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Comment & Response
February 17, 2020

Premature Mortality in Epilepsy—A Reminder for the Untreated Millions—Reply

Author Affiliations
  • 1Cumming School of Medicine, O'Brien Institute for Public Health, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
  • 2Cumming School of Medicine, Hotchkiss Brain Institute, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
  • 3Cumming School of Medicine, O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
JAMA Neurol. 2020;77(4):525-526. doi:10.1001/jamaneurol.2019.5094

In Reply We thank Singh et al for their comments on our article1 demonstrating the benefits of specialist neurology and comprehensive epilepsy care on mortality in patients with epilepsy. We agree that evidence-based care should be driven by data. In a global environment of accelerating health care costs,2 the same methods should be used to demonstrate value for money. However, it may be unsurprising that bespoke care improves outcomes; particularly pertinent for countries offering universal health coverage, the unequivocal demonstration of benefit is an indispensable prerequisite for advocates of the judicious use of finite health care resources. Our study clearly demonstrates said value as referral to a comprehensive epilepsy program (hazard ratio, 0.49; 95% CI, 0.38-0.62) robustly reduces premature mortality,1 a problem that contributes to epilepsy existing as the third most common neurological cause of years lived with disability in the world.3

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