Long-term physical and psychiatric morbidities and mortality of untreated, deferred, and immediately treated epilepsy

Tianrui Ren, Yingtong Li, Michael Burgess, Sameer Sharma, Maria Rychkova, John Dunne, Judy Lee, Cédric Laloyaux, Nicholas Lawn, Patrick Kwan, Zhibin Chen

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: In Australia, 30% of newly diagnosed epilepsy patients were not immediately treated at diagnosis. We explored health outcomes between patients receiving immediate, deferred, or no treatment, and compared them to the general population. Methods: Adults with newly diagnosed epilepsy in Western Australia between 1999 and 2016 were linked with statewide health care data collections. Health care utilization, comorbidity, and mortality at up to 10 years postdiagnosis were compared between patients receiving immediate, deferred, and no treatment, as well as with age- and sex-matched population controls. Results: Of 603 epilepsy patients (61% male, median age = 40 years) were included, 422 (70%) were treated immediately at diagnosis, 110 (18%) received deferred treatment, and 71 (12%) were untreated at the end of follow-up (median = 6.8 years). Immediately treated patients had a higher 10-year rate of all-cause admissions or emergency department presentations than the untreated (incidence rate ratio [IRR] = 2.0, 95% confidence interval [CI] = 1.4–2.9) and deferred treatment groups (IRR = 1.7, 95% CI = 1.0–2.8). They had similar 10-year risks of mortality and developing new physical and psychiatric comorbidities compared with the deferred and untreated groups. Compared to population controls, epilepsy patients had higher 10-year mortality (hazard ratio = 2.6, 95% CI = 2.1–3.3), hospital admissions (IRR = 2.3, 95% CI = 1.6–3.3), and psychiatric outpatient visits (IRR = 3.2, 95% CI = 1.6–6.3). Patients with epilepsy were also 2.5 (95% CI = 2.1–3.1) and 3.9 (95% CI = 2.6–5.8) times more likely to develop a new physical and psychiatric comorbidity, respectively. Significance: Newly diagnosed epilepsy patients with deferred or no treatment did not have worse outcomes than those immediately treated. Instead, immediately treated patients had greater health care utilization, likely reflecting more severe underlying epilepsy etiology. Our findings emphasize the importance of individualizing epilepsy treatment and recognition and management of the significant comorbidities, particularly psychiatric, that ensue following a diagnosis of epilepsy.

Original languageEnglish
Pages (from-to)148-164
Number of pages17
JournalEpilepsia
Volume65
Issue number1
Early online date28 Nov 2023
DOIs
Publication statusPublished - Jan 2024

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