Quality of Care of Epilepsy in Italy: A Multi‐hospital Survey of Diagnosis and Treatment of 1104 Epileptic Patients

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Abstract
The treatment of 1104 patients admitted to 27 departments of neurology (64.5%), neurosurgery (23.0%) and child neurology (12.5%) of Lombardy, Italy, the largest Italian region (population, 9,000,000) was surveyed to assess the penetration of correct diagnostic and clinicopharmacological information into routine practice. A detailed analysis and discussion are given of data concerning reasons for hospital admission (therapeutic adjustment accounting for 27.3%; diagnostic ascertainment, 53.8%); characteristics of the disease, in terms of duration, clinical manifestations and pattern of seizures; associated disorders; prevalence and criteria for the use of instrumental diagnostic procedures (EEG, brain scan, computed tomography, etc.); pattern of prescription of anticonvulsant drugs at admission and at discharge, with particular emphasis on specific drug choices by specialty; prevalence of single-drug therapy (41% at admission and 47.0% at discharge) vs. polytherapy; degree of correspondence between recommended and observed dosage regimens (undertreatment being a more common problem than excessive dosing); and reporting of side effects. The feasibility of a regular audit program of the performance of an entire health care system in the treatment of epilepsy is documented.