Department of Medicine at Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.
Clinical Epidemiology, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Epilepsia. 2020 Mar;61(3):519-527. doi: 10.1111/epi.16435. Epub 2020 Jan 24.
To investigate whether delayed or no treatment was associated with increased mortality and morbidity risks in people with newly diagnosed epilepsy.
We examined New Zealand hospitalization and antiseizure medication prescription data from 2007-2015. Mortality and hospital-diagnosed morbidities were compared between patients immediately treated after epilepsy diagnosis, treated after a delay, or untreated for the duration of follow-up, adjusted for age, sex, and ethnicity.
Three thousand three hundred sixty-six patients (54.7% male, median age = 37.5 years) were included and followed up for a median of 3.39 years. A total of 3123 (92.8%) patients were treated immediately, 125 (3.7%) had delayed treatment, and 118 (3.5%) were untreated. Compared to the general New Zealand population, the cohort had a standardized mortality ratio of 4.60 (95% confidence interval [CI] = 4.24-4.99). Maori patients were less likely to be treated (Holm-Bonferroni adjusted P = .024) and had higher mortality (hazard ratio [HR] = 1.41, 95% CI = 1.08-1.83). There was a trend of increased mortality in the untreated or delayed treatment group compared to the immediate treatment group (HR = 1.36, 95% CI = 0.99-1.87). Hospitalization risk was similar between untreated and immediately treated periods (P = .83). Untreated or delayed treatment patients had higher risk of acute myocardial infarction (HR = 9.64, 95% CI = 1.83-50.8). Maori patients were more likely to develop liver disease (HR = 4.67, 95% CI = 1.32-16.4) and alcohol or drug dependence (HR = 2.55, 95% CI = 1.44-4.51).
Most epilepsy patients were treated at diagnosis in New Zealand, but Maori patients had lower treatment rates and worse health outcomes. The apparent increased risk of acute myocardial infarction among the untreated or delayed treatment patients warrants further research.
研究新诊断癫痫患者延迟或未治疗是否与死亡率和发病率风险增加相关。
我们研究了 2007 年至 2015 年新西兰的住院和抗癫痫药物处方数据。通过比较在癫痫诊断后立即治疗、延迟治疗或在随访期间未治疗的患者的死亡率和医院诊断的发病率，对年龄、性别和种族进行了调整。
共纳入 3366 例患者（54.7%为男性，中位年龄=37.5 岁），中位随访时间为 3.39 年。共有 3123 例（92.8%）患者立即接受治疗，125 例（3.7%）延迟治疗，118 例（3.5%）未治疗。与新西兰一般人群相比，该队列的标准化死亡率为 4.60（95%置信区间[CI]为 4.24-4.99）。毛利人患者接受治疗的可能性较低（Holm-Bonferroni 校正 P=0.024），死亡率较高（风险比[HR]为 1.41，95%CI 为 1.08-1.83）。与立即治疗组相比，未治疗或延迟治疗组的死亡率呈上升趋势（HR 为 1.36，95%CI 为 0.99-1.87）。未治疗和立即治疗期间的住院风险相似（P=0.83）。未治疗或延迟治疗的患者发生急性心肌梗死的风险较高（HR 为 9.64，95%CI 为 1.83-50.8）。毛利人患者更易发生肝脏疾病（HR 为 4.67，95%CI 为 1.32-16.4）和酒精或药物依赖（HR 为 2.55，95%CI 为 1.44-4.51）。
在新西兰，大多数癫痫患者在诊断时得到治疗，但毛利人患者的治疗率较低，健康状况较差。未治疗或延迟治疗患者的急性心肌梗死风险增加，需要进一步研究。
