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Nuthalapati P, Thomas L, Donahue MA, Moura LMVR, DeStefano S, Simpson JR, Buchhalter J, Fureman BE, Pellinen J. Improving Seizure Frequency Documentation and Classification. Neurol Clin Pract 2023; 13:e200212. [PMID: 37873534 PMCID: PMC10586801 DOI: 10.1212/cpj.0000000000200212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 09/01/2023] [Indexed: 10/25/2023]
Abstract
Background and Objectives Accurate and reliable seizure data are essential for evaluating treatment strategies and tracking the quality of care in epilepsy clinics. This quality improvement project aimed to increase seizure documentation (i.e., documentation of seizure frequency from 80% to 100%, date of last seizure from 35% to 50%, and International League Against Epilepsy (ILAE) seizure classification from 35% to at least 50%) over 6 months. Methods We surveyed 7 epileptologists to determine their perceived seizure frequency, ILAE classification, and date of last seizure documentation habits. Baseline data were collected weekly from September to December 2021. Subsequently, we implemented a newly created flowsheet in our Electronic Health Record (EHR) based on the Epilepsy Learning Healthcare System (ELHS) Case Report Forms to increase seizure documentation in a standardized way. Two epileptologists tested this flowsheet tool in their epilepsy clinics between February 2022 and July 2022. Data were collected weekly and compared with documentation from other epileptologists within the same group. Results Epileptologists at our center believed they documented seizure frequency for 84%-87% of clinic visits, which aligned with baseline data collection, showing they recorded seizure frequency for 83% of clinic visits. Epileptologists believed they documented ILAE classification for 47%-52% of clinic visits, and baseline data showed this was documented in 33% of clinic visits. They also reported documenting the date of the last seizure for 52%-63% of clinic visits, but this occurred in only 35% of clinic visits. After implementing the new flowsheet, documentation increased to nearly 100% for all fields being completed by the providers who tested the flowsheet. Discussion We demonstrated that by implementing an easy-to-use standardized EHR documentation tool, our documentation of critical metrics, as defined by the ELHS, improved dramatically. This shows that simple and practical interventions can substantially improve clinically meaningful documentation.
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Affiliation(s)
- Poojith Nuthalapati
- Department of Neurology (PN, MAD, LMVRM), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (LT, SD, JRS, JP), University of Colorado School of Medicine, Aurora; Department of Pediatrics (JB), Cumming School of Medicine, University of Calgary, AB, CA; and Mission Outcomes Team (BEF), Epilepsy Foundation, Landover, MD
| | - Lionel Thomas
- Department of Neurology (PN, MAD, LMVRM), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (LT, SD, JRS, JP), University of Colorado School of Medicine, Aurora; Department of Pediatrics (JB), Cumming School of Medicine, University of Calgary, AB, CA; and Mission Outcomes Team (BEF), Epilepsy Foundation, Landover, MD
| | - Maria A Donahue
- Department of Neurology (PN, MAD, LMVRM), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (LT, SD, JRS, JP), University of Colorado School of Medicine, Aurora; Department of Pediatrics (JB), Cumming School of Medicine, University of Calgary, AB, CA; and Mission Outcomes Team (BEF), Epilepsy Foundation, Landover, MD
| | - Lidia M V R Moura
- Department of Neurology (PN, MAD, LMVRM), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (LT, SD, JRS, JP), University of Colorado School of Medicine, Aurora; Department of Pediatrics (JB), Cumming School of Medicine, University of Calgary, AB, CA; and Mission Outcomes Team (BEF), Epilepsy Foundation, Landover, MD
| | - Samuel DeStefano
- Department of Neurology (PN, MAD, LMVRM), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (LT, SD, JRS, JP), University of Colorado School of Medicine, Aurora; Department of Pediatrics (JB), Cumming School of Medicine, University of Calgary, AB, CA; and Mission Outcomes Team (BEF), Epilepsy Foundation, Landover, MD
| | - Jennifer R Simpson
- Department of Neurology (PN, MAD, LMVRM), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (LT, SD, JRS, JP), University of Colorado School of Medicine, Aurora; Department of Pediatrics (JB), Cumming School of Medicine, University of Calgary, AB, CA; and Mission Outcomes Team (BEF), Epilepsy Foundation, Landover, MD
| | - Jeffrey Buchhalter
- Department of Neurology (PN, MAD, LMVRM), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (LT, SD, JRS, JP), University of Colorado School of Medicine, Aurora; Department of Pediatrics (JB), Cumming School of Medicine, University of Calgary, AB, CA; and Mission Outcomes Team (BEF), Epilepsy Foundation, Landover, MD
| | - Brandy E Fureman
- Department of Neurology (PN, MAD, LMVRM), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (LT, SD, JRS, JP), University of Colorado School of Medicine, Aurora; Department of Pediatrics (JB), Cumming School of Medicine, University of Calgary, AB, CA; and Mission Outcomes Team (BEF), Epilepsy Foundation, Landover, MD
| | - Jacob Pellinen
- Department of Neurology (PN, MAD, LMVRM), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (LT, SD, JRS, JP), University of Colorado School of Medicine, Aurora; Department of Pediatrics (JB), Cumming School of Medicine, University of Calgary, AB, CA; and Mission Outcomes Team (BEF), Epilepsy Foundation, Landover, MD
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Sarmast ST, Abdullahi AM, Jahan N. Current Classification of Seizures and Epilepsies: Scope, Limitations and Recommendations for Future Action. Cureus 2020; 12:e10549. [PMID: 33101797 PMCID: PMC7575300 DOI: 10.7759/cureus.10549] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/20/2020] [Indexed: 11/23/2022] Open
Abstract
The classification of seizures and epilepsies by the International League Against Epilepsy (ILAE), 2017 is the most recent classification model which aimed to simplify terminologies that patients and their caregivers can easily understand, identify seizures that have both focal and generalized onset and incorporate missing seizures. We have exhaustively reviewed the studies, discussed its scope, outlined its limitations and gave recommendations that could help in forming subsequent reviews. We have also described the terminologies that have been replaced, redefined or removed to have a clear view of the previous and the current classification models. We have recommended the use of multidimensional classification model which incorporated the clinical semiology, disease location, etiology and associated comorbidities. The benefits of this model is for prompt diagnosis which will results into early management and then better patient outcomes. It would also have a profound effects on the kind of treatment patients might receive especially in developing countries where there are scarcity of the diagnostic techniques. Overall, in this study we have reviewed the current study on seizures and epilepsy classification model by ILAE, 2017 to clarify the descriptions and coverage, outlined some limitations and suggested recommendations.
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Affiliation(s)
- Shah T Sarmast
- Neurology, California Institute of Behavioral Neuroscience & Psychology, Fairfield, USA
| | - Abba Musa Abdullahi
- Neurology/Neuroscience, California Institute of Behavioral Neuroscience & Psychology, Fairfield, USA
| | - Nusrat Jahan
- Internal Medicine, California Institute of Behavioral Neuroscience & Psychology, Fairfield, USA
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Abstract
PURPOSE OF REVIEW The classification of seizures, epilepsies, and epilepsy syndromes creates a framework for clinicians, researchers, and patients and their families. This classification has evolved over the years, and in 2017 the International League Against Epilepsy (ILAE) published an operational classification of seizures and epilepsies. Understanding this classification is important in the diagnosis, treatment, and understanding of seizures and epilepsies, including epilepsy incidence. RECENT FINDINGS The 2017 ILAE classification system builds on newly formulated definitions of seizures and epilepsy. Seizure classification begins by determining whether the initial manifestations of the seizure are focal or generalized. If the onset of the seizure is missed or unclear, the seizure is of unknown onset. Focal seizures are classified according to the individual's level of awareness, the most prominent motor or nonmotor features of the seizure, and whether the focal seizure evolves to a bilateral tonic-clonic seizure. Similarly, generalized seizures are classified according to motor or nonmotor manifestations. Motor seizures are either tonic-clonic or other motor seizures. Nonmotor generalized seizures primarily refer to absence seizures. Similar to seizure classification, the epilepsies can be classified as focal or generalized. In addition, the new classification system recognizes two new categories: combined generalized and focal epilepsy and unknown epilepsy. The concept of an epilepsy syndrome has been introduced under the new classification system and refers to a cluster of features incorporating seizure types, EEG, imaging, and other features including genetics. The new classification system emphasizes the etiology of seizures and epilepsies. SUMMARY The recent ILAE seizure and epilepsy classification system aims to create a framework to better classify seizures and the epilepsies. Universal adoption and implementation of this system will enable patients, their families, clinicians, and researchers to better define and treat the epilepsies. Incidence studies have not generally classified seizures and the epilepsies, and use of this classification system, which emphasizes etiology, will lead to a better understanding of epilepsy incidence.
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Bosak M, Słowik A, Kacorzyk R, Turaj W. Implementation of the new ILAE classification of epilepsies into clinical practice - A cohort study. Epilepsy Behav 2019; 96:28-32. [PMID: 31077939 DOI: 10.1016/j.yebeh.2019.03.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/22/2019] [Accepted: 03/27/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Appropriate management of patients with epilepsy requires precise classification of their disease. Implementation of the recent International League Against Epilepsy (ILAE) classification of seizures and epilepsies may affect data on the relative proportions of specific types of seizures or epilepsies and should be tested in everyday practice. The aim of the study was to determine the prevalence of specific epilepsy types, syndromes, and etiologies, as defined by the new ILAE classification, in a large cohort of adult patients with epilepsy. MATERIAL AND METHODS The single-center cohort study involved consecutive adult patients with epilepsy seen at the university epilepsy clinic. Information about medical history, neurological examination, neuroimaging, electroencephalography (EEG), genetic tests, epilepsy treatment, and other investigations was collected from medical records and prospectively updated if necessary. Epilepsy types and etiology, as well as epileptic syndromes, were classified according to the new ILAE classifications. RESULTS We studied 653 patients (mean age: 37.2 years, 59.9% were women). Epilepsy was classified as focal in 458 cases (70.2%), generalized in 155 subjects (23.7%), or as combined focal and generalized in 11 patients (1.7%). The epilepsy type was labeled as unknown in 29 (4.4%) patients. A definite cause of epilepsy was identified in 59.4% of the cases, with a structural etiology (n = 179, 27.4%) and genetic or presumed genetic etiology (n = 169, 25.9%) being the most common. In 167 (25.5%) patients, specific epilepsy syndromes, mostly genetic generalized epilepsy syndromes, were diagnosed. CONCLUSION The use of the recent ILAE classification of seizures and epilepsies in the cohort of patients with epilepsy seen in single epilepsy center enabled unequivocal characterization of epilepsy type in >95% of patients. A definite etiology of epilepsy could be established in about 60% of patients.
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Affiliation(s)
- Magdalena Bosak
- Dept. of Neurology, Jagiellonian University Medical College, Krakow, Poland.
| | - Agnieszka Słowik
- Dept. of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Wojciech Turaj
- Dept. of Neurology, Jagiellonian University Medical College, Krakow, Poland
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Wang F, Chen Z, Davagnanam I, Hoskote C, Ding D, Wang W, Yang B, Wang Y, Wang T, Li W, Sander JW, Kwan P. Comparing two classification schemes for seizures and epilepsy in rural China. Eur J Neurol 2018; 26:422-427. [PMID: 30414301 DOI: 10.1111/ene.13857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 11/05/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The International League against Epilepsy (ILAE) updated the classifications of seizures and epilepsies in 2017. The 2017 classifications were compared with the 1980s classifications in rural China. METHODS People with epilepsy receiving treatment under the National Epilepsy Control Programme were recruited from rural areas in China. Their seizures and epileptic syndrome were classified using the 1980s ILAE classification system and then re-classified according to the 2017 system. Differences in seizure, epilepsy and aetiology classifications were identified. RESULTS A total of 597 individuals (58% males, aged 6-78 years) were included. Amongst them 535 (90%) had a single seizure type, 57 (9.55%) had two types and five (0.84%) had three. There was complete agreement between the 1981 and 2017 classifications for the 525 individuals with focal seizures. Seizures originally classified as generalized in 10 of 65 individuals were re-classified as unknown in the 2017 classification. Compared to the 1980s classifications, the proportion of individuals with unknown seizures and unknown epilepsy increased from 1.2% (7/597) to 2.8% (17/597, P = 0.002), and unknown aetiology increased from 32% (189/597: 182 cryptogenic and seven unclassified) to 39% (230/597; P < 0.001) in the 2017 classifications. CONCLUSIONS The 1980s and 2017 classifications had 100% agreement in classifying focal seizures and epilepsy in rural China. A small but significant proportion of generalized seizures and epilepsy and aetiologies classified in the old classifications were re-classified to unknown in the new classifications. These results highlight the need for improvement in clinical evaluation of people with epilepsy in resource-poor settings.
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Affiliation(s)
- F Wang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Z Chen
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - I Davagnanam
- Academic Department of Neuroradiology, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
| | - C Hoskote
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - D Ding
- Fudan University, Shanghai, China
| | - W Wang
- Beijing Neurosurgical Institute, Beijing, China
| | - B Yang
- Jiaozuo People's Hospital, Henan, China
| | - Y Wang
- Ningxia Medical University, Ningxia, China
| | - T Wang
- Jincheng Emergency Medical Rescue Center, Jincheng, China
| | - W Li
- Affiliated Second Hospital, Hebei Medical University, Hebei, China
| | - J W Sander
- NIHR University College London Hospitals, Biomedical Research Centre, UCL Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont St Peter, UK.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - P Kwan
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
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