Abstracts

The Epilepsy Programme at Beaumont Hospital is the tertiary referral centre for patients with epilepsy and related disorders in Ireland. The two bedded epilepsy monitoring unit (EMU) is the only dedicated unit in the country for pre-surgical evaluation. Several thousand patients may benefit from surgical evaluation. The Scottish Intercollegiate Guidelines Network (2003) recommend that referral for assessment for neurosurgical treatment should be considered if the epilepsy is drug resistant, and further define drug resistance as having failed two appropriate antiepileptic drugs at adequate dosage. Surgical work-up involves a complex multidisciplinary, multi-step process involving full clinical assessment, neuro-imaging, video EEG monitoring (vEEG), neuropsychology and neuropsychiatry assessments and for some a sodium amytal (Wada) test., We audited the charts of forty patients who were suitable for epilepsy surgery to determine waiting times from first referral to the neurology clinic and then at various points during the work-up to identify where the most serious delays were occurring. The number of anti-epileptic medications that patients had tried prior to vEEG monitoring was reviewed., The audit indicated that three main delays existed. Firstly, patients were incurring delays of up to two years for their initial appointment with the neurologist. Secondly, patients referred for vEEG waited from 18-24 months prior to its completion. Finally a delay of up to nine months occurred awaiting Wada testing. The lengthy delays for these patients may put them at an added risk of serious injury or death. The review indicated that patients had been tried on between three and nine drugs prior to completion of vEEG monitoring., These delays indicated that the Epilepsy Programme in Beaumont Hospital does not currently meet recommendations regarding access to epilepsy surgery. The delay for the initial appointment is the first stumbling block, reflecting a serious shortage of Neurologists/Epileptologists. There is an insufficient number of monitoring beds to meet the needs of Irish epilepsy patients and too few neuropsychologists to deliver timely assessments of these patients. We endeavour to provide optimum care to people with epilepsy in Beaumont Hospital, but are clearly frustrated and concerned by these issues. It appears the lack of resources within the Irish health service is letting patients down. Epilepsy remains one of the most under-funded, under resourced and neglected areas of healthcare in Ireland.,