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28.01.2020 | Original Article | Ausgabe 6/2020 Open Access

Neurological Sciences 6/2020

Clinical pathways of epileptic seizures and status epilepticus: results from a survey in Italy

Neurological Sciences > Ausgabe 6/2020
Gaetano Zaccara, Giuseppe Citerio, Alfredo Del Gaudio, Monica Ferlisi, Francesco Rocco Pugliese, Danilo Toni
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s10072-020-04270-3) contains supplementary material, which is available to authorized users.

Key points

A survey of physicians from all parts of Italy on the management of patients with epileptic seizures or status epilepticus  in the hospital was conducted.
Epileptologists managed patients with epilepsy, acute seizures, and status epilepticus in 35%, 21%, and 16% of cases, respectively.
Diagnostic, therapeutic, and assistance pathways (PDTA) for patients presenting because of seizure(s) or status epilepticus were available in about 50% of hospitals.
Professionals often included in PDTA were epileptologists/neurologists, emergency physicians, and intensivists.
PDTA should be implemented in all hospitals, and multidisciplinary teams in charge of these patients should be identified.

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Patients with seizures or status epilepticus (SE) access the hospital through emergency departments and may be admitted into different wards according to the level of care required. Clinicians with different expertise are in charge of taking critical therapeutic decisions. To date, very few studies have investigated the stage at which these patients are referred to neurologists or epileptologists and how guideline recommendations are applied in clinical practice.


A survey was used to investigate how patients with epileptic seizures or SE are managed in emergency and in subsequent hospital pathways in Italy.


One hundred and seventy-seven physicians (mainly neurologists) from all parts of Italy filled in a questionnaire. Less than half of the participants (35%) answered that, in their hospital, patients with epilepsy were managed by epileptologists. The percentages were lower for patients presenting with acute seizures (21%) or SE (16%). Diagnostic, therapeutic, and assistance pathways (PDTA) for patients presenting with seizure(s) or SE were available for both conditions in about 50% of cases, while, in the rest of the hospitals, participants indicated informal agreements (about 25% of cases) or lack of any agreement (about 25% of cases) between clinicians. Professionals more often involved in PDTA were epileptologists/neurologists, emergency physicians, and intensivists. More than half ot the participants (55%) thought that organizational issues are the most important criticalities for such patients and need to be improved (61%).


There is a high variability in hospital clinical pathways for epilepsy in Italy.

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