2401 Long-term health burden of deferred or no treatment for newly diagnosed epilepsy

• Published in: BMJ neurology open 2022-08, Vol.4 (Suppl 1), p.A54-A54
• Main Authors: Ren, Tianrui TR, Sharma, Sameer SS, Li, Yingtong YL, Burgess, Michael MB, Rychkova, Maria MR, Dunne, John JD, Lee, Judy JL, Laloyaux, Cédric CL, Lawn, Nicholas NL, Kwan, Patrick PK, Chen, Zhibin ZC
• Format: Article
• Language: English
• Subjects: Abstracts; Convulsions & seizures; Epilepsy
• ISSN: 2632-6140
• DOI: 10.1136/bmjno-2022-ANZAN.144

ObjectiveTo assess if early treatment in newly diagnosed epilepsy is associated with lower health burden than delayed or no treatment.MethodsAdults with newly diagnosed epilepsy between 1999–2016 were linked with state-wide databases to extract hospital admission, ambulatory psychiatric care, and mortality data from 1970–2019. Data were compared between patients receiving immediate, delayed and no treatment at up to 10 years post-diagnosis, adjusted for seizure type, age at onset, baseline comorbidity and others.ResultOf 603 patients (61% male; median age 40 years) with newly diagnosed epilepsy, 422 (70%) were treated immediately, 110 (18%) received delayed treatment, and 71 (12%) were untreated at the end of follow-up (median 6.8 years). Patients immediately treated had higher proportions of epileptogenic lesions on neuroimaging, seizure clusters and more pre-diagnostic seizures.Immediately treated patients had a higher ten-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 delayed treatment groups (IRR=1.7; 95%CI:1.0–2.8).However, mortality was similar when immediate treatment was compared with delayed (hazard ratio [HR]=0.99; 95%CI:0.56–1.76) or no treatment (HR=1.31; 95%CI:0.55–3.10). Immediately treated patients also had similar ten-year risk of developing new physical and psychiatric comorbidities compared with the delayed (p=0.68; p=0.18, respectively) and untreated groups (p=0.69; p=0.28, respectively).ConclusionsNewly diagnosed epilepsy patients with deferred or no treatment did not have worse outcomes, compared to those immediately treated. Instead, patients treated immediately had greater healthcare utilisation, which may reflect more severe underlying epilepsy.