Conference Coverage
PHILADELPHIA—Roughly half of patients newly diagnosed with epilepsy fail to receive a stable and effective treatment that keeps them seizure-free during the first year following their diagnosis, according to an analysis of more than 17,000 incident epilepsy cases in the United States.
“Under the best health care circumstances, we can achieve full seizure control in two-thirds to 70% of patients, but the fact that we fall way short points to a treatment gap,” said David J. Thurman, MD, MPH, a neurologist and epilepsy specialist who practices in Atlanta and is affiliated with Emory University. “We’re doing a lousy job.”
David J. Thurman, MD, MPH
Dr. Thurman suggested that several factors likely contribute to patients with epilepsy receiving less than ideal care, including their access to neurologists and epilepsy subspecialists, patients’ ability to afford the drugs they need to control their seizures, and social limitations, such as the ability to travel to see specialists.
He cited his recent published study that documented these barriers. He and his associates analyzed data collected from US adults in 2010 and 2013 by the National Health Interview Survey run by the Centers for Disease Control and Prevention (CDC). That analysis showed that, compared with the general US adult population, people diagnosed with epilepsy were significantly less likely to be employed and more likely to be disabled. The patients with epilepsy also reported relatively higher rates of inability to afford their medications, mental health care, eyeglasses, and dental care. The patients also reported a relatively high rate of having transportation to health care as a barrier to receiving their care. CDC data also showed that, in 2010, 42% of US adults with epilepsy and uncontrolled seizures had not seen a neurologist or epilepsy specialist during the preceding year.
The new report presented by Dr. Thurman at the 69th Annual Meeting of the American Epilepsy Society used US claims data from patients of any age with private insurance or coverage through Medicare or Medicaid contained in the Truven Health Marketscan database during January 2011 to June 2013. They identified 36,035 patients with newly diagnosed epilepsy, of whom 17,106 received documented treatment for epilepsy and had at least one year of follow-up. About a quarter of these patients had focal epilepsy, about a quarter had generalized epilepsy, and about half had undefined epilepsy.
Among these 17,106 patients, 8,835 (52%) appeared to attain treatment stability, which the researchers defined as no changes in their antiepileptic drug regimen and no epilepsy-related hospitalizations in either the emergency department or as inpatients. About 42% of the patients reached stability with their first antiepileptic drug, another 6% reached stability with their second drug, and about 3% with their third drug, the researchers reported. The vast majority of patients who attained stability maintained it with monotherapy. Variables that linked with a greater likelihood of achieving treatment stability included older age, male sex, a history of a childhood psychiatric disorder, and having identified focal or generalized epilepsy rather than undefined epilepsy.
—Mitchel L. Zoler
