Abstracts

Rationale: In 2022, the Surgical Therapies Commission of the ILAE published a consensus paper recommending patients with drug-resistant epilepsy undergo surgical work up as soon as drug-resistance is established. Delays in surgical evaluation can lead to worse outcomes. Reasons for delay include poor access to care and a shortage of epilepsy physicians. Advanced practice providers (APPs) can help bridge this gap, as has been done in other specialties including pain management, movement disorders, neuromodulation and cardiac device care. The AAN recognized the significance of including APPs in physician-lead care teams in 2015. Incorporating APPs in epilepsy care teams can increase availability of care without compromising quality. Patients with refractory epilepsy who are not candidates for resective or ablative procedures may select neuromodulation, including treatment with the RNS® System. These patients require specialized care for the lifetime of the device. As is common practice in patients treated with other devices, APPs can take an active role in the care of RNS System patients, including programming in partnership with the treating physician; however, this practice model has not been widely adopted yet.

Methods: An 11-question survey was sent to epilepsy APPs regarding current practices in care of refractory epilepsy patients. Fifty (50) surveys were sent; 42 were completed. Most respondents provide in- or outpatient care to adult patients in a level 3 or 4 epilepsy center.

Results: Forty-two APPs completed the survey. Fifty-eight percent of respondents see and bill visits independently under the APPs NPI number. Only 10% of respondents reported feeling ‘most comfortable’ with RNS System programming and providing long-term care to patients with the RNS System. Although respondents desired training on the RNS System, only 56% receive funding for professional education; 37% receive some funding, and 7% receive no funding at all.

Conclusions: APPs report inadequate support for professional education. APPs also expressed a desire for more education related to the care of patients with the RNS System. Given proper training, APPs would readily step up to care for patients treated with the RNS System. This would allow physician partners of APPs to focus on new, complex, or pre-surgical patients. This has been effective in bridging treatment gaps in other specialties. Institutions that have implemented this practice include the Medical University of South Carolina and The University of Pennsylvania, where the majority of RNS System programming is done by APPs independently. Outcomes at these institutions are similar those recently presented for the RNS System Post-Approval Study, which showed an 82% median seizure reduction at 3 years or more of treatment.

Funding: Not applicable.