Study analyzing dialogue between neurologists and epilepsy patients identifies significant gaps

For 2.7 million Americans with epilepsy, seizures are not the only concern. People with epilepsy frequently face mood and behavior challenges and side effects from their medications, such as sleep and cognition problems. And, in many instances, these issues are not getting the attention warranted during visits with neurologists, according to a study supported by Ortho-McNeil Neurologics®, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc.

Today at the American Academy of Neurology Annual Meeting in Seattle, new insights from an in-office linguistic study of neurologists identified gaps in communication between physicians and their epilepsy patients. These findings revealed the need for more thorough conversations about mood and behavior issues and side effects of epilepsy medications between neurologists and their patients.

In this study, office visits were audio- and video-recorded. Both patients and physicians were asked about what they discussed following their appointments. The study found that, in most visits, topics related to mood and behavior were not discussed. Additionally, in one out of four visits, neurologists did not assess side effects of antiepileptic drugs (AEDs).

"The findings are important to note because epilepsy often involves complex treatment issues that extend beyond seizure control," said Frank Gilliam, MD, study author and Director of Neurology at Geisinger Health System in Pennsylvania. "All physicians treating epilepsy patients should ask targeted questions about these topics during office visits. Not knowing when patients are struggling with these issues impacts our ability to help people with epilepsy achieve truly successful outcomes."

• Discussions of mood- and behavior-related topics occurred in only 13 of 60 visits (22%)
• 34 of 60 patients (57%) reported mood- and behavior-related problems postvisit that physicians did not, including irritability, depression, anxiety and hyperactivity
• Postvisit, neurologists admitted that they are not comfortable asking questions about mood/behavior issues and believe mood issues and treatment are other physicians' domain
• Side effects were assessed by neurologists in only 44 of 59 (75%) visits with patients already taking antiepileptic medications
• When a visit companion was present, side effect discussions were more robust
• When asked postvisit, 33 percent of neurologists and patients did not agree on what side effects the patient actually was experiencing
• The presence of a robust side effect discussion did not dramatically affect visit length

To build on these findings, Ortho-McNeil Neurologics® is now sponsoring a study examining new communication strategies and tools that may help improve dialogue between neurologists and their patients. Findings from this study are anticipated later this year.

The study and poster were sponsored by Ortho-McNeil Neurologics®. MBS/Vox, a research consultancy in Parsippany, NJ that studies and analyzes how patients and physicians interact, conducted the study. According to the study, no prior epilepsy communication research has analyzed actual in-office discussions. Researchers have relied on self-reported measures such as questionnaires or surveys.

Letters of invitation were mailed to 1,493 community based neurologists. Of these, 20 met screening criteria and agreed to participate. Patients were recruited from regularly scheduled office visits. Sixty visits were audio- and video-recorded. Postvisit interviews were conducted separately with physicians and patients to capture the intent and comprehension of each. All dialogue components were transcribed, analyzed and correlated using validated sociolinguistic models.

Headquartered in Titusville, NJ, Ortho-McNeil Neurologics®, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc, focuses exclusively on providing solutions that improve neurological health. The company has products for Alzheimer's disease, epilepsy, and acute and preventive migraine treatment. Ortho-McNeil Neurologics®, in conjunction with internal and external research partners, continues to explore new opportunities to develop solutions for unmet healthcare needs in neurology. For more information, visit www.OrthoMcNeilNeurologics.com.

*Dr. Frank Gilliam is a paid consultant for Ortho-McNeil Neurologics®.