Blog #32: Can Your Epilepsy Doctor Do a Better Job?

(This blog was originally posted on March 10, 2013)

 

 

          An online survey measured the quality of care of patients with epilepsy. Gaps in physician epilepsy care were found (1).

          On-line survey forms were sent to 348 active epilepsy patients. Two hundred twenty-one (64%) returned completed forms. Analysis of the results indicated that 80% of the respondents believed that they were aware of their seizure type, their epilepsy syndrome diagnosis and their current seizure frequency. They also had had an EEG and neuroimaging.

          However, fewer (60%) recalled having been asked at each visit about their medication side effects and discussing safety issues with their doctors.   

          It is important for physicians to remind patients that they need to avoid potential dangers during a loss of awareness that accompanied their seizures. These dangers include driving motor vehicles when seizures are not completely controlled. Patients also need to be reminded that they should avoid baths in a tub and taking showers, if at all possible, when no one else is at home. Needless to say, the bathroom door should never be locked; yet, bathroom doors have been broken down in order to attempt rescue. Most practicing clinical neurologists know of patients who have drowned under these circumstances. I personally have discussed these issues with practicing neurologists who admit that they do not always discuss these safety measures with their patients.

          Additionally, mothers need to avoid carrying infants over hot stoves and bodies of water; infants would be in danger should the mother drop the infant during a period of confusion or loss of consciousness.

          Only 46% of patients reported that reproductive issues had been discussed. Antiseizure medications and convulsions carry teratogenic risks, e.g. risks to the development of the fetus.

          Only 48% of patients who qualified for epilepsy surgery were referred to epilepsy surgical specialists. Surgical treatment can be highly beneficial with minimal, if any, discernible side effects.

          The survey demonstrated that potential gaps in epilepsy care exist. Elimination of these oversights could improve the quality of care to our epilepsy patient population. Patients, too, need to be aware that they can take the initiative to discuss these facets of their epilepsy care with their physicians.

1.     Wicks, P, Fountain, NB. Patient assessment of physician performance of epilepsy quality-of-care measures. Neurology: Clinical Practice, December 2012:335-342.

 

 

 

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. DINGS is his first novel.