Zhibin Chen, PhD: Treatment Gap in Patients with Newly Diagnosed Epilepsy

February 13, 2019

Despite accessibility to antiepileptic drugs in high-income settings, more than one-third of patients with newly diagnosed epilepsy were not treated or had delayed treatment.

“This is quite an interesting finding because this kind of untreated epilepsy has long been thought of as a major health issue in low-income countries, because many have trouble accessing drugs or specialized care.”

The epilepsy treatment gap is recognized as a public health crisis in resource-poor countries, where up to 90% of patients with epilepsy do not receive appreciate care and treatment, however, a recent study of 1317 people with newly onset unprovoked seizures demonstrated that nearly one-third did not commence treatment.

Researchers studied 1317 people who attended First Seizure Clinics during the study period, of which 677 fulfilled the International League Against Epilepsy (ILAE) diagnostic criteria for epilepsy. Among the 677 patients, 288 (43%) were not commenced on treatment at the time of diagnosis, including 195 (29%) who were not offered treatment and 93 (14%) who declined treatment. Among those patients initially untreated, 57% (164/288) started treatment after a median delay of 108 days.

According to the results, the most common reason for treatment not being offered by neurologists (n = 139) were presence of seizure precipitating factors (29%), followed by having had single seizure (23%) and waiting for additional investigation (18%). Those who declined treatment (n= 93), the most common reasons were being unconvinced of necessity of treatment (39%), presence of seizure-precipitating factors (15%) and concerns regarding adverse effects (8%).

To provide additional insight into the treatment gap, NeurologyLive sat down with Zhibin Chen, PhD, postdoctoral biostatistician, University of Melbourne, and Monash University, co-supervisor on the study, at the 2018 American Epilepsy Society’s annual meeting in New Orleans, Louisiana. Chen explained that the treatment decision making is complex and influenced by epilepsy-, patient-, and neurologist-related factors.