Authors :
First Author: Sally Shaaban, MD – Mansoura University
Presenting Author: Ibrahim Elmenshawi, MD, PhD, FAES – Mansoura University, School of Medicine
Tamer Belal, PhD – Professor Of Neurology, Department of Neurology, Mansoura University Faculty of Medicine; Shorouk Mohsen, PhD – Lecturer, Department of Public Health and Preventive Medicine, Mansoura University Faculty of Medicine; Ibrahim Elmenshawi, PhD – Professor Of Neurology, Department of Neurology, Mansoura University Faculty of Medicine
Rationale:
This study aims to examine the current clinical practice and attitude of epilepsy health care providers regarding postictal state assessment in their epilepsy units.
Methods:
An online survey was conducted on the Google Forms platform from May 25th to May 30th, 2023. The link was sent to private social media groups for epilepsy healthcare providers and mailed to some epileptologists. The total number of participants with responses recorded via Google Form in this study was 130 from 22 countries. One participant with less than one year of experience in epilepsy was excluded. Participant approval to use the data for research purposes was required. The questionnaire was divided into five sections. The first explored individual and professional characteristics; the second, third, and fourth examined participant practices and attitudes of their epilepsy unit regarding clinical evaluation, EEG tracing, and the most vital test during the postictal period, respectively. The fifth section asked physicians' opinions on whether the postictal assessment of patients with epilepsy (PWE) should be routinely included in clinical practice. We classified participants as follows; those from high-income and high-middle-income countries as Group A and those from low-middle-income and low-income countries as Group B.
Results:
Of the 129 participants, 41 (31.8%) belonged to fourteen countries classified into Group A. Neurologists represented 77.5% of all participants. The majority (70.7% and 59.1%, respectively) in both groups did not routinely screen for postictal psychosis (PIP). Providers with more years of experience (median [IQR] = 17 [8-25] versus 10 [5-19]) were more likely to screen their patients for PIP (P = 0.02). Regarding current practices during the postictal state in long-term video-EEG monitoring units, nearly half (48.9%) usually thoroughly applied the standardized postictal test proposed by the International League Against Epilepsy (ILAE) consensus in 2016. About 86.7% routinely reviewed the postictal EEG. However, only 53.1% often traced both postictal polymorphic delta activity (PPDA) and postictal generalized EEG suppression (PGES). During the routine postictal examination, nearly one-third of each group tended to disregard assessing the oxygen saturation of their patients. Almost all participants agreed on including postictal assessment in routine clinical practice.
Conclusions:
This study identified serious practice and knowledge gaps regarding postictal assessment among epilepsy healthcare providers, irrespective of the country's economic status or physicians' years of experience in epilepsy. Thus, there is a need for ongoing physician education regarding the critical role of postictal evaluation in optimizing the quality of life for PWE via proper diagnosis and management of postictal comorbidities, especially postictal psychosis and postictal hypoxemia.
Funding:
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.