Abstract
ObjectivePatients with seizures and epilepsies comorbid with cerebrovascular disorders (CVDs) or brain tumors (BTs) are managed by different specialists, including neurologists with expertise in epilepsy (epileptologists), CVDs, and neuro-oncology, as well as neurologists without special expertise (general neurologists), and also emergency room physicians (EPs), intensive care physicians, and neurosurgeons. It has never been studied how these specialists interact for the treatment of seizures or epilepsy in these patients.MethodsA survey was used to investigate how patients with such comorbidities are managed in hospitals in Italy.ResultsOne hundred and twenty-eight specialists from hospitals in all parts of Italy filled in a questionnaire. Epileptologists were in charge of treatment of epilepsy in about 50% of cases while acute seizures were treated mainly by general neurologists (52% of cases). Diagnostic, therapeutic, and assistance pathways (PDTAs) for CVD and BT epilepsies were declared by physicians in about half of the hospitals while in about a quarter, there were only informal agreements and, in the remaining hospitals, there were no agreements between specialists. CVD neurologists, specialists in internal medicine, and EP were most often in charge of treatment of epilepsy comorbid with CVD. General neurologists, neuro-oncologists, and neurosurgeons were included in teams that manage BT epilepsies while epileptologists were included only in a small percentage of hospitals.ConclusionsClinical decisions on epilepsy or seizures in patients with such comorbidities are often handled by different specialists. A new team culture and PDTAs are needed to guarantee high standards of diagnostic and therapeutic procedures.
Highlights
Rome, Italy 4 Center for Brain Tumor-Related Epilepsy, UOSD Neurology, I.R.C.C.S
In the second and third group of questions, participants were asked to indicate whether formal diagnostic, therapeutic and assistance pathways (PDTAs), or only informal agreements were available for patients with seizures and cerebrovascular diseases (CVDs) (Qs = 3, 4, 5, 6) or brain tumors (BTs) (Qs = 7, 8, 9, 10) and which professionals were involved in their treatment
Answers to questions concerning which specialist is in charge of chronic treatment of people with epilepsy or takes treatment decisions for patients with seizures are reported in Fig. 1a and 1b
Summary
4 Center for Brain Tumor-Related Epilepsy, UOSD Neurology, I.R.C.C.S. IFO- Regina Elena National Cancer Institute, Rome, Italy 5 U.O.S.D. Stroke Unit, Department of Clinical and Experimental. The prevalence of patients with epilepsy comorbid with other chronic diseases (a greater than coincidental association of two conditions in the same individual) (1) has consistently increased (2, 3). Within this context, comorbidity between acute seizures or epilepsy and cerebrovascular diseases (CVDs) or brain tumors (BTs) is of particular relevance. Incidence of acute symptomatic seizures in stroke patients lies between 3 and 6% (4) while the incidence is up to 10–16% of cases (5) in patients with intracranial (intracerebral or subarachnoid) hemorrhages. Several data indicate a complex relationship between these two diseases (7)
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