Results of a National Delphi consensus on the outpatient management of pediatric psychogenic nonepileptic seizures in the United States

IF 4.6 Q2 MATERIALS SCIENCE, BIOMATERIALS

ACS Applied Bio Materials Pub Date : 2024-10-20 DOI:10.1016/j.yebeh.2024.110096

Afsaneh Talai , Daniel A Freedman , Kristen Trott , Maija R Steenari , Sigita Plioplys , Hillary Kimbley , Jennifer Madan Cohen , Priya Tatachar , Dara V.F. Albert , On behalf of the Pediatric Epilepsy Research Consortium

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Abstract

Background and objectives

The purpose of this study was to develop national consensus based on expert opinion on the optimal outpatient care model of pediatric psychogenic nonepileptic seizures (PNES).

Methods

A core working group (CWG) within the PNES special interest group of the Pediatric Epilepsy Research Consortium was established. The CWG developed a rigorous scoring rubric to select experts in pediatric PNES within the United States of America and a three-round Delphi study was conducted to assess consensus on key components of the management of pediatric PNES in the outpatient setting.

Results

Eighteen experts representing neurology, psychology, psychiatry, social work and nursing participated in the study. Strong consensus was reached that the multidisciplinary clinic (MDC) model is the gold standard for the outpatient management of pediatric PNES. Consensus was obtained that a neurologist, psychologist and social worker are essential members of the MDC and in the setting of unlimited resources, psychiatry and nursing are also recommended. Further consensus was established on the roles of specific personnel, structure of the clinic, billing practices, trainee inclusion, patient inclusion and exclusion, and end of visit management. While consensus was reached that a new term should be developed for this diagnosis, consensus was not reached on the ideal term.

Discussion

Expert consensus was established for the multidisciplinary management of pediatric PNES in the outpatient setting. Specific recommendations were provided that can facilitate the development and implementation of MDCs in other institutions. Further prospective studies are warranted to validate this practice model.

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关于美国儿科精神性非癫痫发作门诊管理的全国德尔菲共识的结果。

背景和目的：本研究的目的是根据专家意见就小儿精神性非癫痫发作（PNES）的最佳门诊护理模式达成全国共识：本研究的目的是根据专家意见，就小儿精神性非癫痫发作（PNES）的最佳门诊护理模式达成全国共识：方法：在儿科癫痫研究联盟的精神性非癫痫性发作（PNES）特别兴趣小组内成立了一个核心工作组（CWG）。CWG 制定了严格的评分标准，以遴选美国儿科 PNES 专家，并进行了三轮德尔菲研究，以评估在门诊环境中管理儿科 PNES 的关键要素的共识：代表神经病学、心理学、精神病学、社会工作和护理学的 18 位专家参与了研究。大家一致认为，多学科门诊（MDC）模式是儿科 PNES 门诊治疗的黄金标准。大家一致认为，神经科医生、心理学家和社工是多学科门诊的重要成员，在资源有限的情况下，还建议配备精神科和护理人员。会议还就特定人员的角色、诊所的结构、计费方式、受训人员的加入、病人的加入和排除以及就诊结束后的管理等问题达成了进一步共识。虽然专家们一致认为应该为这一诊断制定一个新的术语，但并未就理想术语达成共识：讨论：专家们就门诊环境中儿科 PNES 的多学科管理达成了共识。专家们提出的具体建议有助于其他机构制定和实施多学科综合治疗方案。有必要进一步开展前瞻性研究，以验证这一实践模式。

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来源期刊

ACS Applied Bio Materials Chemistry-Chemistry (all)

CiteScore

9.40

自引率

2.10%

发文量

464