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Konomatsu K, Kakisaka Y, Ishida M, Soga T, Ukishiro K, Osawa SI, Jin K, Aoki M, Nakasato N. Referral odyssey plot to visualize causes of surgical delay in mesial temporal lobe epilepsy with hippocampal sclerosis. Epilepsy Behav 2023; 147:109434. [PMID: 37716330 DOI: 10.1016/j.yebeh.2023.109434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/26/2023] [Accepted: 08/31/2023] [Indexed: 09/18/2023]
Abstract
The "odyssey plot" was used to visualize referral delays in epilepsy surgery. Participants were 36 patients (19 males; 13-67 years, median 27 years) with mesial temporal lobe epilepsy with hippocampal sclerosis (HS) who underwent resection surgery. The "referral odyssey plot" included five clinical episodes: seizure onset (T1), first visits to a non-epileptologist (T2) and to an epileptologist (T3), first admission to our epilepsy monitoring unit (EMU) (T4), and resection surgery (T5). For each patient, we identified the first seizure type: the physician who first diagnosed focal aware seizure (FAS), focal impaired awareness seizure (FIAS), focal to bilateral tonic-clonic seizure (FBTCS), and radiologically suspected HS. Within the overall delay (T1-T5, median 18 years; interquartile range [IQR] 14), non-epileptologist's delay (T2-T3, 11.5 years; IQR 12.25) was far (p < 0.0001) longer than patient's (T1-T2, 0 year; IQR 2.25), epileptologist's (T3-T4, 1 year; IQR 4), or after-EMU delay (T4-T5, 1 year; IQR 1). FAS onset cases had significantly longer T1-T2 (N = 5, median 7 years; IQR 6) than FIAS (N = 22, 0 year; IQR 1, p < 0.005) or FBTCS onset cases (N = 9, 0 year; IQR 0, p < 0.001). FAS was correctly diagnosed first by non-epileptologists in 17.9%, by out-patient epileptologists in 35.7%, and at the EMU in 46.4%. FIAS was correctly diagnosed first by non-epileptologists in 94.4% and by out-patient epileptologists in 5.6%. Non-epileptologists diagnosed FBTCS in all cases. HS was diagnosed by non-epileptologists in 13.9%, by out-patient epileptologists in 47.2%, and at the EMU in 38.9%. Early referral to epileptologists is most critical for early surgery. Early utilization of the EMU is highly recommended because FAS is often overlooked by outpatient epileptologists. The odyssey plot will be useful to improve the healthcare system for other types of epilepsy.
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Affiliation(s)
- Kazutoshi Konomatsu
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Departments of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yosuke Kakisaka
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Makoto Ishida
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Temma Soga
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Departments of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazushi Ukishiro
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shin-Ichiro Osawa
- Departments of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazutaka Jin
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Masashi Aoki
- Departments of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Nobukazu Nakasato
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Pieters H, Watson M, Baca CM. Pediatric and adult epileptologist perspectives and experiences of pediatric to adult epilepsy care transition: "Saying goodbye and opening a door.". Epilepsy Behav 2021; 120:107981. [PMID: 33962252 DOI: 10.1016/j.yebeh.2021.107981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/05/2021] [Indexed: 11/28/2022]
Abstract
We aimed to describe perspectives of transition and transfer of adolescents and young adults with childhood-onset epilepsy from pediatric to adult care from the viewpoints of both pediatric and adult epileptologists. Telephone semi-structured interviews with pediatric (n = 15) and adult (n = 11) epileptologists at leading U.S. epilepsy centers were used to collect data about the transition process. Interviews were audio-recorded, transcribed, systematically coded using thematic analysis by two independent researchers, and subsequently checked for agreement during regular meetings. Participants were on average 46 years old (SD = 7.4), 50% male, 91% Non-Hispanic and 85% Caucasian; all had completed a formal epilepsy or clinical neurophysiology fellowship (mean = 11 years since terminal training) and were employed at a comprehensive epilepsy center. Three interrelated themes regarding epileptologists' perspectives of epilepsy transition and transfer of care were evident: (1) the process is unnatural and disruptive, (2) clinicians make the best of challenges, and (3) the epilepsy transition process includes a spectrum of broad needs some of which are unique to epilepsy care while others are common to other chronic diseases. Despite challenges, epilepsy clinicians spontaneously expressed stress, empathy, and commitment to providing the best possible care.
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Affiliation(s)
- Huibrie Pieters
- School of Nursing, University of California Los Angeles, Los Angeles, CA, United States
| | - Meagan Watson
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Christine M Baca
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States.
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