Medications used for seizure-emergency management in the UK community: A clinical practice research datalink retrospective database study.

Abstract

Objective: Assess the prevalence, characteristics, and healthcare resource utilization (HCRU) of patients prescribed certain benzodiazepines for seizure-emergency management in the United Kingdom.

Methods: Retrospective cohort study using Clinical Practice Research Datalink (CPRD-Aurum) and Hospital Episode Statistics (HES) data that included patients with ≥1 recorded seizure-emergency medication prescription between 2016 and 2020. Patient characteristics were described for the whole sample. Inpatient, outpatient, and Accident and Emergency (A&E) encounters during 2019 were described. The 2019 prevalence of seizure-emergency medication prescription among patients with epilepsy was calculated.

Results: In 2019, 6.7% (9336/139667) of CPRD-Aurum patients with epilepsy were prescribed seizure-emergency medication. Between 2016 and 2020, 26 534 patients with seizure-emergency medication were identified (mean/median age: 41.5/41.0 years [71.8% were adults]; 50.3% male). In this sample, the most prescribed seizure-emergency medication was buccal midazolam (60.6% of patients). Rectal diazepam was prescribed for 19.0%; oral benzodiazepines for 20.3%. Of the oral benzodiazepines prescribed for seizure-emergency management, oral diazepam was most common (97.5%). Buccal midazolam was prescribed both to children and adults (44.2%/55.8%); rectal diazepam and oral benzodiazepines mainly to adults (93.3%/99.5%). Among 11 594 patients with HES linkage in 2019, 25.1% experienced ≥1 epilepsy-specific inpatient hospitalization (median hospitalization days in patients with ≥1 hospitalization = 2.9 [IQR 12.0]); 35.7% had ≥1 neurology-specific outpatient visit (median visits in patients with ≥1 visit = 2.6 [3.4]); 8.7% had ≥1 epilepsy-related emergency attendance (median attendances in patients with ≥1 attendance = 3.0 [4.0]); 7.8% arrived in A&E by ambulance due to epilepsy (median arrivals in patients with ≥1 arrival = 2.2 [3.4]).

Significance: In 2019, 6.7% of patients with epilepsy were prescribed seizure-emergency medication. Nevertheless, patients continue to encounter challenges to manage seizure-related emergencies, as shown by high HCRU, suggesting that it may be time for a new treatment paradigm. The recently proposed concept of Rapid and Early Seizure Termination (REST) warrants further investigation.

Plain language summary: In people with epilepsy, some seizures last too long and will not stop on their own, or may happen one after another, becoming emergencies that need medical attention; seizure-emergency medications are given to stop the seizure and prevent other medical problems. We looked at the share of people with epilepsy who had a seizure-emergency medication prescription in a UK database, and this group's use of health services. In 2019, 7% of people with epilepsy were prescribed a seizure-emergency medication. Use of health services was high in this group, highlighting the need for better treatment options.