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Objective: A diagnosis of epilepsy has been associated with adverse cardiovascular events (CEs), but the extent to which antiseizure medications (ASMs) may contribute to this is not well understood. The aim of this study was to compare the risk of adverse CEs associated with ASM in patients with epilepsy (PWE). Methods: A retrospective case–control cohort study was conducted using TriNetX, a global health federated network of anonymized patient records. Patients older than 18 years, with a diagnosis of epilepsy (International Classification of Diseases, 10th Revision code G40) and a medication code of carbamazepine, lamotrigine, or valproate were compared. Patients with cardiovascular disease prior to the diagnosis of epilepsy were excluded. Cohorts were 1:1 propensity score matched (PSM) according to age, sex, ethnicity, hypertension, heart failure, atherosclerotic heart disease, atrial and cardiac arrythmias, diabetes, disorders of lipoprotein metabolism, obesity, schizophrenia and bipolar disorder, medications, and epilepsy classification. The primary outcome was a composite of adverse CEs (ischemic stroke, acute ischemic heart disease, and heart failure) at 10 years. Cox regression analyses were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) following 1:1 PSM. Results: Of 374 950 PWE included; three cohorts were established after PSM: (1) carbamazepine compared to lamotrigine, n = 4722, mean age 37.4 years; (2) valproate compared to lamotrigine, n = 5478, mean age 33.9 years; and (3) valproate compared to carbamazepine, n = 4544, mean age 37.0 years. Carbamazepine and valproate use were associated with significantly higher risk of composite cardiovascular outcome compared to lamotrigine (HR = 1.390, 95% CI = 1.160–1.665 and HR = 1.264, 95% CI = 1.050–1.521, respectively). Valproate was associated with a 10‐year higher risk of all‐cause death than carbamazepine (HR = 1.226, 95% CI = 1.017–1.478), but risk of other events was not significantly different. Significance: Carbamazepine and valproate were associated with increased CE risks compared to lamotrigine. Cardiovascular risk factor monitoring and careful follow‐up should be considered for these patients. [ABSTRACT FROM AUTHOR]

Objective: This study was undertaken to investigate the trends and mechanisms of epilepsy‐related deaths in Scotland, highlighting the proportion that were potentially avoidable. Methods: This was a retrospective observational data‐linkage study of administrative data from 2009–2016. We linked nationwide data encompassing mortality records, hospital admissions, outpatient attendance, antiepileptic drug (AED) prescriptions, and regional primary care attendances. Adults (aged ≥16 years) suffering epilepsy‐related death were identified for study using International Classification of Diseases, 10th Revision coding combined with AED prescriptions. We reported epilepsy‐related mortality rate (MR), age‐specific mortality ratios, multiple cause‐of‐death frequencies, and the proportion of potentially avoidable deaths (identified as those with an underlying cause listed as avoidable by the Office for National Statistics). Results: A total of 1921 epilepsy‐related deaths were identified across Scotland; 1185 (62%) decedents were hospitalized for seizures in the years leading up to death, yet only 518 (27%) were seen in a neurology clinic during the same period. MR remained unchanged over time, ranging from 5.9 to 8.7 per 100 000 Scottish population (95% confidence interval [CI] = −.05 to.66 per 100 000 for annual change in MR). Mortality ratios were significantly increased in young adults aged 16–54 years (2.3, 95% CI = 1.8–2.8), peaking at age 16–24 years (5.3, 95% CI = 1.8–8.8). Sudden unexpected death in epilepsy (SUDEP) constituted 30% of the 553 young adult epilepsy‐related deaths, with several other non‐SUDEP fatal mechanisms identified including aspiration pneumonia, cardiac arrest, AED or narcotic poisoning, drowning, and alcohol dependence. Seventy‐six percent of young adult epilepsy‐related deaths were potentially avoidable. Significance: Epilepsy‐related deaths are a major public health problem in Scotland, given that they are not reducing, people are dying young, and many deaths are potentially avoidable. SUDEP is only one of several important mechanisms by which epilepsy‐related deaths are occurring in young adults. Services may need to be re‐evaluated to improve specialist referral following seizure‐related hospital admissions. [ABSTRACT FROM AUTHOR]

Our objective was to undertake a systematic review ascertaining the accuracy of using administrative healthcare data to identify epilepsy cases. We searched MEDLINE and Embase from 01/01/1975 to 03/07/2018 for studies evaluating the diagnostic accuracy of routinely collected healthcare data in identifying epilepsy cases. Any disease coding system in use since the International Classification of Diseases, Ninth Revision (ICD‐9) was permissible. Two authors independently screened studies, extracted data, and quality‐assessed studies. We assessed positive predictive value (PPV), sensitivity, negative predictive value (NPV), and specificity. The primary analysis was a narrative synthesis of review findings. Thirty studies were included, published between 1989 and 2018. Risks of bias were low, high, and unclear in 4, 14, and 12 studies, respectively. Coding systems included ICD‐9, ICD‐10, and Read Codes, with or without antiepileptic drugs (AEDs). PPVs included ranges of 5.2%–100% (Canada), 32.7%–96.0% (USA), 47.0%–100% (UK), and 37.0%–88.0% (Norway). Sensitivities included ranges of 22.2%–99.7% (Canada), 12.2%–97.3% (USA), and 79.0%–94.0% (UK). Nineteen studies contained at least one algorithm with a PPV >80%. Sixteen studies contained at least one algorithm with a sensitivity >80%. PPV was highest in algorithms consisting of disease codes (ICD‐10 G40‐41, ICD‐9 345) in combination with one or more AEDs. The addition of symptom codes to this (ICD‐10 R56; ICD‐9 780.3, 780.39) lowered PPV. Sensitivity was highest in algorithms consisting of symptom codes with one or more AEDs. Although using AEDs alone achieved high sensitivities, the associated PPVs were low. Most NPVs and specificities were >90%. We conclude that it is reasonable to use administrative data to identify people with epilepsy (PWE) in epidemiological research. Studies prioritizing high PPVs should focus on combining disease codes with AEDs. Studies prioritizing high sensitivities should focus on combining symptom codes with AEDs. We caution against the use of AEDs alone to identify PWE. [ABSTRACT FROM AUTHOR]