Current challenges in focal epilepsy treatment: An Italian Delphi consensus

Giancarlo Di Gennaro; Simona Lattanzi; Oriano Mecarelli; Francesco Saverio Mennini; Federico Vigevano

doi:10.1016/j.yebeh.2024.109796

Current challenges in focal epilepsy treatment: An Italian Delphi consensus

Epilepsy Behav. 2024 Apr 20:155:109796. doi: 10.1016/j.yebeh.2024.109796. Online ahead of print.

Authors

Giancarlo Di Gennaro¹, Simona Lattanzi², Oriano Mecarelli³, Francesco Saverio Mennini⁴, Federico Vigevano⁵

Affiliations

¹ IRCCS NEUROMED, Pozzilli, IS, Italy. Electronic address: gdigennaro@neuromed.it.
² Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy.
³ Department of Human Neurosciences, Sapienza University, Rome (Retired) and Past President of LICE, Italian League Against Epilepsy, Rome, Italy.
⁴ Faculty of Economics, Economic Evaluation and HTA (EEHTA), CEIS, University of Rome "Tor Vergata", Rome, Italy; Institute for Leadership and Management in Health, Kingston University London, London, UK. Electronic address: mennini@uniroma2.it.
⁵ Head of Paediatric Neurorehabilitation Department, IRCCS San Raffaele, Rome, Italy. Electronic address: federico.vigevano@sanraffaele.it.

PMID: 38643659
DOI: 10.1016/j.yebeh.2024.109796

Abstract

Background: Epilepsy, a globally prevalent neurological condition, presents distinct challenges in management, particularly for focal-onset types. This study aimed at addressing the current challenges and perspectives in focal epilepsy management, with focus on the Italian reality.

Methods: Using the Delphi methodology, this research collected and analyzed the level of consensus of a panel of Italian epilepsy experts on key aspects of focal epilepsy care. Areas of focus included patient flow, treatment pathways, controlled versus uncontrolled epilepsy, follow-up protocols, and the relevance of patient-reported outcomes (PROs). This method allowed for a comprehensive assessment of consensus and divergences in clinical opinions and practices.

Results: The study achieved consensus on 23 out of 26 statements, with three items failing to reach a consensus. There was strong agreement on the importance of timely intervention, individualized treatment plans, regular follow-ups at Epilepsy Centers, and the role of PROs in clinical practice. In cases of uncontrolled focal epilepsy, there was a clear inclination to pursue alternative treatment options following the failure of two previous therapies. Divergent views were evident on the inclusion of epilepsy surgery in treatment for uncontrolled epilepsy and the routine necessity of EEG evaluations in follow-ups. Other key findings included concerns about the lack of pediatric-specific research limiting current therapeutic options in this patient population, insufficient attention to the transition from pediatric to adult care, and need for improved communication. The results highlighted the complexities in managing epilepsy, with broad consensus on patient care aspects, yet notable divergences in specific treatment and management approaches.

Conclusion: The study offered valuable insights into the current state and complexities of managing focal-onset epilepsy. It highlighted many deficiencies in the therapeutic pathway of focal-onset epilepsy in the Italian reality, while it also underscored the importance of patient-centric care, the necessity of early and appropriate intervention, and individualized treatment approaches. The findings also called for continued research, policy development, and healthcare system improvements to enhance epilepsy management, highlighting the ongoing need for tailored healthcare solutions in this evolving field.

Keywords: Epilepsy Management; Expert Consensus; Focal Epilepsy; Patient-Centered Care; Unmet Needs.