Treatment initiation decisions in newly diagnosed epilepsy-A longitudinal cohort study.
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Anticonvulsants
/ therapeutic use
Clinical Decision-Making
Cohort Studies
Electroencephalography
Epilepsy
/ diagnosis
Female
Humans
Longitudinal Studies
Male
Middle Aged
Neuroimaging
Neurologists
Odds Ratio
Patient Preference
Practice Patterns, Physicians'
Recurrence
Risk Assessment
Severity of Illness Index
Social Class
Western Australia
Young Adult
early seizures
management
patient preference
Journal
Epilepsia
ISSN: 1528-1167
Titre abrégé: Epilepsia
Pays: United States
ID NLM: 2983306R
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
received:
11
09
2019
revised:
08
01
2020
accepted:
08
01
2020
pubmed:
6
2
2020
medline:
21
10
2020
entrez:
6
2
2020
Statut:
ppublish
Résumé
To examine the factors and reasons influencing treatment initiation decisions in patients with newly diagnosed epilepsy. We assessed antiseizure medication initiation decisions in adults with newly diagnosed epilepsy seen at first seizure clinics in Western Australia between 1999 and 2016 and followed to 2018. Of 610 patients (median age 40 years, 61.0% male), 426 (69.8%) were diagnosed after two or more seizures and 184 (30.2%) after a single seizure with risk factors for recurrence. Treatment was commenced in 427 patients (70.0%) at diagnosis, 112 (18.4%) during follow-up, mostly after further seizures, whereas 71 (11.6%) remained untreated at last follow-up. Elders (≥65 years, odds ratio [OR] = 3.06, 95% confidence interval [CI]: 1.62-5.80), more seizures (OR = 3.48, 95% CI: 2.03-5.96), and epileptogenic lesions on neuroimaging (OR = 2.15, 95% CI: 1.26-3.68) had a higher likelihood of treatment at diagnosis. Patients with less than one seizure per year within the preceding year (OR = 0.40, 95% CI: 0.21-0.73) and of higher socioeconomic status (OR = 0.985, 95% CI: 0.977-0.994) were less likely to be treated. For 93 patients (15.2%), treatment was not recommended at diagnosis, most commonly because only a single seizure had occurred. Ninety patients (14.8%) declined recommended treatment, mostly because they were unconvinced of the need for treatment or the diagnosis. Thirty percent of adults with newly diagnosed epilepsy were not immediately treated. Treatment initiation in this real-world cohort was influenced by age, number of seizures prior to diagnosis, imaging findings, patient preferences, and socioeconomic status.
Substances chimiques
Anticonvulsants
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
445-454Subventions
Organisme : UCB US
Pays : International
Informations de copyright
Wiley Periodicals, Inc. © 2020 International League Against Epilepsy.
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