[Transition of Children with Epilepsy to Adult Care: Current Status and Challenge].

Thirty percent of the patients consulting a pediatric neurologist have already reached adulthood as patients and their families do not like transfer to the adult clinics; moreover, there are no suitable clinics. Pediatric neurologists find it difficult to examine adult patients with childhood-onset epilepsy as they are unfamiliar with the psychiatric and psychological symptoms manifested in adulthood, and the common diseases of adulthood. On the other hand, adult neurologists have difficulty obtaining a complete picture of the patient's clinical history since childhood, and are unfamiliar with childhood-specific epilepsy syndrome. When it comes to transition, the patient's decision should be prioritized. Transition should be patient-centered, with cornerstones of flexibility, responsiveness, continuity, comprehensiveness, and coordination. For successful transition to occur, there must be psychosocial support, patient education, better medical system organization with inclusion of a transition process, such as transition clinic, increased number of epilepsy-specialized physicians/nurses, and resources such as checklists and programs to aid in transition.

[Symptoms and clinical course of epilepsy with myoclonic absences].

There is no comprehensive study so far in Japan on epilepsy with myoclonic absences (EMA), characterized by myoclonic absences (MA) as a specific seizure type. We retrospectively studied 9 patients (4 males and 5 females) with EMA confirmed by ictal video EEG and polygraph (EEG+EMG) recordings. The age at MA onset ranged from 18 to 92 months and the age at the last follow-up ranged from 3 to 39 years. The patients had IQ of 40 to 79. Eight patients had been free from seizures for more than one year at the last follow up. MA was controlled by valproate sodium monotherapy or combination of valproate sodium and ethosuximide with appropriate plasma levels. Generalized tonic clonic seizures and severe mental retardation were not necessarily associated with poor seizure outcome. Patients with long MA duration or MA status epilepticus were prone to be refractory to medication. EMA can be divided into two subgroups based on the seizure outcome, favorable and unfavorable. Further large-scale study is required.

[The study of the recognition gap on the quality of life in people with epilepsy between the affected pediatric and adolescent patient's families and the attending physicians].

The aims of this study were to investigate the recognition gap on the quality of life (QOL) in people with epilepsy (PWE) between the affected pediatric and adolescent patient's families and the attending physicians, and to devise future management strategies for epilepsy based on the results. We conducted a large-scale questionnaire survey on the QOL in 5,122 PWE/their families who were members of the Japanese Epilepsy Association in 2006 and 1,701 PWE/their families and 502 attending physicians responded. Out of the responders, 107 matched pairs of PWE aged under 16 years (with an adult family member actually responding by proxy) and their physicians responding to the questionnaire were examined. The results demonstrated that the physicians were not sufficiently aware of 1) concern about drug therapy for epilepsy from the perspective of their patients/families, 2) ictal and post-ictal symptoms recognized by the patients/their families, and 3) the worry about the disease of the patients/their families. Thus, efforts are needed to minimize the recognition gap within the limited consultation hour in routine clinical practice between children and adolescents having epilepsy/their families and physicians : physicians should efficiently acquire necessary information from PWE/their families, and should negotiate with PWE/their families about the goal of therapy and future management strategies for epilepsy.

[Social support for people with epilepsy].

People with epilepsy (PWEs) find it difficult to join society because of their seizures and because of the many kinds of problems that they face in the interictal periodo. These interictal issues include coexistent disabilities other than epilepsy, comorbidity (depression or anxiety), and psychosocial issues. PWEs show a high rate of impairment of intelligence and of, psychological, verbal, and motor functions; these impairments are classified according to the International Classification of Impairments, Disabilities, and Handicaps (ICIDH; 1980). These impairments lead to disabilities such as those with regard to communication, social functions, personal care, mobility, skillful work, and engaging in an occupation. Social ignorance and discrimination also make it difficult for PWEs to integrate in the society. Therfore, social support for PWEs is important, and doctors should be aware regarding the social resources, social welfare systems, and laws for PWEs. In this study, the current Japanese social support systems for PWEs have been briefly reviewed. For example, since 2002, PWEs can hold a driving license if they are seizure free for more than 2 years, can prove that their seizures occur only during sleep for more than 2 years and can also prove that these seizures do not impair of consciousness (simple partial seizure) nor affect their ability to drive for more than 1 year.

Assessment of health-related quality of life and influencing factors using QOLIE-31 in Japanese patients with epilepsy.

The aim of epilepsy treatment is not only to eliminate seizures, but also to improve health-related quality of life (HRQOL). We conducted a postal self-administered survey of HRQOL for Japanese patients using the Quality of Life in Epilepsy inventory (QOLIE-31), Version 1.0, and analyzed factors influencing their quality of life (QOL). Data from 599 analyzable patients were evaluated and a number of factors influencing QOL were identified, including severity and frequency of seizures, seizure control, type of epilepsy, contributing events such as injuries and falls during seizures, number of antiepileptic drugs, employment status, and surgical outcome. These findings suggest that comprehensive management of the patient should be emphasized. Consideration of all the results led to classification of these factors as one of two types: "all or nothing" and "linear." With respect to "all or nothing" factors (e.g. "daytime remarkable seizures"), patients may not be able to improve their QOL unless these factors can be completely controlled. Comparison of each score on the QOLIE-31 subscales with published data revealed that the scores for the subscale Medication Effects were markedly low.