title: Epilepsy transition: challenges of caring for adults with childhood-onset seizures.
abstract: OBJECTIVE
  Children with severe chronic epilepsy are living longer, and they eventually transition to the adult health care system. Additional research is required to better define the population that is being transferred and the qualifications of those who are assuming their care. We aimed to evaluate the complexity of epilepsy patients transitioning between tertiary centers, and to evaluate neurologists' confidence in dealing with childhood-onset epilepsies.
  
  
  METHODS
  Patients aged from 18 to 25 years were divided into two groups: Group 1 comprised patients referred from the pediatric tertiary center; and Group 2 comprised patients referred from the community. Clinical data were retrospectively studied and groups were compared using appropriate statistics. We also created a survey to evaluate neurologists' levels of confidence in diagnosing and treating childhood-onset epilepsies. Differences among responders were compared.
  
  
  RESULTS
  Group 1 comprised 170 patients, whereas group 2 had 132. Patients in group 1 had earlier seizure onset, longer epilepsy duration (p < 0.001), and more patients with symptomatic etiologies, epileptic encephalopathy, and cognitive delay (p < 0.001). Group 1 patients required more referrals to other specialties (p = 0.001). Treatment with polytherapy (p = 0.003), epilepsy surgery (p < 0.001), ketogenic diet (p < 0.001), and vagus nerve stimulator were more common in group 1 (p < 0.001). In addition, our survey applied to adult (n = 86) and pediatric (n = 29) neurologists indicated that adult neurologists have lower levels of confidence in diagnosing and treating severe forms of childhood-onset epilepsies (p < 0.001), as well as epilepsy associated with cognitive delay (p < 0.001).
  
  
  CONCLUSIONS
  These findings suggest that patients from tertiary centers present more complex health care needs and require more resources than age-matched patients from the community; and that adult neurologists may not feel prepared to diagnose and treat adult patients with some childhood-onset epilepsies.
authors.affiliation: Division of Neurology, Epilepsy Genetics Program, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Hospital for Sick Children (SickKids), University of Toronto, Toronto, Ontario, Canada.
authors.forename: Felippe
authors.initials: F
authors.lastname: Borlot
authors.forename: Jose F
authors.initials: JF
authors.lastname: Tellez-Zenteno
authors.forename: Anita
authors.initials: A
authors.lastname: Allen
authors.forename: Anfal
authors.initials: A
authors.lastname: Ali
authors.forename: O Carter
authors.initials: OC
authors.lastname: Snead
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Andrade
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D002648:Child; D004827:Epilepsy / Q000628:therapy*; D006801:Humans; D009462:Neurology / Q000592:standards / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012017:Referral and Consultation; D012189:Retrospective Studies; D063128:Tertiary Health Care; D060305:Transition to Adult Care; D055815:Young Adult
keywords: Adult health care; Complex needs; Dravet syndrome; Epilepsy; Tertiary center; Transition