Is there a delay in seeking medical care after the first seizure in “resource limited settings”: a pilot study from Sri Lanka

Abstract

ObjectivesCurrent guidelines suggest that patients presenting with the first seizure should be assessed by a specialist, preferably with investigations such as electroencephalography and imaging to reach a definitive diagnosis. We conducted a cross sectional study among patients with confirmed epilepsy, at a tertiary level neurology clinic in Sri Lanka with the aim of assessing delays in first contact with a medical doctor and in performing key investigations after the first seizure.ResultsMajority had sought medical attention within 24 h of the first seizure (71.2%) and had seen a specialist within the 1st week since the seizure (61%). Also a significant proportion had completed key investigations such as electroencephalography (63.2%) and brain imaging within a month (51%) since the first medical consultation. Of many socio-demographic and illness related factors examined, only a non-generalized tonic–clonic presentation was significantly associated with delay in seeking medical help.

Missed, mistaken, stalled: Identifying components of delay to diagnosis in epilepsy

“…In studies that examined very long delays, the proportions of patients affected were relatively consistent. Delays of 1 year or more were reported for 16% of patients in the two studies by Forsgren et al 15,16 and 13% in Berg et al 19 Herath et al 26 reported a delay of more than 1 year to seek medical attention in 7%, and to specialist consultation it was more than 1 year for 16% of patients. Firkin et al 4 found 14% had delays of more than 2 years.…”

“…After assessment of full-text papers, we found 15 papers that met the criteria for inclusion, plus an additional two earlier papers from our own library (see Tables S1 and S2). [2][3][4][15][16][17][18][19][20][21][22][23][24][25][26][27][28] One paper was a registry study that used International Classification of Diseases (ICD) codes to identify patients and included individuals who obtained antiepileptic drugs (AEDs) before the epilepsy diagnosis was coded. 23 This study was included, as it met our criteria, and the numbers of treated and nontreated patients were noted.…”

“…After the removal of duplicates, a review of abstracts resulted in 54 potentially eligible studies. After assessment of full‐text papers, we found 15 papers that met the criteria for inclusion, plus an additional two earlier papers from our own library (see Tables and ) 2–4,15–28 . One paper was a registry study that used International Classification of Diseases (ICD) codes to identify patients and included individuals who obtained antiepileptic drugs (AEDs) before the epilepsy diagnosis was coded 23 .…”

“…In children, some parents considered the events to be behavioral or due to other reasons (many children in this study had developmental problems), 18 or did not think the events were of concern. 19 Practical problems or lack of opportunity to seek assessment were also reported (i.e., "lack of time," 20,26 single parent families, 18 or poor access to health care 2 ). Concern over potential negative social impact was also noted, 26 and some individuals sought traditional/alternative treatment before conventional medical care.…”

“…Concern over potential negative social impact was also noted, 26 and some individuals sought traditional/alternative treatment before conventional medical care. 26 Nocturnal seizures may be missed. 19,21 Triggers to eventually seeking medical assessment included an increase in frequency or severity of seizures, or occurrence of convulsions.…”