Validating epilepsy diagnoses in routinely collected data

Fonferko‐Shadrach, Beata; Lacey, Arron; White, Catharine P.; Powell, Harrison; Sawhney, I. M. S.; Lyons, Ronan A; Smith, Phil E M; Kerr, Mike; Rees, Mark I.; Pickrell, William Owen

doi:10.1016/j.seizure.2017.10.008

Cited by 57 publications

(79 citation statements)

References 14 publications

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“…18 Given the potential for misclassification, we also examined a second definition that required medication information (definition 2): participants with 1 or more ICD-9 codes 345.00-345.91 or 780.39, and the use of an antiepileptic drug obtained from Medicare Part D data or recorded at the fifth in-person ARIC visit (2011-2013). The use of an epilepsy-related code with use of antiepileptic drug is reported to have a sensitivity of 82% to 84% and specificity of 94% to 98% 19,20 for identification of epilepsy.…”

Section: Methodsmentioning

confidence: 99%

Association Between Midlife Risk Factors and Late-Onset Epilepsy

et al. 2018

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IMPORTANCE The incidence of epilepsy is higher in older age than at any other period of life. Stroke, dementia, and hypertension are associated with late-onset epilepsy; however, the role of other vascular and lifestyle factors remains unclear. OBJECTIVE To identify midlife vascular and lifestyle risk factors for late-onset epilepsy. DESIGN, SETTING, AND PARTICIPANTS The Atherosclerosis Risk in Communities (ARIC) study is a prospective cohort study of 15 792 participants followed up since 1987 to 1989 with in-person visits, telephone calls, and surveillance of hospitalizations (10 974 invited without completing enrollment). The ARIC is a multicenter study with participants selected from 4 US communities. This study included 10 420 black or white participants from ARIC with at least 2 years of Medicare fee-for-service coverage and without missing baseline data. Data were analyzed betweeen April 2017 and May 2018. EXPOSURES Demographic, vascular, lifestyle, and other possible epilepsy risk factors measured at baseline (age 45-64 years) were evaluated in multivariable survival models including demographics, vascular risk factors, and lifestyle risk factors. MAIN OUTCOMES AND MEASURES Time to development of late-onset epilepsy (2 or more International Classification of Diseases, Ninth Revision codes for epilepsy or seizures starting at 60 years or older in any claim [hospitalization or outpatient Medicare through 2013]), with first code for seizures after at least 2 years without code for seizures. RESULTS Of the 10 420 total participants (5878 women [56.4%] and 2794 black participants [26.8%]; median age 55 years at first visit), 596 participants developed late-onset epilepsy (3.33 per 1000 person-years). The incidence was higher in black than in white participants (4.71; 95% CI, 4.12-5.40 vs 2.88; 95% CI, 2.60-3.18 per 1000 person-years). In multivariable analysis, baseline hypertension (hazard ratio [HR], 1.30; 95% CI, 1.09-1.55), diabetes (HR, 1.45; 95% CI, 1.17-1.80), smoking (HR, 1.09; 95% CI, 1.01-1.17), apolipoprotein E ε4 genotype (1 allele HR, 1.22; 95% CI, 1.02-1.45; 2 alleles HR, 1.95; 95% CI, 1.35-2.81), and incident stroke (HR, 3.38; 95% CI, 2.78-4.10) and dementia (HR, 2.56; 95% CI, 2.11-3.12) were associated with an increased risk of late-onset epilepsy, while higher levels of physical activity (HR, 0.90; 95% CI, 0.83-0.98) and moderate alcohol intake (HR, 0.72; 95% CI, 0.57-0.90) were associated with a lower risk. Results were similar after censoring individuals with stroke or dementia. CONCLUSIONS AND RELEVANCE Potentially modifiable risk factors in midlife and the APOE ε4 genotype were positively associated with risk of developing late-onset epilepsy. Although stroke and dementia were both associated with late-onset epilepsy, vascular and lifestyle risk factors were significant even in the absence of stroke or dementia.

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Section: Methodsmentioning

confidence: 99%

Association Between Midlife Risk Factors and Late-Onset Epilepsy

et al. 2018

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“…The study observation period was 01/01/1998–31/03/2014 to correspond with linkage availability. We used our previously published definition to identify people with epilepsy [1] which requires a diagnostic code for epilepsy and an associated prescription for an antiepileptic drug (AED) [9, 10]. We defined the epilepsy index date as the latest of the epilepsy diagnosis date and AED prescription in the 6 months prior, or 1 month after diagnosis.…”

Section: Methodsmentioning

confidence: 99%

Risk factors for self-harm in people with epilepsy

et al. 2018

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ObjectiveTo estimate the risk of self-harm in people with epilepsy and identify factors which influence this risk.MethodsWe identified people with incident epilepsy in the Clinical Practice Research Datalink, linked to hospitalization and mortality data, in England (01/01/1998–03/31/2014). In Phase 1, we estimated risk of self-harm among people with epilepsy, versus those without, in a matched cohort study using a stratified Cox proportional hazards model. In Phase 2, we delineated a nested case–control study from the incident epilepsy cohort. People who had self-harmed (cases) were matched with up to 20 controls. From conditional logistic regression models, we estimated relative risk of self-harm associated with mental and physical illness comorbidity, contact with healthcare services and antiepileptic drug (AED) use.ResultsPhase 1 included 11,690 people with epilepsy and 215,569 individuals without. We observed an adjusted hazard ratio of 5.31 (95% CI 4.08–6.89) for self-harm in the first year following epilepsy diagnosis and 3.31 (95% CI 2.85–3.84) in subsequent years. In Phase 2, there were 273 cases and 3790 controls. Elevated self-harm risk was associated with mental illness (OR 4.08, 95% CI 3.06–5.42), multiple general practitioner consultations, treatment with two AEDs versus monotherapy (OR 1.84, 95% CI 1.33–2.55) and AED treatment augmentation (OR 2.12, 95% CI 1.38–3.26).ConclusionPeople with epilepsy have elevated self-harm risk, especially in the first year following diagnosis. Clinicians should adequately monitor these individuals and be especially vigilant to self-harm risk in people with epilepsy and comorbid mental illness, frequent healthcare service contact, those taking multiple AEDs and during treatment augmentation.Electronic supplementary materialThe online version of this article (10.1007/s00415-018-9094-2) contains supplementary material, which is available to authorized users.

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“…We created a control cohort matched on maternal age, gestational age and socioeconomic deprivation, but we were unable to control for maternal body weight at time of pregnancy. The children born to mothers with epilepsy in this study have an increased deprivation score when compared with Welsh children as a whole, as is expected given the association with epilepsy and deprivation 14. Using a standardised national assessment as a measure of performance ensures that each child has the opportunity to be assessed based on the same curriculum, and as such these results would closer reflect the learning experience of children at this age compared with an IQ test.…”

Section: Discussionmentioning

confidence: 60%

Educational attainment of children born to mothers with epilepsy

Lacey

Pickrell

Thomas

et al. 2018

J Neurol Neurosurg Psychiatry

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In utero exposure to AEDs in combination, or sodium valproate alone, is associated with a significant decrease in attainment in national educational tests for 7-year-old children compared with both a matched control group and the all-Wales national average. These results give further support to the cognitive and developmental effects of in utero exposure to sodium valproate as well as multiple AEDs, which should be balanced against the need for effective seizure control for women during pregnancy.

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Validating epilepsy diagnoses in routinely collected data

Cited by 57 publications

References 14 publications

Association Between Midlife Risk Factors and Late-Onset Epilepsy

Association Between Midlife Risk Factors and Late-Onset Epilepsy

Risk factors for self-harm in people with epilepsy

Educational attainment of children born to mothers with epilepsy

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