Epilepsy patients may live longer with specialist care

People with epilepsy who receive care from specialists may be less likely to die prematurely than their counterparts who don’t, a Canadian study suggests.

For the study, researchers followed 23,663 adults with epilepsy for an average of 7.5 years. Overall, the mortality rate during the study was 7.2% – but it ranged from a low of 2.8% for patients seen by neurologists specializing in epilepsy, to 5.6% for patients who saw general neurologists, to a high of 9.4% for people who didn’t see neurologists all.

“Adequate access to specialized care is increasingly recognized as associated with improved outcomes, not only in terms of seizure control and quality of life, but as we have demonstrated in this paper because of the association with decreased mortality,” said Mark Lowerison, lead author of the study and a researcher at the Cumming School of Medicine at the University of Calgary in Canada.

“When compared to non-neurologist, or general neurologist care, epilepsy specialists would tend to have deeper knowledge of epilepsy, common epilepsy comorbidities, and epilepsy management practices,” Lowerison said by email.

Epilepsy is a seizure disorder that is commonly caused by genetics, brain injuries or a stroke. About two-thirds of patients with epilepsy can control seizures with medicine, and about two-thirds of people who don’t get relief from drugs respond to surgical treatment, researchers note in JAMA Neurology.

Despite these treatment options, people with epilepsy have mortality rates up to three times as high as individuals without the neurological disorder, the study team writes.

In the study, people who saw neurologists or neurologists specializing in epilepsy were younger than patients who didn’t, and they were also healthier and had less severe symptoms. Patients who saw epilepsy specialists were 43 years old on average, compared to 48 for people who saw general neurologists and 54 for people who saw non-neurologists.

After accounting for factors that can impact longevity like age, sex, and symptom severity, people who saw epilepsy specialists were 51% less likely to die during the study than patients who saw non-neurologists. And people who saw general neurologists were 15% less likely to die.

The study wasn’t designed to prove that patients’ doctors directly impacted their survival odds.

Researchers also relied on administrative claims data and records from health registries, so it’s possible they lacked data on patient characteristics that might influence survival.

“We speculate that epilepsy specialists would have more experience dealing with patients with epilepsy that is difficult or highly resistant to drugs,” Lowerison said. “We also speculate that epilepsy specialists would have more familiarity with all of the avenues of care available.”

SOURCE: bit.ly/2yH3RcZ JAMA Neurology, online August 5, 2019.