小児てんかん患者の成人期ケアへのトランジションの現状と課題

Transition of Children with Epilepsy to Adult Care: Current Status and Challenge

小児神経科医が診察しているてんかん患者の3割は，成人期に達した患者だった。成人期ケアへの移行を妨げていたのは，患者・家族が転院を嫌がることと，近くに適切な紹介先がないことだった。移行を円滑に行うためには，心理・社会的サポート，患者教育，トランジション・クリニックを含めた体制の整備，てんかん専門医や専門看護師の養成，チェックリストや移行プログラムの準備が必要である。

Abstract

Thirty percent of the patients consulting a pediatric neurologist have already reached adulthood as patients and their families do not like transfer to the adult clinics; moreover, there are no suitable clinics. Pediatric neurologists find it difficult to examine adult patients with childhood-onset epilepsy as they are unfamiliar with the psychiatric and psychological symptoms manifested in adulthood, and the common diseases of adulthood. On the other hand, adult neurologists have difficulty obtaining a complete picture of the patient's clinical history since childhood, and are unfamiliar with childhood-specific epilepsy syndrome. When it comes to transition, the patient's decision should be prioritized. Transition should be patient-centered, with cornerstones of flexibility, responsiveness, continuity, comprehensiveness, and coordination. For successful transition to occur, there must be psychosocial support, patient education, better medical system organization with inclusion of a transition process, such as transition clinic, increased number of epilepsy-specialized physicians/nurses, and resources such as checklists and programs to aid in transition.