Transition From Pediatric to Adult Care in Epilepsy

Официальное название

Transitioning From Pediatric to Adult Care in Epilepsy: Efficacy of a Novel Italian Model

Обзор

The transition from pediatric to adult healthcare services for individuals with epilepsy represents a major clinical and organizational challenge. This complexity arises from the heterogeneity of the underlying epileptic disorders and the frequent presence of multiple comorbidities. Furthermore, the process entails a profound shift in the patient-physician relationship, which must be re-established to allow open discussion of sensitive issues and to adapt to a different model of care. In pediatric settings, medical care is predominantly family-centered, with parents actively involved in the decision-making process. In contrast, adult care is primarily patient-centered, emphasizing individual autonomy and self-management. The \*\*transition\*\* therefore constitutes a structured process designed to prepare adolescents and young adults for adult-oriented healthcare. It aims to enhance their understanding of epilepsy, increase awareness of available treatments, and develop self-management skills that help minimize the long-term psychosocial and medical impact of the disorder. The \*\*transfer\*\*, by contrast, refers to the formal handover of medical responsibility from pediatric to adult healthcare providers. While transfer is an event, transition represents a multidimensional process that should begin well before the actual shift of care. Over the past decade, several studies have sought to address the challenges associated with this critical phase by proposing transitional programs based on different organizational models. These structured interventions are designed to bridge the gap between pediatric and adult services, fostering continuity of care and improving clinical outcomes. A recent and promising example is a \*\*French transitional model\*\*, published following a retrospective study involving 70 persons with epilepsy (PWE). This model provided evidence supporting the feasibility and benefits of a dedicated, multidisciplinary transition program tailored to the specific needs of young individuals with epilepsy. In contrast, within the Italian scientific and clinical context-particularly in the field of epilepsy-no formally structured or validated transition program has yet been established. This gap underscores the need for the development of standardized national guidelines and the implementation of evidence-based transitional pathways. A well-designed transition program can significantly facilitate the adjustment of adolescents to adult neurological care, promoting therapeutic adherence, clinical stability, and psychosocial well-being. Ultimately, structured transitional care represents a crucial step toward ensuring continuity, safety, and quality of care for individuals with epilepsy as they move from pediatric to adult health services.

Вмешательства

• Диагностический тест EpiTRAQ
  Clinical and neuropsychological evaluations with standardised and internationally validated questionnaires and interviews, already used in clinical practice.

Первичные конечные точки

• Adult Clinic Attendance Rate [Срок оценки: 12 months]
• Return Rate: [Срок оценки: 12 months]

Вторичные конечные точки (3)

• Adult Clinic Attendance Rate and the EpiTRAQ [Срок оценки: 36 months]
• Return Rate and the EpiTRAQ [Срок оценки: 36 months]
• QOLIE-31 [Срок оценки: 36 months]

Критерии участия

Критерии включения

Prospective Study

Case Group:

• Persons with epilepsy (PWE) or epileptic syndromes (6,7) without intellectual disability (ID); PWE with mild ID, with or without comorbidities; and individuals diagnosed with tuberous sclerosis complex.
• PWE who are at least 15 years old at the time of the DH BRIDGE admission.
• PWE who are regularly followed at the Fondazione Policlinico Universitario A. Gemelli IRCCS, with documentation of at least two prior evaluations conducted at the Child Neuropsychiatry Unit.
• Signed informed consent obtained from the parents or legal guardians, or from the patient if of legal age. In cases where an adult patient is unable to provide informed consent, authorization will be obtained from a parent or legal guardian.
• Signed assent form from the minor participant.

Control Group:

• Persons with epilepsy (PWE) or epileptic syndromes (6,7) without intellectual disability (ID); PWE with mild ID, with or without comorbidities; and individuals diagnosed with tuberous sclerosis complex.
• PWE who are at least 18 years old at the time of their first visit to the Adult Neurology Outpatient Clinic.
• PWE who are regularly followed at the Fondazione Policlinico Universitario A. Gemelli IRCCS, with documentation of at least two visits at the Day Hospital for Drug-Resistant Epilepsies.
• Signed informed consent obtained directly from the patient or, in cases of incapacity, from the parents or legal guardian.

Retrospective Study

• Persons with epilepsy (PWE) or epileptic syndromes without intellectual disability (ID); PWE with mild ID, with or without comorbidities; and individuals diagnosed with tuberous sclerosis complex.
• PWE who were over 18 years of age at the time of their first visit to the Adult Neurology Outpatient Clinic, and who have completed at least six months of follow-up after that visit. When available, follow-up data at 12 months will also be collected.
• PWE who have been regularly followed at the Fondazione Policlinico Universitario A. Gemelli IRCCS, with at least two documented visits conducted at the same institution.
• Signed informed consent obtained directly from the patient or, in cases of incapacity, from the parents or legal guardian.

Критерии исключения

-Patients will be excluded if they are not regularly followed at the Day Hospital for the Diagnosis and Treatment of Drug-Resistant Epilepsies (fewer than two visits).

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Модель наблюдения

Случай-контроль

Центры проведения

Италия · 1 центр

• Fondazione Policlincio Universitario Agostino Gemelli — Roma

Идентификаторы

NCT: NCT07592676 · 7918

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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