By Christian Duffin
Mortality in patients with epilepsy is increasing, with a series of risk factors influencing death rates including alcohol use, depression and a history of injury, a new study concludes.
Researchers established a series of key risk factors after studying a large general practice population, and urged GPs to routinely track them in order to provide advanced warning of an increased risk of death.
A team at King’s College London analysed Office for National Statistics data, and found that mortality with epilepsy coded as an underlying cause increased by 31% in males and 39% in females between 1993 and 2005.
They also conducted a nested case-control study using data from the UK General Practice Research Database from 1993 to 2007 in order to establish the key risk factors influencing mortality.
Patients who had alcohol problems were at almost three-fold increased risk, while risk in patients who had not collected their most recent anticonvulsant prescription for between 90 and 182 was nearly doubled.
Having ‘a history of injury’ during the previous year increased risk by 41% and having depression by about the same amount. Patients who had been seizure free in the previous 12 months had a 22% reduced risk of dying, however.
The charity that commissioned the study, Epilepsy Bereaved, said the work – published in the British Journal of General Practice – was a ‘wake-up call’ for GPs to pinpoint patients with extra risk.
Professor Leone Ridsdale, one of the study researchers and professor of neurology and general practice at King’s College London, said: ‘There are QOF points for epilepsy, but they are not specifically applied to the risk factors we identified. We hope that in the future risk data will be linked to new performance indicators under QOF, to reward GPs for improving outcomes.’
After identifying patients at risk GPs should improve care plans in general practice or make referrals to neurologists or specialist nurses, she added.
Dr Henry Smithson, a GP in Sheffield who has a research interest in epilepsy, said GPs could use computer software to flag up patients who have not re-ordered medication.
He added: ‘It is difficult to measure or find people who are non-adherent to medication. GPs do become aware of problems if patients order medication early, but I haven’t seen a GP practice system that gives a warning if patients are late in ordering their repeat prescriptions.’