Utilisation of specialist epilepsy services and antiseizure medication adherence rates in a cohort of people with epilepsy (PWE) accessing emergency care

Taha, M., Hanif, S., Dickson, G., Todd, J., Fyfe, D., MacBride-Stewart, S., Hassett, R., Marshall, A.D. and Heath, C.A. (2023) Utilisation of specialist epilepsy services and antiseizure medication adherence rates in a cohort of people with epilepsy (PWE) accessing emergency care. Seizure, (doi: 10.1016/j.seizure.2023.12.019) (In Press)

Abstract

Background: An epilepsy-related attendance at A&E is associated 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 accessing specialist neurology services following an epilepsy-related admission/unscheduled care episode and consider ASM adherence at the point of attendance. Methods: Patients were identified retrospectively via the NHS Greater Glasgow and Clyde live integrated epilepsy Dashboard following an unscheduled epilepsy-related admission or A&E attendance between 1st January 2022 and 30th June 2022. We calculated adherence to anti-seizure medication for a period of 6 months prior to admission and defined poor medication adherence as a medication possession ratio of less than 80%. We evaluated the rate of any outpatient neurology clinic attendance in the subsequent 3, 6 and 12 months following an epilepsy-related unscheduled care episode. Additional clinical information was identified via the electronic patient records. Results: Between 1st Jan 2022 and 30th June 2022, there were 266 emergency care seizure-related attendances. The mean age at attendance was 46 years (range: 16-91). Most of PWE were males (63%) and 37% were females. Epilepsy classification-29.3% had GGE, 41.7 % had focal epilepsy, and in 29% of cases the epilepsy was unclassified. Of the admissions, 107/ 266 (40.2%) generated follow-up within 6 months of attendance. Poor medication adherence was noted in 54/266 (20.3%). 28.2% of cases had input from on-call neurology service during admission/ED attendance, and of those 60% had ASM adjusted. 18% of attendances had a background diagnosis of learning disability. One-third of attendances of PWE had a history of mental health disorder 35% (93/266). 25% of ED attendances noted an active history of alcohol consumption misuse or/and recreational drug use. 14 (5.5%) of PWE died during the period of interest (12 months following the last ED visit). In 6/14 (42.3%) death was associated with poor medication adherence. Conclusion: This study demonstrates that a significant proportion of patients who experienced seizure-related admissions/ attendance did not access specialist neurology services in a timely manner. In addition, poor medication adherence remains a problem for a substantial number of people living with epilepsy. Early access to specialist services may go some way to improving care and reducing excessive mortality in PWE by allowing anti-seizure medication to be titrated and poor medication adherence to be addressed in those at greatest risk.

• Item Type: Articles
• Keywords: Epilepsy service, ED seizure-related attendance, ASM adherence, people with epilepsy.
• Status: In Press
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Heath, Dr Craig and Marshall, Dr Alex
• Authors: Taha, M., Hanif, S., Dickson, G., Todd, J., Fyfe, D., MacBride-Stewart, S., Hassett, R., Marshall, A.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: 27 December 2023
• Copyright Holders: Copyright © 2024 The Authors
• First Published: First published in Seizure 2024
• Publisher Policy: Reproduced under a Creative Commons License