TY - JOUR
T1 - Risk characteristics of alcohol and/or drug misuse in repeat emergency department attendees for seizures
T2 - a case–control study
AU - Lennard, Sarah
AU - Henley, William
AU - McLean, Brendan
AU - Thompson, Tom
AU - Jadav, Mark
AU - Laugharne, Richard
AU - Shankar, Rohit
N1 - Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
PY - 2023/6/24
Y1 - 2023/6/24
N2 - 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.
AB - 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.
KW - Anti-seizure medication
KW - Death
KW - Emergency department
KW - Non-compliance
KW - Seizures
KW - Substance misuse
UR - http://www.scopus.com/inward/record.url?scp=85162882668&partnerID=8YFLogxK
U2 - 10.1007/s00415-023-11833-9
DO - 10.1007/s00415-023-11833-9
M3 - Article
C2 - 37354269
AN - SCOPUS:85162882668
SN - 0340-5354
VL - 270
SP - 4914
EP - 4921
JO - Journal of Neurology
JF - Journal of Neurology
IS - 10
ER -