & Sprissler, R. (2018). Leukocyte expression profiles reveal gene sets with prognostic value for seizure-free outcome following stereotactic laser amygdalohippocampotomy. Scientific Reports, 9(1), 1086. doi:10.1038/s41598-018-37763-5
• Denski, K. M., & Labiner, D. M. (2014). Should I offer vagus nerve stimulation as part of my neurology practice?. Neurology. Clinical practice, 4(4), 313-318.
  More info

  Vagus nerve stimulation (VNS) is a safe and effective adjunctive therapy approved for patients with partial-onset seizures. A pulse generator, which is implanted in the chest wall, delivers programmed electrical pulses through an electrode that is attached to the left vagus nerve. VNS plays an important role in the treatment of patients with drug-resistant epilepsy. It is currently offered in academic as well as private practice settings. After a comprehensive workup is performed, VNS should be offered to patients with drug-resistant epilepsy who are not candidates for surgery.
• Gross, R. E., Willie, J. T., Cascino, G. D., Couture, D. E., Curry, D. J., Labiner, D. M., Laxton, A. W., Marsh, W. R., Popli, G., Sharan, A. D., Shih, J. J., Sperling, M. R., Tatum, W. O., Weinand, M. E., Wharen, R. E., Wilfong, A. A., & Worrell, G. A. (2014). 103 Stereotactic Laser Amygdalohippocampotomy for Mesial Temporal Lobe Epilepsy: Collective Experience From 7 Single-Center, Prospective, Investigator-Initiated Studies. Neurosurgery, 61(Supplement 1), 192. doi:10.1227/01.neu.0000452377.10458.80
  More info

  INTRODUCTION: Stereotactic laser amygdalohippocampotomy (SLAH) is a minimally-invasive potential alternative to open resection for mesial temporal lobe epilepsy (MTLE), but outcome data are limited (Willie et al, 2014). Here we present data on effectiveness, safety, and related findings collected from investigator-initiated, prospective, observational studies at 7 centers. METHODS: Fifty-one subjects who met entry criteria for surgical treatment of MTLE were enrolled in IRB-approved prospective data collection and underwent SLAH. Screening and follow-up visits were arranged per protocol at a given center, typically at 1, 3, 6, and/or 12-months, with some variation by center. Data captured via case report forms included medical/surgical history, number of anti-epileptic drugs (AEDs) tried, duration from epilepsy diagnosis to screening for this study, seizure count since last visit, concomitant medications, adverse events, radiographic findings, neuropsychological tests, and healthcare utilization variables including length-of-stay and level-of-care during hospitalization. RESULTS: Median age was 40 years (5-70 years). AEDs were kept constant throughout the 1-year course by most centers. At 6-month follow-up of all available consecutive subjects (ie, since 10/20/10) for whom data was available, 52% (20/39) at 6-months and 48% (14/29) at 12-months follow-up were seizure-free. However, for procedures performed after 7/1/12, at 6-month follow-up 63% (15/24), and at 12-months 69% (9/13) were seizure-free, suggesting improved outcome with experience. Similarly, 64% (9/14) for procedures performed after 1/1/13 were seizure-free at 6-months. Procedure-related adverse events recorded in all patients included headache (N = 10), visual field disturbance (N = 3), psychiatric disturbance (N = 3), hemorrhage (N = 2), and cellulitis (N = 1). Median length-of-stay was 1 day. Four patients underwent anterior temporal lobectomy for persistent seizures. CONCLUSION: SLAH appears to be a safe procedure and achieves seizure-freedom for a substantial proportion of patients with MTLE. Data support a procedural “learning curve,” plateauing at ∼65% seizure-free. Further prospective study, with greater numbers of subjects, could help elucidate and/or strengthen these findings.
• Sim, Y., Nokes, B., Byreddy, S., Chong, J., Coull, B. M., & Labiner, D. M. (2014). Healthcare utilization of patients with epilepsy in Yuma County, Arizona: do disparities exist?. Epilepsy & behavior : E&B, 31, 307-11.
  More info

  The aim of this study was to describe the disparities in healthcare utilization and costs between Hispanic and non-Hispanic patients with seizures or epilepsy. We reviewed the insurance status and healthcare resource utilization data from 2005 to 2008 for all patients with seizures and epilepsy seen at the Yuma Regional Medical Center (YRMC). Charges for medical services provided to Hispanic patients with epilepsy between the ages of 18 and 49 were significantly less than those for non-Hispanic patients with epilepsy (Hispanic: $3167.63 versus non-Hispanic: $5154.36, P
• Chong, J., Hesdorffer, D. C., Thurman, D. J., Lopez, D., Harris, R. B., Hauser, W. A., Labiner, E. T., Velarde, A., & Labiner, D. M. (2013). The prevalence of epilepsy along the Arizona-Mexico border. Epilepsy research, 105(1-2), 206-15.
  More info

  This study describes the epidemiology of epilepsy on the Arizona-Mexico border.
• Labiner, D. M., & Drake, K. W. (2013). Formularies, costs, and quality of care: Formulary restrictions are not the answer, especially for epilepsy. Neurology. Clinical practice, 3(1), 71-74.
  More info

  The goal of treating an individual with epilepsy is to have no seizures and no side effects. Limiting availability of medications appears to be a simple way of controlling costs of patient care. This approach potentially jeopardizes both efficacy and safety. We argue, in this edition of Current Controversies, that limiting costs by restricting formularies is detrimental to the patients from an efficacy, safety, and cost perspective.
• Bateman, L. M., Begley, C. E., Ben-Menachem, E., Berg, A. T., Berkovic, S. F., Cascino, G. D., Drazkowski, J., Edwards, J. C., Engel, J., French, J. A., Gilliam, F. D., Hoerth, M. T., Jehi, L. E., Kanner, A. M., Krauss, G. L., Labiner, D. M., Loddenkemper, T., Luders, H. O., McKhann, G. M., , McLachlan, R., et al. (2012). Overcoming barriers to successful epilepsy management. Epilepsy currents / American Epilepsy Society, 12(4), 158-60.
• Chong, J., Drake, K., Atkinson, P. B., Ouellette, E., & Labiner, D. M. (2012). Social and family characteristics of Hispanics with epilepsy. Seizure, 21(1), 12-6.
  More info

  The purpose of this study is to determine how acculturation, social support, family emotional involvement, perceived family criticism and stigma are associated with epilepsy self-efficacy and depression. A principal components analysis (PCA) was used to describe the salience of these characteristics within a sample of Hispanics with epilepsy. A total of 50 Hispanic adults of Mexican descent identified in our Epilepsy Clinic participated in this study. The PCA identified four distinct types, two were relatively culture-free, and two were distinctly culturally oriented. The first non-culture affiliated type described a well-adjusted group of individuals that tended to be males with moderate self-efficacy, who received social support, and who were unlikely to have depression or feel stigmatized. The second non-culture affiliated type described a dimension in which family emotional involvement tended to co-occur with perceived criticism. The Anglo-oriented group had a family environment that did not appear to criticize the individual with epilepsy and had good self-efficacy. The Mexican-oriented group had high self-efficacy and was unlikely to have depression. Results suggest that acculturation variables must be taken into consideration among ethnic groups because social, psychological and acculturation variables interact in complex ways. Additionally, it is clear that a diagnosis of epilepsy does not automatically lead to poor quality of life, stigma, or depression.
• Helmers, S. L., Begnaud, J., Cowley, A., Corwin, H. M., Edwards, J. C., Holder, D. L., Kostov, H., Larsson, P. G., Levisohn, P. M., De Menezes, M. S., Stefan, H., & Labiner, D. M. (2012). Application of a computational model of vagus nerve stimulation. Acta neurologica Scandinavica, 126(5), 336-43.
  More info

  The most widely used and studied neurostimulation procedure for medically refractory epilepsy is vagus nerve stimulation (VNS) Therapy. The goal of this study was to develop a computational model for improved understanding of the anatomy and neurophysiology of the vagus nerve as it pertains to the principles of electrical stimulation, aiming to provide clinicians with a systematic and rational understanding of VNS Therapy.
• Kleinman, N. L., Sadosky, A., Seid, J., Martin, R. C., & Labiner, D. M. (2012). Costs, work absence, and adherence in patients with partial onset seizures prescribed gabapentin or pregabalin. Epilepsy research, 102(1-2), 13-22.
  More info

  Few studies have examined cost of illness of epileptic partial onset seizures (POS) from the employer perspective or compared users of gabapentin and pregabalin in treatment of POS. This study compares pharmacotherapy, direct/indirect costs, and work absences of patients with POS newly started on gabapentin or pregabalin.
• Labiner, D. M., & Cascino, G. D. (2012). Are neurologists really data driven in selecting epilepsy treatment?. Neurology, 78(16), 1194-5.
• Ouellette, E., Chong, J., Drake, K., & Labiner, D. M. (2011). Emergency department care of seizure patients: demographic trends in southern Arizona. Epilepsy & behavior : E&B, 21(4), 382-6.
  More info

  The aim of this study was to describe the epidemiology of epilepsy and characteristics of patients with seizures who presented at the Yuma Regional Medical Center Emergency Department (YRMC ED) from 2005 to 2008. A seizure diagnosis was present in 2.7% of the patients, and accounted for 1.7% of all ED visits. Visits by patients identified as having epilepsy accounted for 0.3% of all ED visits. Patients with seizures were 2.8 times more likely to have used the ED for 2 or more years of the study period compared with control patients. Patients with at least one ED visit because of seizures were more likely to have multiyear visits, 43.6% visiting the ED within 2 or more years. Patients with epilepsy and seizures were significantly younger than the no-seizure control group. Patients who had ever been admitted to the ED for seizures or epilepsy had higher ED utilization even if the subsequent admissions were not seizure related.
• Stern, J. M., Labiner, D. M., Gilliam, F. G., Penovich, P. E., Onofrey, M., Eagan, C. A., & Holmes, G. L. (2011). More effective assessment of adverse effects and comorbidities in epilepsy: results of a Phase II communication study. Epilepsy & behavior : E&B, 22(3), 552-6.
  More info

  Research was conducted to evaluate conversations about epilepsy between community-based neurologists and patients. Adverse effects of antiepileptic drugs and mood/behavioral issues were infrequently discussed, and neurologists and patients disagreed about these issues postvisit. Follow-up research was conducted to assess the impact of a previsit assessment tool on discussions of epilepsy. Twenty neurologists reviewed a tool incorporating questions from validated instruments (Adverse Events Profile [AEP] and Neurological Disorders Depression Inventory for Epilepsy [NDDI-E]). Naturally occurring interactions between neurologists and 60 patients were recorded. Neurologists and patients were interviewed separately. All components were transcribed and analyzed using sociolinguistics. Using the previsit assessment tool increased the number of discussions about adverse effects and mood/behavioral issues and increased neurologist-patient agreement about issues postvisit. Visit length did not increase significantly when the tool was used. Ten months after follow-up research, 50% of neurologists reported continuing to use the tool in everyday practice with patients with epilepsy.
• Thurman, D. J., Beghi, E., Begley, C. E., Berg, A. T., Buchhalter, J. R., Ding, D., Hesdorffer, D. C., Hauser, W. A., Kazis, L., Kobau, R., Kroner, B., Labiner, D., Liow, K., Logroscino, G., Medina, M. T., Newton, C. R., Parko, K., Paschal, A., Preux, P., , Sander, J. W., et al. (2011). Standards for epidemiologic studies and surveillance of epilepsy. Epilepsia, 52 Suppl 7, 2-26.
  More info

  Worldwide, about 65 million people are estimated to have epilepsy. Epidemiologic studies are necessary to define the full public health burden of epilepsy; to set public health and health care priorities; to provide information needed for prevention, early detection, and treatment; to identify education and service needs; and to promote effective health care and support programs for people with epilepsy. However, different definitions and epidemiologic methods complicate the tasks of these studies and their interpretations and comparisons. The purpose of this document is to promote consistency in definitions and methods in an effort to enhance future population-based epidemiologic studies, facilitate comparison between populations, and encourage the collection of data useful for the promotion of public health. We discuss: (1) conceptual and operational definitions of epilepsy, (2) data resources and recommended data elements, and (3) methods and analyses appropriate for epidemiologic studies or the surveillance of epilepsy. Variations in these are considered, taking into account differing resource availability and needs among countries and differing purposes among studies.
• Chong, J., Kudrimoti, H. S., Lopez, D. C., & Labiner, D. M. (2010). Behavioral risk factors among Arizonans with epilepsy: Behavioral Risk Factor Surveillance System 2005/2006. Epilepsy & behavior : E&B, 17(4), 511-9.
  More info

  Modifiable risk factors to help improve health outcomes for people with epilepsy in Arizona were identified using the 2005-2006 Arizona Behavioral Risk Factor Surveillance System (BRFSS). Of 9524 adults who participated in this survey, 125 reported ever being diagnosed with epilepsy (lifetime prevalence=1.3%, 95% CI=1.1-1.6%). Individuals with active epilepsy (those who had seizures in the prior 3 months and/or were taking anticonvulsants) had an overall lower quality of life. This likely resulted from a large number of medical comorbidities and poor mental and physical health days. Regression models suggested that for individuals with active epilepsy, physical activity was associated with fewer activity-limited days, whereas for individuals with inactive epilepsy, medical comorbidity was positively associated with activity-limited days. Further research is needed to increase the reliability of the findings.
• Drake, K., & Labiner, D. M. (2010). Severe constipation associated with the use of rufinamide (Banzel) in an adolescent. Epilepsy & behavior : E&B, 18(1-2), 132.
• Helmers, S. L., Paradis, P. E., Manjunath, R., Duh, M. S., Lafeuille, M., Latrémouille-Viau, D., Lefebvre, P., & Labiner, D. M. (2010). Economic burden associated with the use of generic antiepileptic drugs in the United States. Epilepsy & behavior : E&B, 18(4), 437-44.
  More info

  This study quantifies the economic burden associated with generic-versus-branded use of antiepileptic drugs (AEDs) in the United States. Adult patients with epilepsy receiving carbamazepine, gabapentin, phenytoin, primidone, or zonisamide were selected from the PharMetrics database. By use of an open-cohort design, patients were classified into mutually exclusive periods of generic-versus-branded AED use. Annualized cost differences (CDs) between periods were estimated using multivariate regressions. Results were stratified into stable versus unstable epilepsy and newer-generation versus older-generation AEDs. A total of 33,625 patients (52% male, mean age=51 years) were observed. Periods of generic AED treatment were associated with higher medical service costs (adjusted CD [95% CI]=$3186 [$2359; $4012]), stable pharmacy costs ($69 [$-34; $171]), and greater total costs ($3254 [$2403; $4105]) versus brand use. Epilepsy-related costs represented 30% of incremental costs. Similar findings were observed for patients with stable and unstable epilepsy and users of newer-generation and older-generation AEDs. Significantly higher health care costs were observed during generic AED use across seizure control and AED subgroups.
• Labiner, D. M., Bagic, A. I., Herman, S. T., Fountain, N. B., Walczak, T. S., Gumnit, R. J., & , N. A. (2010). Essential services, personnel, and facilities in specialized epilepsy centers--revised 2010 guidelines. Epilepsia, 51(11), 2322-33.
  More info

  This document was developed by the members of the Committee to Revise the Guidelines for Services, Personnel, and Facilities at Specialized Epilepsy Centers. After discussions with the general membership they were adopted by the Board of the National Association of Epilepsy Centers. The Guidelines will be reviewed and updated when considered necessary by the Board.
• Labiner, D. M., Paradis, P. E., Manjunath, R., Duh, M. S., Lafeuille, M., Latrémouille-Viau, D., Lefebvre, P., & Helmers, S. L. (2010). Generic antiepileptic drugs and associated medical resource utilization in the United States. Neurology, 74(20), 1566-74.
  More info

  To evaluate whether generic substitution was associated with any difference in medical resource utilization for 5 widely used antiepileptic drugs (AEDs) in the United States.
• Gilliam, F., Penovich, P. E., Eagan, C. A., Stern, J. M., Labiner, D. M., Onofrey, M., Holmes, G. L., Mathis, E., & Cramer, J. (2009). Conversations between community-based neurologists and patients with epilepsy: results of an observational linguistic study. Epilepsy & behavior : E&B, 16(2), 315-20.
  More info

  An in-office linguistic study was conducted to assess neurologist-patient discussions of epilepsy. Naturally occurring interactions among 20 neurologists and 60 of their patients with epilepsy were recorded. Participants were interviewed separately postvisit. Transcripts were analyzed using sociolinguistic techniques. Of 59 patients taking antiepileptic drugs previsit, 44 (75%) discussed side effects with their neurologist. Side effect discussions were most often neurologist initiated. Postvisit, patients and neurologists often disagreed about which side effects were experienced. The presence of a caregiver (e.g., spouse) usually resulted in lengthier, more detailed discussions of side effects, without drastically increasing overall visit length. Discussions of mood- and behavior-related comorbidities occurred infrequently (14 of 60 visits); postvisit, neurologists stated that they felt that management of these conditions was outside their area of expertise. Communication gaps observed in discussions of epilepsy and its treatment warrant further exploration. Additional research is currently underway to assess the efficacy of a previsit assessment tool.
• Labiner, D. M., Ettinger, A. B., Fakhoury, T. A., Chung, S. S., Shneker, B., Tatum Iv, W. O., Mitchell Miller, J., Vuong, A., Hammer, A. E., & Messenheimer, J. A. (2009). Effects of lamotrigine compared with levetiracetam on anger, hostility, and total mood in patients with partial epilepsy. Epilepsia, 50(3), 434-42.
  More info

  To assess anger/hostility during treatment with lamotrigine adjunctive therapy versus levetiracetam adjunctive therapy in patients with partial seizures.
• Thayer, J. F., Sollers, J. J., Labiner, D. M., Weinand, M., Herring, A. M., Lane, R. D., & Ahern, G. L. (2009). Age-related differences in prefrontal control of heart rate in humans: a pharmacological blockade study. International journal of psychophysiology : official journal of the International Organization of Psychophysiology, 72(1), 81-8.
  More info

  The Neurovisceral Integration Model is based on the premise of significant central nervous system-peripheral nervous system interactions. In support of this model we have previously shown that the prefrontal cortex tonically inhibits cardioacceleratory circuits as evidenced by increased heart rate (HR) when the prefrontal cortex is inactivated by injections of sodium amobarbitol (ISA) into the internal carotid artery. In this report we re-examine these data to investigate possible age-related differences in the prefrontal control of HR in humans. Seventy-three patients were divided into three groups based on a tertile split with mean ages of 20, 34, and 47, respectively. There were significant age-related differences in cortical control of HR as evidenced by a significant three way interaction of age (young, middle, old) by side (left versus right) by time (baseline and epochs 1-10 of inactivation) [Roy's Root (10,59)=0.378, p=0.028]. Results showed significant HR increases that did not differ between hemispheres in the youngest age group, significant increases in the middle age group that were larger in the right hemisphere than in the left, and significant HR increases in the oldest group in the right hemisphere only. The findings suggest important age-related differences in cortical inhibitory control of HR that appear less lateralized in the youngest group and significantly attenuated in the oldest age group. These results have important implications for the understanding of age-related differences in cognitive, affective, behavioral, and physiological functioning. In addition they support the importance of investigating central nervous system-peripheral nervous system relationships.
• Weinand, M., Serxner, B., Labiner, D., & Ahern, G. (2009). Interhemispheric propagation time and temporal lobe epileptogenicity. Pathophysiology : the official journal of the International Society for Pathophysiology / ISP, 16(1), 39-42.
  More info

  Long-term subdural electroencephalographic (EEG) recording was performed in a series of patients with medically intractable complex partial seizures to test the hypothesis that ictal interhemispheric propagation time (IHPT) is correlated with temporal lobe epileptogenicity. In 41 patients, the duration from initial subdural EEG seizure onset to the first appearance of subdural EEG epileptic activity in the contralateral hemisphere (IHPT) was measured in seconds and analyzed for a quantitative relationship to temporal lobe seizure interval (frequency⁻¹), in hours. A statistically significant, nonlinear correlation between IHPT and seizure interval was found (Arctan y=-0.009x²+0.598x+75.187, y=IHPT, in seconds, x=seizure interval, in hours, r=0.326, d.f.=39, t=2.15, p
• Antonucci, S. M., Beeson, P. M., Labiner, D. M., & Rapcsak, S. Z. (2008). Lexical retrieval and semantic knowledge in patients with left inferior temporal lobe lesions. Aphasiology, 22(3), 281-304.
  More info

  BACKGROUND: It has been proposed that anomia following left inferior temporal lobe lesions may have two different underlying mechanisms with distinct neural substrates. Specifically, naming impairment following damage to more posterior regions (BA 37) has been considered to result from a disconnection between preserved semantic knowledge and phonological word forms (pure anomia), whereas anomia following damage to anterior temporal regions (BAs 38, 20/21) has been attributed to the degradation of semantic representations (semantic anomia). However, the integrity of semantic knowledge in patients with pure anomia has not been demonstrated convincingly, nor were lesions in these cases necessarily confined to BA 37. Furthermore, evidence of semantic anomia often comes from individuals with bilateral temporal lobe damage, so it is unclear whether unilateral temporal lobe lesions are sufficient to produce significant semantic impairment. AIMS: The main goals of this study were to determine whether anomia following unilateral left inferior temporal lobe damage reflected a loss of semantic knowledge or a post-semantic deficit in lexical retrieval and to identify the neuroanatomical correlates of the naming impairment. METHODS #ENTITYSTARTX00026; PROCEDURES: Eight individuals who underwent left anterior temporal lobectomy (L ATL) and eight individuals who sustained left posterior cerebral artery strokes (L PCA) completed a battery of language measures that assessed lexical retrieval and semantic processing, and 16 age- and education-matched controls also completed this battery. High-resolution structural brain scans were collected to conduct lesion analyses. OUTCOMES #ENTITYSTARTX00026; RESULTS: Performance of L ATL and L PCA patients was strikingly similar, with both groups demonstrating naming performance ranging from moderately impaired to unimpaired. Anomia in both groups occurred in the context of mild deficits to semantic knowledge, which manifested primarily as greater difficulty in naming living things than nonliving things and greater difficulty in processing visual/perceptual as opposed to functional/associative semantic attributes. Lesion analyses indicated that both patient groups sustained damage to anterior inferior temporal lobe regions implicated in semantic processing. CONCLUSIONS: These results contribute to a better understanding of the cognitive mechanism of naming impairment in patients with temporal lobe damage and support the notion that pure anomia and semantic anomia represent two endpoints along a continuum of semantic impairment. Unilateral left temporal lobe lesions in our patients resulted in relatively mild semantic deficits that were apparent primarily in lexical production tasks, whereas severe semantic impairment likely requires bilateral temporal lobe damage.
• Hayes, S. M., Melin, J. D., Dupuis, M., Murray, S., & Labiner, D. M. (2007). Assessing the true learning needs of health care professionals in epilepsy care. Epilepsy & behavior : E&B, 11(3), 434-41.
  More info

  This needs assessment, initiated by the American Epilepsy Society (AES) in cooperation with AXDEV Group Inc. (AXDEV), used a mixed-method approach to explore the educational and clinical practice needs of health care professionals in epilepsy care and to identify significant barriers to caring for people with epilepsy. The multiphase assessment began with key informant interviews with AES educational leaders. In Phase II, 26 stakeholders, including epileptologists, neurologists, professionals in epilepsy care, and people with epilepsy, shared their experiences in epilepsy care during four focus groups at the AES annual meeting. In Phase III, a quantitative online survey based on Phase II results was distributed to 228 respondents, including epileptologists (n=84), neurologists (n=55), professionals in epilepsy care (n=69), and others (n=20). Results of the comprehensive analysis of Phase III quantitative data are presented here. They reveal the unmet needs of health care professionals in this therapeutic domain and are discussed in terms of their implications for epilepsy care.

Presentations

• Labiner, D. M., Addy, R., Martin, K., Garcia Quintana, A., Czerniak4, K., Shegog, R., Sepulveda, R., & Sepulveda, R. (2023). Advancing epilepsy care and self-management for Latino Spanish speaking patients through the use of a mobile web-based application (MINDSET 2.0). . American Public Health AssociationAmerican Public Health Association.
• Labiner, D. M. (2016, January). Pain & Your Brain. University of Arizona: Living Healthy with Arthritis Conference. Tucson, Arizona.
• Labiner, D. M. (2015, December). Partnering epilepsy centers in the Americas: the Costa Rica experience. Global Health Special Interest Group at the Annual Meeting of the American Epilepsy Society. Philadelphia, PA.
• Labiner, D. M., & Skoch, J. (2015, September). Cortical gene expression associated with seizure outcome following temporal lobectomy with amygdalohippocampectomy. Western Neurosurgical Society meeting. Kauai, HI.

Poster Presentations

• Labiner, D. M., Addy, R., Thomas, S., Moreau, R., Guerrero, R., Ardis, D., Garcia-Quintana,, A., Czerniak, K., Shegog, R., & Sepulveda, R. (2023). A New MINDSET: Assessing CHW Readiness for Implementing Epilepsy Self-Management Educational Support Using Adapted Knowledge, Self-Efficacy, and Attitude Scales. American Epilepsy SocietyAmerican Epilepsy Society.
• Labiner, D. M. (2015, December). Development of an epilepsy self-management decision-support tool: Spanish-MINDSET 4.1. Annual Meeting of the American Epilepsy Society. Philadelphia, PA.
  More info

  poster 1.376
• Rueda, S., Sepulveda, R., Chong, J. W., Begley, C., Shegog, R., & Labiner, D. M. (2015, December 4-8). Development of an epilepsy self-management decision-support tool: Spanish-MINDSET 4.1. 69th Annual Meeting of the American Epilepsy Society.
• Rueda, S., Sepulveda, R., Chong, J. W., Begley, C., Shegog, R., Labiner, D. M., Rueda, S., Sepulveda, R., Chong, J. W., Begley, C., Shegog, R., & Labiner, D. M. (2015, December 4 – 8, 2015). Poster 1.376 Development of an epilepsy self-management decision-support tool: Spanish-MINDSET 4.1. 69th Annual Meeting of the American Epilepsy Society. Philadelphia, PA.: Rueda S, Sepulveda R, Chong J, Begley C, Shegog R, Labiner D (2015).