Call to `Red-Flag’ people at risk in General Practice and cut epilepsy deaths

An editorial published this month in the British Medical Journal, a highly regarded resource for health professionals, calls for GP screening of people with epilepsy at high risk of premature death to allow for a step-up of care.  It calls on General Practitioners, who already routinely collect and use patient data on stroke; heart disease and cancers, to also use the data they have on patients with epilepsy to step-up care.

The feasibility for screening using electronic medical records to `red flag’ people at risk is based on a pilot study led by Leone Ridsdale, Professor of  Neurology and General Practice at Kings College London recently highlighted in an editorial in the British Medical Journal.  The study was commissioned by SUDEP Action and a team of researchers at King’s College, London (The SUDEP Research Initiative) and researched mortality in a very large general practice population. 

Whilst information that epilepsy deaths are potentially avoidable deaths has been known in the UK for some time, the editorial highlights the need for a national risk assessment tool to support lessons from research being put into practice. 

The editorial highlights the main risk factors and suggests how they can be red flagged by General practitioners using electronic medical records to identify people with epilepsy who are at high risk of death. The Red flags that exist for epilepsy and could be used include:

•    Patients experiencing injury in the previous year
•    Patients not collecting their medication prescription
•    Patients with epilepsy and depression 
•    Patients misusing alcohol

Professor Ridsdale commenting on her editorial said: “Whilst GPs are having funds cut for reviewing people with epilepsy, we know from this research that the risks for many deaths might be identified, and potentially reduced. Screening for risk has halved deaths from cervical cancer. Epilepsy causes more deaths and could benefit in the same way.
If health services research funding is provided, an electronic risk assessment tool can be developed that would help GPs identify people at risk of death in epilepsy, just as they do in heart disease and cancer. If a risk-assessment tool were developed, and GPs funded to use it by the Quality & Outcome Framework, then a premature deaths might be avoided, just as they have been for cervical cancer."

In order to capture those at risk, Professor Ridsdale suggested that everyone with epilepsy has to be assessed and this is possible using General Practice records. She points out that detailed records on people with epilepsy were kept by GPs between 2004 and 2014. An in-depth analysis of data between 2004 and 2014 could be used to develop an automatic risk assessment tool that would alert GPs to profiles that had been red-flagged.

Jane Hanna from SUDEP Action: “The development of a risk assessment tool is not rocket science. Of course we will always need more research into new treatments and bio-markers, but bereaved families will always ask why existing research that might save lives is not being used in practice to benefit people with epilepsy”.

For more see:

• BMJ editorial on Sudep Action site
• Full report available at 2015 BMJ Avoiding Epilepsy Deaths
• Readers may access papers authored by Leone Ridsdale using the following link: https://www.researchgate.net/profile/Leone_Ridsdale/contributions

Other related articles:

Jane Hanna's January Blog  
Systematic Review of Epilepsy Deaths