An audit of the organization of adult epilepsy services in the UK: A comparative review of epilepsy and general neurology clinics

Abstract

A survey of all consultant neurologists was carried out to investigate the current provision of hospital-based adult epilepsy services in the UK and to compare the level of services offered by epilepsy and general neurology clinics. The valid response rate was 75%. Fifty-four epilepsy clinics were identified led by 43 neurologists in 46 hospitals. Over half the major neurological centres represented in the dataset had epilepsy clinics (31/58). Epilepsy clinics were significantly more likely than general neurology clinics to have on-site provision of a wide range of relevant investigations and associated specialists, and also shorter waiting times to see new patients with suspected seizures. There were also significant differences between epilepsy clinics and general neurology clinics in the provision of written information and counselling. Epilepsy clinics have definite advantages for patients over general neurology clinics in improving access to investigations and specialists and provision of psychosocial support, but the extent to which these translate into positive health outcomes needs further evaluation. A second survey of directors of public health concerning purchasing arrangements for epilepsy services confirmed that purchasers, as yet, are making little use of the contracting process to influence the quality of epilepsy services offered by providers of care.

Population based, prospective study of the care of women with epilepsy in pregnancy

“…3 4 Most women with epilepsy in our region are supervised by their general practitioner, control of seizures is poor, compliance with medication is variable, and methods of preconceptional counselling are ineffective. Less than 50% of these pregnancies are planned, partly because of oral contraceptive failure.…”

“…The malformation rate in their infants is double that of the background population, and not all malformations are attributable to antiepileptic drugs 2. Most published guidelines are targeted at neurologists, 3 4 thereby failing to improve management of women under the care of their general practitioner. Considerable expansion of epilepsy services in primary and secondary care is needed if the guideline recommendations 3 4 are to be achieved 5…”

Differences in the process of diabetic care between south Asian and white patients in inner-city practices in Nottingham, UK

“…Patients receiving shared care were more likely to receive an annual review and a range of items of care than those receiving practice‐only care. It may be argued that this finding is not new and that there are a number of clinical areas where a more structured approach to care results in better process measures; for example, epilepsy (Wallace et al . 1997, Trost 2000) or mental health (Schneider et al .…”

Effect of maternal anticonvulsant treatment on neonatal blood coagulation

“…As immediate prophylaxis with intramuscular vitamin K at birth might well have prevented all the published cases of documented symptomatic factor deficiency unassociated with trauma to the liver or spleen, many clinicians will prefer to give a physiological dose of vitamin K to the baby at delivery, rather than a pharmacological dose to the mother before delivery, as is frequently recommended,4 17 23 26 especially while there remains any continuing possibility that high doses could be carcinogenic 2728 The problem should become less common as other drugs come to be used in the management of adult epilepsy—valproate, in particular, does not seem to cause neonatal hypoprothrombinaemia 3…”