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Continuity of specialized care upon transfer of adolescents with epilepsy from a pediatric to adult outpatient service

https://doi.org/10.17749/2077-8333.2019.11.4.348-356

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Abstract

Introduction. One of the most serious periods in the treatment and follow-up of adolescent patients with early debut epilepsy is the transition to a medical center for adults. It is important to carefully watch any possible replacement of antiepileptic drugs (AEDs), which may affect the further course of epilepsy.

Aim: to study the algorithms and procedures for bringing patients with epilepsy from a pediatric to adult outpatient practice, and also to evaluate the efficacy of therapy with synonymously replaced AEDs during this period.

Materials and methods. A retrospective study involved 218 patients who were transferred from pediatric care to an adult outpatient network. The inclusion criteria were the presence of epilepsy diagnosed in childhood (before age of 18 years), continuous treatment with AEDs, age 18 through 20 years. The exclusion criteria were: irregular observations, failure to comply with medical prescriptions. In case of unplanned pregnancy or failure to take AEDs, the patient was excluded from the ongoing study. History, neurological status, EEG, video EEG monitoring and neuroimaging data were examined. The efficacy of AEDs was graded as “complete remission” (in the absence of epileptic seizures), “incomplete remission” (if the number of seizures dropped by 50% or more), and “without effect” (if the seizures continued). Two groups of patients were analyzed: those receiving original AEDs and those receiving generic AEDs.

Results. The study showed that during the transition to an adult outpatient network, the specialized medical care continued: the young patients were monitored by epileptologists; at the same time, we noted a significant increase in the rate of replacement of original AEDs with the respective generics (54 patients). Of these patients, 25 individuals (46.3%) had recurrent seizures.

Discussion. Maintaining the continuity of specialized medical care depends on the availability of the city center of epilepsy for children. In addition, the network of outpatient clinics for adult patients with epilepsy and other paroxysmal conditions should be organized in each administrative district. The procedure of synonymous AED replacement is regulated by medical and legal documents; thus, the drugs are prescribed according to their INNs, and pharmacies dispense the medicines under the same INNs but with the trade names that are currently available in the stock. According to reports, the seizures are controlled significantly better under therapy with original AEDs compared to generics.

Conclusion. The present study demonstrates the relevance of medical care continuity during transition of young patients with epilepsy from a pediatric to adult outpatient network. However, more extensive comparative studies on the efficacy and safety of synonymous replacement of antiepileptic drugs with the same INNs are needed.

All authors contributed equally to this article.

About the Authors

M. N. Sarzhina
Scientific and Practical Center of Pediatric psychoneurology
Russian Federation
Marina N. Sarzhina – Deputy Director for Clinical Care


S. G. Burd
Scientific and Practical Center of Pediatric psychoneurology; Pirogov Russian National Research Medical University; Federal Center for Cerebrovascular Pathology and Stroke
Russian Federation
Sergey G. Burd – MD, PhD, Professor at the Department of Neurology, Neurosurgery and Medical Genetics, Faculty of Pediatrics


M. B. Mironov
Federal Center for Cerebrovascular Pathology and Stroke
Russian Federation

Mikhail B. Mironov – MD, PhD, Lead Researcher at the Department of Paroxysmal Diseases,

Head of the Laboratory of Video-EEG Monitoring, Medical Center for Pediatric Neurology and Pediatrics;

SPIN-code: 1144-7120, Auth or ID: 632779



M. M. Gunchenko
Scientific and Practical Center of Pediatric psychoneurology
Russian Federation
Marina M. Gunchenko – Deputy Director for Outpatient Clinical Care


T. T. Batysheva
Scientific and Practical Center of Pediatric psychoneurology
Russian Federation
Tatyana T. Batysheva – MD, PhD, Professor, Honored Doctor of the Russian Federation, Director


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For citation:


Sarzhina M.N., Burd S.G., Mironov M.B., Gunchenko M.M., Batysheva T.T. Continuity of specialized care upon transfer of adolescents with epilepsy from a pediatric to adult outpatient service. Epilepsy and paroxysmal conditions. 2019;11(4):348-356. (In Russ.) https://doi.org/10.17749/2077-8333.2019.11.4.348-356

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ISSN 2077-8333 (Print)
ISSN 2311-4088 (Online)