Professional Education

Abstract

EpilepsiaVolume 44, Issue s6 p. 62-63 Free Access Professional Education First published: 18 August 2003 https://doi.org/10.1046/j.1528-1157.44.s6.26.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Education plays a key role in increasing professional knowledge about epilepsy as a treatable brain disorder and in reducing, or ultimately preventing, social exclusion of patients with epilepsy (1). Education is needed on multiple levels to reach all those involved in epilepsy management, including the patients themselves. Within the classic medical disciplines, new specialties have developed which try to cover not only medical, but also psychosocial, aspects of particular disorders, to ensure a higher quality of life for patients. Epilepsy has become a specialist field (within neurology) in its own right in several European countries. The management of epilepsy requires multidisciplinary cooperation between neurologists, paediatric neurologists, psychiatrists, psychologists, neuropsychologists, clinical neurophysiologists, epilepsy nurses, social workers, neurosurgeons, neuropathologists and pharmacologists. Every member of the team needs special expertise in epilepsy. European countries have widely varying structures and systems for the provision of healthcare. There are differences in the balance between primary and secondary care, in the availability of specialised diagnostic facilities and epilepsy surgery, in the incorporation of psychosocial management and in the quality of training. However, the incidence and prevalence of epilepsy, and the type and range of medical problems that afflict the patients, are broadly similar throughout Europe. Epilepsy services and epilepsy centres are provided in many European countries. The consensus paper produced by the Commission of European Affairs (CEA) of the International League Against Epilepsy (ILAE) (2) aims to provide common guidelines and standards in epilepsy management across Europe. Epilepsy management covers every aspect of the disorder from initial diagnosis to prognosis, treatment, long-term care, and rehabilitation. Psychosocial issues must be considered at every stage of the process. Some European countries have special training programmes in epilepsy for medical and paramedical personnel (e.g., the MSc course in epileptology at King's College London, U.K., and the Inter-University Diploma of Epileptology organised by the French League against Epilepsy). Teaching could be promoted by academic “epilepsy chairs” supervising official educational programmes. In the last 2 years, the European Epilepsy Academy (EUREPA), has become the main force behind epilepsy education (see laterw). EUREPA has an “epilepsy licence” programme under evaluation. EUROPEAN EPILEPSY ACADEMY (EUREPA) EUREPA was founded on August 30, 1996, as a result of the deliberations and efforts of the CEA and the European Advisory Council (EAC). EUREPA is responsible for epilepsy education in Europe, and for the organisation of European research in neglected fields. The purpose of the association, incorporating individual and institutional members, is to improve education and further training of all people in Europe involved with epilepsy. This has given a new dimension to epilepsy education, providing a unified modular system validated by quality control and certification. Since 1997, EUREPA has organised advanced courses in conjunction with the European epilepsy congresses (3). EUREPA has also begun to educate certified trainers in epileptology. The first “train-the-trainers” course was held in Budapest in November 1998 for Eastern European countries. A further educational activity of the Academy is to produce and certify printed, audiovisual or electronic educational materials, and to approve educational courses throughout Europe. EUREPA is also now responsible for some of the traditional epilepsy educational courses in different countries (e.g., the Gargnano courses in Italy, or the “comprehensive care” courses of Bielefeld-Bethel). EUROPEAN CERTIFICATION IN EPILEPSY (EURO-LICENCE) To ensure standardised diagnostic workup and care, and to acknowledge specialisation in epilepsy throughout Europe, a licensing procedure should be implemented. A supranational board should be established to define criteria for epileptologists and to assess how certification could be obtained, to accredit training centres and programmes, to define eligibility criteria for entry to training programmes, and to estimate the number of certified epileptologists needed in Europe. USING EDUCATION TO IMPROVE EPILEPSY MANAGEMENT IN EASTERN EUROPE In Eastern Europe, standards of epilepsy management, in line with those of general healthcare, are below those of Western Europe. However, epilepsy has become a specialty in several Middle-European countries. Diagnostic facilities there are well developed—although clinical neurophysiology lags behind—and antiepileptic drugs (AEDs), including the newest drugs, are readily available in most countries, but there are considerable differences between urban and rural areas in access to these facilities. The high cost of the newer AEDs has begun to create a relative treatment gap, depriving the most severely affected and socially disabled patients. Economic difficulties in these countries hinder rehabilitation efforts (especially in employment and comprehensive care—see “Quality of Life and Comprehensive Care,” page 59). Epilepsy surgery is underdeveloped (except in the Czech Republic, Poland, and Hungary) compared with that in Western Europe. Psychologists, social workers, and other paramedical helpers are not included in comprehensive management teams, for theoretic and financial reasons. In the new independent states emerging after the collapse of the Soviet Union, the situation is even worse, characterised by lack of expertise, lack of diagnostic facilities [EEG, computed tomography (CT), magnetic resonance imaging (MRI), serum level estimation of AEDs], new drugs, and specialised epilepsy services and surgical programmes; and by the presence of stigmatisation and concealment, and lack of public awareness. Education seems to be the most important tool to improve this situation. Action should be taken to increase the availability of books and journals more widely. Support should be provided to teach the possible future trainers and to promote local conferences, to provide advisers for grant applications, to involve these countries in international multicentre studies, to promote fellowships enabling the future leaders in epilepsy from these countries to study at leading institutions, and for the lay organisations to promote local patient movements. The EUREPA activities discussed earlier have already begun to address this task, but most work still lies ahead. RECOMMENDATIONS EUREPA aims to improve education and training in epilepsy across Europe. Further work is needed, especially but not solely, to enable Eastern European countries to achieve the same standards as those of Western Europe. To ensure standardised diagnostic workup and care, and to acknowledge specialisation in epilepsy throughout Europe, a licensing procedure should be implemented. REFERENCES 1 WHO, ILAE, IBE. European Declaration on Epilepsy. Heidelberg: WHO, 1998. 2 Brodie MJ, Shorvon SD, Canger R, et al. Commission on European Affairs: appropriate standards of epilepsy care across Europe. Epilepsia 1997; 38: 1245– 50. 3 Duncan JS, Johannessen S, eds. The use of neuroimaging techniques in the diagnosis and treatment of epilepsy: Second European Epileptology Congress Educational Course, 1 September 1996, The Hague, The Netherlands. Epilepsia 1997; 38(suppl 10). Volume44, Issues6September 2003Pages 62-63 ReferencesRelatedInformation