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In recent years, several treatment modalities have emerged for people with intractable epilepsy, including new surgical techniques and vagus nerve stimulation. These new developments— in addition to advances in diagnostic technology—have improved the management of this patient group.

A sizeable number of patients have medically intractable epilepsy, which accounts for the majority of healthcare costs relating to the disease. The high morbidity and low mortality associated with epilepsy combine to create a disproportionately high cost of illness when compared with other diseases. Few clinical studies have analyzed the socioeconomic impact of caring for the disease.

New Research on the Epilepsy Burden

In the March 2012 issue of Neurosurgery Focus, my colleagues and I analyzed data from more than 1.1 million patients admitted to hospitals in the United States for epilepsy over 15 years. We analyzed length of stay (LOS), hospital charges, in-hospital mortality, and disposition at discharge. Between 1993 and 2008, the average hospital charge per admission escalated from $10,050 to $23,909, representing an increase of 137.9%. This occurred despite a 33% decrease in the average LOS. Furthermore, the percentage of in-hospital deaths decreased by 57.9%, and more patients were discharged to care outside the hospital. The total national charges associated with epilepsy in 2008 were in excess of $2.7 billion.

Results from our study highlight the continuous and significant healthcare burden of epilepsy in the U.S. The increased healthcare costs are concerning because medical and surgical treatment for epilepsy remained relatively unchanged during the study period. Also, these costs occurred despite advances in technology, greater access to video-EEG units, and improved care for critically ill patients.

Avoid Complacency When Treating Epilepsy

In light of our findings, physicians need to change their philosophy about epilepsy and make greater efforts to avoid complacency. Striving for an accurate diagnosis early on is critical. Research suggests that about one-third of patients considered to have intractable epilepsy are misdiagnosed. In many cases, these patients were suffering from another condition, oftentimes for as long as 10 years. A delayed or incorrect diagnosis can be a tremendous burden on quality of life and healthcare costs. In addition, patients who become seizure-free with resective surgery have waited as long as 15 years before that option was offered.

“Physicians need to change their philosophy about epilepsy and make greater efforts to avoid complacency.”

The key for physicians is to adhere to guideline recommendations from respected organizations like the American Academy of Neurology and the American Epilepsy Society when managing the disease. Patients should be followed closely on a regular basis to see if epilepsy medications are working. If several drugs are tried over a course of 2 or 3 years but fail to work, patients should be assessed for a different diagnosis. If epilepsy is confirmed, they should be offered surgical interventions early. With our current treatment armamentarium of medications and advanced interventions, we can target the best candidates for appropriate therapies and ease the burden for our patients.

References

Vivas AC, Baaj AA, Benbadis SR, Vale FL. The health care burden of patients with epilepsy in the United States: an analysis of a nationwide database over 15 years. Neurosurg Focus. 2012;32:e1. Available at: http://thejns.org/doi/full/10.3171/2012.1.FOCUS11322.

Benbadis SR. Seizures: the next level of care: the Comprehensive Epilepsy Center. Epilepsy.com. July 25, 2011. Available at http://www.epilepsy.com/epilepsy/newsletter/may11_center?print=true.

Kwan P, Arzimanoglou A, Berg AT, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010;51:1069-1077.

Fountain NB, Van Ness PC, Swain-Eng R, et al. Quality improvement in neurology: AAN epilepsy quality measures: report of the Quality Measurement and Reporting Subcommittee of the American Academy of Neurology. Neurology. 2011;76;94-99.

Gumnit RJ, Walczak TS; National Association of Epilepsy Centers. Guidelines for essential services, personnel, and facilities in specialized epilepsy centers in the United States. Epilepsia. 2001;42:804-818.

Benbadis SR, Tatum WO, Vale FL. When drugs don’t work: an algorithmic approach to medically intractable epilepsy. Neurology. 2000;55:1780-1784.

Vale FL, Ahmadian A, Youssef AS, et al. Long-term outcome of vagus nerve stimulation therapy after failed epilepsy surgery. Seizure. 2011;20:244-248.

Baaj AA, Benbadis SR, Tatum WO, Vale FL. Trends in the use of vagus nerve stimulation for epilepsy: analysis of a nationwide database. Neurosurg Focus. 2008;25:3E10.

Strzelczyk A, Reese JP, Dodel R, Hamer HM. Cost of epilepsy: a systematic review. Pharmacoeconomics. 2008;26:463-476.