Chronic Disease Management
While many patients achieve complete seizure control after the initiation of antiepileptic drugs, others do not. These patients are said to have refractory seizures and require additional medical attention, including teaching about seizure triggers and medication management. They may also need further evaluation of their seizure disorder by a general neurologist or epilepsy specialist.
These quality indicators provide guidance regarding some specific actions a primary care or general neurologist will want to take when a patient does not achieve complete seizure control either because the medication is ineffective or the patient experiences drug side-effects.
Patients whose seizures are completely or nearly completely controlled also need information and assessment to assure that they are able to effectively manage their epilepsy and that they do not have other problems such as mood disorders that may require evaluation and treatment.
The links at the bottom provide information about finding epilepsy specialists and comprehensive epilepsy centers, mood disorders, and medication related side effects, and also provide tools that can help your patients track their seizures.
| QI 1. IF the diagnosis or seizure type remains unclear after the initial evaluations, or the patient has recurrent seizures THEN the patient should be referred to the next highest level of epilepsy care. | Primary |
| QI 2. WHEN a patient with epilepsy receives follow-up care, THEN an estimate of the number of seizures since the last visit and an assessment of drug side effects should be documented. | Primary |
| QI 3. IF the patient reports unacceptable side-effects from AED monotherapy, THEN an alternative AED should be started (with carefully planned crossover). | Primary |
| QI 4. IF use of at least two different AED monotherapies has not resulted in seizure freedom, THEN referral for more highly specialized epilepsy care is indicated. | Primary |
| QI 5. IF the patient is on AEDs for 2 or more years THEN providers should assess bone health. | Primary |
| QI 6. IF a person with epilepsy is found to have evidence of a mood disorder (e.g., depression, anxiety) THEN s/he should receive treatment or a referral for mental health care. | Primary |
|
QI 7. IF the patient continues to have seizures after initiating treatment THEN interventions should be performed.
|
Primary |
|
QI 8. Patients with epilepsy should receive an annual review of information including topics such as:
|
Secondary |
| QI 9. A person with epilepsy should receive screening for depression at least once each year. | Secondary |
| QI 10. IF a person with epilepsy is well controlled THEN s/he should have an annual review of adverse effects of drugs and self-management issues. | Secondary |
QI = Quality Indicator
Primary = Items that were rated as both valid and necessary indicators are primary quality indicators.
Secondary = Items that were rated as valid but not necessary are secondary quality indicators.
For more information:
- French JA, Kanner AM, Bautista J, et al. Efficacy and tolerability of the new antiepileptic drugs II: Treatment of refractory epilepsy. Neurology 2004;62:1261-1273.
See also: http://aan.com/professionals/practice/pdfs/clinician_ep_refractory_e.pdf and http://aan.com/professionals/practice/pdfs/patient_ep_refract_c.pdf - Pugh MJ, Berlowitz DR, Montouris G, et al. What constitutes high quality of care for adults with epilepsy? Neurology 2007;69:2020-2027.
