Social Disparities in the Utilization of Seizure Rescue Medications Among a Treatment-Resistant Focal Epilepsy Population
Abstract number :
1.309
Submission category :
7. Anti-seizure Medications / 7E. Other
Year :
2023
Submission ID :
485
Source :
www.aesnet.org
Presentation date :
12/2/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Leticia Tedesco Silva, MD, PhD – University of Miami
Enrique Carrazana, MD – Neurelis; Hillary Doyle, PhD – UCB; Caitlin Grzeskowiak, PhD – Epilepsy Foundation of America; Sunita Misra, MD, PhD – Neurelis; Ojas Potnis, B.S – Texas A&M College of Medicine; Konrad Werhahn, MD, PhD – UCB; Jacqueline French, MD – NYU Comprehensive Epilepsy Center; Detyniecki Kamil, MD – University of Miami Miller School of Medicine
Rationale:
Seizure rescue medications are critical in the management of patients with seizure clusters. Rescue medications can prevent additional seizures and avoid progression to prolonged seizures and status epilepticus. This study aimed to examine the overall utilization of rescue medication and identify factors associated with the prescription of rescue medications in a cohort of patients with treatment-resistant focal epilepsy.
Methods:
The Human Epilepsy Project 2 (HEP2) enrolled participants between 16 and 35 years of age recruited from thirteen epilepsy centers across the United States. Subjects were diagnosed with focal epilepsy and failed four anti-seizure medications trials, with at least two due to failure of seizure control. Information obtained at the initial visit included baseline data on demographics, seizure history, history of neurological insult, medical history, family history of epilepsy, EEG and MRI results. We compared the social, demographic and epilepsy characteristics of subjects who were prescribed seizure rescue medications with those who were not. Logistic regression analysis was performed to evaluate the impact of age, gender, education level, race, epilepsy characteristics and ethnicity on the likelihood of receiving rescue medication. The rescue medications included oral clonazepam, lorazepam, and diazepam, rectal diazepam, and intranasal diazepam and midazolam.
Results:
Out of the 154 subjects included, 68 (44%) were prescribed seizure rescue medications at some point during the study. Demographic characteristic data is displayed in Table 1. As shown in Table 2, seizure rescue medications were prescribed to 55 (51%) of the 107 white subjects and to 11 (23%) of the 47 non-white subjects (p=.006 for difference between white and all other races). Five (17%) of the Hispanic/Latino patients were prescribed rescue medications, compared to 48 (49%) of the 118 Non-Hispanic/Latino patients (p=.002). There were no significant differences in age, education level or gender, or presence of prolonged or multiple daily seizures between subjects who were prescribed rescue medications and those who were not. In a logistic regression analyses, Non-Hispanic/Latino subjects were 3.6 times more likely to be prescribed seizure rescue medications than Hispanic/Latino subjects.
Conclusions:
In this population of treatment-resistant epilepsy patients, a substantial proportion of individuals considered at high risk for a seizure emergency were not prescribed rescue therapy. Identifying barriers to treatment options in patients with refractory epilepsy is critical. The HEP2 data suggests that Non-White and Hispanic/Latino patients are less likely to be prescribed rescue medications. Further studies investigating how race and ethnicity may affect eligibility for rescue therapy and patient decision-making are warranted.
Funding: The HEP2 study was funded by UCB, Neurelis, and SK Life Sciences
Anti-seizure Medications