Veterans and patients with epilepsy are at higher risk of suicide than the general population. Some studies suggest that antiepileptic drugs (AEDs) further increase the risk of suicide. The nature of the relationship between suicidality and epilepsy treatment needs clarification. We examined this relationship in a cohort of veterans with seizures.We performed a retrospective chart analysis of patients at the Philadelphia VA Medical Center with a diagnosis of seizure disorder between January 2000 and April 2007. Patients with suicidal ideation and/or suicidal behaviors were analyzed with respect to the following risk factors: age, history of traumatic brain injury (TBI), substance abuse and AED prescription.526 charts were reviewed, 385 of which met inclusion criteria. Patients with substance abuse were more likely to have suicidal ideation (adjusted odds ratio 3.37, 95% CI 1.84 -6.18). Risk decreased with age (adjusted odds ratio 0.94, 95% CI 0.92 - 0.97 for each year). There was no statistically significant relationship between suicidality and AED use or history of TBI.In our population, AEDs were not associated with increased risk of suicidality, whereas substance abuse was associated with a substantial risk increase. The interactions among seizures, suicidality, substance abuse and other neuropsychiatric diseases are complex. Large-scale studies in patients with seizures are needed to understand the impact of individual drugs and other contributing factors. Providers should be cautious not to withhold potentially beneficial treatment, however patients with risk factors such as history of substance abuse should be followed closely after AED initiation or adjustment.
Objective: To investigate the relationship between antiepileptic drug (AED) prescriptions and suicidal ideation or suicidal behaviors among veterans with epilepsy. Background: Veterans and patients with epilepsy are at higher risk of suicide than the general population. Some studies have suggested that antiepileptic drugs further increase the risk of suicide. However, the nature of the relationship between suicidality and epilepsy treatment remains unclear in this population. We examined associations between suicidal ideation and AED therapy, along with other purported risk factors, in a cohort of veterans with epilepsy. Design/Methods: We performed a retrospective chart analysis of patients at the Cpl. Michael J. Crescenz VA Medical Center Philadelphia with a diagnosis of epilepsy between January 1, 2000 and April 3, 2007. Diagnoses of suicidal ideation and/or suicide-related behaviors were analyzed with respect to the following risk factors: age, history of traumatic brain injury (TBI), substance abuse and AED prescription. Results: 526 charts were reviewed, 385 of which met inclusion criteria. Patients with substance abuse were more likely to have suicidal ideation (adjusted odds ratio 3.37, 95% CI 1.84–6.18). Risk decreased with age (adjusted odds ratio 0.94, 95% CI 0.92–0.97 for each year). There was no relationship between suicidality and AED use or history of TBI. Conclusions: In our population, the use of AEDs was not associated with an increased risk of suicidality, whereas substance abuse was associated with a substantial risk increase. The interactions among epilepsy, suicidality, substance abuse and other neuropsychiatric diseases is complex. Large-scale studies are needed to understand the impact of individual drugs and other contributing factors. Providers should be cautious not to withhold potentially beneficial treatment on the basis of generalizations. Study Supported by: This work was supported in part by NIH (5T32-91006-2). Disclosure: Dr. Williams has nothing to disclose. Dr. Rehman has nothing to disclose. Dr. Bucurescu has nothing to disclose.
Background: Women Veterans with epilepsy (WVE) may have unique psychiatric comorbidities that affect presentation, treatment, and outcomes. This large, nationally representative study of Veterans Health Administration (VHA) patients explores sex differences in psychiatric diagnoses and treatment to better characterize WVE. Methods: This study included a retrospective cohort design utilizing VHA Corporate Data Warehouse administrative data. Data from 58,525 Veterans with epilepsy (8.5% women) were obtained. Psychiatric diagnoses and treatment were analyzed, with comparisons between men with epilepsy and WVE. Secondary analyses included further exploration of select gynecological conditions. Results: WVE had higher psychiatric burden than men, as evidenced by higher rates of nearly all psychiatric diagnoses, including depression (59.1% vs. 38.9%; χ2 = 771.6), posttraumatic stress disorder (42.0% vs. 26.5%; χ2 = 549.1), and anxiety disorder (44.9% vs. 24.5%; χ2 = 977.7), as well as higher use of psychotropic medication prescriptions (2.3 vs. 1.4 average number of psychotropics prescribed). Furthermore, higher percentages of women versus men utilized the emergency room for psychiatric purposes (11.7% vs. 6.9%; χ2 = 153.06) and were hospitalized with psychiatric diagnoses (9.8% vs. 6.1%; χ2 = 100.95). Discussion: Veterans with epilepsy represent a unique group with high rates of psychiatric comorbidity. These results suggest that among Veterans, men and women with epilepsy have differing psychiatric comorbidities, leading to disparate health care needs. Based on this study's findings, WVE may require a different approach to care with an increased focus on specialized psychiatric treatment for WVE.
Abstract Objective Hispanic/Latino people with epilepsy are a growing population that has been understudied in clinical epilepsy research. U.S. veterans are at a higher risk of epilepsy due to greater exposures including traumatic brain injury. Hispanic/Latino Veterans with Epilepsy (HL‐VWEs) represent a growing population; however the treatment utilization patterns of this population have been vastly understudied. Methods HL‐VWE were identified from administrative databases during fiscal year 2019. Variables compared between Hispanic and non‐Hispanic VWEs included demographics, rurality, service era, utilization of clinical services/investigations, and service‐connected injury. Chi‐square and Student's t tests were used for comparisons. Results Among 56 556 VWEs, 3247 (5.7%) were HL. HL‐VWEs were younger (59.2 vs 63.2 years; p < .01) and more commonly urban‐dwelling (81.6% vs 63.2%, p < .01) compared to non–HL‐VWEs. They were also more likely to have served in recent missions such as the Persian Gulf War and post‐ 9/11 wars ( p < .01). HL‐VWEs had a higher utilization of all neurology services examined including neurology clinic visits, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, electroencephalography (EEG), epilepsy monitoring, and comprehensive epilepsy care ( p < .01 for all). HL‐VWEs were more likely to visit an emergency room or have seizure‐related hospitalizations ( p < .01). HL‐VWEs were more likely to have a service‐connected disability greater or equal to 50% ( p < .01). Significance This study is one of the largest cohorts examining HL‐VWEs. We found higher utilization of services in neurology, epilepsy, and neuroimaging by HL‐VWEs. HL‐VWE are younger, more commonly urban‐dwelling, and more likely to have served during recent combat periods and have higher amounts of service‐connected disability. Given that the proportion of Hispanic veterans is projected to rise over time, more research is needed to provide the best interventions and mitigate the long‐term impact of epilepsy on this diverse patient group.
Objective: Epilepsy, and specifically drug-resistant epilepsy (DRE), is associated with an increased risk of psychiatric dysfunction, likely due to a combination of physiological mechanisms, emotional reactions to disease burden, and bi-directional influences. Women with epilepsy warrant special consideration due to many factors, including hormonal influences on seizure susceptibility, reproductive health considerations, and unique psychiatric and clinical profiles. However, there is yet to be large-scale research characterizing women with DRE. The present study characterized psychiatric conditions, treatment, and hospitalization data in a Veterans Health Administration (VHA)-wide sample of women Veterans and then compared results to a male Veteran sample to explore sex differences. Participants and Methods: Data from 52,579 Veterans enrolled in VHA care between FY2014 and 2nd Quarter FY2020 were gathered from the VHA Corporate Data Warehouse administrative data. The sample was comprised of 5,983 women (11.4%) and 46,596 men (88.6%). Demographics, psychiatric diagnoses, psychiatric medications, ER visits, and hospitalizations were characterized. Chi-square analyses were used to examine group differences between men and women. Results: The vast majority of the women Veteran sample had at least one psychiatric diagnosis (86.1%), with over half of the sample diagnosed with depression (68.3%), PTSD (54.1%), and/or anxiety disorders (57.7%). When compared to men, women Veterans were more likely to have a psychiatric diagnosis (86.1% vs. 68.1%), evidenced a higher number of co-morbid psychiatric conditions (2.4 vs. 1.6), and were prescribed more psychiatric medications (3.4 vs. 2.3; all significant at p<0.001). All individual psychiatric diagnoses were more prevalent in women than men and, notably, suicidality was also higher in women (13.5% vs. 10.0%; p < 0.001). Women Veterans also had a higher number of ER visits (6.9 vs. 5.5; p < 0.001) and psychiatric hospitalizations than men (.4 vs. .3, p < 0.001). Conclusions: The present study represents the largest known investigation to date of women with DRE and is also the largest study of women Veterans with any form of epilepsy. It highlights a vast psychiatric burden in this subset of women Veterans, with high rates of psychiatric comorbidity, lending to downstream effects on psychiatric medication burden and risk for emergency care usage and psychiatric hospitalization. Comparisons to men emphasize that women are differentially impacted by the psychiatric toll of DRE and warrant special consideration. The markedly higher rates of depressive disorders and suicidality in women Veterans with DRE is especially notable when considering risk of harm and mortality. Overall, the present work adds to the paucity of literature of women Veterans with seizures and gaps in the broader DRE research base, with implications for specialized screening and maximizing treatment interventions in this population.
OBJECTIVE: Identify trends in the use of antiepileptic drugs (AEDs) for Veterans with epilepsy within the Veterans Health Administration (VHA), including whether age influences the choice or number of AEDs prescribed. BACKGROUND: The VHA is a large healthcare organization in which AEDs were prescribed to approximately 74,000 Veterans with a seizure diagnosis during Fiscal Year 2011 (FY11), October 1, 2010 to September 30, 2011. Understanding which AEDs are prescribed to which populations of Veterans is useful in guiding the care of Veterans. For example, it is hypothesized that older AEDs are still being used by older Veterans, who may have been taking these AEDs for years. DESIGN/METHODS: Demographic characteristics, including age and gender, were collected for Veterans within the VHA with a seizure diagnosis, seizure on their problem list and who were prescribed an AED for at least 30 days during FY11. AEDs were divided between older (first-generation) and newer. Veteran ages were grouped by decades, e.g., twenties, thirties, etc. The frequencies of each AED within each age group and in total were measured. RESULTS: The majority of Veterans were prescribed either one (66%) or two (27%) AEDs during FY11. Also, 43% of Veterans were taking only older AEDs and 20% took both older and newer AEDs. The age groups with the highest percentages of using only older AEDs were in their 60's (44%), 70's (51%) and 80's (53%). Phenytoin (36%), levetiracetam (27%), gabapentin (20%) and valproate (15%) were the most commonly prescribed AEDs. CONCLUSIONS: Older Veterans use older medications more than younger Veterans. Phenytoin is still the most prescribed AED within the VHA. Study Supported by: Epilepsy Centers of Excellence
To evaluate the prognostic significance of discharge diagnosis (i.e. epilepsy, psychogenic non-epileptic seizures [PNES], mixed epileptic and non-epileptic seizures, versus nondiagnostic admissions) on mortality following admission to VHA ECoE EMUs.
