Barrow Neurological Institute, Phoenix, AZ, United States.
University of Miami Health System, Miami, FL, United States.
Epilepsy Behav. 2023 Mar;140:109002. doi: 10.1016/j.yebeh.2022.109002. Epub 2023 Feb 21.
Seizure emergencies and potential emergencies, ranging from seizure clusters to prolonged seizure and status epilepticus, may affect adults with epilepsy despite stable antiseizure therapy. Seizure action plans (SAPs) are designed for patients and their caregivers/care partners to provide guidance on the individualized treatment plan, including response to potential seizure emergencies and appropriate use of rescue therapy. The use of pediatric SAPs is common (typically required by schools), however, most adults with epilepsy do not have a plan. Patient-centered action plans are integral to care for other chronic conditions and may offer insights applicable to the care of adults with epilepsy. This review analyzes the potential benefits of action plans for medical conditions by exploring their utility in conditions such as asthma, diabetes, chronic obstructive pulmonary disease, heart disease, and opioid overdose. Evidence across these conditions substantiates the value of action plans for patients, and the benefits of adult SAPs in epilepsy are emerging. Because wide implementation of SAPs has faced barriers, other conditions may provide insights that are relevant to implementing SAPs in epilepsy. Based on these analyses, we propose concrete steps to improve the use of SAPs among adults. A recent consensus statement promoting the use of formal SAPs in epilepsy and advances in rescue therapy delivery methods provides support to engage patients around the value of SAPs. The precedent for use of SAPs for pediatric epilepsy patients serves as the foundation to support increased usage in adults. Seizure action plans in the context of improved clinical outcomes are expected to reduce healthcare utilization, improve patient quality of life, and optimize epilepsy management.
尽管抗癫痫治疗稳定,但癫痫患者仍可能会出现癫痫发作急症和潜在急症,从癫痫发作群到持续癫痫发作和癫痫持续状态。癫痫发作行动计划(SAP)旨在为患者及其护理人员/护理伙伴提供指导,包括针对潜在癫痫发作急症的治疗计划和适当使用急救治疗。儿科 SAP 的使用很常见(通常由学校要求),然而,大多数癫痫患者没有计划。以患者为中心的行动计划是其他慢性疾病护理的重要组成部分,并且可能为癫痫患者的护理提供有用的见解。本综述通过分析哮喘、糖尿病、慢性阻塞性肺疾病、心脏病和阿片类药物过量等疾病中行动计划的效用,来分析行动计划对医疗状况的潜在益处。这些疾病的证据证实了行动计划对患者的价值,并且癫痫患者的成人 SAP 的益处也逐渐显现。由于 SAP 的广泛实施面临障碍,因此其他疾病可能提供与癫痫中 SAP 实施相关的有用见解。基于这些分析,我们提出了改善成人 SAP 使用的具体步骤。最近的一项共识声明促进了在癫痫中使用正式 SAP 以及推进急救治疗方法,为围绕 SAP 的价值让患者参与提供了支持。为儿科癫痫患者使用 SAP 的先例为支持在成人中增加使用提供了基础。改善临床结局的情况下的癫痫发作行动计划有望减少医疗保健的使用、提高患者的生活质量,并优化癫痫管理。