Assessment and effect of a gap between new-onset epilepsy diagnosis and treatment in the US

Kalilani, Linda; Faught, Edward; Kim, Hyun-Mi; Burudpakdee, Chakkarin; Seetasith, Arpamas; Laranjo, Scott; Friesen, David; Haeffs, Kathrin; Kiri, Victor A.; Thurman, David J.

doi:10.1212/wnl.0000000000007448

Cited by 52 publications

(65 citation statements)

References 29 publications

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“…Each patient alive for the duration of the study had at least 12 months of follow‐up. In line with a recent similar study in the United States, a 2‐year baseline period from 2007‐2008 was used to exclude patients with a potential prior epilepsy diagnosis (defined as having a previous epileptic seizure‐related hospitalization or a prescription for ASMs), and to record baseline comorbidities.…”

Section: Methodsmentioning

confidence: 99%

“…The patient inclusion and exclusion criteria were similar to those adopted and validated in recent studies . Two inclusion criteria were used.…”

Section: Methodsmentioning

confidence: 99%

“…Few studies have investigated the effect of no treatment on morbidity and mortality of people with epilepsy. In the US study, untreated patients had significantly more hospitalizations and seizure‐related injuries . Another study showed that delayed treatment was associated with increased seizure frequency but had no effect on mortality .…”

Section: Introductionmentioning

confidence: 97%

“…In high‐income countries, their mortality rates are 1.6‐3.0 times higher than the general population, and up to 7.2 times higher in low‐ and middle‐income countries . A substantial proportion of people with epilepsy are either not treated or have delayed antiseizure medication (ASM) treatment . In low‐ and middle‐income countries, this "treatment gap" has been reported to range from 46.8% to 73.3% .…”

Section: Introductionmentioning

confidence: 99%

“…In low‐ and middle‐income countries, this "treatment gap" has been reported to range from 46.8% to 73.3% . A recent large study using a health insurance claims database in the United States found that 36.7% of people with newly diagnosed epilepsy were untreated 3 years after diagnosis . Few studies have investigated the effect of no treatment on morbidity and mortality of people with epilepsy.…”

Section: Introductionmentioning

confidence: 99%

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Mortality and morbidity of patients with treated and untreated epilepsy in New Zealand

Hamilton

Chen

Tomlin³

et al. 2020

Epilepsia

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Objective To investigate whether delayed or no treatment was associated with increased mortality and morbidity risks in people with newly diagnosed epilepsy. Methods We examined New Zealand hospitalization and antiseizure medication prescription data from 2007‐2015. Mortality and hospital‐diagnosed morbidities were compared between patients immediately treated after epilepsy diagnosis, treated after a delay, or untreated for the duration of follow‐up, adjusted for age, sex, and ethnicity. Results Three thousand three hundred sixty‐six patients (54.7% male, median age = 37.5 years) were included and followed up for a median of 3.39 years. A total of 3123 (92.8%) patients were treated immediately, 125 (3.7%) had delayed treatment, and 118 (3.5%) were untreated. Compared to the general New Zealand population, the cohort had a standardized mortality ratio of 4.60 (95% confidence interval [CI] = 4.24‐4.99). Maori patients were less likely to be treated (Holm‐Bonferroni adjusted P = .024) and had higher mortality (hazard ratio [HR] = 1.41, 95% CI = 1.08‐1.83). There was a trend of increased mortality in the untreated or delayed treatment group compared to the immediate treatment group (HR = 1.36, 95% CI = 0.99‐1.87). Hospitalization risk was similar between untreated and immediately treated periods (P = .83). Untreated or delayed treatment patients had higher risk of acute myocardial infarction (HR = 9.64, 95% CI = 1.83‐50.8). Maori patients were more likely to develop liver disease (HR = 4.67, 95% CI = 1.32‐16.4) and alcohol or drug dependence (HR = 2.55, 95% CI = 1.44‐4.51). Significance Most epilepsy patients were treated at diagnosis in New Zealand, but Maori patients had lower treatment rates and worse health outcomes. The apparent increased risk of acute myocardial infarction among the untreated or delayed treatment patients warrants further research.

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Section: Methodsmentioning

confidence: 99%

“…The patient inclusion and exclusion criteria were similar to those adopted and validated in recent studies . Two inclusion criteria were used.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Mortality and morbidity of patients with treated and untreated epilepsy in New Zealand

Hamilton

Chen

Tomlin³

et al. 2020

Epilepsia

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Early Access to First-Seizure Clinics, Subsequent Outcomes, and Factors Associated With Attendance

Li,

Ren,

Burgess

et al. 2024

JAMA Neurol

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ImportanceFirst-seizure clinics (FSCs) aim to deliver prompt specialist care to patients with new-onset undifferentiated seizure events.ObjectiveTo determine whether FSC attendance and time to FSC are associated with subsequent health care utilization and mortality and to investigate factors associated with FSC nonattendance.Design, Setting, and ParticipantsThis was a record-linkage, retrospective, cohort study of patients who booked appointments at 2 FSCs between 2007 and 2018. Patients’ records were linked to state-wide administrative databases between 2000 and 2021. The setting comprised the FSCs of 2 major metropolitan public hospitals in Melbourne, Australia, providing national inpatient and outpatient adult epilepsy services. Of patients who booked appointments at the FSCs, those who were successfully linked for analysis were included in the study. Patients who recorded only canceled appointments were excluded from analysis of outcomes. Study data were analyzed from January 2000 to December 2021.ExposureFSC attendance.Main Outcomes and MeasuresSubsequent all-cause and seizure-related emergency department (ED) presentations and hospital admissions.ResultsOf 10 162 patients with appointments at FSCs, 9392 were linked for analysis, with mean (SD) follow-up time 6.9 (2.8) years after FSC referral. A total of 703 patients were excluded. Among 9392 linked patients, 5398 were male (57.5%; mean [SD] age, 59.7 [11.2] years). FSC attendance was associated with reduced subsequent all-cause emergency presentations (adjusted incidence rate ratio [aIRR], 0.72; 95% CI, 0.66-0.79) and all-cause hospitalization (aIRR, 0.81; 95% CI, 0.75-0.88). Those who attended at the first-scheduled appointment, compared with those who attended only a rescheduled, delayed appointment, had reduced subsequent all-cause emergency presentations (aIRR, 0.83; 95% CI, 0.76-0.91), all-cause hospitalization (aIRR, 0.71; 95% CI, 0.65-0.79), seizure-related presentations (aIRR, 0.40; 95% CI, 0.33-0.49), and mortality (hazard ratio, 0.82; 95% CI, 0.69-0.98). Male sex was associated with nonattendance (adjusted relative risk [aRR], 1.12; 95% CI, 1.03-1.22), as were injury at emergency presentation (aRR, 1.12; 95% CI, 1.01-1.24), psychiatric comorbidity (aRR, 1.68; 95% CI, 1.55-1.81), previous seizure-related presentations (aRR, 1.35; 95% CI, 1.22-1.49), and delays (&gt;14 days) between FSC referral and appointment (aRR, 1.35; 95% CI, 1.18-1.54). Hospitalization at referral was associated with reduced nonattendance (aRR, 0.80; 95% CI, 0.72-0.90), as were non-English language preference (aRR, 0.81; 95% CI, 0.69-0.94), distance greater than 6 mi from home to clinic (aRR, 0.85; 95% CI, 0.76-0.95), and physical comorbidity (aRR, 0.80; 95% CI, 0.72-0.89).Conclusions and RelevanceResults of this cohort study suggest that FSC attendance, particularly early attendance, was associated with reduced rates of subsequent hospital utilization. This knowledge may support adequately resourcing FSCs to improve equitable, timely access. Future study directions include assessing interventions that may support FSC attendance for at-risk groups.

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Scalp Ripples Can Predict Development of Epilepsy After First Unprovoked Seizure in Childhood

Klotz

Sağ

Schönberger

et al. 2020

Annals of Neurology

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Objective Identification of children at risk of developing epilepsy after a first unprovoked seizure can be challenging. Interictal epileptiform discharges are associated with higher risk but have limited sensitivity and specificity. High frequency oscillations (HFOs) are newer biomarkers for epileptogenesis. We prospectively evaluated the predictive value of HFOs for developing epilepsy in scalp electroencephalogram (EEG) of children after a first unprovoked seizure. Methods After their first seizure, 56 children were followed prospectively over 12 months and then grouped in “epilepsy” or “no epilepsy.” Initial EEGs were visually analyzed for spikes, spike ripples, and ripples. Inter‐group comparisons of spike‐rates and HFO‐rates were done by Mann–Whitney U test. Predictive values and optimal thresholds were calculated by receiver operating characteristic (ROC) curves. Results In the epilepsy group (n = 26, 46%), mean rates of ripples (0.3 vs 0.09 / minute, p < 0.0001) and spike ripples (0.6 vs 0.06 / minute, p < 0.05) were significantly higher, with no difference in spike rates (1.7 vs 3.0 / minute, p = 0.38). Of those 3 markers, ripples showed the best predictive value (area under the curve [AUC]ripples = 0.88). The optimal threshold for ripples was calculated to be ≥ 0.125 / minute with a sensitivity of 87% and specificity of 85%. Ripple rates were negatively correlated to days passing before epilepsy‐diagnosis (R = −0.59, p < 0.0001) and time to a second seizure (R = −0.64, 95% confidence interval [CI] = −0.77 to 0.43, p < 0.0001). Interpretation We could show that in a cohort of children with a first unprovoked seizure, ripples predict the development of epilepsy better than spikes or spike ripples and might be useful biomarkers in the estimation of prognosis and question of treatment. ANN NEUROL 2021;89:134–142

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Assessment and effect of a gap between new-onset epilepsy diagnosis and treatment in the US

Cited by 52 publications

References 29 publications

Mortality and morbidity of patients with treated and untreated epilepsy in New Zealand

Mortality and morbidity of patients with treated and untreated epilepsy in New Zealand

Early Access to First-Seizure Clinics, Subsequent Outcomes, and Factors Associated With Attendance

Scalp Ripples Can Predict Development of Epilepsy After First Unprovoked Seizure in Childhood

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