Re: Avoiding premature death in epilepsy
Leone Ridsdale’s editorial “Avoiding premature death in epilepsy”(1) presents a renewed and perhaps revised challenge to primary care. There have been recurrent challenges over the past 20 years, with The National Sentinel Clinical Audit of Epilepsy-Related Death: Epilepsy–death in the Shadows(2), being a notable example. Epilepsy remains a Cinderella medical condition and has a number of differences when compared with other chronic diseases, for instance, the impact of a single seizure resulting in injury or death, or the social impact of the loss of a driving licence, or the loss of employment.
The impact on primary care epilepsy management of the epilepsy QoF points has, I would suggest, been limited. The results of my own review of annual QoF results in my locality in a previous year which suggest to me an excessive tolerance of poor seizure control. But I would also suggest the removal of these QoF points may well be more damaging. Professor Ridsdale’s suggestion that risk management by close management of medicine adherence could have been a welcome extension. However as it stands the message from policy makers in respect to encouraging epilepsy management in primary care is dispiriting. The treatment of depression can be inhibited or delayed by the concern that antidepressants lower seizure threshold although the data may only be based on observations in overdose rather than therapeutic dosage. As Professor Ridsdale points out, there is a positive impact of effective depression treatment on seizure control. In this respect, the challenge is to national clinical leaders to provide advice and guidance. In primary care, epilepsy and its treatments remain, at least in part, poorly understood, thereby inhibiting clinical activity. The challenges in Professor Ridsdale’s editorial, however, rely on routine general practice skills and should be examined closely, resources allowing. A cornerstone of general practice is the provision of continuing care and there is an opportunity to enhance this role to this patient group.
1. Ridsdale, l. “Avoiding premature death in epilepsy”. BMJ 2015;350:h718
2. Hanna N J, Black M, Sander JWS, Smithson WH, Appleton R, Brown S, Fish DR (2002). The Stationery Office.
Competing interests: No competing interests