Abstracts

Rationale: Despite the wide array of antiepileptic drugs (AEDs) available, approximately a third of individuals with epilepsy do not attain satisfactory seizure control. In addition, some patients who achieve adequate seizure control with a particular therapy, may experience bothersome adverse events, requiring the patient to be switched to another therapy. Evidence suggests that many neurologists are challenged to utilize the most appropriate AEDs to address poor seizure control or tolerability. A study was conducted to determine if an online medical simulation could improve the performance of neurologists in appropriately assessing patients with epilepsy and switching therapy in those who experience a poor response to their current AED regimen. Methods: A cohort of practicing US-based neurologists who participated in a simulation-based CME intervention were evaluated. The simulation consisted of two cases presented in a platform that allowed physician learners to choose from numerous lab tests and assessment scales as well as thousands of diagnoses, treatments and procedures matching the scope and depth of actual practice. The first case was a female patient who continued to experience depression symptoms on her current AED, whereas the second case was a male patient who did not receive adequate seizure control after trying several AEDs. The clinical decisions made by the participants using open-ended responses were analyzed using a sophisticated decision engine, and instantaneous clinical guidance was provided employing current evidence-based and expert faculty recommendations. Participant decisions were collected after clinical guidance and compared with each user’s baseline decisions using a 2-tailed paired T-test where P < .05 was considered statistically significant. Data were collected between November 29, 2016 and February 12, 2017. Results: The assessment sample consisted of neurologists (Case 1, n=189; Case 2, n=169) who made clinical decisions within the simulation. For the first case, learners exhibited significant improvements (P .The most common reasons for selection of a particular agent to switch to related to the perceived lack of psychiatric adverse events. For the second case, learners exhibited significant improvements (P < 0.05) in performance related to ordering a chemistry screen and urinalysis, discontinuation of the current AED, initiation of a once-daily AED formulation, and starting patient counseling about the importance of medication adherence, following clinical guidance. The two most common rationales for choosing a particular AED were based on improving adherence and the reduction in seizure frequency.      Conclusions: This study demonstrated the success of an online medical simulation platform for improving evidence-based clinical decisions of neurologists in the management of patients with epilepsy. Learners demonstrated improvements in performance relating to patient assessment and personalizing AED therapy. Further education should continue to provide additional resources and guidance for personalizing care in epilepsy.  Funding: The educational activity and related analysis was supported by an unrestricted educational grant from Sunovion Pharmaceuticals, Inc.