Epilepsy management in older people: Lessons from National Audit of Seizure management in Hospitals (NASH)

Ziso, Besa; Dixon, Peter; Marson, Anthony G

doi:10.1016/j.seizure.2017.05.002

Cited by 18 publications

(17 citation statements)

References 38 publications

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“…For first seizures there was also a downward trend, with 52 % in the 60-69 age range being referred and 25 % in the 80-89 age range. A further indication of lack of structured escalation is that NASH found sodium valproate was the most commonly prescribed ASMs which likely reflects outdated practice and recommend the need for improved working between primary care and specialists [21].…”

Section: Care and Treatment Reviewmentioning

confidence: 99%

Exploring epilepsy attendance at the emergency department and interventions which may reduce unnecessary attendances: A scoping review

Burrows

Lennard

Hudson

et al. 2020

Seizure

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Background: Repeat attendances to emergency departments for seizures, impacts on the individual and burdens health care systems. We conducted a review to identify implementable measures which improve the management of people with epilepsy reducing healthcare costs and their supportive evidence. Methods: A scoping review design using suitable search strategy as outlined by PRISMA-ScR was used to examine seven databases: MEDLINE, EMBASE, CINAHL, AMED, PsychINFO, HMIC and BNI. A manual search of the COCHRANE database and citation searching was also conducted. A thematic analysis was conducted to explore the context and reasons of emergency department attendance for seizures, particularly repeat attendances and the strategies and measures deployed to reduce repeat attendances. Results: Twenty-nine reports were included, comprising of a systematic review, a randomised control study, a multi-method study, quantitative studies (n = 17), qualitative studies (n = 6), an audit, a survey and a quality improvement project. Thematic analysis identified four broad areas for reducing repeat attendances. These were developing care pathways, conducting care and treatment reviews, providing educational interventions and role of ambulance staff. Conclusion: The findings indicate varied reasons for attendance at ED following seizure, including mental health and knowledge of seizure management and lack of education. Implementations of care pathways in ED have been found to reduce admission related costs.

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Section: Care and Treatment Reviewmentioning

confidence: 99%

Exploring epilepsy attendance at the emergency department and interventions which may reduce unnecessary attendances: A scoping review

Burrows

Lennard

Hudson

et al. 2020

Seizure

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“…The low referral rate may be due to some clinicians holding an incorrect nihilistic view that intractability is inevitable if seizure control is not obtained within a few years of therapy onset. Assumptions about the willingness of certain patient groups to attend clinics may also be being made 35 36…”

Section: Introductionmentioning

confidence: 99%

Developing patient-centred, feasible alternative care for adult emergency department users with epilepsy: protocol for the mixed-methods observational ‘Collaborate’ project

et al. 2019

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IntroductionEmergency department (ED) visits for epilepsy are common, costly, often clinically unnecessary and typically lead to little benefit for epilepsy management. An ‘Alternative Care Pathway’ (ACP) for epilepsy, which diverts people with epilepsy (PWE) away from ED when ‘999’ is called and leads to care elsewhere, might generate savings and facilitate improved ambulatory care. It is unknown though what features it should incorporate to make it acceptable to persons from this particularly vulnerable target population. It also needs to be National Health Service (NHS) feasible. This project seeks to identify the optimal ACP configuration.Methods and analysisMixed-methods project comprising three-linked stages. In Stage 1, NHS bodies will be surveyed on ACPs they are considering and semi-structured interviews with PWE and their carers will explore attributes of care important to them and their concerns and expectations regarding ACPs. In Stage 2, Discrete Choice Experiments (DCE) will be completed with PWE and carers to identify the relative importance placed on different care attributes under common seizure scenarios and the trade-offs people are willing to make. The uptake of different ACP configurations will be estimated. In Stage 3, two Knowledge Exchange workshops using a nominal group technique will be run. NHS managers, health professionals, commissioners and patient and carer representatives will discuss DCE results and form a consensus on which ACP configuration best meets users’ needs and is NHS feasible.Ethics and disseminationEthical approval: NRES Committee (19/WM/0012) and King’s College London ethics Committee (LRS-18/19-10353). Primary output will be identification of optimal ACP configuration which should be prioritised for implementation and evaluation. A pro-active dissemination strategy will make those considering developing or supporting an epilepsy ACP aware of the project and opportunities to take part in it. It will also ensure they are informed of its findings.Project registration numberResearchregistry4723.

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“…Epilepsy is the third most common neurological condition in older people, following dementia and stroke. [1] By the age of 70 years, the incidence of epilepsy is almost double that of children, and at older than 80 years, it is over three times the rate in childhood. [23] The number of people aged 60 years or older had reached 241 million in China by the end of 2017.…”

Section: Introductionmentioning

confidence: 99%

New-Onset Geriatric Epilepsy in China

Chen¹,

Zhou²,

Lü³

et al. 2018

Chinese Medical Journal

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Background:Few studies have been published on new-onset geriatric epilepsy especially in older Chinese people. This study was to have a comprehensive understanding of new-onset geriatric epilepsy and find a more reasonable diagnosis and management of epilepsy in older people.Methods:One hundred and three patients with onset age 60 years and older were admitted between January 2008 and December 2016. Electronic medical records were reviewed to collect information.Results:There were 103 older patients with new-onset epilepsy. The mean age of the patients was 68.5 ± 6.4 years (range: 60–89 years), and there were 67 (65%) men and 36 (35%) women. The mean onset age was 67.9 ± 6.2 years (range: 60–89 years). The most common identifiable etiology of symptomatic seizures was autoimmune epilepsy in 43 (41.7%) patients. The second most common etiology was stroke in 15 (14.6%) patients. Seven (6.8%) older patients with acute seizures present with status epilepticus and 26 (25.2%) patients experienced clustered seizures (more than three events in 24 h) at seizure onset. Focal seizures (96.1%) were more common than generalized seizures (3.9%). Fifty-three (51.5%) patients had an abnormal brain magnetic resonance imaging (MRI) scan. Among them, video-electroencephalogram findings in 31 (30.1%) patients correlated with MRI abnormalities. Levetiracetam was the most used drugs before admission, in hospital, and during follow-up.Conclusions:Autoimmune encephalitis is becoming an increasing risk factor of subsequent epilepsy in older people. Older patients with new epilepsy are more likely to respond to antiepileptic drugs, and drug-resistant epilepsy is uncommon.

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Epilepsy management in older people: Lessons from National Audit of Seizure management in Hospitals (NASH)

Abstract: Older patients presenting with seizures are more likely to be admitted to hospital and have imaging. They are less likely to be referred to specialist services on discharge. There appears to be significant disparity in patient age and rate of referral.

Cited by 18 publications

References 38 publications

Exploring epilepsy attendance at the emergency department and interventions which may reduce unnecessary attendances: A scoping review

Exploring epilepsy attendance at the emergency department and interventions which may reduce unnecessary attendances: A scoping review

Developing patient-centred, feasible alternative care for adult emergency department users with epilepsy: protocol for the mixed-methods observational ‘Collaborate’ project

New-Onset Geriatric Epilepsy in China

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