1. Transition from Pediatric to Adult Care
Jorge Asconapé, MD
Professor of Neurology
Stritch School of Medicine
Loyola University Chicago

2. Transition of Epilepsy Care from Children to Adults
Pediatric
Neurologist
Adult
Neurologist
Transition versus Transfer

3. Transition of Epilepsy Care from Children to Adults
Pediatric care is family centered
Pediatric
Neurologist
Patient
Family

4. Transition of Epilepsy Care from Children to Adults
Adult care is individual centered
Adult
Neurologist
Patient

5. Transition of Epilepsy Care from Children to Adults
Adult care is individual centered
Adult
Neurologist
Family
Patient
Group Home

6. Transition of Epilepsy Care from Children to Adults: Challenges for the adult neurologist
Pediatric epilepsy is more complex because of the variety of disorders.
Comorbidities
Cognitive
Behavioral
Many adult neurologists are not familiar with certain pediatric epilepsy syndromes or uncomfortable managing cognitive or behavioral problems.

7. Epilepsy Syndromes that may be problematic for adult neurologists
Epileptic encephalopathies
Lennox Gastaut syndrome
Dravet Syndrome
Epilepsy with continuous spike-wave during sleep
Landau-Kleffner syndrome
Tuberous sclerosis complex
Sturge-Weber disease
Rasmussen encephalitis
Mitochondrial or metabolic disorders
Chromosomal disorders

8. Therapies that may be problematic for adult neurologists
Certain antiepileptic drugs
Vigabatrin
Rufinamide
Clobazam
Felbamate
Ketogenic diet and its variants

9. Comorbidities that may be problematic for adult neurologists
Attention deficit disorders
Learning disability
Autism spectrum disorders
Severe cognitive disability
Psychiatric disorders:
Adjustment disorders
Psychosis
Aggressiveness/impulsivity/self-injurious behaviors

10. Most common clinical scenarios in the transition/transfer process
Three main groups of patients
Early onset of epilepsy with persistent seizures and concomitant intellectual or behavioral disabilities.
Onset of epilepsy in adolescence, with small likelihood of remission, but with no intellectual or behavioral disabilities.
Epilepsy that remits in childhood, but patient is left with intellectual or behavioral comorbidities.

11. Transition of Epilepsy Care from Children to Adults
Pediatric
Neurologist
Adult
Neurologist
Pediatric
Epileptologist
Adult
Epileptologist

12. How to develop a transition program: Academic Institutions
Pediatric
Epileptologists
Adult
Epileptologists +
Joint, multidisciplinary Epilepsy Clinic

13. How to develop a transition program: Private Practice
Pediatric
Neurologist
Adult
Neurologist
Communication!

14. How to develop a transition program: Role of the pediatric neurologist
Identify adult neurologists or epileptologists that are willing to care for these special patients.
Establish a close communication between pediatric and adult health providers.
Consider developing a “transition” clinic.
At a minimum, provide a transfer summary letter with detailed information including diagnosis and medication history.
Make sure that the etiologic work-up is up to date, with particular emphasis on neuroimaging and genetics.

15. Transition of Epilepsy Care: Adolescent Issues
How to become a responsible adult
Adjustment disorders, self-esteem, stigma.
Adherence to medication schedules
Driving
Sexual education

16. We have a lot of work to do!!
Conclusion
We have a lot of work to do!!
Thank you