[A difficult transition from childhood to adult healthcare: the case of epilepsy].
OBJECTIVE
The purpose of this study was to analyze modalities of the transition from pediatric to adult epilepsy care and patients' acquisition of autonomy.


METHODS
This study was conducted using semidirected interviews composed of three major parts: the patient's criteria of transition toward adult healthcare (factors taken into account, anticipation, the patient's opinion, etc.), conditions (teamwork with the neurologists, transmission of the medical record, continuity of health care, etc.), and the role played by social workers and psychologists. We interviewed 10 doctors belonging to six major Parisian hospital units involved in the monitoring of children and adolescents with epilepsy and working in Pediatric Neurology Departments of the Île-de-France region.


RESULTS
For most of the doctors, reaching 18 years of age was the major argument taken into account to consider transition to adult care. According to the doctors interviewed, parents are generally worried when their child has to find another doctor (7/10). According to eight out of 10 doctors, the neurologist is selected to take over. The doctors recognize the importance of psychologists and social workers even if they are not always included. The process by which the patient gains autonomy depends a great deal on the role played by the pediatricians and parents, although some parents are very protective. This behavior weakens the patient's capacity for autonomy and it varies according to the degree of his or her physical and/or neurological disabilities. Furthermore, developing autonomy requires interdisciplinary work that is not yet fully in place.


CONCLUSIONS
The lack of structures well-adapted to the uniqueness of each patient and the lack of coordination between the various institutions do not favor the acquisition of autonomy. A network that could efficiently respond to the needs of epileptic patients as well as medical care tailored to adolescents would be the answer to this dilemma.
Institut international de recherche en éthique biomédicale (IIREB), laboratoire d'éthique médicale et médecine légale, faculté de médecine, université Paris 5, 45, rue des Saints-Pères, 75006 Paris, France. Electronic address: affdal-aliya@orange.fr.
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Affdal
Service de neuropédiatrie, hôpital Trousseau, 26, rue du Docteur Arnold-Netter, 75012 Paris, France.
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Moutard
Service de neuropédiatrie, hôpital Trousseau, 26, rue du Docteur Arnold-Netter, 75012 Paris, France.
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Billette de Villemeur
Institut international de recherche en éthique biomédicale (IIREB), laboratoire d'éthique médicale et médecine légale, faculté de médecine, université Paris 5, 45, rue des Saints-Pères, 75006 Paris, France.
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Duchange
Institut international de recherche en éthique biomédicale (IIREB), laboratoire d'éthique médicale et médecine légale, faculté de médecine, université Paris 5, 45, rue des Saints-Pères, 75006 Paris, France.
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Hervé
Institut international de recherche en éthique biomédicale (IIREB), laboratoire d'éthique médicale et médecine légale, faculté de médecine, université Paris 5, 45, rue des Saints-Pères, 75006 Paris, France.
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Moutel
D000293:Adolescent; D004827:Epilepsy / Q000628:therapy*; D006801:Humans; D010372:Pediatrics; D026684:Personal Autonomy; D010818:Practice Patterns, Physicians'; D060305:Transition to Adult Care