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Sillanpää ML, Camfield P, Löyttyniemi E. The changing incidence of childhood epilepsy in Finland. Seizure 2024; 117:20-27. [PMID: 38308905 DOI: 10.1016/j.seizure.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/05/2024] Open
Abstract
INTRODUCTION to investigate the childhood epilepsy incidence, population trends, associated factors, and validate the national population registers. METHODS a comprehensive comparative analysis of childhood epilepsy in the population during two distinct time intervals using medical records, appropriate national medical and population registers, and two random samples for control. RESULTS In 1961-1964, the average incidence of epilepsy was 38/100,000 and during 1991-2000 65.9 (95 % CI 59.6 to 72.2) and 65.6/100,000 person-years after adjustment for the European Standard Population. This increase was significant (p<0.0001) as was a decline (p<0.003) from 1991 to 1995 to 1996-2000. The decline in incidence for girls occurred at a younger age compared to boys. Epilepsy cases associated with prenatal and perinatal factors were 50 % lower in 1991-2000 than in 1961-1964, especially related to asphyxia, infections, pre-eclampsia, and imminent abortion. The national Register for Healthcare independently identified 94.5 % of relevant cases (University Hospital alone 81.2 %, and Drug Register alone 74.3 %). DISCUSSION Over the past five decades, the incidence rate of childhood epilepsy has exhibited a dynamic pattern, with a notable increase until the 1990's, followed by a stabilization at an incidence rate of approximately 60-70 per 100,000 person-years. Our findings, in line with other recent Finnish research, support a significant decrease in incidence since the mid-1990's. The underlying reasons for the increase and decrease remain unclear. Finnish national registers for epilepsy have established themselves as highly dependable resources for conducting epidemiological research. CONCLUSION Childhood epilepsy incidence in Finland is similar to other industrialized countries, but there are signs of a declining trend emerging.
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Affiliation(s)
- Matti L Sillanpää
- Departments of Child Neurology and Family Practice, University of Turku and Turku University Hospital, Turku, Finland.
| | - Peter Camfield
- Department of Pediatrics, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Eliisa Löyttyniemi
- Department of Biostatistics, University of Turku and Turku University Hospital, Turku, Finland
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Hernandez-Ronquillo L, Thorpe L, Feng C, Hunter G, Dash D, Hussein T, Dolinsky C, Waterhouse K, Roy PL, Jette N. Diagnostic Accuracy of Ambulatory EEG vs Routine EEG in Patients With First Single Unprovoked Seizure. Neurol Clin Pract 2023; 13:e200160. [PMID: 37197370 PMCID: PMC10184557 DOI: 10.1212/cpj.0000000000200160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/27/2023] [Indexed: 05/19/2023]
Abstract
Background and Objective To evaluate the diagnostic accuracy of the ambulatory EEG (aEEG) at detecting interictal epileptiform discharges (IEDs)/seizures compared with routine EEG (rEEG) and repetitive/second rEEG in patients with a first single unprovoked seizure (FSUS). We also evaluated the association between IED/seizures on aEEG and seizure recurrence within 1 year of follow-up. Methods We prospectively evaluated 100 consecutive patients with FSUS at the provincial Single Seizure Clinic. They underwent 3 sequential EEG modalities: first rEEG, second rEEG, and aEEG. Clinical epilepsy diagnosis was ascertained based on the 2014 International League Against Epilepsy definition by a neurologist/epileptologist at the clinic. An EEG-certified epileptologist/neurologist interpreted all 3 EEGs. All patients were followed up for 52 weeks until they had either second unprovoked seizure or maintained single seizure status. Accuracy measures (sensitivity, specificity, negative and positive predictive values, and likelihood ratios), receiver operating characteristic (ROC) analysis, and area under the curve (AUC) were used to evaluate the diagnostic accuracy of each EEG modality. Life tables and the Cox proportional hazard model were used to estimate the probability and association of seizure recurrence. Results Ambulatory EEG captured IED/seizures with a sensitivity of 72%, compared with 11% for the first rEEG and 22% for the second rEEG. The diagnostic performance of the aEEG was statistically better (AUC: 0.85) compared with the first rEEG (AUC: 0.56) and second rEEG (AUC: 0.60). There were no statistically significant differences between the 3 EEG modalities regarding specificity and positive predictive value. Finally, IED/seizure on the aEEG was associated with more than 3 times the hazard of seizure recurrence. Discussion The overall diagnostic accuracy of aEEG at capturing IED/seizures in people presenting with FSUS was higher than the first and second rEEGs. We also found that IED/seizures on the aEEG were associated with an increased risk of seizure recurrence. Classification of Evidence This study provides Class I evidence supporting that, in adults with First Single Unprovoked Seizure (FSUS), 24-h ambulatory EEG has increased sensitivity when compared with routine and repeated EEG.
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Affiliation(s)
- Lizbeth Hernandez-Ronquillo
- Community Health and Epidemiology (LH-R, LT), Saskatoon, SK; Division of Neurology, Department of Medicine (LH-R, GH.), Saskatoon, SK; Department of Community Health and Epidemiology (CF), Halifax, NS; Neurophysiology Laboratory (DD, CD), Royal University Hospital, Saskatoon, SK; Neurophysiology Laboratory (TH), BC Children's Hospital, Vancouver, BC; Neuromodulation/Epilepsy Programs (KW), Royal University Hospital, Saskatoon, SK; Division of Neurology, Department of Medicine (PLR), Lakeridge Health Oshawa, Oshawa, ON; Department of Neurology and Population Health Science & Policy (NJ), NY
| | - Lilian Thorpe
- Community Health and Epidemiology (LH-R, LT), Saskatoon, SK; Division of Neurology, Department of Medicine (LH-R, GH.), Saskatoon, SK; Department of Community Health and Epidemiology (CF), Halifax, NS; Neurophysiology Laboratory (DD, CD), Royal University Hospital, Saskatoon, SK; Neurophysiology Laboratory (TH), BC Children's Hospital, Vancouver, BC; Neuromodulation/Epilepsy Programs (KW), Royal University Hospital, Saskatoon, SK; Division of Neurology, Department of Medicine (PLR), Lakeridge Health Oshawa, Oshawa, ON; Department of Neurology and Population Health Science & Policy (NJ), NY
| | - Cindy Feng
- Community Health and Epidemiology (LH-R, LT), Saskatoon, SK; Division of Neurology, Department of Medicine (LH-R, GH.), Saskatoon, SK; Department of Community Health and Epidemiology (CF), Halifax, NS; Neurophysiology Laboratory (DD, CD), Royal University Hospital, Saskatoon, SK; Neurophysiology Laboratory (TH), BC Children's Hospital, Vancouver, BC; Neuromodulation/Epilepsy Programs (KW), Royal University Hospital, Saskatoon, SK; Division of Neurology, Department of Medicine (PLR), Lakeridge Health Oshawa, Oshawa, ON; Department of Neurology and Population Health Science & Policy (NJ), NY
| | - Gary Hunter
- Community Health and Epidemiology (LH-R, LT), Saskatoon, SK; Division of Neurology, Department of Medicine (LH-R, GH.), Saskatoon, SK; Department of Community Health and Epidemiology (CF), Halifax, NS; Neurophysiology Laboratory (DD, CD), Royal University Hospital, Saskatoon, SK; Neurophysiology Laboratory (TH), BC Children's Hospital, Vancouver, BC; Neuromodulation/Epilepsy Programs (KW), Royal University Hospital, Saskatoon, SK; Division of Neurology, Department of Medicine (PLR), Lakeridge Health Oshawa, Oshawa, ON; Department of Neurology and Population Health Science & Policy (NJ), NY
| | - Dianne Dash
- Community Health and Epidemiology (LH-R, LT), Saskatoon, SK; Division of Neurology, Department of Medicine (LH-R, GH.), Saskatoon, SK; Department of Community Health and Epidemiology (CF), Halifax, NS; Neurophysiology Laboratory (DD, CD), Royal University Hospital, Saskatoon, SK; Neurophysiology Laboratory (TH), BC Children's Hospital, Vancouver, BC; Neuromodulation/Epilepsy Programs (KW), Royal University Hospital, Saskatoon, SK; Division of Neurology, Department of Medicine (PLR), Lakeridge Health Oshawa, Oshawa, ON; Department of Neurology and Population Health Science & Policy (NJ), NY
| | - Tabrez Hussein
- Community Health and Epidemiology (LH-R, LT), Saskatoon, SK; Division of Neurology, Department of Medicine (LH-R, GH.), Saskatoon, SK; Department of Community Health and Epidemiology (CF), Halifax, NS; Neurophysiology Laboratory (DD, CD), Royal University Hospital, Saskatoon, SK; Neurophysiology Laboratory (TH), BC Children's Hospital, Vancouver, BC; Neuromodulation/Epilepsy Programs (KW), Royal University Hospital, Saskatoon, SK; Division of Neurology, Department of Medicine (PLR), Lakeridge Health Oshawa, Oshawa, ON; Department of Neurology and Population Health Science & Policy (NJ), NY
| | - Chelsea Dolinsky
- Community Health and Epidemiology (LH-R, LT), Saskatoon, SK; Division of Neurology, Department of Medicine (LH-R, GH.), Saskatoon, SK; Department of Community Health and Epidemiology (CF), Halifax, NS; Neurophysiology Laboratory (DD, CD), Royal University Hospital, Saskatoon, SK; Neurophysiology Laboratory (TH), BC Children's Hospital, Vancouver, BC; Neuromodulation/Epilepsy Programs (KW), Royal University Hospital, Saskatoon, SK; Division of Neurology, Department of Medicine (PLR), Lakeridge Health Oshawa, Oshawa, ON; Department of Neurology and Population Health Science & Policy (NJ), NY
| | - Karen Waterhouse
- Community Health and Epidemiology (LH-R, LT), Saskatoon, SK; Division of Neurology, Department of Medicine (LH-R, GH.), Saskatoon, SK; Department of Community Health and Epidemiology (CF), Halifax, NS; Neurophysiology Laboratory (DD, CD), Royal University Hospital, Saskatoon, SK; Neurophysiology Laboratory (TH), BC Children's Hospital, Vancouver, BC; Neuromodulation/Epilepsy Programs (KW), Royal University Hospital, Saskatoon, SK; Division of Neurology, Department of Medicine (PLR), Lakeridge Health Oshawa, Oshawa, ON; Department of Neurology and Population Health Science & Policy (NJ), NY
| | - Pragma Laboni Roy
- Community Health and Epidemiology (LH-R, LT), Saskatoon, SK; Division of Neurology, Department of Medicine (LH-R, GH.), Saskatoon, SK; Department of Community Health and Epidemiology (CF), Halifax, NS; Neurophysiology Laboratory (DD, CD), Royal University Hospital, Saskatoon, SK; Neurophysiology Laboratory (TH), BC Children's Hospital, Vancouver, BC; Neuromodulation/Epilepsy Programs (KW), Royal University Hospital, Saskatoon, SK; Division of Neurology, Department of Medicine (PLR), Lakeridge Health Oshawa, Oshawa, ON; Department of Neurology and Population Health Science & Policy (NJ), NY
| | - Nathalie Jette
- Community Health and Epidemiology (LH-R, LT), Saskatoon, SK; Division of Neurology, Department of Medicine (LH-R, GH.), Saskatoon, SK; Department of Community Health and Epidemiology (CF), Halifax, NS; Neurophysiology Laboratory (DD, CD), Royal University Hospital, Saskatoon, SK; Neurophysiology Laboratory (TH), BC Children's Hospital, Vancouver, BC; Neuromodulation/Epilepsy Programs (KW), Royal University Hospital, Saskatoon, SK; Division of Neurology, Department of Medicine (PLR), Lakeridge Health Oshawa, Oshawa, ON; Department of Neurology and Population Health Science & Policy (NJ), NY
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Bensken WP, Alberti PM, Khan OI, Williams SM, Stange KC, Vaca GFB, Jobst BC, Sajatovic M, Koroukian SM. A framework for health equity in people living with epilepsy. Epilepsy Res 2022; 188:107038. [PMID: 36332544 PMCID: PMC9797034 DOI: 10.1016/j.eplepsyres.2022.107038] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 08/22/2022] [Accepted: 10/17/2022] [Indexed: 12/31/2022]
Abstract
Epilepsy is a disease where disparities and inequities in risk and outcomes are complex and multifactorial. While most epilepsy research to date has identified several key areas of disparities, we set out to provide a multilevel life course model of epilepsy development, diagnosis, treatment, and outcomes to highlight how these disparities represent true inequities. Our piece also presents three hypothetical cases that highlight how the solutions to address inequities may vary across the lifespan. We then identify four key domains (structural, socio-cultural, health care, and physiological) that contribute to the persistence of inequities in epilepsy risk and outcomes in the United States. Each of these domains, and their core components in the context of epilepsy, are reviewed and discussed. Further, we highlight the connection between domains and key areas of intervention to strive towards health equity. The goal of this work is to highlight these domains while also providing epilepsy researchers and clinicians with broader context of how their work fits into health equity.
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Affiliation(s)
- Wyatt P Bensken
- Department of Population and Quantitative Health Sciences, School of Medicine Case Western Reserve University, Cleveland, OH, USA.
| | - Philip M Alberti
- AAMC Center for Health Justice, Association of American Medical Colleges, Washington, DC, USA
| | - Omar I Khan
- Epilepsy Center of Excellence, Baltimore VA Medical Center US Department of Veterans Affairs, Baltimore, MD, USA
| | - Scott M Williams
- Department of Population and Quantitative Health Sciences, School of Medicine Case Western Reserve University, Cleveland, OH, USA; Department of Genetics and Genome Sciences, School of Medicine Case Western Reserve University, Cleveland, OH, USA
| | - Kurt C Stange
- Department of Population and Quantitative Health Sciences, School of Medicine Case Western Reserve University, Cleveland, OH, USA; Center for Community Health Integration, Departments of Family Medicine & Community Health, and Sociology Case Western Reserve University, Cleveland, OH, USA
| | - Guadalupe Fernandez-Baca Vaca
- Department of Neurology, University Hospitals Cleveland Medical Center, School of Medicine Case Western Reserve University, Cleveland, OH, USA
| | - Barbara C Jobst
- Department of Neurology, Geisel School of Medicine Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Martha Sajatovic
- Department of Neurology, University Hospitals Cleveland Medical Center, School of Medicine Case Western Reserve University, Cleveland, OH, USA; Department Psychiatry, University Hospitals Cleveland Medical Center, School of Medicine Case Western Reserve University, Cleveland, OH, USA
| | - Siran M Koroukian
- Department of Population and Quantitative Health Sciences, School of Medicine Case Western Reserve University, Cleveland, OH, USA
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Santos JDM, Fowler S, Jennings D, Brass C, Porter L, Porter R, Sanderson R, Peña-Sánchez JN. Health care utilization differences between First Nations people and the general population with inflammatory bowel disease: a retrospective cohort study from Saskatchewan, Canada. CMAJ Open 2022; 10:E964-E970. [PMID: 36319027 PMCID: PMC9633056 DOI: 10.9778/cmajo.20220118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Indigenous people in Canada often face barriers to access specialized care, with limited data in evaluating health care utilization among Indigenous people with inflammatory bowel disease (IBD). We aimed to compare health care utilization between First Nations patients and those in the general population diagnosed with IBD in Saskatchewan. METHODS We conducted a patient-oriented, population-based, retrospective cohort study by linking administrative health databases of Saskatchewan between fiscal years 1998/99 and 2017/18. We designed and completed this study in partnership with Indigenous patients and family advocates. We applied a validated algorithm to identify IBD incident cases and then used the self-declared First Nations status variable to divide those cases. We applied a 1:5 ratio for age and sex matching and used Cox proportional models to assess associations. Hazard ratios (HRs) and 95% confidence intervals (CIs) were reported. RESULTS We created a matched cohort with 696 IBD incident cases: 116 First Nations patients and 580 patients in the general population. We observed differences between the groups for IBD-specific hospital admissions (HR 1.33, 95% CI 1.01-1.75), IBD-related hospital admissions (HR 1.55, 95% CI 1.20-2.01), medication claims for IBD (HR 0.52, 95% CI 0.41-0.65) and 5-aminosalicylic acid claims (HR 0.56, 95% CI 0.45-0.71) adjusting by rural or urban residence and diagnosis type. There were no significant differences in the hazard rate of outpatient gastroenterology visits (HR 1.13, 95% CI 0.90-1.41), colonoscopies (HR 1.14, 95% CI 0.92-1.41) and surgeries for IBD (HR 1.14, 95% CI 0.80-1.64). INTERPRETATION We identified that First Nations patients diagnosed with IBD had a higher rate of hospital admissions owing to IBD than patients in the general population diagnosed with IBD. We also found an inverse association between First Nations status and having prescription medication claims for IBD.
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Affiliation(s)
- José Diego Marques Santos
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Sharyle Fowler
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Derek Jennings
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Colten Brass
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Linda Porter
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Robert Porter
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Rhonda Sanderson
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Juan Nicolás Peña-Sánchez
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask.
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Şahin Yıldız Y, Kasapoğlu ES, Dülger H. An evaluation of the knowledge and attitudes that Health Care Services department students have about epilepsy. Epilepsy Behav 2022; 134:108840. [PMID: 35849866 DOI: 10.1016/j.yebeh.2022.108840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/14/2022] [Accepted: 07/02/2022] [Indexed: 11/30/2022]
Abstract
AIM This study was conducted to examine the knowledge and attitudes that students in the field of healthcare services have about epilepsy. METHOD This cross-sectional and descriptive study was conducted with 312 students of the Department of Health Care Services (home patient and elderly care) in Turkey. The data were collected using a sociodemographic information form, the Epilepsy Knowledge Level Scale, and the Attitudes Towards Epilepsy Scale. Descriptive statistics, the Shapiro-Wilk test, the Mann-Whitney U test, the Kruskal-Wallis H test and the Spearman correlation test were used to analyze the data. Significance was considered as p < 0.05. RESULTS Students in the field of healthcare services constituted the sample of the study, and more than half of the students (68.3%) were female. The mean scores obtained from the Epilepsy Knowledge Scale and the Epilepsy Attitude Scale were 8.38 ± 4.29 and 60.02 ± 7.28 respectively. A positive and significant relationship was found between the students' knowledge and attitude scores about epilepsy (p < 0.01). It was found that students' attitudes toward epilepsy positively increased as their knowledge increased. It was observed that female students who received education about epilepsy, witnessed seizures, and had relatives with epilepsy had more positive attitudes toward epilepsy. CONCLUSION In this study, it was found that the student participants had a moderate level of knowledge about epilepsy and exhibited a positive attitude toward epilepsy. It was determined that the students' attitudes toward epilepsy positively increased as their level of knowledge about epilepsy increased.
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Affiliation(s)
- Yasemin Şahin Yıldız
- Department of Home Patient Care, Vocational College of Health Services, University of Bartın, Bartın, Turkey.
| | - Elçin Sebahat Kasapoğlu
- Department of Elderly Care, Vocational College of Health Services, University of Bartın, Bartın, Turkey.
| | - Hanifi Dülger
- Department of Midwifery, Faculty of Health Sciences, University of Bartın, Bartın, Turkey.
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Singh A, Woelfle R, Chepesiuk R, Southward C, Antflick J, Cowan K, Hum K, Ng M, Burneo JG, Suller Marti A. Canadian epilepsy priority-setting partnership: Toward a new national research agenda. Epilepsy Behav 2022; 130:108673. [PMID: 35367726 DOI: 10.1016/j.yebeh.2022.108673] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Health research agendas are often set by researchers or by industry and may not reflect the needs and priorities of end users. This priority-setting partnership (PSP) for epilepsy was undertaken to identify the most pressing unanswered questions about epilepsy and seizures from the perspective of people with epilepsy (PWE) and their care providers. METHODS Using the methodology developed by the James Lind Alliance (JLA), evidence uncertainties were gathered via online surveys from stakeholders across Canada. Submissions were formed into summary questions and checked against existing evidence to determine if they were true uncertainties. Verified uncertainties were then ranked by patients, caregivers, and healthcare providers and a final workshop was held to reach a consensus on the top 10 priorities. RESULTS The final top 10 list reflects the priority areas of focus for research as identified by the Canadian epilepsy community, including genetic markers for diagnosis and treatment, concerns about living with the long-term effects of epilepsy, and addressing knowledge gaps in etiology and treatment approaches. CONCLUSION This project represents the first systematic evidence of patient- and clinician-centered research priorities for epilepsy. The results of this priority-setting exercise provide an opportunity for researchers and funding agencies to align their agendas with the values and needs of the epilepsy community in order to improve clinical outcomes and quality of life (QOL) for PWE.
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Affiliation(s)
- Amaya Singh
- EpLink - The Epilepsy Research Program of the Ontario Brain Institute, Toronto, Ontario, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada.
| | - Rebecca Woelfle
- EpLink - The Epilepsy Research Program of the Ontario Brain Institute, Toronto, Ontario, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Katherine Cowan
- The James Lind Alliance, The Wessex Institute, University of Southampton, Southampton, United Kingdom
| | - Kathryn Hum
- EpLink - The Epilepsy Research Program of the Ontario Brain Institute, Toronto, Ontario, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Marcus Ng
- Section of Neurology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jorge G Burneo
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Neuroepidemiology Unit, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ana Suller Marti
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Paediatrics Department, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Neurosciences Program, Western University, London, Ontario, Canada
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Denton A, Thorpe L, Carter A, Angarita-Fonseca A, Waterhouse K, Hernandez Ronquillo L. Definitions and Risk Factors for Drug-Resistant Epilepsy in an Adult Cohort. Front Neurol 2021; 12:777888. [PMID: 34966348 PMCID: PMC8710721 DOI: 10.3389/fneur.2021.777888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Less than one-third of people with epilepsy will develop drug-resistant epilepsy (DRE). Establishing the prognosis of each unique epilepsy case is an important part of evaluation and treatment.Most studies on DRE prognosis have been based on a pooled, heterogeneous group, including children, adults, and older adults, in the absence of clear recognition and control of important confounders, such as age group. Furthermore, previous studies were done before the 2010 definition of DRE by the International League Against Epilepsy (ILAE), so data based on the current definitions have not been entirely elucidated. This study aimed to explore the difference between 3 definitions of DRE and clinical predictors of DRE in adults and older adults. Methods: Patients with a new diagnosis of epilepsy ascertained at a Single Seizure Clinic (SSC) in Saskatchewan, Canada were included if they had at least 1 year of follow-up. The first study outcome was the diagnosis of DRE epilepsy at follow-up using the 2010 ILAE definition. This was compared with 2 alternative definitions of DRE by Kwan and Brodie and Camfield and Camfield. Finally, risk factors were analyzed using the ILAE definition. Results: In total, 95 patients with a new diagnosis of epilepsy and a median follow-up of 24 months were included. The median age of patients at the diagnosis of epilepsy was 33 years, and 51% were men. In the cohort, 32% of patients were diagnosed with DRE by the Kwan and Brodie definition, 10% by Camfield and Camfield definition, and 15% by the ILAE definition by the end of follow-up. The only statistically significant risk factor for DRE development was the failure to respond to the first anti-seizure medication (ASM). Conclusion: There were important differences in the percentage of patients diagnosed with DRE when using 3 concurrent definitions. However, the use of the ILAE definition appeared to be the most consistent through an extended follow-up. Finally, failure to respond to the first ASM was the sole significant risk factor for DRE in the cohort after considering the age group.
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Affiliation(s)
- Alyssa Denton
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Lilian Thorpe
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Alexandra Carter
- Division of Neurology, Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.,Saskatchewan Epilepsy Program, Department of Medicine, Division of Neurology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Adriana Angarita-Fonseca
- Universite du Quebec en Abitibi-Temiscamingue, Rouyn Noranda, QC, Canada.,Centre de Recherche du Centre Hospitalier del l'Universite de Montreal, Montreal, QC, Canada.,Universidad de Santander, Bucaramanga, Colombia
| | - Karen Waterhouse
- Saskatchewan Epilepsy Program, Department of Medicine, Division of Neurology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Lizbeth Hernandez Ronquillo
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada.,Saskatchewan Epilepsy Program, Department of Medicine, Division of Neurology, University of Saskatchewan, Saskatoon, SK, Canada
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Ng MC, Pavlova M. Status epilepticus in the Canadian Arctic: A public health imperative hidden in plain sight. Epilepsia Open 2021; 6:703-713. [PMID: 34510825 PMCID: PMC8633482 DOI: 10.1002/epi4.12538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/18/2021] [Accepted: 09/04/2021] [Indexed: 02/02/2023] Open
Abstract
Objective The World Health Organization, International League Against Epilepsy (ILAE), and International Bureau for Epilepsy have called epilepsy a public health imperative, with appropriate emphasis on low‐to‐middle‐income countries (LMIC). Although Canada is a high‐income country (HIC), income is not distributed uniformly. Furthermore, epilepsy data from the national statistical agency explicitly overlook the Arctic by excluding these territories. A common neurologic emergency, status epilepticus (SE) is a life‐threatening manifestation of epilepsy that demands prompt treatment to avoid death and long‐term sequelae. Therefore, we examined the rate of SE in a well‐defined Canadian Arctic region. Methods This study takes epidemiologic advantage of the Kivalliq Region's geographical isolation, which is accessible only by air. All SE patients requiring emergency care are consistently flown 1200‐1900 kilometers to a single designated hospital in a distinct southern part of Canada for further management and electroencephalography (EEG). We conducted a retrospective database and chart review at this “bottleneck” hospital to identify patients with seizure(s) severe enough to justify emergency airborne medical evacuation over a 11.25‐year period from 2009 to 2020. Results We screened 40 392 EEGs to yield 117 distinct medical evacuations for “operational SE” from 99 patients to derive estimated SE incidences of 99.9 evacuations per 100 000/year and 84.5 patients per 100 000/year. The average time from seizure onset to EEG was 3.2 days. Only 16.2% of SE patients had known epilepsy. For “confirmed SE” cases meeting ILAE criteria, or cases with persistently epileptiform EEG despite days of empiric treatment, estimated incidence was 77.7 evacuations per 100 000/year and 64.9 patients per 100 000/year. Significance High SE and epilepsy rates in the Canadian Arctic are consistent with LMIC rather than HIC. Our findings demonstrate the paradox of LMIC‐equivalent epilepsy populations camouflaged within HIC. Our findings also highlight the long‐standing plight of these under‐served and overlooked populations hidden in plain sight.
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Affiliation(s)
- Marcus C Ng
- Section of Neurology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Milena Pavlova
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Maloney EM, O'Reilly ÉJ, Costello DJ. Causes and classification of first unprovoked seizures and newly-diagnosed epilepsy in a defined geographical area- an all-comers analysis. Seizure 2021; 92:118-127. [PMID: 34508947 DOI: 10.1016/j.seizure.2021.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/06/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE The ILAE recently updated the operational definition of epilepsy and the classifications of seizures and epilepsy incorporating aetiology into the classification framework. To date, these classifications have not been applied in any whole population incidence study. METHODS Multiple overlapping methods of case identification were applied to a defined geographical area (population 542,868 adults and children) to identify all first unprovoked seizures and new diagnosis of epilepsy presenting during the calendar year 2017. The 2017 ILAE classification frameworks were applied. Incidence was age-standardised to the 2013 Standard European Population. RESULTS The annual incidence per 100,000 population was 44 for focal epilepsy, 6.8 for generalized epilepsy and 10.9 for unclassified epilepsy (age standardized 56, 6.9 and 11.4, respectively). Focal epilepsy was diagnosed in all age groups, though incidence increased in those ≥55 years of age. Primary generalised epilepsy accounted for 10% (n = 32) of newly diagnosed epilepsy. The most frequently diagnosed aetiology was structural (54%, n = 182). In 30% (n = 102) of newly diagnosed epilepsy, aetiology was not established. CONCLUSION We report on the causes of incident first unprovoked seizures and epilepsy in accordance with recently updated ILAE definitions and classification systems employing standard diagnostic investigations. We report a higher proportion of structural aetiology than previous studies, which may reflect incorporation of imaging in aetiology classification. Despite improved access to diagnostic testing, aetiology of a large fraction of first seizures and newly diagnosed epilepsy remains unknown.
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Affiliation(s)
- Eimer M Maloney
- Department of Neurology, Cork University Hospital, Ireland; College of Medicine and Health, University College Cork, Ireland; School of Public Health, University College Cork, Ireland.
| | - Éilis J O'Reilly
- School of Public Health, University College Cork, Ireland; Department of Nutrition, Harvard TH Chan School of Public Health, Boston, U.S.A
| | - Daniel J Costello
- Department of Neurology, Cork University Hospital, Ireland; College of Medicine and Health, University College Cork, Ireland; FutureNeuro SFI Research Centre for Chronic and Rare Neurological Diseases hosted in RCSI, Dublin 2, Ireland
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10
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Babunovska M, Boskovski B, Kuzmanovski I, Isjanovska R, Kiteva Trencevska G, Cvetkovska E. Incidence and prevalence of epilepsy in the Republic of North Macedonia: Data from nationwide integrated health care platform. Seizure 2021; 87:56-60. [PMID: 33690108 DOI: 10.1016/j.seizure.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/09/2021] [Accepted: 03/01/2021] [Indexed: 01/10/2023] Open
Abstract
PURPOSE This study aimed to evaluate the incidence and period prevalence of epilepsy in the Republic of North Macedonia, an upper-middle-income country with universal access to healthcare, based on a nationwide healthcare platform (NHP). METHODS NHP contains reports from all inpatient and outpatient medical encounters and procedures, and all electronic medical records are linked together with a unique patient number. We performed the analysis of the data maintained at the Macedonian Ministry of Health, concerning the five years of the study (2014 through 2018). Population and demographic data for each year were obtained from the State Statistical Office. RESULTS The period prevalence was 6.67 per 1,000 inhabitants. There were 6383 (46.2%) females and 7435 (53.8%) males; the gender difference was significant: 6.17 per 1,000 females and 7.16 per 1,000 males (p = 0.0000). Between 2015 and 2018 the median annual incidence of epilepsy was 68 new epilepsy patients per 100,000, with an upward trend over time. The age-specific incidence was high in childhood and adolescence, was constant (and low) in the adult years, and gradually increased in each successive age group after the age of 50 years. The greatest incidence was found in group 70-79 years of age. The incidence in childhood and adolescence tends to gradually decrease from 2015 to 2018, while it progressively increased in population over 50 years of age, which may explain a rise in overall incidence. We found a statistically significant higher incidence in males than in females, a ratio consistently being 1.2: 1. CONCLUSION The data from the study provides accurate findings on the prevalence and incidence of epilepsy in the upper-middle-income Southeastern European country.
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Affiliation(s)
- Marija Babunovska
- University Clinic of Neurology, Ss. Cyril and Methodius University, Mother Theresa str. 17, Skopje, North Macedonia
| | - Bojan Boskovski
- University Clinic of Neurology, Ss. Cyril and Methodius University, Mother Theresa str. 17, Skopje, North Macedonia
| | - Igor Kuzmanovski
- University Clinic of Neurology, Ss. Cyril and Methodius University, Mother Theresa str. 17, Skopje, North Macedonia
| | - Rozalinda Isjanovska
- Institute of Epidemiology, Ss Cyril and Methodius University, Mother Theresa str. 17, Skopje, North Macedonia
| | - Gordana Kiteva Trencevska
- University Clinic of Neurology, Ss. Cyril and Methodius University, Mother Theresa str. 17, Skopje, North Macedonia
| | - Emilija Cvetkovska
- University Clinic of Neurology, Ss. Cyril and Methodius University, Mother Theresa str. 17, Skopje, North Macedonia.
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11
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Paley EL. Discovery of Gut Bacteria Specific to Alzheimer's Associated Diseases is a Clue to Understanding Disease Etiology: Meta-Analysis of Population-Based Data on Human Gut Metagenomics and Metabolomics. J Alzheimers Dis 2020; 72:319-355. [PMID: 31561379 DOI: 10.3233/jad-190873] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Alzheimer's disease (AD)-associated sequence (ADAS) of cultured fecal bacteria was discovered in human gut targeted screening. This study provides important information to expand our current understanding of the structure/activity relationship of ADAS and putative inhibitors/activators that are potentially involved in ADAS appearance/disappearance. The NCBI database analysis revealed that ADAS presents at a large proportion in American Indian Oklahoman (C&A) with a high prevalence of obesity/diabetes and in colorectal cancer (CRC) patients from the US and China. An Oklahoman non-native group (NNI) showed no ADAS. Comparison of two large US populations reveals that ADAS is more frequent in individuals aged ≥66 and in females. Prevalence and levels of fecal metabolites are altered in the C&A and CRC groups versus controls. Biogenic amines (histamine, tryptamine, tyramine, phenylethylamine, cadaverine, putrescine, agmatine, spermidine) that present in food and are produced by gut microbiota are significantly higher in C&A (e.g., histamine/histidine 95-fold) versus NNI (histamine/histidine 16-fold). The majority of these bio-amines are cytotoxic at concentrations found in food. Inositol phosphate signaling implicated in AD is altered in C&A and CRC. Tryptamine stimulated accumulation of inositol phosphate. The seizure-eliciting tryptamine induced cytoplasmic vacuolization and vesiculation with cell fragmentation. Present additions of ADAS-carriers at different ages including infants led to an ADAS-comprising human sample size of 2,830 from 27 studies from four continents (North America, Australia, Asia, Europe). Levels of food-derived monoamine oxidase inhibitors and anti-bacterial compounds, the potential modulators of ADAS-bacteria growth and biogenic amine production, were altered in C&A versus NNI. ADAS is attributable to potentially modifiable risk factors of AD associated diseases.
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Affiliation(s)
- Elena L Paley
- Expert Biomed, Inc., Miami, FL, USA.,Stop Alzheimers Corp, Miami, FL, USA
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Solli E, Colwell NA, Say I, Houston R, Johal AS, Pak J, Tomycz L. Deciphering the surgical treatment gap for drug-resistant epilepsy (DRE): A literature review. Epilepsia 2020; 61:1352-1364. [PMID: 32558937 DOI: 10.1111/epi.16572] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/28/2020] [Accepted: 05/14/2020] [Indexed: 12/18/2022]
Abstract
Patients with drug-resistant epilepsy (DRE) rarely achieve seizure freedom with medical therapy alone. Despite being safe and effective for select patients with DRE, epilepsy surgery remains heavily underutilized. Multiple studies have indicated that the overall rates of surgery in patients with DRE have stagnated in recent years and may be decreasing, even when hospitalizations for epilepsy-related problems are on the rise. Ultimately, many patients with DRE who might otherwise benefit from surgery continue to have intractable seizures, lacking access to the full spectrum of available treatment options. In this article, we review the various factors accounting for the persistent underutilization of epilepsy surgery and uncover several key themes, including the persistent knowledge gap among physicians in identifying potential surgical candidates, lack of coordinated patient care, patient misconceptions of surgery, and socioeconomic disparities impeding access to care. Moreover, factors such as the cost and complexity of the preoperative evaluation, a lack of federal resource allocation for the research of surgical therapies for epilepsy, and difficulties recruiting patients to clinical trials all contribute to this multifaceted dilemma.
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Affiliation(s)
- Elena Solli
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Nicole A Colwell
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Irene Say
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rebecca Houston
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Anmol S Johal
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jayoung Pak
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Luke Tomycz
- New Jersey Neuroscience Institute, Morristown, NJ, USA
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Maloney EM, Chaila E, O'Reilly ÉJ, Costello DJ. Incidence of first seizures, epilepsy, and seizure mimics in a geographically defined area. Neurology 2020; 95:e576-e590. [PMID: 32518150 DOI: 10.1212/wnl.0000000000009980] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/14/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the incidence of first seizures, epilepsy, and seizure mimics in a geographically defined area using the updated 2014 International League Against Epilepsy (ILAE) definition, which allows an epilepsy diagnosis after a single seizure when the risk of further seizures over the next 10 years is ≈60% or greater. This replaced the 1993 definition by which epilepsy was diagnosed when a person had ≥2 seizures separated by 24 hours. METHODS Using multiple overlapping methods of case ascertainment followed by individual case classification by an epileptologist, we identified all first seizures, new diagnosis of epilepsy, and seizure mimics occurring in a defined geographic area (population 542,868) from January 1, 2017, to December 31, 2017. Incidence was age standardized to the Standard European Population. We compared incidence rates using the 2014 and 1993 ILAE definitions. RESULTS When the 2014 ILAE definition of epilepsy was applied, the incidence of new diagnosis of epilepsy was 62 per 100,000 (age standardized 74) compared to 41 per 100,000 (age standardized 48) when the 1993 definition was applied, and the difference was more pronounced at older ages. The incidence of all first seizures and of seizure mimics was 102 per 100,000 (age standardized 123) and 94 per 100,000 (age standardized 111), respectively. The most frequently encountered seizure mimic was syncope. CONCLUSION Application of the 2014 ILAE definition of epilepsy resulted in a higher incidence of new diagnosis of epilepsy compared to the 1993 definition. The incidence of seizure mimics almost equals that of all first seizures. Seizures, epilepsy, and seizure mimics represent a significant burden to health care systems.
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Affiliation(s)
- Eimer M Maloney
- From the Epilepsy Service (E.M.M., D.J.C.), Department of Neurology, Cork University Hospital; College of Medicine and Health (E.M.M., D.J.C.) and School of Public Health (E.M.M., É.J.O.), University College Cork; Department of Neurology (E.C.), University Hospital Limerick, Ireland; Department of Nutrition (É.J.O.), Harvard T.H. Chan School of Public Health, Boston, MA; and FutureNeuro SFI Research Centre for Chronic and Rare Neurological Diseases hosted in RCSI (D.J.C.), Dublin, Ireland.
| | - Elijah Chaila
- From the Epilepsy Service (E.M.M., D.J.C.), Department of Neurology, Cork University Hospital; College of Medicine and Health (E.M.M., D.J.C.) and School of Public Health (E.M.M., É.J.O.), University College Cork; Department of Neurology (E.C.), University Hospital Limerick, Ireland; Department of Nutrition (É.J.O.), Harvard T.H. Chan School of Public Health, Boston, MA; and FutureNeuro SFI Research Centre for Chronic and Rare Neurological Diseases hosted in RCSI (D.J.C.), Dublin, Ireland
| | - Éilis J O'Reilly
- From the Epilepsy Service (E.M.M., D.J.C.), Department of Neurology, Cork University Hospital; College of Medicine and Health (E.M.M., D.J.C.) and School of Public Health (E.M.M., É.J.O.), University College Cork; Department of Neurology (E.C.), University Hospital Limerick, Ireland; Department of Nutrition (É.J.O.), Harvard T.H. Chan School of Public Health, Boston, MA; and FutureNeuro SFI Research Centre for Chronic and Rare Neurological Diseases hosted in RCSI (D.J.C.), Dublin, Ireland
| | - Daniel J Costello
- From the Epilepsy Service (E.M.M., D.J.C.), Department of Neurology, Cork University Hospital; College of Medicine and Health (E.M.M., D.J.C.) and School of Public Health (E.M.M., É.J.O.), University College Cork; Department of Neurology (E.C.), University Hospital Limerick, Ireland; Department of Nutrition (É.J.O.), Harvard T.H. Chan School of Public Health, Boston, MA; and FutureNeuro SFI Research Centre for Chronic and Rare Neurological Diseases hosted in RCSI (D.J.C.), Dublin, Ireland
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Pan HH, Hung TW, Tsai JD, Chen HJ, Liao PF, Sheu JN. Children with allergic rhinitis and a risk of epilepsy: A nationwide cohort study. Seizure 2020; 76:64-71. [PMID: 32028113 DOI: 10.1016/j.seizure.2020.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Little is known about whether allergic disease is associated with a subsequent increased risk of childhood-onset epilepsy. We used a large, population-based cohort study to examine whether children with antecedent allergic rhinitis (AR) were associated with a subsequent increased risk of epilepsy. METHODS This retrospective population-based cohort study was conducted by using data from the 2000-2012 Taiwan's National Health Insurance Research Database. We enrolled 67,537 children aged 0-18 years diagnosed with AR and 67,537 age- and gender-matched children without the diagnosis of AR. The incidence rate (per 10,000 person-years) of epilepsy was calculated. We used Cox proportional hazards regression analysis to estimate hazard ratios (HRs) and 95 % confident interval (CI). RESULTS Of the 135,074 children included in the analyses, those with AR had a higher incidence rate of epilepsy (6.84 versus 3.95 per 10,000 person-years, p < 0.001) and an earlier age at diagnosis of epilepsy than those without AR [8.54 (4.90) versus 9.33 (5.40) years, p = 0.03)]. The Kaplan-Meier survival analysis demonstrated that the children with AR had a higher likelihood of developing epilepsy than those without AR (p < 0.001). After adjusting for confounding factors in multivariate model, children with AR had a 76 % increased risk of epilepsy (HR 1.76, 95 % CI 1.51-2.04) than those without AR. Boys had a 21 % increased risk of epilepsy (HR 1.21, 95 % CI 1.05-1.40) than girls. CONCLUSIONS These results suggest that children with AR were associated with an increased subsequent risk of epilepsy.
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Affiliation(s)
- Hui-Hsien Pan
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - Tung-Wei Hung
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - Jeng-Dau Tsai
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
| | - Pei-Fen Liao
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - Ji-Nan Sheu
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
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Jacob L, Bohlken J, Schmitz B, Kostev K. Incidence of epilepsy and associated factors in elderly patients in Germany. Epilepsy Behav 2019; 90:107-111. [PMID: 30529258 DOI: 10.1016/j.yebeh.2018.10.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 10/23/2018] [Accepted: 10/24/2018] [Indexed: 11/29/2022]
Abstract
AIMS Little is known about the recent epidemiology of epilepsy in the elderly in Germany. Therefore, the goal of this study was to analyze the incidence of epilepsy and associated factors in elderly patients followed in general practices in this country. METHODS The incidence of epilepsy was estimated using data from all patients aged ≥60 years who were followed in 1203 general practices in Germany in 2017 (IQVIA Disease Analyzer database). The association between predefined variables and epilepsy was further studied using a case-control design (n = 4690 matched pairs). Cases were patients aged ≥60 years who had received a first diagnosis of epilepsy in general practices between 2015 and 2017 (index date). Controls without epilepsy were matched (1:1) to cases by age, gender, index year, and physician. RESULTS The incidence of epilepsy was 157 per 100,000 elderly persons. This incidence increased with age (92 per 100,000 persons in patients aged 60-65 years versus 311 in those aged >90 years) and was higher in men (166) than in women (150). The three disorders that had the strongest association with epilepsy were subarachnoid, intracerebral or intracranial hemorrhage (odds ratio [OR] = 3.31), stroke, including transient ischemic attack (OR = 2.32), and mental and behavioral disorders due to use of alcohol (OR = 2.20). In addition, there was a positive association between atypical neuroleptics and epilepsy (OR = 2.40). CONCLUSIONS The incidence of epilepsy was high and increased with age in elderly patients followed in general practices in Germany. Addressing identified risk factors may help reduce the risk of developing epilepsy.
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Affiliation(s)
- Louis Jacob
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux 78180, France
| | - Jens Bohlken
- Praxis für Neurologie und Psychiatrie, Berlin, Germany
| | - Bettina Schmitz
- Department of Neurology, Vivantes Humboldt-Klinikum, Berlin, Germany
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