Transitional medicine for epilepsy

Abstract

The current status and issues of transitional medicine in epilepsy care was outlined in this review article. There are three main types of transition in epilepsy care in Japan : (1) complete transfer to adult department after a certain overlapping period, (2) continued care by both pediatric and adult departments, and (3) continued care by pediatric department. In (1), patients with idiopathic generalized epilepsy and favorable focal epilepsy of childhood onset are included. Although diagnosis and treatment are not difficult in this group, a long–term treatment surely produces additional care as follows. It is important to understand the special condition of long–term treatment for school attendance and employment, and special precautions for driving, marriage, and pregnancy. In (2) and (3), a wide range of patients with generalized or focal epilepsy with hereditary or congenital diseases are included, and comorbidities other than epilepsy such as developmental or progressive disorders. The transition can be relatively smooth in patients with lesser medical care needs and good seizure control. On the other hand, if the patients suffer from psychiatric comorbidities or conditions that is unique for pediatric population and need the support by multiple departments, then the transition can be rather complicated. In order to conduct smooth transition for the sake of patients in the future, it is necessary in advance to have psychosocial support, patient education, and joint conferences with medical staff in order to share sufficient information among them. In addition, appropriate medical care and treatment should be provided by regional medical institutes and affiliated organizations together with different role to endorse equalization and standardization of epilepsy care. With the recent COVID–19 global pandemic, clinic visit in person has decreased and online treatment is recommended instead. In addition, technological advancement such as information technology system, data server system etc. appropriately endorsed by medical insurance system in Japan may further help us promote transitional medicine for epilepsy.