Cross sectional study of reporting of epileptic seizures to general practitioners

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Abstract
Objective: Comparison of reporting of recent epileptic seizures by patients to a doctor and anonymously. Design: Cross sectional study of patients with epilepsy by comparison of paired questionnaires. Setting: Rural and urban general practices in Norfolk. Participants: 122 patients aged over 16 years and able to self complete a questionnaire who were recruited by 31 general practitioners when attending for review of their epilepsy. Main outcome measure: The difference in reported occurrence of seizure to general practitioners and in a linked anonymous questionnaire. Results: 18 patients failed to report a seizure in the past year to their general practitioner (uncontrolled epilepsy). 40% (24/60) of people with epilepsy who anonymously reported a seizure in the past year held a driving licence, but only six revealed this to their general practitioner. The unemployment rate was 34%, substantially higher than the 9% in the general population. Measures of anxiety, depression, and stigmatisation were higher in patients with uncontrolled epilepsy. Conclusions: A significant proportion of patients with epilepsy underreport their seizures. Recognition of underreporting is important if patients are to benefit from adequate and appropriate treatment. General practitioners' ability to treat epilepsy is hampered by their role in regulating the rights of epileptic patients to hold a driving licence or access certain occupations. People with epilepsy may be reluctant to report seizures to their general practitioners as epilepsy affects their eligibility for a driving licence and access to various employment and leisure activities In this study about a sixth of patients anonymously reported seizures in the past year which they had not revealed to their general practitioner 40% of patients who anonymously reported a seizure in the past year held a driving licence, but only a quarter of these admitted this to their general practitioner People who had had seizures in the past year were significantly more depressed and felt more stigmatised than those who had not had a seizure Underreporting of seizures has important consequences for treatment, and doctors need to put more effort into explaining this to patients