Socioeconomic and occupational risk factors for epilepsy: a nationwide epidemiological study in Sweden

Danish population based study of familial epilepsy and childhood cancer

Results from studies investigating the association between maternal or child epilepsy, use of anticonvulsants in pregnancy, and childhood cancer are inconsistent and at times contradictory. Linking Danish national databases, we obtained epilepsy and childhood cancer diagnoses, and anticonvulsant use data. We estimated adjusted odds ratios of all or specific childhood cancers in relation to maternal or child epilepsy and anticonvulsant therapies using conditional logistic regression. Maternal epilepsy was positively associated with all childhood cancers in offspring, specifically, with acute lymphoblastic leukemia (Odds Ratio (OR) = 1.68, 95% Confidence Interval (CI) = 1.16, 2.43) and Wilms tumor (OR = 2.13, 95% CI = 0.97, 4.68). When considering maternal ever (lifetime) ingestion of anticonvulsants, a positive association was found with all cancers (OR = 1.14, 95% CI = 1.00, 1.30), and central nervous system tumors (CNS) (OR = 1.36, 95% CI = 1.04, 1.76) as well as neuroblastoma (OR = 1.76, 95% CI = 1.06, 2.90) among offspring. Maternal anticonvulsant use before or during the index pregnancy was related to CNS tumors in offspring (OR = 1.99, 95% CI = 0.99, 4.00).

Socioeconomic status and healthcare utilization disparities among children with epilepsy in the United States: Results from a nationally representative sample

Epilepsy affects 1% of the US population. Healthcare disparities are well-studied among adults with epilepsy but less so among children. We examined whether children with epilepsy (1) have lower income than or (2) utilize the emergency department (ED) differently from children without epilepsy, and (3) if income moderates ED utilization. Data from the 2016-2019 National Survey of Children's Health were used to identify children with active "epilepsy or seizure disorder". Children with versus without epilepsy were compared. Income and ED visits were modeled with logistic and Poisson regressions. This analysis included 131,326 children; 835 were diagnosed with epilepsy. Estimated population prevalence of epilepsy was 0.6%. Children from higher-income-households were less likely to have epilepsy (aOR: 0.7). Children with epilepsy were more likely to visit EDs (aOR = 10.2), see healthcare professionals (aOR: 2.7), and receive care from specialists (aOR: 10.3). Income moderated the relationship between having epilepsy and ED visits. 7.7% of children with epilepsy did not receive needed healthcare. Some barriers were acquiring appointments (aOR: 3.9) and transportation (aOR: 4.7). In conclusion, children with epilepsy were more likely than children without epilepsy to live in lower-income-households, visit EDs, see healthcare professionals, and not receive needed healthcare. Barrier-specific policy interventions may improve medical access for children with epilepsy.

Occupational risk factors for multiple sclerosis: a systematic review with meta-analysis

Objective

We decided to conduct the first systematic review with meta-analysis to provide the highest level of up-to-date evidence on the occupational risk factors for Multiple Sclerosis.

Methods

A systematic, comprehensive literature search was performed in four electronic academic databases. We included any case-control study that enrolled working-age subjects and compared the proportion of MS cases with controls who were not exposed to an occupational risk factor. The primary outcome was the occurrence of MS. The quality assessment was performed with the Critical Appraisal Checklist for Case Control Studies, developed, and validated by the Joanna Briggs Institute. All the selection process was also carried out by two independent and previously trained researchers.

Results

Overall, the total sample included 19,004 people with MS and 4,164,162 controls. Agricultural workers (OR = 1.44, 95% CI 1.13-1.83), offshore workers (OR = 3.56, 95% CI 2.74-4.61), and hairdressers (OR = 8.25, 95% CI 1.02-66.52) were associated with a higher probability of being diagnosed with MS. In parallel, workers exposed to toxic fumes from oil wells (OR = 16.80, 95% CI 8.33-33.90), low-frequency magnetic fields (OR = 1.71, 95% CI 1.03-2.72), and pesticides (OR = 3.17, 95% CI = 2.53-3.99) also had an increased likelihood of having MS.

Conclusion

Our study has the potential to influence more assertive public policies. Nevertheless, future studies on how the occupational setting may contribute to the incidence of MS are highly recommended.

Systematic review registration

The protocol was registered in the international prospective register of systematic reviews (PROSPERO- CRD42023443257).

[Quality of life in people with epilepsy: beyond seizures]

INTRODUCTION

People with epilepsy have multiple barriers to recovery: access to medication, comorbidities and social problems. The aim of this study is to determine psychosocial factors associated with the perception of quality of life in people with epilepsy in the department of Bolivar, Colombia, in the year 2022.

SUBJECTS AND METHODS

Descriptive cross-sectional study, correlational, with a sample stratified with a margin of error of 5%, according to the calculation of the average number of people treated for epilepsy in Colombia. 174 people participated with a mean age of 39.55 years, 50% men and 50% women. An instrument was used that determined sociodemographic data, quality of life (Quality of Life in Epilepsy Inventory-10), adherence to treatment (Morisky test), self-care behaviors, perception of disability and provision of health services. All the instruments showed a Cronbach's Alpha greater than 0.686 for this population.

RESULTS

21.3% had focal onset epilepsy; 41% with generalized epilepsy without focal onset; 18.4% with focal onset that generalized; 12.6% did not know their type of epilepsy; and 6.3% reported that they were not informed about their type of epilepsy. Based on correlations, an explanatory model of quality of life is shown, with pillars such as drug adherence, self-care habits, time without seizures, and perceived disability.

CONCLUSIONS

Although time without seizures is a fundamental element in recovery, living conditions and mental health problems are key elements to achieve a better quality of life in epilepsy.

Danish Population Based Study of Familial Epilepsy and Childhood Cancer

Objective

Results from studies investigating the association between maternal or child epilepsy, use of anticonvulsants in pregnancy, and childhood cancer are inconsistent and at times contradictory.

Methods

Linking Danish national databases, we obtained epilepsy and childhood cancer diagnoses, and anticonvulsant use data. We estimated adjusted odds ratios of all or specific childhood cancers in relation to maternal or child epilepsy and anticonvulsant therapies using conditional logistic regression.

Results

Maternal epilepsy was positively associated with all childhood cancers in offspring, specifically, with acute lymphoblastic leukemia (Odds Ratio (OR) = 1.68, 95% Confidence Interval (CI) = 1.16, 2.43) and Wilms tumor (OR = 2.13, 95%CI = 0.97, 4.68). When considering maternal ever (lifetime) ingestion of anticonvulsants, a positive association was found with all cancers (OR = 1.15, 95%CI = 1.01, 1.31), and central nervous system tumors (OR = 1.32, 95%CI = 1.03, 1.69) as well as neuroblastoma (OR = 2.05, 95%CI = 1.29, 3.28) among offspring. Maternal anticonvulsant use before or during the index pregnancy was related to CNS tumors in offspring (OR = 1.78, 95%CI = 0.99, 3.21), however the confidence interval included the null.

Significance

Maternal use of certain anticonvulsant medications may be a risk factor for cancer in offspring. Medical providers may need to consider what type of treatments to prescribe to pregnant mothers with epilepsy.

The burden of epilepsy and unmet need in people with focal seizures

BACKGROUND

Epilepsy is one of the most common neurological conditions worldwide. As a chronic condition, epilepsy imposes a significant burden on people with epilepsy and society. We aimed to assess the burden and unmet need of individuals with epilepsy and their caregivers, focusing on focal seizures, the main type of seizure in adults and children.

METHODS

A targeted evidence review of the burden of epilepsy, focusing on focal seizures, was conducted to identify articles reporting: epidemiology, mortality, morbidity, quality of life (QoL), and costs.

RESULTS

Focal seizures affect up to ∼61% of people with epilepsy. They are associated with an increased risk of injury and premature death than the general population. People with epilepsy also have high comorbidity, particularly depression, anxiety, and cognitive impairments. Higher seizure frequency, adverse treatment events, and employment concerns reduce QoL. A reduction in caregivers' QoL is also often reported. Epilepsy requires long-term treatment accounting for high individual costs. Hospitalizations and antiseizure medications (ASMs) are the leading cost drivers of inpatient management and indirect costs with high unemployment rates, particularly in drug-resistant populations. Despite the advent of new treatments, a high unmet need remains unaddressed; approximately 40% of people with epilepsy are drug-resistant, further increasing the risks associated with epilepsy.

CONCLUSIONS

Our findings highlight a substantial burden of illness and unmet needs in individuals with focal seizures, especially those with drug-resistant epilepsy. Suboptimal treatment options negatively impact QoL and, consequently, a sizeable economic burden indicating the need for new treatments and prioritizing this condition.

Educational inequalities in epilepsy mortality in the Baltic countries and Finland in 2000-2015

Little is known about socioeconomic differences in epilepsy mortality. This study examined educational inequalities in epilepsy mortality in the general population in the Baltic countries and Finland in 2000-2015. Education-specific mortality estimates for individuals aged 30-74 in Estonia, Latvia and Lithuania were obtained from census-linked mortality datasets while data for Finland came from the register-based population and death data file of Statistics Finland. Trends and educational inequalities in epilepsy mortality were assessed using age-standardised mortality rates (ASMRs) per 100,000 person years and age-adjusted mortality rate ratios (RRs) calculated using Poisson regression. ASMRs were higher in men than women in all countries. ASMRs reduced in 2000-2015 among all men and women except for Finnish women. Among men, an inverse educational gradient in epilepsy mortality in 2000-2007 widened in 2008-2015 with ASMRs falling among high and mid educated men in all countries but increasing among low educated men in three countries. An inverse educational gradient in female mortality remained in all countries throughout 2000-2015. Although epilepsy mortality fell in the Baltic countries and Finland (men only) in 2000-2015, this masked a clear inverse educational gradient in mortality that became steeper across the period.

Neurological symptoms and disorders following electrical injury: A register-based matched cohort study

Introduction

Electric shocks may have neurological consequences for the victims. Although the literature on the neurological consequences of electric shocks is limited by retrospective designs, case studies and studies of selected patient groups, previous research provides some evidence of a link between electric shocks, and diseases and symptoms of the central nervous system (CNS)(e.g. epilepsy, migraine and vertigo) and the peripheral nervous system (PNS)(e.g. loss of sensation, neuropathy and muscle weakness). This study aims to employ a register-based, matched cohort study, to investigate whether individuals demonstrate a greater risk of neurological diseases and symptoms of the CNS or PNS in the years following an electrical injury.

Materials and methods

We identified 14,112 electrical injuries over a period of 19 years in two Danish registries, and matched these with three different groups of persons in a prospective matched cohort study: (1) patients with dislocation/sprain injuries, (2) patients with eye injuries and (3) persons employed in the same occupation. Year of injury, sex and age were used as matching variables. The outcomes we identified comprised neurological disorders and central or peripheral nervous system symptoms that covered a range of diagnoses in the Danish National Patient Register. The associations were analysed using conditional logistic regression for a range of time periods (six months to five years) and conditional Cox regression for analyses of the complete follow-up period (up to 20 years).

Results

For victims of electric shock, the CNS sequelae we identified included an increased risk of epilepsy, convulsions, abnormal involuntary movements, headache, migraine and vertigo. We also identified an uncertain, increased risk of spinal muscular atrophy and dystonia, whereas we identified no increased risk of Parkinson’s disease, essential tremor, multiple sclerosis or other degenerative diseases of the nervous system. For victims of electric shock, the PNS sequelae we identified included an increased risk of disturbances of skin sensation, mononeuropathy in the arm or leg and nerve root and plexus disorders. We also identified an uncertain, increased risk of facial nerve disorders, other mononeuropathy, and polyneuropathy.

Conclusion

Our results confirm that electrical injuries increase the risk of several neurological diseases and symptoms of the CNS or PNS in the years following the injury. Most often the diseases and symptoms are diagnosed within the first six months of the injury, but delayed onset of up to 5 years cannot be ruled out for some symptoms and diagnoses. Some of the conditions were rare in our population, which limited our ability to identify associations, and this warrants cautious interpretation. Therefore, further studies are needed to confirm our findings, as are studies that examine the mechanisms underlying these associations.

The quality of life among Sudanese patients with epilepsy, Khartoum, Sudan

INTRODUCTION

This is the first study done in the National Center for Neurological Sciences, Khartoum State, to assess the quality of life among more than 100 Sudanese epileptic patients, in the period from September to December 2020.

METHODOLOGY

This is a descriptive cross-sectional study; data were collected using an interview-based semi-structured structured questionnaire and this questionnaire was modified from the SF-36 model.

RESULTS

Most of the patients were from urban areas and origin (60.2%), most of which were housewives; the majority of the patients were single and from low socioeconomic status, history of the disease was less than 3 years for most of the cases covered in this study, most of the cases were classified as generalized tonic clonic epilepsy, and normal EEG findings and normal MRI brain were found in 75.7% and 78.6%, respectively. Most patients mentioned that they experienced no attacks during the last month. Regarding mental health, 47.6% experienced symptoms of depression, and 75.7% had memory problems. In terms of physical health, 51.5% felt energetic all of the time, 9.7% experienced remarkable sleep disturbance, most of the patients are not driving nor have established hobbies during leisure time. 63.1% of the participants do not have health problems; 32% mentioned that they would feel stigmatized if an attack takes place in public. Commonest medication prescribed was carbamazepine, out of which 73.8% are fully compliant with their medication. 95.1% are not worried about long term use of medication.

CONCLUSION

Lower levels of education and manual labor are associated with poor quality of life. Epilepsy has an adverse impact on social life. There is a global decrease in cognitive function, and most of the patients are not worried about the side effects and duration of the medication usage.

Frequency and predictors of 30-day readmission after an index hospitalization for generalized convulsive status epilepticus: A nationwide study

OBJECTIVE

The objective of the study was to assess the frequency and factors associated with all-cause 30-day readmission among patients hospitalized with generalized convulsive status epilepticus (GCSE) in a nationwide sample in the United States.

METHODS

We used The 2014 Nationwide Readmission Database (NRD) as the data source. We included adults (age ≥18 years) with a primary discharge diagnosis of GCSE, identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 345.3. We excluded patients who died during hospitalization and those who had missing information on the length of stay (LOS). We also excluded those discharged in December 2014. We computed the overall 30-day readmission rate and compared prespecified groups by their 30-day readmission status. We applied a multiple logistic regression analysis to identify independent predictors of all-cause 30-day readmission adjusting for potential confounders.

RESULTS

Among 14,562 (weighted 31,062) adults discharged with a diagnosis of GCSE, 2520 (17.3%) were readmitted within 30 days. In multivariate analysis, patients with comorbid conditions (odds ratio (OR) for Charlson Comorbidities Index (CCI) = 1 and ≥2 was 1.12, 95% confidence interval (CI): 1.0-1.36 and 1.32, 95% CI: 1.17-1.48, respectively), LOS >6 days (OR: 1.42; 95% CI: 1.05-192), discharged against medical advice (OR: 1.45; 95% CI: 1.09-1.92), or discharged to a short-term hospital (OR: 1.39; 95% CI: 1.0-1.88), had higher odds of 30-day readmission, while there was an inverse association for those aged ≥45 years or with high income. Seizures were the most common cause associated with readmission, followed by sepsis and cerebrovascular diseases, respectively.

SIGNIFICANCE

Little is known about the frequency and predictors of early readmission after GCSE. This study showed that more than one in six patients with GCSE was readmitted within 30 days after discharge. More considerable attention to high-risk subgroups may identify opportunities to ameliorate the clinical outcome and lessen the economic burden of early readmission after GCSE.

Socioeconomic inequalities in hospitalizations for chronic ambulatory care sensitive conditions: a systematic review of peer-reviewed literature, 1990-2018

BACKGROUND

Hospitalizations for chronic ambulatory care sensitive conditions are an important indicator of health system equity and performance. Chronic ambulatory care sensitive conditions refer to chronic diseases that can be managed in primary care settings, including angina, asthma, and diabetes, with hospitalizations for these conditions considered potentially avoidable with adequate primary care interventions. Socioeconomic inequities in the risk of hospitalization have been observed in several health systems globally. While there are multiple studies examining the association between socioeconomic status and hospitalizations for chronic ambulatory care sensitive conditions, these studies have not been systematically reviewed. The objective of this study is to systematically identify and describe socioeconomic inequalities in hospitalizations for chronic ambulatory care sensitive conditions amongst adult populations in economically developed countries reported in high-quality observational studies published in the peer-reviewed literature.

METHODS

Peer-reviewed literature was searched in six health and social science databases: MEDLINE, EMBASE, PsycInfo, CINAHL, ASSIA, and IBSS using search terms for hospitalization, socioeconomic status, and chronic ambulatory care sensitive conditions. Study titles and abstracts were first screened followed by full-text review according to the following eligibility criteria: 1) Study outcome is hospitalization for selected chronic ambulatory care sensitive conditions; 2) Primary exposure is individual- or area-level socioeconomic status; 3) Study population has a mean age ± 1 SD < 75 years of age; 4) Study setting is economically developed countries; and 5) Study type is observational. Relevant data was then extracted, and studies were critically appraised using appropriate tools from The Joanna Briggs Institute. Results were narratively synthesized according to socioeconomic constructs and type of adjustment (minimally versus fully adjusted).

RESULTS

Of the 15,857 unique peer-reviewed studies identified, 31 studies met the eligibility criteria and were of sufficient quality for inclusion. Socioeconomic constructs and hospitalization outcomes varied across studies. However, despite this heterogeneity, a robust and consistent association between lower levels of socioeconomic status and higher risk of hospitalizations for chronic ambulatory care sensitive conditions was observed.

CONCLUSIONS

This systematic review is the first to comprehensively identify and analyze literature on the relationship between SES and hospitalizations for chronic ambulatory care sensitive conditions, considering both aggregate and condition-specific outcomes that are common to several international health systems. The evidence consistently demonstrates that lower socioeconomic status is a risk factor for hospitalization across global settings. Effective health and social interventions are needed to reduce these inequities and ensure fair and adequate care across socioeconomic groups.

TRIAL REGISTRATION

PROSPERO CRD42018088727.

High-resolution mapping of epilepsy prevalence, ambulance use, and socioeconomic deprivation in an urban area of Sweden

OBJECTIVE

Geographic differences in epilepsy prevalence between areas of different socioeconomic standing have been demonstrated in the United Kingdom, but knowledge from other health care systems is scarce. Our objective was to compare epilepsy prevalence and emergency medical service (EMS) assignments for seizures in areas of different socioeconomic standings in the urban area of Gothenburg.

METHODS

Register-based study in Gothenburg (population 690 000), the second largest city in Sweden. Epilepsy cases were identified in the comprehensive national patient register in 2014-2015. EMS assignments were identified in the EMS dispatch system in 2013-2018. Socioeconomic variables were mean income and proportion of welfare recipients.

RESULTS

Significant correlations were seen between epilepsy prevalence and the proportion of welfare recipients (r = .49, P = .0014) and annual income per capita (r = -.42, P = .0071). There were 7907 assignments for seizures during the study years. GPS-based analysis showed that most assignments occurred in the city center. In addition, several high-density areas correlated with areas with a high proportion of inhabitants receiving welfare. Correlation analysis showed significant associations between the number of EMS assignments per capita and the proportion of welfare recipients (r = .31, P < .0001) and income (r = -.19, P < .0001). When comparing representative areas, a greater proportion of assignments was given the highest priority in high status areas compared to low status areas, both by the dispatch center and EMS clinicians on scene.

SIGNIFICANCE

Our findings that epilepsy prevalence and seizure frequency differ with socioeconomic status on a microgeographic level considerably strengthen the generalizability of previous observations across different health care systems. Differences in priority may reflect health utilization behavior or access to neurologic care.

Descriptive epidemiology: prevalence, incidence, sociodemographic factors, socioeconomic domains, and quality of life of epilepsy: an update and systematic review

INTRODUCTION

The purpose of this study was to investigate the contributions of quality of life (QOL), sociodemographic factors (age, sex, etc.), residential areas, general attitudes toward epilepsy, socioeconomic domains, prevalence and incidence in epileptic patients from Iran.

MATERIAL AND METHODS

A systematic literature search was conducted, including database searches in PubMed, Medline, Embase, ScienceDirect, Scopus, ISC, Health, Web of Science, and the Cochrane Library Database of relevant articles, personal files and systematic reviews to identify studies examining risk factors in epilepsy.

RESULTS

This review article shows that certain socio-demographic and socio-economic factors, geographic variation in epidemiologic patterns of epilepsy as well as clinical factors may be crucial in determining QOL in epilepsy patients and provides further evidence supporting the validity of the scale in QOL based on consideration of different target groups in different areas.

CONCLUSIONS

Prevalence of epilepsy appears to be correlated with socioeconomic status in the lower socioeconomic groups. Also demographic characteristics, socio-economic factors and clinical presentation are linked to different QOL of these patients among nations. The educational program has a beneficial effect on self-management behaviors in patients with epilepsy. More work needs to be done to improve tools that help to evaluate efficiently the health-related quality of life of people with epilepsy.

Electroconvulsive therapy and subsequent epilepsy in patients with affective disorders: A register-based Danish cohort study

OBJECTIVE

It has been suggested that Electroconvulsive Therapy (ECT) might increase the risk of epilepsy but the few patient studies with retrospective data from medical records do not support the hypothesis. The aim of this study was to examine the relationship between ECT and subsequent incident epilepsy in patients with affective disorder. We also explored whether any association varied with number of ECTs and time since last treatment.

METHODS

All 169,457 patients with first hospital contact for an affective disorder between January 2005 and December 2015 were identified in the Danish National Patient Registry and followed for incident epilepsy from January 2005 until November 2016. The association between ECT and epilepsy was examined using Cox proportional hazard regression with adjustment for gender, age, educational level, comorbid schizophrenia, previous stroke and antidepressant and antipsychotic medication use.

RESULTS

A total of 5875 patients had at least one ECT and 1873 patients developed epilepsy (Incidence rate: 213 pr. 100,000 person years) during the follow-up of mean 5 years. In patients below age 40 years, ECT was associated with a higher rate of epilepsy after adjustment for covariables (Hazard Ratio (HR) = 1.84; 95% Confidence Intervals (CI) = [1.24-2.74]). In patients aged 41-60 years ECT was not associated with epilepsy, while for those above 60 treated with ECT the rate was lower (HR = 0.57; (95% CI = [0.37-0.89]).

CONCLUSION

In patients with affective disorders, we found a weak positive association between ECT and subsequent diagnosis of epilepsy in those younger than 40 years, and a weak negative association in patients older than 60 years. The associations might be subject to residual confounding from risk factors related to ECT.

Occupational class differences in diagnostic-specific sickness absence: a register-based study in the Finnish population, 2005-2014

BACKGROUND

Musculoskeletal diseases and mental disorders are major causes of long-term sickness absence in Western countries. Although sickness absence is generally more common in lower occupational classes, little is known about class differences in diagnostic-specific absence over time. Focusing on Finland during 2005-2014, we therefore set out to examine the magnitude of and changes in absolute and relative occupational class differences in long-term sickness absence due to major diagnostic causes.

METHODS

A 70-per-cent random sample of Finns aged 25-64 linked to register data on medically certified sickness absence (of over 10 working days) in 2005-2014 was retrieved from the Social Insurance Institution of Finland. Information on occupational class was obtained from Statistics Finland and linked to the data. The study focused on female (n = 658,148-694,142) and male (n = 604,715-642,922) upper and lower non-manual employees and manual workers. The age-standardised prevalence, the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) were calculated for each study year to facilitate examination of the class differences.

RESULTS

The prevalence of each diagnostic cause of sickness absence declined during the study period, the most common causes being musculoskeletal diseases, mental disorders and injuries. The prevalence of other causes under scrutiny was less than 1 % annually. By far the largest absolute and relative differences were in musculoskeletal diseases among both women and men. Moreover, the absolute differences in both genders (p < 0.0001) and the relative differences in men (p < 0.0001) narrowed over time as the prevalence declined most among manual workers. Both genders showed modest and stable occupational class differences in mental disorders. In the case of injuries, no major changes occurred in absolute differences but relative differences narrowed over time in men (p < 0.0001) due to a strong decline in prevalence among manual workers. Class differences in the other studied diagnostic causes under scrutiny appeared negligible.

CONCLUSIONS

By far the largest occupational class differences in long-term sickness absence concerned musculoskeletal diseases, followed by injuries. The results highlight potential targets for preventive measures aimed at reducing sickness absence and narrowing class differences in the future.

Influence of Occupational Status on the Quality of Life of Chinese Adult Patients with Epilepsy

Background:

Epilepsy is one of the most common serious neurological disorders. The present study aimed to investigate the influence of occupational status on the quality of life of Chinese adult patients with epilepsy.

Methods:

This study surveyed 819 subjects clinically diagnosed with epilepsy for more than 1 year in 11 hospitals in Beijing; 586 were employed (71.55%). All subjects completed the case report form with inquiries on demographic data, social factors, and illness. The patients’ quality of life was assessed using the quality of life in patients with epilepsy-31 items (QOLIE-31) questionnaire.

Results:

The QOLIE-31 score in the employed group was significantly higher than that in the unemployed group. Furthermore, the scores in all the sections (overall quality of life, energy/fatigue, emotional well-being, seizure worry, cognition, social function, and medication effects) of the employed group were higher than those of the unemployed group. Both the employed and unemployed groups achieved the highest difference in social function. The QOLIE-31 score of students was higher than those of farmers and workers. Both the students and workers scored higher in the quality of life compared with the adult peasants living with epilepsy. The students and farmers showed significant differences in QOLIE-31 score, cognition, emotional well-being, overall quality of life, energy/fatigue, and social function. In contrast, no significant difference was noted in seizure worry and medication effects across the three different kinds of occupation.

Conclusion:

Occupational status might affect the quality of life of Chinese adult patients with epilepsy, and social function is the most important contributing factor.

Epilepsy in India I: Epidemiology and public health

Of the 70 million persons with epilepsy (PWE) worldwide, nearly 12 million PWE are expected to reside in India; which contributes to nearly one-sixth of the global burden. This paper (first of the two part series) provides an in-depth understanding of the epidemiological aspects of epilepsy in India for developing effective public health prevention and control programs. The overall prevalence (3.0-11.9 per 1,000 population) and incidence (0.2-0.6 per 1,000 population per year) data from recent studies in India on general population are comparable to the rates of high-income countries (HICs) despite marked variations in population characteristics and study methodologies. There is a differential distribution of epilepsy among various sociodemographic and economic groups with higher rates reported for the male gender, rural population, and low socioeconomic status. A changing pattern in the age-specific occurrence of epilepsy with preponderance towards the older age group is noticed due to sociodemographic and epidemiological transition. Neuroinfections, neurocysticercosis (NCC), and neurotrauma along with birth injuries have emerged as major risk factors for secondary epilepsy. Despite its varied etiology (unknown and known), majority of the epilepsy are manageable in nature. This paper emphasizes the need for focused and targeted programs based on a life-course perspective and calls for a stronger public health approach based on equity for prevention, control, and management of epilepsy in India.

Prevalence and Incidence of Epilepsy in an Elderly and Low-Income Population in the United States

Background and Purpose

The purpose of this study was to estimate the incidence and prevalence of epilepsy among an elderly and poor population in the United States.

Methods

Arizona Medicaid claims data from January 1, 2008 to December 31, 2010 were used for this analysis. Subjects who were aged ≥65 years and were continuously enrolled in any Arizona Medicaid health plans (eligible to patients with low income) for ≥12 months between January 1, 2008 and December 31, 2009 were considered eligible for inclusion in the study cohort. In addition to meeting the aforementioned criteria, incident and prevalent cases must have had epilepsy-related healthcare claims. Furthermore, incident cases were required to have a 1-year "clean" period immediately preceding the index date. Negative binomial and logistic regression models were used to assess the factors associated with epilepsy incidence and prevalence.

Results

The estimated epilepsy incidence and prevalence for this population in 2009 were 7.9 and 19.3 per 1,000 person-years, respectively. The incidence and prevalence rates were significantly higher for patients with comorbid conditions that were potential risk factors for epilepsy and were of younger age than for their non-comorbid and older counterparts (p<0.05). The prevalence rates were significantly higher for non-Hispanic Blacks and male beneficiaries than for non-Hispanic Whites and female beneficiaries, respectively (p<0.05).

Conclusions

This patient population had higher epilepsy incidence and prevalence compared with the general US population. These differences may be at least in part attributable to their low socioeconomic status.

Socioeconomic deprivation is an independent risk factor for behavioral problems in children with epilepsy

AIM

The aim of this study was to examine whether socioeconomic deprivation in children with epilepsy (CWE) increases risk for behavioral problems independent of seizure factors.

METHODS

A cross-sectional study was done in which parents of children attending a specialist epilepsy clinic were invited to complete a child behavior checklist (CBCL) questionnaire about their child. Medical and sociodemographic data on CWE were obtained through their pediatric neurologists. Home postal code was used to obtain quintiles of Scottish Index of Multiple Deprivation 2012 (SIMD2012) scores for individuals. Lower (1-3) quintiles correspond to higher socioeconomic deprivation. Regression analysis was used to investigate whether a lower quintile was an independent risk factor for scores >63 (significant behavioral problem).

RESULTS

Parents of 87 children (42 male, mean age of 10.5years) were enrolled. Fifty-nine percent had total scores >63. A higher proportion of children from quintiles 1-3 compared to those from quintiles 4-5 had externalizing (49% vs. 25%, p=0.02) and total (54% vs. 30%, p=0.02) scores >63. Adjusted OR of quintiles 1-3 vs. 4-5 for scores >63=14.8, 95% CI=3.0, 68.0. Fewer children with scores >63 and from quintiles 1-3 were known to the child and adolescent mental health service (CAMHS) compared to those in quintiles 4-5 (p=0.01).

INTERPRETATION

Socioeconomic deprivation was an independent risk factor for behavioral problems in CWE. Children with epilepsy and behavioral problems who lived in socioeconomically deprived areas received less help.

Epilepsy and deprivation, a data linkage study

OBJECTIVE

To investigate whether the link between epilepsy and deprivation is due to factors associated with deprivation (social causation) or factors associated with a diagnosis of epilepsy (social drift).

METHODS

We reviewed electronic primary health care records from 2004 to 2010, identifying prevalent and incident cases of epilepsy and recording linked deprivation scores. Logistic and Poisson regression models were used to calculate odds ratios and incidence rate ratios. The change in deprivation was measured 10 years after the initial diagnosis of epilepsy for a cohort of people.

RESULTS

Between 2004 and 2010, 8.1 million patient-years of records were reviewed. Epilepsy prevalence and incidence were significantly associated with deprivation. Epilepsy prevalence ranged from 1.13% (1.07-1.19%) in the most deprived decile to 0.49% (0.45-0.53%) in the least deprived decile (adjusted odds ratio 0.92, p < 0.001). Epilepsy incidence ranged from 40/100,000 per year in the most deprived decile to 19/100,000 per year in the least deprived decile (adjusted incidence rate ratio 0.94, p < 0.001). There was no statistically significant change in deprivation index decile 10 years after a new diagnosis of epilepsy (mean difference -0.04, p = 0.85).

SIGNIFICANCE

Epilepsy prevalence and incidence are strongly associated with deprivation; the deprivation score remains unchanged 10 years after a diagnosis of epilepsy. These findings suggest that increasing rates of epilepsy in deprived areas are more likely explained by social causation than by social drift. The nature of the association between incident epilepsy and social deprivation needs further exploration.

Prevalence and risk factors for canine epilepsy of unknown origin in the UK

Epidemiological evaluation of canine epilepsy is an under-researched area. The objectives of this study were to estimate prevalence and investigate risk factors for epilepsy of unknown origin (EUO) among dogs attending primary veterinary practices in the UK. The clinical data analysed spanned a two-year period and included all dogs attending 92 primary veterinary clinics participating in the VetCompass project. Five hundred and thirty-nine EUO cases were identified giving a prevalence of 0.62% (95% CI 0.57% to 0.67%). Males were over 1.5 times as likely to have EUO compared with females (95% CI 1.44 to 2.06; P < 0.001). Of purebred dogs, the border terrier had 2.70 (95% CI 1.57 to 4.62; P < 0.001) and the German shepherd dog had 1.90 (95% CI 1.28 to 2.80; P=0.001) times increased odds of EUO compared with crossbred dogs. In addition, the West Highland white terrier had reduced odds (OR 0.23; 95% CI 0.08 to 0.62; P=0.004) of EUO compared with crossbred dogs (likelihood ratio test P < 0.0001). No association was found with neuter status, colour or weight. The current study highlights the clinical importance of epilepsy as a canine disorder in the UK. Increased awareness of sex and breed predispositions may assist clinicians with diagnosis. Further research is merited to evaluate the specific breed associations identified.

The descriptive epidemiology of epilepsy-a review

Epilepsy is a chronic disease experienced by millions and a cause of substantial morbidity and mortality. This review summarizes prevalence and incidence studies of epilepsy that provided a clear definition of epilepsy and could be age-adjusted: requirements if comparisons across studies are to be made. Although few exceptions, age-adjusted prevalence estimates from record-based studies (2.7-17.6 per 1000), are lower than those from door-to-door surveys (2.2-41.0 per 1000). Age-adjusted incidence ranged from 16 to 51 per 100,000, with one exception in Chile, where incidence was 111 per 100,000. Variation in reported prevalence and incidence may be related to factors such as access to health care, regional environmental exposures, or socioeconomic status. A higher proportion of epilepsy characterized by generalized seizures was reported in most prevalence studies. Epilepsy characterized by partial seizures accounted for 20-66% of incident epilepsies. Virtually all prevalence and incidence studies report a preponderance of seizures of unknown cause. Additional prevalence studies are needed in regions where data does not exist, and additional incidence studies in all regions. Interpretation of differences in prevalence and incidence will require understanding of the role of cultural, social and economic factors influencing epilepsy and its care.

Labor market participation following onset of seizures and early epilepsy: Findings from a UK cohort

PURPOSE

Previous studies have reported a considerable employment disadvantage among people with epilepsy. In a cohort of men and women who had experienced a single seizure or had early epilepsy at study entry we explored employment status and social mobility over 4 years and investigated whether employment outcomes were more disadvantageous for certain social groups.

METHODS

Analyses were based on 350 individuals of working age identified via the UK Multicentre Study of Early Epilepsy and Single Seizures. Employment rates were calculated for the cohort and general population. Employment trajectories over 4 years were explored according to occupational social class. The relative risk of employment was calculated by clinical features of seizures and social class.

RESULTS

Individuals with single seizures or early epilepsy had significantly lower employment rates than the general population at study entry, and 2- and 4-year follow-up. Employment rates of men and women in the cohort did not differ significantly. Although little social class mobility occurred during follow-up, there was evidence of some downward mobility between first seizure(s) and study entry. In the fully adjusted model, nonemployment was predicted at all time points by having fair/poor self-rated health and experiencing four or more seizures. We observed that some individuals continued to work in hazardous occupations or drive professionally within a year of experiencing seizure(s).

DISCUSSION

People who have recently experienced a single seizure or who have early epilepsy are exposed to substantial employment disadvantage. Greater efforts are necessary to help these people return to work and stay employed.