Who should take care of children with epilepsy?
BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7428.1413 (Published 11 December 2003) Cite this as: BMJ 2003;327:1413
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We read with interest Dr Chinthapallis view of ‘who should take care
of children with epilepsy?’ (BMJ 2003;327:1413). His view is both timely
and well informed. He has obviously moved things forward in his own
district with an appropriate epilepsy network. However although we
appreciate that services are variable in different areas in Britain,
initiatives to address these issues are in progress. We write to highlight
those which have come from the British Paediatric Neurology Association
(BPNA) in conjunction with the Royal College of Paediatrics and Child
Health (RCPCH).
Following a request for a response to the National Sentinel Audit
into Epilepsy Related Deaths by the CMO, a national service framework was
put forward by the BPNA and RCPCH. This proposes an epilepsy network with
a service plan similar to that in practice by Dr Chinthapalli; district
based paediatricians with an expertise in epilepsy supported by district
based epilepsy nurses, linked to a tertiary paediatric neurology centre
with shared investigation protocols. The full proposal is available on the
BPNA website (http://www.bpna.org.uk/training/epilepsymanage.htm).
Unfortunately funding has been limited in following these proposals and
the CMO has asked ‘local initiatives’ to take this further. Certainly the
development of local epilepsy networks linking into tertiary paediatric
neurology centres would enhance the care pathways of children with
epilepsy. As an example, a pilot scheme of a managed clinical
network,developed in conjunction with the NHS Modernisation Agency
Clinical Governance Team is to start in the North West early this year,
with other local initiatives elsewhere. The model emphasises the need for
good liaison between medical, educational and social services at Primary
Care Trust level backed by good information systems.
The definition of a paediatrician with a special interest or
expertise in epilepsy (which the BPNA prefers to call special
responsibility for epilepsy) has been discussed in various fora. Whether
this is defined in the first instance according to committed sessions and
audit, or in the medium term by a competency based system, is yet to be
determined; dialogue continues between general paediatricians and
paediatric neurologists. In the long term it is recognised that further
training and competency assessment will be required. The first proposal is
that a series of interactive courses are developed with standardised
material, at differing levels catering for requirement. One such course
has already been piloted in Sunderland, and further development will be
discussed within the BPNA in January.
The BPNA continues to respond to the increasing needs of children
with epilepsy and the professionals involved, but it cannot do so without
the committed and enthusiastic support of grass root general
paediatricians such as Dr Chinthapalli.
Competing interests:
None declared
Competing interests: No competing interests
Children with epilepsy
I think there is no substitute for some form of formal diadatic
training.In most countries you cannot become a sub-specialist without
formal training.Having said that ,like the author states it is not
currently realistic to expect all children with epilepsy to be managed by
a sub-specialist.The problem with self-training is the wide diversity of
skills and knowledge that people acquire during this process.Dr Cross and
others have eloquently stated the BPNA's position in the argument.I think
a form of certfying exam at the end of training would to some extend
reassure the public and fellow professionals of basic skills and
competence.I also think we are doing a disservice by repeating that a 30-
40% misdiagnosis rate is somehow widely prevalant and hence somehow
acceptable.
Competing interests:
Did Most of my Paediatric Neurology training in the USA
Competing interests: No competing interests