Abstract：
BACKGROUND: There is a bi-directional relationship between seizures and substance misuse, i.e., alcohol and recreational drugs. Seizures and substance misuse are recognised separately to influence increased emergency department (ED) admissions and early death. There is however no understanding of the cumulative influence of these matters on repeat ED attenders for seizures esp. as a third are likely to re-attend within the year. This case-control study compares the characteristics of people with substance misuse to those without substance misuse presenting recurrently with seizures to the ED.
METHODS: From a single ED serving a rural population in the Southwest of England, data of all people presenting more than once with a seizure over a 4-year period were examined. The diagnosis of alcohol or drug misuse, deaths, demographic characteristics, and service use were captured.
RESULTS: Of 450 repeat attenders, 95 had a recorded history of alcohol and/or drug problems. Those with substance misuse had double the mortality when adjusted for age and gender compared to those without. They were also more likely to be male, younger in age, have mental health issues, live in socially deprived neighborhoods, not take anti-seizure medications and not have had a specialist review in epilepsy services in the previous year. Nearly a quarter of those with addiction issues died in the 4-year period.
CONCLUSIONS: Service provision for this vulnerable group may need to be modelled along different lines to traditional approaches, such as an assertive outreach community-based service as provided for chronic psychiatric and addiction management.
METHODS: From a single ED serving a rural population in the Southwest of England, data of all people presenting more than once with a seizure over a 4-year period were examined. The diagnosis of alcohol or drug misuse, deaths, demographic characteristics, and service use were captured.
RESULTS: Of 450 repeat attenders, 95 had a recorded history of alcohol and/or drug problems. Those with substance misuse had double the mortality when adjusted for age and gender compared to those without. They were also more likely to be male, younger in age, have mental health issues, live in socially deprived neighborhoods, not take anti-seizure medications and not have had a specialist review in epilepsy services in the previous year. Nearly a quarter of those with addiction issues died in the 4-year period.
CONCLUSIONS: Service provision for this vulnerable group may need to be modelled along different lines to traditional approaches, such as an assertive outreach community-based service as provided for chronic psychiatric and addiction management.
摘要：
背景：癫痫发作和药物滥用之间存在双向关系，即，酒精和娱乐药物。癫痫发作和药物滥用分别被认为会影响急诊科（ED）入院人数增加和早期死亡。但是，尚不了解这些事项对癫痫发作的重复ED参与者的累积影响。三分之一的人可能会在一年内重新出席。这项病例对照研究将滥用药物的人的特征与没有滥用药物的人的特征进行了比较，这些人反复出现癫痫发作。
方法：从为英格兰西南部农村人口提供服务的单个ED，我们检查了所有在4年内出现一次以上癫痫发作的患者的数据.酒精或药物滥用的诊断，死亡,人口特征，和服务使用被捕获。
结果：在450名重复参与者中，95人有酒精和/或药物问题的记录史。如果根据年龄和性别进行调整，那些滥用药物的人的死亡率是没有滥用药物的人的两倍。他们也更有可能是男性，年龄更年轻，有心理健康问题，生活在社会贫困的社区，没有服用抗癫痫药物，并且在前一年没有接受过癫痫服务的专家审查。近四分之一的成瘾问题患者在4年内死亡。
结论：为这一弱势群体提供的服务可能需要按照与传统方法不同的方式进行建模，例如为慢性精神病和成瘾管理提供的自信的外展社区服务。
方法：从为英格兰西南部农村人口提供服务的单个ED，我们检查了所有在4年内出现一次以上癫痫发作的患者的数据.酒精或药物滥用的诊断，死亡,人口特征，和服务使用被捕获。
结果：在450名重复参与者中，95人有酒精和/或药物问题的记录史。如果根据年龄和性别进行调整，那些滥用药物的人的死亡率是没有滥用药物的人的两倍。他们也更有可能是男性，年龄更年轻，有心理健康问题，生活在社会贫困的社区，没有服用抗癫痫药物，并且在前一年没有接受过癫痫服务的专家审查。近四分之一的成瘾问题患者在4年内死亡。
结论：为这一弱势群体提供的服务可能需要按照与传统方法不同的方式进行建模，例如为慢性精神病和成瘾管理提供的自信的外展社区服务。
