Specialist epilepsy service input following an epilepsy related unscheduled care episode

Marshall, A. D. , Mackay, D. and Heath, C. A. (2023) Specialist epilepsy service input following an epilepsy related unscheduled care episode. Seizure, 112, pp. 15-17. (doi: 10.1016/j.seizure.2023.09.009) (PMID:37722242)

Abstract

Background: Emergency and unplanned epilepsy-related attendances are associated with an increased risk of subsequent death within 6 months. Although further work is required to provide a definitive explanation to account for these findings, in the interim it would seem reasonable that services are designed to ensure timely access and provide support at a time of greatest risk. We aim to determine the frequency of patients with epilepsy (PWE) accessing specialist neurology services following an epilepsy-related admission/unscheduled care episode. Methods: Patients were included in the cohort if they had at least 1 prescription for an anti-seizure medication and at least one epilepsy-related admission, emergency department attendance, or outpatient neurology clinic attendance between January 2011 and November 2021. We evaluated the rate of any outpatient neurology clinic attendance in the subsequent 6 months following an epilepsy related unscheduled care episode. Results: Of the 6,449 PWE included in the cohort, 4,465 were included for analysis. At the end of the follow up period less than 40% were accessing specialist services within 6 months of an episode of admission/ unscheduled care episode. Around a third (31.1%) of deaths occurred within 6 months of an epilepsy-related admission, and in the majority of cases patients were not seen by an epilepsy specialist in the period between discharge and death. The frequency of mental health comorbidity in PWE accessing unscheduled care remains very high with almost 80% having a diagnosis of either depression or anxiety. Conclusion: A significant proportion of PWE are not accessing specialist services in a timely manner following an episode of unscheduled care. Such provision may potentially provide an opportunity to reduce epilepsy related mortality by altering antiseizure medication doses and considering reversible factors associated with poor outcomes in PWE, such as poor medication adherence.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Mackay, Professor Daniel and Heath, Dr Craig and Marshall, Dr Alex
• Authors: Marshall, A. D., Mackay, D., and Heath, C. A.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Seizure
• Publisher: Elsevier
• ISSN: 1059-1311
• ISSN (Online): 1532-2688
• Published Online: 09 September 2023
• Copyright Holders: Copyright © 2023 The Author(s)
• First Published: First published in Seizure 112:15-17
• Publisher Policy: Reproduced under a Creative Commons license