Audit of healthcare provision for UK prisoners with suspected epilepsy.
OBJECTIVE
To describe the prevalence and nature of epileptic seizure disorders in a typical UK prison and compare the care offered to prisoners to the recommendations of the National Institute for Clinical Excellence (NICE).


METHODS
Over a 14-month period, all prisoners identified as having epilepsy were registered by prison primary healthcare services at a category 'C' prison holding 640 male adults. Prison and National Health Service health records were reviewed, prisoners were re-assessed by members of a specialist secondary care service based in the local general hospital NHS.


RESULTS
Twenty-six prisoners were thought to have epilepsy. 61.5% of diagnoses had not been made by epilepsy specialists, 73.1% had uncontrolled seizures, only 19.2% had had computed tomography, none magnetic resonance imaging. At review, 30.8% of prisoners were thought to require neuroimaging, 19.2% cardiac investigations. The diagnosis of epilepsy was confirmed in only 57.9% of those prisoners considered to have the condition by prison healthcare services. 53.8% of those prisoners confirmed as having epilepsy had not had a medical review in the past 12 months; 63.2% required a change in their antiepileptic drugs (AEDs).


CONCLUSIONS
Although the prevalence of epilepsy in this prison population appeared high at first sight, a critical review of the diagnoses reduced the difference to the prevalence of epilepsy in the population at large. Fewer prisoners than expected achieved seizure control. Collaboration with specialist epilepsy services was poor. There were significant discrepancies between the healthcare provision in prison and the NICE epilepsy guidelines.
Tittensor
P
P
Mid Staffordshire General Hospitals NHS Trust, Department of Neurology, Weston Road, Stafford, Staffordshire ST16 3SA, United Kingdom. phil.tittensor@msgh-tr.wmids.nhs.uk
Collins
J
J
Grünewald
R A
RA
Reuber
M
M
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D003415:Crime / Q000706:statistics & numerical data; D003625:Data Collection; D003695:Delivery of Health Care / Q000592:standards* / Q000706:statistics & numerical data*; D004827:Epilepsy / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D005006:Ethnicity; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D008485:Medical Audit / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000150:complications / Q000523:psychology; D008875:Middle Aged; D011329:Prisoners / Q000706:statistics & numerical data*; D012640:Seizures / Q000188:drug therapy / Q000628:therapy; D019966:Substance-Related Disorders / Q000150:complications; D006113:United Kingdom
D000927:Anticonvulsants; D013287:Illicit Drugs