What is the effect of delays in access to specialist epilepsy care on patient outcomes? A systematic review and meta-analysis

Abstract

Objective: To determine the association between delays in access to specialist epilepsy care and patient outcomes.

Methods: Three databases were searched using eligibility criteria related to the concepts of timely access, epilepsy, and clinical outcome. Comparative data on patient outcomes by time to treatment was required for inclusion. Studies were selected independently by two researchers who reviewed title/abstract, then full text articles. Data were extracted and risk of bias was evaluated. Results were synthesized in random effects model meta-analyses, and strength of the body of evidence was evaluated. Descriptive analysis was conducted for studies not included in meta-analyses.

Results: Thirty-five studies, reported in 40 papers, were included. The studies investigated impact of delays in diagnosis, commencement of medication, or surgery for children and adults. Early diagnosis and access to specialist neurology care was associated with improvements in seizure status, development, and/or intelligence quotients. Meta-analyses provided low to high certainty evidence of increased odds of improved seizure outcome with early commencement of medication depending on follow-up period and individual risk factors. There was moderate certainty evidence that people with favorable seizure outcomes wait less time (MD 2.8 years, 95% CI 1.7-3.9) for surgery compared to those with unfavorable outcomes.

Significance: This review provides evidence that earlier access to specialist epilepsy care for diagnosis, commencement of medication, and surgery is associated with better patient outcomes.

Keywords: Access to healthcare; Diagnosis; Epilepsy; Medication; Outpatients; Surgery.