Abstracts

Rationale: Okinawa mainland holds almost one million populations, where there is no epilepsy center. There is no full-time adult epilepsy specialist. This means that any epilepsy patient could not be benefited from long term video EEG monitoring (LT-vEEG), intracranial electrodes recordings or conventional epilepsy surgery ourselves. In addition, Okinawa area is geographically as well as philosophically a typical archipelago locality, where most epilepsy patient would hesitate to travel out to other areas for further treatment. Okinawa is such an isolated area for epilepsy treatment. What can we do? This was the initial motif of our project. This report mentions the proper treatment of epilepsy in the lower epilepsy resource area in Japan, and also discusses the minimum requirement for the modern epilepsy therapy. Methods: We have started up by inviting a part-time epilepsy specialist and opened the epilepsy out-patient clinic in our institute. Results: This out-patient could serve not only as to provide conventional epilepsy therapy to our area but also as for the source of the epilepsy education to our medical staff. Three medical specialists, neurosurgeon, neurologist, and the epilepsy specialist sit together in one booth at the time of out-patient, facing one patient and her/his family members. Two out of three clinicians are full-time neurology/neurosurgery specialists in our institute. Our epilepsy out-patient are held on Thursday afternoon every other week, but the part-time epilepsy specialist could join to us only once in every other months. Therefore, after patients are examined, diagnosed, and plotted for therapeutic strategy with the epilepsy specialist, the rest of the two clinicians had to follow the policy by ourselves until the next chance when epilepsy specialist is coming. Eventually, the clinical skills for the two local clinicians are elevated. The roles for each of us are like three actors on theater. We called our practice as "Theatrical Epilepsy Practice" in a friendly manner. Conclusions: The minimum requirement for intractable epilepsy treatment would be EEG, MRI, and LT-vEEG in general; but out of our successful launch of our out-patient, we would address our novel minimum requirements are EEG, MRI, and the experienced epilepsy specialist with the Theatrical Epilepsy Out-Patient.