Danielle Andrade, MD, MSc

“Developing this network of colleagues that you can work with in the adult setting is very important [in epilepsy care].”

Danielle Andrade, MD, MSc, professor of medicine, neurology, University of Toronto, spoke at the

, in Bangkok, Thailand, about the need for better programs focused on the transition of care from pediatric to adult settings for patients with epilepsy. She shared her experience working within one, and the advantages it can provide for the adult neurologist who will be caring for a new patient.

, Andrade spoke about how this process can be immediately improved by focusing on the relationships between the adult care team and the pediatric care team. While communication can vary from center to center, she noted that maintaining a consistent relationship with the pediatric team is exceptionally helpful in ensuring patients are transitioned smoothly and with the correct information.

Additionally, she shared advice on the need for a network of other specialties, such as psychiatrists and nephrologists, who can help the adult neurologist co-manage their patients with intellectual challenges or tuberous sclerosis.

Andrade D. The need for transition programs. Presented at: 2019 International Epilepsy Congress. June 22-26, 2019; Bangkok, Thailand. Presentation 71.

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The professor of medicine, neurology, at the University of Toronto shared insight into the importance of communication and a good network of physicians to an adult neurologist caring for patients with epilepsy.

Danielle Andrade, MD, MSc: Communicating and Network Building in Epilepsy Care

“One big gap that I see is that the adult neurologist’s knowledge of certain pediatric-onset epilepsies still needs some improvement, especially some genetic syndromes.”

For quite some time, the adult neurologist caring for the patient with epilepsy would encounter patients with epilepsy, but without a diagnosis, then referred to as symptomatic epilepsy. Patients would experience these diseases and undergo a number of exams, tests, and evaluations, only to fail to be properly diagnosed.

These physicians now have the good fortune of having next-generation sequencing and screenings, previously undiagnosed conditions—such as STXBP1 encephalopathy, PCDH19 epilepsy, and SCN1A mutations, to name a few&mdash;can now be addressed. New therapies and research have helped open the door for better methods of treatment.

Although, for Danielle Andrade, MD, MSc, professor of medicine, neurology, University of Toronto, who treats these pediatric patients, there is still a gap in the understanding of how to treat these childhood-onset diseases. To find out more about this gap, 

The professor of medicine, neurology, at the University of Toronto discussed the best ways for adult neurologists to ensure a smooth transition of care for patients with epilepsy entering their care.

Danielle Andrade, MD, MSc: Education for Adult Neurologists on Pediatric-Onset Epilepsies

“Do things step by step. You don’t have to do everything [for the transition] when the patient is 17 years old. Actually, you shouldn’t be doing everything when the patient is 17 or close to their last visit in the pediatric system. Things should be done slowly as the patient is growing up.”

Transitioning a patient with epilepsy from pediatric care to adult care is a challenge for not only the patient, who is losing their physician, but for the physicians involved in actually transitioning the patient. Danielle Andrade, MD, MSc, told 

 that “it is impossible for one person to do everything,” and that oftentimes, a team of health care professionals is involved.

Andrade, an adult neurologist and professor of medicine, neurology, at the University of Toronto, discussed the transition process at the 

, in Bangkok, Thailand, detailing the need for more institutions and practices to take advantage of programs that aid in moving the process along. In her conversation with 

, she provided further insight into what pediatric neurologists should be aware of when providing the adult neurologist information about the patient.

She noted that—outside of certain particularly difficult to manage epilepsies&mdash;having a summarized version of the trajectory of the disease and the patient’s responses to medications to provide the new physician, in place of volumes of charts, is certainly helpful.

The professor of medicine, neurology, at the University of Toronto discussed the best ways for pediatric neurologists to ensure a smooth transition of care for patients with epilepsy who are leaving the pediatric system.

Danielle Andrade, MD, MSc: Ensuring Smooth Transitions to Adult Epilepsy Care

“You need to have a lot of people who are interested in helping with this process because there is a lot of interaction with different people, not only within the epilepsy group, but many times also you need to work with other specialties.”

Although Danielle Andrade, MD, MSc, professor of medicine, neurology, University of Toronto, treats adult patients with epilepsy, many of them ultimately come into her care as childhood-onset patients. Before they enter her care, she and her fellow physicians must transition them from the pediatric to adult care systems, which can often result in challenges.

, in Bangkok, Thailand, Andrade detailed how this challenge can be addressed with a team of health care professionals. Those included in the team must, she said, have an understanding of the patient and their epilepsy, as this transition process often includes interactions with other physicians whose care the patient—who may have any number of comorbidities&mdash;is in. These can include cognitive disability, congenital issues, and others.

This, Andrade noted, requires the team to not only transfer care from one neurologist to another, but to potentially a pediatric psychiatrist, orthopedic surgeon, or cardiologist to their adult counterpart. While some patients are educated enough to smoothen this process, she shared that ensuring the physicians are active in making getting patients to the proper care channels is paramount.

The professor of medicine, neurology, at the University of Toronto discussed the need for physicians to work together while transitioning patients with epilepsy&mdash;who may have any number of comorbidities&mdash;from pediatric care to adult care.

Danielle Andrade, MD, MSc: Coordinating Epilepsy Care Transition Between Physicians

“I see the patient after he or she left the pediatric system, but there are lots of things that need to be prepared before they leave. It is impossible for one person to do everything. Ideally, we would like to have a team of people working together.”

The old adage says it takes a village to raise a child—but what about a child with epilepsy? While childhood onset epilepsy obviously offers both parents and physicians a number of challenges, one of the oft undiscussed hurdles to overcome is the transition from pediatric to adult care.

Danielle Andrade, MD, MSc, is an adult neurologist at the University of Toronto who sees these patients transitioning from the pediatric system. Although she noted in a conversation with 

 that there are several, often individualized, hurdles which arise in this process, but the lack of adequate resources needed to prepare the patient for the transition almost always becomes apparent.

, in Bangkok, Thailand, Andrade discussed this challenge in depth with 

, in addition to speaking at the meeting to address the need for transition programs in epilepsy care.

She detailed how a multi-faceted team is the best and most ideal approach to managing a patient with epilepsy who is moving into adulthood, as a number of health care professionals—social workers, nurses, physicians&mdash;are needed to ensure the patient handles their disease. Andrade also shared insight into additional measures and tools which can be utilized between the ages of 12 and 17 years to help prepare the patient to the adult care system.

The professor of medicine, neurology, at the University of Toronto spoke to the hurdles faced by both pediatric and adult neurologists when transitioning a patient with epilepsy from childhood care to adult care.

Danielle Andrade, MD, MSc

Articles

Danielle Andrade, MD, MSc: Communicating and Network Building in Epilepsy Care

Danielle Andrade, MD, MSc: Education for Adult Neurologists on Pediatric-Onset Epilepsies

Danielle Andrade, MD, MSc: Ensuring Smooth Transitions to Adult Epilepsy Care

Danielle Andrade, MD, MSc: Coordinating Epilepsy Care Transition Between Physicians

Danielle Andrade, MD, MSc: Transitioning Patients With Epilepsy to Adult Care

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