Joseph Sirven, MD

"That’s where we looked: What’s our treatment delay? What’s our treatment gap after the initial diagnosis? How do these individual determents impact these particular treatment delays?”

Using Arizona Medicaid claims records from 2015 to 2019, researchers aimed to examine the underlying drivers and extent of treatment delays for individuals with epilepsy. Within the study population, they found that the epilepsy treatment gap was at least 40.6%, with mean and median delays in treatment of 180 and 73 days, respectively.

The study was led by Joseph Sirven, MD, and was presented at the 

2021 American Academy of Neurology Annual Meeting

, April 17-22. Of the social determinants of health factors investigated, the most significant variables correlating with treatment delays were care setting, age, marital status, race, homelessness, and employment. The researchers concluded that these results underscore the need for a deeper understanding of the complex interplay of social determinants of health factors on epilepsy care.

Sirven, a professor of neurology at Mayo Clinic, sat down with 

to discuss what prompted him to conduct this study, and the relatively limited literature currently available on social determinants of health in epilepsy.

Sirven J, Sprout G, Speer M, Simic G, Reddy S. The role of social determinants in epilepsy treatment delays for Arizonans on Medicaid. Presented at American Academy of Neurology Annual Meeting; April 17-22. Abstract

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The professor of neurology at Mayo Clinic discussed the reasoning for the research he presented at AAN 2021 on social determinants and their impact on epilepsy treatment times. 

Role of Social Determinants in Epilepsy Treatment Delays: Joseph Sirven, MD

“The issue of driving is probably one of the most emotionally latent, polarizing topics that any neurologist has and there is nothing more, in terms of how emotional and upset everyone gets because driving is life.”

At the American Epilepsy Society’s annual meeting in New Orleans, Louisiana, Joseph Sirven, MD, Director of the Epilepsy Division at Mayo Clinic in Phoenix, Arizona, sat down with 

to discuss variables impacting the issue of driving for patients withdrawing from seizure medication.

Sirven explains that while time seems to be an essential variable, there has been interesting ways of applying big data to individualize the decision for the patient. New analyses have been published utilizing nomograms to determine a patients’ risk of seizure recurrence, which then informs physicians if a patient should or should not drive.

Another approach is based on a recently published paper that identified and compared cases of seizure-related vehicle crashes involving patients with epilepsy with non-seizure-related crashes by cross referencing medical records and the Victorian Police Traffic Incident database and the Road Crash Information System Database.

This type of data, which Sirven adds never existed before, can be used to feed algorithms that input the creation of autonomous cars, which could ultimately disrupt this entire debate.

The bottom line, Sirven concludes, is that clinicians need to document their counsel with patients according to state driving laws and that while nomograms and EEG have been used to better estimate the risk of seizure occurrence, good old-fashioned time is still the ultimate component of making the decision.

1. Neal A, Carne R, Odell M, et al. Characteristics of motor vehicle crashes associated with seizure. 

. 2018;91(12). doi: 10.1212/WNL.0000000000006208.

The Director of the Epilepsy Division at Mayo Clinic in Phoenix discussed the issue of driving when withdrawing patients off seizure medication either because of treatment, remission or surgical intervention.

Joseph Sirven, MD

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Role of Social Determinants in Epilepsy Treatment Delays: Joseph Sirven, MD

Joseph Sirven, MD: Variables Impacting Vehicle Use for Patients with Epilepsy