Mortality rates were significantly higher among veterans with drug-resistant epilepsy compared with other veterans and the general United States population, researchers reported in JAMA Neurology. Mortality rates were significantly higher among veterans with drug-resistant epilepsy compared with other veterans and the general United States population, researchers reported in JAMA Neurology.
According to the authors, epilepsy affects about 70 million people globally. Most epilepsy patients can manage seizures with anti-seizure medications, but up to 36% of patients have drug-resistant epilepsy.
Zulfi Haneef, MBBS, MD, associate professor of neurology at Baylor College of Medicine, and colleagues aimed to examine the association of utilization of care with mortality in U.S. veterans with drug-resistant epilepsy.
Researchers conducted an observational cohort study between Oct. 1, 2013, and March 31, 2020, and included 9.6 million U.S. veterans, of whom 164,435 (1.7%) had epilepsy and 55,571 (33.8%) of those had drug-resistant epilepsy. Drug-resistant epilepsy was defined as the use of two or more anti-seizure medications.
Among veterans with drug-resistant epilepsy (mean age, 58.3 years; 88.9% male), standardized mortality rate was 1.5 (95% CI, 1.47-1.53) compared with the general U.S. population and 1.56 (95% CI, 1.53-1.59) compared with all veterans within the Veterans Health Administration.
Researchers further reported that 81.1% of patients with drug-resistant epilepsy had been seen by a neurologist, but only 15% had comprehensive epilepsy evaluations, and 6% were monitored for epilepsy. Nearly 50% of patients underwent electroencephalography testing and two-thirds received an MRI.
According to the study, lower mortality was linked with increased utilization of care, including evaluation at a neurology clinic or an epilepsy center of excellence and diagnostic testing.
“Mortality among veterans is generally lower than civilians due to the so-called healthy soldier effect, presumed to be due to factors including the initial physical screening for healthy recruits, emphasis on physical fitness during service and better health care during and after service,” the authors wrote. “Thus, our observation that mortality was increased among veterans with [drug-resistant epilepsy] compared to the U.S. population was notable.”
Source: healio.com, Ken Downey Jr.