Primary treatment gap among adults with epilepsy: A cross-sectional analysis.

Objective: Despite recommendations to initiate antiseizure medication treatment once the diagnosis of epilepsy is confirmed, a certain proportion of patients with epilepsy who should receive antiseizure medication treatment remain untreated. We aimed to evaluate the rate of and the reasons for the treatment gap in patients with epilepsy who were referred to their first visit in our epilepsy clinic.

Methods: We retrospectively reviewed the computerized database and the medical records of all the patients with epilepsy who had their first visit in our outpatient epilepsy clinic during a 10-year period (2012-2021).

Results: Forty-nine (6.5%) of 746 patients with epilepsy were not treated with antiseizure medications: 27 (3.6%) were nonadherent to treatment, 12 (1.6%) patients were not definitively diagnosed with epilepsy prior to their first epilepsy clinic visit, and in 10 (1.3%) patients antiseizure medication treatment was not recommended. Untreated patients had shorter epilepsy duration compared to patients treated with antiseizure medications (p = .003). At last follow-up, 77% of the untreated patients at first visit were receiving antiseizure medications compared to 97% of the initially treated group, and fewer were receiving antiseizure medication polytherapy (p = .0001).

Significance: Although the rate of treatment gap was relatively low, we believe that it should be further reduced. Efforts may focus on addressing individual causes of nonadherence to antiseizure medication treatment and on promoting knowledge of diagnosis and treatment of epilepsy among healthcare professionals.