Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.
Epilepsia. 2024 Jan;65(1):148-164. doi: 10.1111/epi.17819. Epub 2023 Nov 28.
In Australia, 30% of newly diagnosed epilepsy patients were not immediately treated at diagnosis. We explored health outcomes between patients receiving immediate, deferred, or no treatment, and compared them to the general population.
Adults with newly diagnosed epilepsy in Western Australia between 1999 and 2016 were linked with statewide health care data collections. Health care utilization, comorbidity, and mortality at up to 10 years postdiagnosis were compared between patients receiving immediate, deferred, and no treatment, as well as with age- and sex-matched population controls.
Of 603 epilepsy patients (61% male, median age = 40 years) were included, 422 (70%) were treated immediately at diagnosis, 110 (18%) received deferred treatment, and 71 (12%) were untreated at the end of follow-up (median = 6.8 years). Immediately treated patients had a higher 10-year rate of all-cause admissions or emergency department presentations than the untreated (incidence rate ratio [IRR] = 2.0, 95% confidence interval [CI] = 1.4-2.9) and deferred treatment groups (IRR = 1.7, 95% CI = 1.0-2.8). They had similar 10-year risks of mortality and developing new physical and psychiatric comorbidities compared with the deferred and untreated groups. Compared to population controls, epilepsy patients had higher 10-year mortality (hazard ratio = 2.6, 95% CI = 2.1-3.3), hospital admissions (IRR = 2.3, 95% CI = 1.6-3.3), and psychiatric outpatient visits (IRR = 3.2, 95% CI = 1.6-6.3). Patients with epilepsy were also 2.5 (95% CI = 2.1-3.1) and 3.9 (95% CI = 2.6-5.8) times more likely to develop a new physical and psychiatric comorbidity, respectively.
Newly diagnosed epilepsy patients with deferred or no treatment did not have worse outcomes than those immediately treated. Instead, immediately treated patients had greater health care utilization, likely reflecting more severe underlying epilepsy etiology. Our findings emphasize the importance of individualizing epilepsy treatment and recognition and management of the significant comorbidities, particularly psychiatric, that ensue following a diagnosis of epilepsy.
在澳大利亚，30%的新诊断癫痫患者在诊断后并未立即接受治疗。我们探讨了接受即刻、延迟或未治疗的患者之间的健康结局，并将其与普通人群进行比较。
1999 年至 2016 年间，西澳大利亚州新诊断为癫痫的成年人与全州医疗保健数据采集相关联。比较了在诊断后立即接受治疗、延迟治疗和未治疗的患者，以及与年龄和性别匹配的人群对照者在多达 10 年的时间内的医疗保健利用情况、合并症和死亡率。
纳入 603 名癫痫患者（61%为男性，中位年龄为 40 岁），422 名（70%）在诊断后立即接受治疗，110 名（18%）接受延迟治疗，71 名（12%）在随访结束时未治疗（中位时间为 6.8 年）。即刻治疗的患者在 10 年内的全因住院或急诊就诊率高于未治疗者（发病率比 [IRR] = 2.0，95%置信区间 [CI] = 1.4-2.9）和延迟治疗组（IRR = 1.7，95%CI = 1.0-2.8）。与延迟治疗和未治疗组相比，他们在 10 年内的死亡率和新出现的身体和精神合并症风险相似。与普通人群对照者相比，癫痫患者的 10 年死亡率更高（风险比 [HR] = 2.6，95%CI = 2.1-3.3），住院率（IRR = 2.3，95%CI = 1.6-3.3）和精神科门诊就诊率（IRR = 3.2，95%CI = 1.6-6.3）更高。癫痫患者新发身体和精神合并症的风险分别为 2.5 倍（95%CI = 2.1-3.1）和 3.9 倍（95%CI = 2.6-5.8）。
延迟或未治疗的新诊断癫痫患者的结局并未比即刻治疗者更差。相反，即刻治疗的患者有更多的医疗保健利用，可能反映出更严重的潜在癫痫病因。我们的研究结果强调了个体化治疗癫痫以及认识和管理诊断后随之而来的显著合并症（尤其是精神合并症）的重要性。
