SEATTLE—Hospital stays associated with the principal diagnosis of epilepsy increased between 2000 and 2006 by 55%, according to a study presented at the 62nd Annual Meeting of the American Epilepsy Society. Middle-aged patients (45 to 64) and those younger than 18 saw the largest increases (83% and 66%, respectively), reported Andrew N. Wilner, MD, and Anne Elixhauser, PhD.
The researchers compared epilepsy hospitalization data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1993 with data from 2006. “We wanted to assess the rate of hospitalization for epilepsy in light of recent changes in epilepsy care, such as increased use of the vagus nerve stimulator, epilepsy surgery, and new antiepileptic drugs,” said Dr. Wilner, an epileptologist at Goat Island Neurology in Fall River, Massachusetts. Data from community and academic hospitals were included. Federal, long-term care, rehabilitation, psychiatric, alcoholism, and chemical dependency data were excluded.
Hospital stays associated with the principal diagnosis of epilepsy increased from 47,000 in 2000 to 73,000 in 2006. During this time, overall hospitalization rates in the US increased by 8%. In the epilepsy population, children and adolescents saw an increase of 66% (13,500 to 22,400). In the middle-aged group, hospitalizations increased by 83% (9,500 to 17,400). Hospitalizations among elderly patients (older than 65) increased by 36% (6,900 to 9,400). Among adults ages 18 to 44, hospitalizations increased from 16,000 to 23,600 (42%). Hospitalizations for grand mal status epilepticus accounted for 15% of the overall increase in hospitalizations. A slight decrease in length of hospital stay occurred, from 4.8 days in 2000 to 4.3 days in 2006. There was no significant difference in the number of hospitalizations between men and women.
“At present, we cannot explain the findings and can only speculate,” Dr. Wilner told Neurology Reviews. One consideration was the possibility that shorter hospital stays resulted in frequent rehospitalizations, but the duration of hospitalization only decreased by 0.5 days during the study period, and did not likely have a significant impact. “Data on repeat hospitalizations for individual patients were not in the original database, but we will try and obtain these figures,” Dr. Wilner stated.
Changes in clinical practice may also account for the increased hospitalization rate. “It may be that the threshold for admission has been lowered, so that patients who would not have been hospitalized for seizures in 2000 were hospitalized earlier in 2006,” Dr. Wilner commented. Breakthrough seizures, possibly related to drug interactions that lower AED levels, may also contribute to the increase. “Along with many other possibilities, the increased use of generic drugs may be resulting in both an increase in breakthrough seizures and an increase in episodes of toxicity due to less predictable bioavailability, resulting in more hospitalizations,” Dr. Wilner added. Complete data for patients who underwent specific diagnostic and therapeutic procedures were not available.
—Laura Sassano