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Hospital Admissions for Epilepsy and Convulsions Increase Nationwide

Stump, Elizabeth

doi: 10.1097/01.NT.0000314455.74483.e0
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The number of epilepsy-related hospitalizations — which had declined from 176,000 in 1993 to 95,000 in 2000 — has increased 43 percent in the past five years, jumping to 136,000 in 2005. Hospital stays with epilepsy as the principal cause have increased 51 percent since 2000.

Epilepsy experts, who were not involved in data collection, speculated that more elective admissions for evaluation and an increasing elderly population who may need more intensive care might explain the trend.

The findings, reported in January by the Agency for Healthcare Research and Quality, were based on hospital admissions data from 1993 to 2005 from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, a nationwide database of inpatient hospital stays.

According to the report, in 2005, epilepsy or convulsions were diagnosed in about 1.4 million (3.6 percent) of the 39.2 million total hospital admissions. Epilepsy or convulsions was the chief reason for hospitalization in an estimated 277,000 stays, and admission rates for epilepsy were nearly equal across the U.S.

Convulsion-related hospitalizations increased 69 percent between 1993 and 2005 — from 730,000 to 1.2 million — and 20 percent from 2000 to 2005.

Does this rise signal an increase in the prevalence of epilepsy? Not necessarily, experts told Neurology Today.

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“There is no indication that the prevalence of epilepsy has changed in the last several decades,” said Carl W. Bazil, MD, PhD, associate professor of clinical neurology at Columbia University College of Physicians and Surgeons.

“These statistics could reflect coding practices — perhaps influenced by increased awareness of the disease, particularly as a secondary diagnosis — or increasing elective admissions for epilepsy evaluation, which I think is more likely.”

Dr. Bazil noted that epilepsy and convulsions are often diagnosed interchangeably and don't accurately reflect an actual difference. He added that there are also more epilepsy units in hospitals and greater awareness in the medical and lay community about epilepsy and available treatment.

Kimford J. Meador, MD, the Melvin Greer Professor of Neurology at the University of Florida McKnight Brain Institute in Gainesville, FL, theorized that an increased elderly population — who would be more likely to be admitted after a convulsion — could possibly explain the trend. The report found, for example, that patients over age 65 had twice the likelihood as younger people to be hospitalized with convulsions.

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Elderly people do not recover as quickly as younger patients after a convulsion, are more likely to have comorbidities with a higher risk for complications, and have a high rate of new-onset epilepsy, Dr. Meador observed. He pointed out that private insurance and Medicaid covered more epilepsy patients in the database, while patients with convulsions more often used Medicare.

Whether the trend will decrease in the future is unclear, the neurologists said. “If inpatient evaluation for epilepsy, an underutilized procedure, is responsible for the increase, we can hope the trend will continue because that means better care for patients,” Dr. Bazil said.

The report, “Hospitalizations for Epilepsy and Convulsions, 2005,” is available online at http://hcup-us.ahrq.gov/reports/statbriefs/sb46.pdf.

©2008 American Academy of Neurology