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

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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.

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Data statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

This research received funding from LivaNova as an investigator-initiated grant.

Author information

Authors and Affiliations

  1. Department of Intellectual Disability Neuropsychiatry, Research Team, Cornwall Partnership NHS Foundation Trust, Truro, TR1 3QB, UK

    Sarah Lennard, Richard Laugharne & Rohit Shankar

  2. CIDER, University of Plymouth Peninsula School of Medicine, Truro, TR1 3QB, UK

    Sarah Lennard, Tom Thompson, Richard Laugharne & Rohit Shankar

  3. Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, EX1 2LU, UK

    William Henley

  4. Royal Cornwall Hospital NHS Trust, Truro, TR1 3HD, UK

    Brendan McLean & Mark Jadav

  5. Chygovenck, Three Milestone Industrial Estate, Truro, TR4 9LD, Cornwall, UK

    Rohit Shankar

Authors
  1. Sarah Lennard
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  4. Tom Thompson
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Contributions

All authors satisfy the ICMJE guidance by substantially contributing to the design, analysis, and interpretation of the work, drafting of the manuscript, and final approval of the manuscript, and all agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Rohit Shankar.

Ethics declarations

Conflicts of interest

SL was employed as a result of an investigator-initiated Grant from LivaNova. BM has received institutional and research support from UCB, Eisai, Biogen, Bial, Roche, GW Pharma, and Novartis. RS has received institutional and research support from LivaNova both for this project and other projects. In addition, he has received institutional and research support from UCB, Eisai, Veriton Pharma, Bial, Angelini, UnEEG, and Jazz Pharma outside the submitted work. He holds grants from NIHR AI, SBRI, and other funding bodies all outside this work.

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Supplementary file2 (PDF 99 KB)

Appendix 1: Elements recorded following ED attendance

Appendix 1: Elements recorded following ED attendance

Relevant seizure, clinical, social and risk characteristics captured

Demographics

Previous general medical history

Seizure history

Other

Gender

Sub-population (ID, GP_ID or brain tumour or injury)

First seizure

Number of admissions following a seizure

Age

Mental health history

Date of epilepsy onset/diagnosis

Outcome of visit (admission of discharge)

Social situation, including lives alone, family, care home, supported living or no fixed abode, first section of postcode

Alcohol and/or drug misuse

Usual seizure frequency

Deceased

  

Seizure type and character

Current medication

  

VNS

 
  

Specialist epilepsy review past or planned

 

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Lennard, S., Henley, W., McLean, B. et al. Risk characteristics of alcohol and/or drug misuse in repeat emergency department attendees for seizures: a case–control study. J Neurol 270, 4914–4921 (2023). https://doi.org/10.1007/s00415-023-11833-9

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  • DOI: https://doi.org/10.1007/s00415-023-11833-9

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