Risk characteristics of alcohol and/or drug misuse in repeat emergency department attendees for seizures: a case–control study

Sarah Lennard, William Henley, Brendan McLean, Tom Thompson, Mark Jadav, Richard Laugharne, Rohit Shankar*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Background: There is a bi-directional relationship between seizures and substance misuse, i.e., alcohol and recreational drugs. Seizures and substance misuse are recognised separately to influence increased emergency department (ED) admissions and early death. There is however no understanding of the cumulative influence of these matters on repeat ED attenders for seizures esp. as a third are likely to re-attend within the year. This case–control study compares the characteristics of people with substance misuse to those without substance misuse presenting recurrently with seizures to the ED. Methods: From a single ED serving a rural population in the Southwest of England, data of all people presenting more than once with a seizure over a 4-year period were examined. The diagnosis of alcohol or drug misuse, deaths, demographic characteristics, and service use were captured. Results: Of 450 repeat attenders, 95 had a recorded history of alcohol and/or drug problems. Those with substance misuse had double the mortality when adjusted for age and gender compared to those without. They were also more likely to be male, younger in age, have mental health issues, live in socially deprived neighborhoods, not take anti-seizure medications and not have had a specialist review in epilepsy services in the previous year. Nearly a quarter of those with addiction issues died in the 4-year period. Discussion: Service provision for this vulnerable group may need to be modelled along different lines to traditional approaches, such as an assertive outreach community-based service as provided for chronic psychiatric and addiction management.

Original languageEnglish
Pages (from-to)4914-4921
Number of pages8
JournalJournal of Neurology
Volume270
Issue number10
DOIs
Publication statusPublished - 24 Jun 2023

ASJC Scopus subject areas

  • Neurology
  • Neurology (clinical)

Keywords

  • Anti-seizure medication
  • Death
  • Emergency department
  • Non-compliance
  • Seizures
  • Substance misuse

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