鳥取臨床科学 13(1-2), 1-11, 2021

鳥取医療センターてんかん外来における移行期医療の現況
齋藤潤 1) 房安恵美 1) 北川達也 1) 植田俊幸 2) 下田光太郎 1) 田賀栄之 1) 有馬和志 2)
吉岡大祐 2) 中尾寛宙 1) 田中愛 1) 土居充 1) 金藤大三 1) 小西吉裕 1) 高橋浩士 1)
1) 国立病院機構鳥取医療センター脳神経内科,
2) 国立病院機構鳥取医療センター精神科

Current status of transitional-phase medical care at the Epilepsy Outpatient
Clinic, National Hospital Organization Tottori Medical Center
Jun Saito1) Emi Fusayasu1) Tatsuya Kitagawa1) Toshiyuki Ueta2) Kotaro Shimoda1) Hideyuki Taga1)Kazushi Arima2) Daisuke Yoshioka2) Hiromichi Nakao1) Ai Tanaka1) Mitsuru Doi1) Daizo Kaneto1)
Yoshihiro Konishi1) Hiroshi Takahashi1)1) Department of Neurology, NHO Tottori Medical Center2) Department of Psychiatry, NHO Tottori Medical Center
要旨2012 年 4 月から 2020 年 3 月までの 8 年間に, 小児科医（脳神経小児科を含む）からの移行目的に鳥取医療センターてんかん外来を初診した 52 名（男女とも 26 名）について検討した. 発症年齢は全例 18歳以下であり, 当院てんかん外来初診時年齢は 15～42 歳であった. 紹介元は院内 3 名, 鳥取県立中央病院等の県内医療機関 44 名, 県外医療機関 5 名であった. 国際てんかん連盟（ILAE）の発作分類（1981年）では, 部分発作 39 名, 全般発作 12 名, 分類不能てんかん発作 1 名であり, ILAE のてんかん・てんかん症候群分類（1989 年）では, 特発性局在関連性てんかんおよび症候群 2 名, 症候性局在関連性てんかんおよび症候群 36 名, 特発性全般てんかんおよび症候群 10 名, 潜因性全般てんかんおよび症候群 2 名,焦点性か全般性か決定できないてんかんおよび症候群 2 名であった. 障害の程度について, 八木らの包括的分類では, 就労可能な第 1-3 群が 31 名（60%）, 保護就労なら可能な第 4 群が 9 名（15%）, 介護を要する第 5-6 群が 12 名（23%）であった. また松友のてんかんによる「障害」の等級表では, 第 1-2 群が 22 名（42%）, 軽度（第 3-4 群）が 11 名（21%）, 中度（第 5-6 群）が 8 名（15%）, 重度（第 7-8 群）が 11 名（21%）であった. 医療費に関し, 47 名は障害者自立支援法や鳥取県の特別医療費助成制度等を利用して助成を受けていた.
2020 年 3 月までに他医療機関に転医したものが 13 名あり, その主な理由は, 就職や進学などによる転居, 合併症の治療であった. 障害の程度は軽症のものが多く, また 10 名で発作が 1 年以上抑止されていた.
2020 年 3 月に当院通院を継続していた 39 名について, 薬物療法, 発作コントロール状況, 就労・自動車運転などの社会的状況などを検討した. 初診時よりも 2020 年 3 月で, 使用抗てんかん薬数が増加したものがあったが, コントロールの改善には繋がらなかった. バルプロ酸（VPA）, カルバマゼピン（CBZ）を服用している患者は減少し, ラモトリギン（LTG）, レベチラセタム（LEV）, ラコサミド（LCM）を服用している患者が増加した. LEV の用量は減少し, LTG の用量は増加した. 発作が 2 年以上抑止されている患者と 1 年以内に発作を生じていた患者が増加した. 八木らの包括的分類では, 第 1-3 群が 22 名（56%）, 第 4 群が 6 名（15%）, 第 5-6 群が 11 名（28%）であった. また松友のてんかんによる「障害」の等級表では, 第 1-2 群が 15 名（38%）, 第 3-4 群が 9 名（23%）, 第 5-6 群が 4 名（10%）, 第 7-8 群が11 名（28%）であった. 特別支援学校（養護学校などを含む）を卒業した患者は 18 名であった. 在学中の 2 名を除いた就労状況では, 一般就労が 19 名（一般枠 13, 障害者枠 6 名）, 福祉的就労 8 名, 無職 10名であった. 一般枠の職種はサービス業が多く, 障害者枠では製造業が多かった. 13 名が自動車運転免許を保有し, 12 名が実際に運転していた. 1 名は免許取得したが発作のコントロール不良により返納した.
住居は, 1 名がグループホームに居住している他は自宅で生活していた. 鳥取臨床科学 13 (1-2), 1-11,2021
Abstract
We investigated 52 patients (26 males, 26 females) who consulted the Epilepsy Outpatient Clinic, National
Hospital Organization Tottori Medical Center for the first time for a shift from the Departments of Pediatrics(including the Departments of Pediatric Neurology) between April 2012 and March 2020. The age at the time ofepilepsy onset was <18-years in all patients. Ages on the initial consultation at the Epilepsy Outpatient Clinic of
our hospital ranged from 15 to 42 years. Three patients were referred from the Department of Pediatrics in ourhospital, 44 from prefectural medical institutions, such as the Tottori Prefectural Central Hospital, and 5 frommedical institutions in other prefectures. According to the ILAE classification of the epilepsies (1981) preparedby the International League Against Epilepsy (ILAE), 39 patients were regarded as having partial seizures, 12 as
having generalized seizures, and 1 as having unclassified epileptic seizures. According to the epilepsies andepileptic syndromes classification established by ILAE in 1989, 2 patients were regarded as having idiopathic
localization-related epilepsies and epileptic syndromes, 36 as having symptomatic localization-related epilepsies
and epileptic syndromes, 10 as having idiopathic generalized epilepsies and epileptic syndromes, 2 as having
cryptogenic generalized epilepsies and epileptic syndromes, and 2 as having undetermined whether focal orgeneralized epilepsies and epileptic syndromes. With respect to Yagi’s medico-social comprehensiveclassification of epilepsy, Groups 1 to 3, in which working is possible, consisted of 31 patients (60%), Group 4,
in which working under protection is possible, consisted of 9 (15%), and Groups 5 to 6, which require nursing,consisted of 12 (23%). In accordance with Matsutomo’s disability grading of epilepsy, Groups 1 to 2 consistedof 22 patients (42%), and the condition was evaluated as mild (Groups 3 to 4) in 11 (21%), moderate (Groups 5to 6) in 8 (15%), and severe (Groups 7 to 8) in 11 (21%). Concerning health expenditure, 47 patients were
subsidized by the Services and Supports for Persons with Disabilities Act or special health expenditure support
system in Tottori Prefecture.
Thirteen patients were referred to other medical institutions before March 2020. The primary reasons included
moving related to obtaining employment or advancing to the next stage of education and treatment forcomplications. The grade of disability was mild in many patients. In 10, seizures had been prevented for >1 year.
In 39 patients who regularly consulted our hospital as of March 2020, we examined drug therapy, seizurecontrol, and social circumstances such as working/driving. In some patients, the number of antiepileptic drugs(AEDs) in March 2020 was greater than on the initial consultation. However, this did not lead to better control.
The number of patients taking valproate (VPA) or carbamazepine (CBZ), first-line drugs for epilepsy, decreased,
whereas that of those taking lamotrigine (LTG), levetiracetam (LEV), or lacosamide (LCM), which are newantiepileptic drugs, increased. The dose of LEV decreased, and that of LTG increased. The number of patients inwhom seizures had been prevented for >2 years, as well as that of those in whom seizures had occurred within 1year, increased. According to Yagi’s medico-social comprehensive classification of epilepsy, Groups 1 to 3
consisted of 22 patients (56%), Group 4 consisted of 6 (15%), and Groups 5 to 6 consisted of 11 (28%). In
accordance with Matsutomo’s disability grading of epilepsy, Groups 1 to 2 consisted of 15 patients (38%), Groups
3 to 4 consisted of 9 (23%), Groups 5 to 6 consisted of 4 (10%), and Groups 7 to 8 consisted of 11 (28%). Eighteenpatients graduated from special support schools (including schools for physically handicapped or mentallyretarded children). Concerning the state of working, excluding 2 in school, general employment was achieved in
19 patients (general entry: 13, handicapped entry: 6), welfare employment in 8, and no occupation in 10. The
greater portion of general-entry jobs comprised the service industry. Most handicapped-entry jobs comprised themanufacturing industry. Thirteen patients had a driver’s license. Of these, 12 had actually driven a car, whereas
1 returned it due to poor seizure control. Concerning residence, all but 1 living in a group home had lived at home.
Tottori J. Clin. Res. 13(1-2), 1-11, 2021
Key words: てんかん, 外来通院, 移行期医療, 地域連携, 抗てんかん薬, 発作コントロール, 就労, 医療費補助, 自動車運転免許,てんかん合併症; epilepsy, outpatient visits, transitional-phase medical care,regional cooperation, anti-epileptic drugs, seizure control, working, health expenditure support, driver’s license,
epilepsy-related complications