Authors :
Presenting Author: Kazutoshi Konomatsu, MD – Tohoku university graduate school of medicine
Yosuke Kakisaka, PhD – Epileptology – Tohoku University Graduate school of medicine; Makoto Ishida, PhD – Epileptology – Tohoku University Graduate school of medicine; Temma Soga, MD – Epileptology – Tohoku University Graduate school of medicine; Kazushi Ukishiro, MD – Epileptology – Tohoku University Graduate school of medicine; Shin-ichiro Osawa, PhD – Neurosurgery – Tohoku University Graduate school of medicine; Kazutaka Jin, PhD – Epileptology – Tohoku University Graduate school of medicine; Masashi Aoki, PhD – Neurology – Tohoku University Graduate school of medicine; Nobukazu Nakasato, PhD – Epileptology – Tohoku University Graduate school of medicine
Rationale:
The “odyssey plot” was used to visualize referral delay in epilepsy surgery.
Methods:
Subjects were 36 patients (19 males; 13–67 years, median 27 years) with mesial temporal lobe epilepsy with hippocampal sclerosis (HS) who underwent resection surgery. The “referral odyssey plot” included five clinical episodes: seizure onset (T1), first visits to a non-epileptologist (T2) and to an epileptologist (T3), first admission to our epilepsy monitoring unit (EMU) (T4), and resection surgery (T5). For each patient, we identified the first seizure type; the physician who firstly diagnosed focal aware seizure (FAS), focal impaired awareness seizure (FIAS), and focal to bilateral tonic-clonic seizure (FBTCS), and radiologically suspected HS.
Results:
Within the overall delay (T1-T5, median 18 years; interquartile range [IQR] 14), non-epileptologist’s delay (T2-T3, 11.5 years; IQR 12.25) was far (p < .0001) longer than patient’s (T1-T2, 0 year; IQR 2.25), epileptologist’s (T3-T4, 1 year; IQR 4), or after-EMU delay (T4-T5, 1 year; IQR 1). FAS onset cases had significantly longer T1-T2 (N = 5, median 7 years; IQR 6) than FIAS (N = 22, 0 year; IQR 1, p < .005) or FBTCS onset cases (N = 9, 0 year; IQR 0, p < .001). FAS was correctly diagnosed first by non-epileptologists in 17.9%, by out-patient epileptologists in 35.7%, and at the EMU in 46.4%. FIAS was correctly diagnosed first by non-epileptologists in 94.4% and by out-patient epileptologists in 5.6%. Non-epileptologists diagnosed FBTCS in all cases. HS was diagnosed by non-epileptologists in 13.9%, by out-patient epileptologists in 47.2%, and at the EMU in 38.9%.