Early seizures more than double risk of death , review finds .

Rachel Carter PATIENTS with post-stroke seizures

have more than double the risk of death and poor functional outcomes compared with those without , report researchers in the largest review to date .

The Yale University – led team — which included Australian doctors — said , while post-stroke seizures were known to affect neurological and cognitive outcomes , published data on the association with death and disability had been inconsistent .

Their systematic review and meta-analysis of 71 studies included more than 20,000 patients with post-stroke seizures and 1.17 million without .

Follow-up duration ranged from the point of hospital discharge to 26 years .

Overall , adults who had seizures after the index stroke had a 2.1-fold higher mortality risk and a 2.2-fold increased risk of poor functional outcomes compared with those with a history of stroke alone .

The researchers found that early seizures , but not late seizures , were associated with increased mortality ( 2.4-fold higher risk ).

A stronger association was also seen in patients with ischaemic versus haemorrhagic stroke , although both subtypes were significantly tied to worse outcomes . But while early seizures after ischaemic stroke were linked with increased mortality risk , there was “ no significant association ” for early or late seizures following

haemorrhagic stroke .

In terms of poor functional outcomes , there was a significantly increased risk with early and late seizures ( 2.4-2.7-fold ) and both stroke subtypes ( 2.6-fold for ischaemic and 1.9-fold for haemorrhagic ).

Writing in JAMA Neurology , the authors added : “ Mechanisms of early and late seizures are very different and , not surprisingly , have very different clinical significance .” JAMA Neurol 2023 ; 18 Sep .

Antony Scholefield THE RACGP has developed a pro forma letter for GPs to send to local MPs about the bureaucratic rules for bulk-billed telehealth consultations .

The GP backlash over demands they email or text Services Australia forms to patients who verbally consent to bulk-billing in telehealth appointments has spilt into the mainstream , with independent MP and paediatric neurologist Dr Monique Ryan declaring the rules “ crazy ”.

Last month , Minister for Health and Aged Care Mark Butler said his department was drawing up options to address GPs ’ concerns , including possible changes to the Health Insurance Act 1973 . “ My department has advised me that , until these changes are made , there are no plans to pursue any broad punitive actions on this issue unless it relates to fraudulent claims against Medicare ,” Mr Butler stressed .

The RACGP letter warned that the rules “ will further contribute to declining rates of bulk-billing ”, calling them “ a 20th century approach to 21st century healthcare that is inefficient and cumbersome ”.

“ I am urging you to raise this issue with the Health Minister to ensure a quick resolution to this issue and ensure the people … can continue to access the bulkbilled telehealth services that are essential to their health ,” it said .

Dr Ryan , the member for Kooyong , Victoria , said : “ People are missing out on bulkbilled sessions because of a poorly thought through regulation that requires patients to provide written consent for telehealth appointments .”

She added that patients being punished included the elderly , those in rural areas , migrants or those in other groups less likely to have access to email or mobile phones .