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Biomedical subjects

E Beghi

Publications and source records attributed to E Beghi.

At least 73 records · Page 4Linked to original sources
PubMed1997

Epilepsy and everyday life risks. A case-referent study: rationale, study design, and preliminary results. Risk in Epilepsy Study Group.

Despite its favorable outcome in up to 90% of patients, epilepsy is still considered to carry a higher than normal risk of morbidity and accidents. Knowledge of the everyday life risks (illnesses, accidents) in patients with epilepsy is mostly anecdotal. For these reasons, a multinational cohort study has been started in 9 European countries to investigate the incidence and number of medical events and accidents in children and adults with unprovoked epilepsy (diagnosed in the recruiting centers in the previous 10 years) and in age- and sex-matched controls (relatives or friends). The 2 groups are being followed for at least 12 months. Using patients' diaries, data are being collected regarding the number and type of illnesses and accidents, the number of medical contacts and the actions taken, the number of hospital admissions, and the total number of days off work/school. In a preliminary report on 833 patients and 833 controls, the cases reported slightly less illnesses, medical contacts, and actions taken by doctors. Accidents and related events occurred in similar proportions in the 2 groups. Based on the results of the pilot study, idiopathic, cryptogenic and remote symptomatic epilepsy may be compatible with an at least fairly normal social life.

Absenteeism↗
PubMed1997

Alcohol use is a risk factor for a first generalized tonic-clonic seizure. The ALC.E. (Alcohol and Epilepsy) Study Group.

We performed a multicenter case-control study to estimate whether chronic alcoholism and alcohol consumption are risk factors for developing a first generalized tonic-clonic seizure (GTCS). We studied 237 first-seizure patients (158 men, 79 women) matched to 474 hospital controls for center, sex, age (+/-5 years), and weekday of the seizure. The risk of first GTCS in alcoholics was greater than in non-alcoholics for men (odds ratio, 6.8; 95% confidence limits, 3.6-13.0) and women (6.8, 1.6-32.6). The odds ratio (both sexes) was 1.2 (0.8-1.8) for an average daily intake of absolute alcohol of 1 to 25 g/day and rose with the amount of alcohol consumed daily: 1.3 (0.8-2.1) for 26 to 50 g/day, 3.0 (1.7-5.4) for 51 to 100 g/day, 7.9 (2.9-21.9) for 101 to 200 g/day, and 16.6 (1.9-373.4) for >200 g/day. Our study provides evidence of a powerful association between alcohol use, alcoholism, and the first GTCS.

Alcohol Drinking↗
PubMed1997

Treatment of first tonic-clonic seizure does not improve the prognosis of epilepsy. First Seizure Trial Group (FIRST Group).

It is widely agreed that after two or more seizures patients should be given antiepileptic treatment, but there is still controversy about the treatment of patients after a first unprovoked seizure. In a multicenter, randomized, open trial, patients with a first tonic-clonic seizure were randomized to immediate treatment (carbamazepine, phenytoin, phenobarbital, or sodium valproate) or to treatment only after another seizure. Fifty-two (24%) of the 215 patients randomized to immediate treatment and 85 (42%) of the 204 randomized to delayed treatment experienced seizure recurrence during follow-up. Age, acute treatment of the seizure with benzodiazepines, remote etiologic factors, and EEG abnormalities were significant predictors of relapse. Of the immediately treated patients, 87% had no seizures for a year and 68% had no seizures for 2 years, whereas only slightly fewer initially untreated patients (83% and 60%) achieved these endpoints. Patients treated after the first seizure and those treated after seizure relapse had the same time-dependent probability of achieving 1 and 2 seizure-free years. None of the variables that were prognostic predictors of relapse was significantly associated with the probability of having 1 or 2 years of seizure control. Anticonvulsants in patients presenting a first tonic-clonic seizure reduce the risk of relapse; however, 50% of patients who are not treated will never experience a second seizure. Moreover, the probability of long-term remission is not influenced by treatment of the first seizure.

Adolescent↗
PubMed1997

Diabetic polyneuropathy in the elderly. Prevalence and risk factors in two geographic areas of Italy. Italian General Practitioner Study Group (IGPSG).

OBJECTIVE: To assess the prevalence and the risk factors of diabetic polyneuropathy in representative samples of elderly individuals. PATIENTS: 4191 subjects 55 years and older from two areas of Italy were screened by their general practitioners (GPs) and those positive for neuropathic symptoms were subjected to a standard clinical examinations. METHODS: The screening questionnaire included a list of clinical conditions possibly causing polyneuropathy, including diabetes. In patients with diabetes, the date of diagnosis, the most recent fasting and post-prandial blood glucose value and glycosylated hemoglobin were sought. Probable polyneuropathy was diagnosed through impairment of 2 or 3 nerve functions (strength, sensation, tendon reflexes) in the extremities with symmetrical and distal distribution. RESULTS: The sample included 347 patients with diabetes (8.3%). Sixty-six of them (19%) had symptoms and signs consistent with probable polyneuropathy (overall prevalence 1.6%). The disease prevailed in women and in subjects aged 75 years and older. Diabetic patients with polyneuropathy had a longer disease course (P < 0.02) and high mean fasting (P < 0.001) and post-prandial (P < 0.02) blood glucose. CONCLUSION: Diabetic polyneuropathy in the elderly is a fairly common clinical condition prevailing in women and in subjects 75 years and older. Risk factors for polyneuropathy include prolonged disease duration and high mean fasting and post-prandial blood glucose.

Aged↗
PubMed1996

The Guillain-Barrè syndrome (GBS). Implementation of a register of the disease on a nationwide basis. Italian GBS Study Group.

A register of the Guillain-Barrè syndrome (GBS) has been started in Lombardy on February 1 1994, aiming at: 1) Making more correct estimates of the incidence and time and geographic trends of the disease; 2) Having a target population which serves for reference for analytical and experimental epidemiological studies; 3) Contributing to the validation of selected diagnostic procedures; 4) Implementing an audit of the diagnosis and treatment of GBS; 5) Collecting biochemical, hemathological and electrophysiological data to be stored in ad-hoc data-banks. In a pilot study undertaken during the period February 1 1994-May 31 1995 a total of 109 patients (M 63; F 46) were recruited in 32 hospitals. The crude annual incidence rate of GBS was 0.92 per 100,000 population. Typical GBS had been diagnosed in 87% of cases, followed by atypical GBS (7%). The disease could not be classified according to the available criteria in 6% of cases. Electrophysiological features suggesting demyelination were present in 29% of cases; axonopathy was documented in 14%, and mixed patterns in 34%. Plasma exchange was the suggested treatment in 51% of cases, followed by immunoglobulins (24%) and steroids (23%).

Cluster Analysis↗
PubMed1996

Motor neuron disease in the Padua district of Italy: an epidemiological study.

Recent epidemiological surveys indicated that the rate of morbidity and mortality from motor neuron disease (MND) has increased worldwide. We evaluated whether the incidence of the disease has also changed in Padua, Italy, using a retrospective method to study all MND cases hospitalized in the Padua district from 1980 to 1991. As in other regions of the world, we also found an increased incidence of the disease.

Age Distribution↗
PubMed1995

The imbalance of brain large-chain aminoacid availability in amyotrophic lateral sclerosis patients treated with high doses of branched-chain aminoacids.

Following the report of an increased mortality among patients with amyotrophic lateral sclerosis given high daily doses of branched-chain aminoacids, we assessed the plasma concentrations of large neutral aminoacids and glutamic acid and the large neutral aminoacid brain influx in 24 amyotrophic lateral sclerosis patients receiving placebo or branched-chain aminoacids (L-leucine 12 g, L-isoleucine 6 g, L-valine 6 g daily), in 15 untreated amyotrophic lateral sclerosis patients and in 15 healthy volunteers. The branched-chain aminoacid plasma concentrations increased three- to six-fold in the treated group compared to the patients receiving placebo or no treatment and to the healthy controls. Plasma glutamic acid concentrations in healthy volunteers were 51.59 +/- 7.53 nmol/ml while in the amyotrophic lateral sclerosis patients receiving no treatment, placebo or branched-chain aminoacids were 92.33 +/- 12.15 nmol/ml, 91.21 +/- 15.86 nmol/ml and 95.08 +/- 17.96 nmol/ml respectively. The glutamic acid concentration was significantly higher (P < 0.01) in amyotrophic lateral sclerosis patients than in healthy individuals. Plasma phenylalanine and tyrosine were lower in the amyotrophic lateral sclerosis patients than in healthy controls, regardless of treatment, whereas tryptophan levels were not significantly different. The branched-chain aminoacid brain influx of the treated group was 110-140% of that measured in the patients receiving placebo and in the healthy controls. The aromatic aminoacid brain influx was lower in the treated group than in the placebo group or healthy controls. An impairment of brain large neutral aminoacid availability might possible contribute to enhancing the progression of symptoms in patients with amyotrophic lateral sclerosis.

Adult↗
PubMed1995

Stroke and alcohol intake in a hospital population. A case-control study.

BACKGROUND AND PURPOSE: The aim of the study was to assess whether excessive alcohol intake is an independent risk factor for stroke. METHODS: A case-control study was undertaken in 200 consecutive ischemic and hemorrhagic stroke patients and 372 age- and sex-matched control subjects (170 hospital-based and 202 community-based individuals). Data were collected through direct interview regarding demographics, risk factors for stroke, current daily alcohol consumption, and diagnosis of alcoholism. Blood was also taken to test the common biological markers of alcohol intake (erythrocyte mean cell volume, uric acid, aspartate aminotransferase, and gamma-glutamyl transferase). RESULTS: After controlling for the most significant risk factors (antecedent strokes, hypertension, diabetes, smoking) and using hospital control subjects for reference, we determined the risk of stroke to be 2.2 (95% confidence interval [CI], 1.2 to 4.0) in moderate drinkers (men, < or = 60 g/d; women, < or = 40 g/d) and 2.9 (95% CI, 1.4 to 6.1) in heavy drinkers (men, > 60 g/d; women, > 40 g/d). The corresponding risk values obtained when we compared case subjects and external control subjects were 1.4 (95% CI, 0.8 to 2.7) and 3.0 (95% CI, 1.3 to 7.0). Even with some fluctuations across groups, the risk did not change significantly after subgroup analysis in men, patients with first-ever stroke, patients with ischemic stroke, and after exclusion of subjects with risk factors for stroke. Compared with hospital and external control subjects, stroke patients included a higher proportion of heavy drinkers (26.6% versus 20.6% versus 10.8%), alcoholics (14.6% versus 7.7% versus 2.5%), and cases with abnormal erythrocyte mean cell volume (63.0% versus 47.6% versus 34.2%) or gamma-glutamyl transferase (35.5% versus 32.4% versus 12.9%). Mean alcohol consumption was 42.2 g/d in the case subjects, 30.8 g/d in the hospital control subjects, and 23.2 g/d in the external control subjects. CONCLUSIONS: The study indicates that alcohol can be considered an independent risk factor for stroke in Italy.

Adult↗
PubMed1995

The management of epilepsy in the 1990s. Acquisitions, uncertainties and priorities for future research.

The pharmacological treatment of epilepsy has made considerable progress during the last decade, due to improved knowledge of the clinical pharmacology of individual drugs, acquisition of new information on the factors affecting response and need for drug treatment, and development of promising new agents. Once a clinical diagnosis of epilepsy has been made (which generally requires the occurrence of more than one seizure), treatment should be started with a single drug selected on the basis of seizure type and tolerability profile. Although there are important regional differences in prescribing patterns and individual circumstances may dictate alternative choices, carbamazepine is generally regarded as the preferred treatment for partial seizures (with or without secondary generalisation) while valproic acid (sodium valproate) is usually the first choice in most forms of generalised epilepsies. To achieve therapeutic success, the daily dosage must be tailored to meet individual needs, and there is suggestive evidence that in some patients the dosage prescribed initially may be unnecessarily large. Plasma antiepileptic drug concentrations may aid in the individualization of dosage, but should not be regarded as a substitute for careful monitoring of clinical response. Although overall about 70% of patients can be completely controlled, response rate is influenced by a number of factors, the most important of which are seizure type and syndromic form. The importance of a correct syndromic classification for rational drug selection has been poorly assessed and represents a major area for future research. Patients who do not respond to the highest tolerated dose of the initially prescribed drug may be switched to monotherapy with an alternative agent or may be given add-on treatment with a second drug. Appropriate prospective trials are required to assess the merits of either strategy. If add-on therapy is selected and the patient becomes seizure free, it may be possible to discontinue the drug prescribed initially and reinstitute monotherapy. Only a minority of patients are likely to require multiple drug therapy, and it remains to be established whether specific drug combinations are more effective than others. Until further information becomes available, the new agents should be reserved for patients failing to respond to the conventional treatments of first choice. Patients whose seizures cannot be controlled by available drugs should be reassessed, and polytherapy should be maintained only when there is clear evidence that benefits outweigh possible adverse effects. In many patients who have been seizure free for at least 2 years it may be possible to gradually discontinue all medications.(ABSTRACT TRUNCATED AT 400 WORDS)

Algorithms↗
PubMed1994

The prevalence of parkinsonism in Italy: an epidemiological survey of the disease in general practice. The Italian General Practitioner Study Group (IGPSG).

The prevalence and characteristics of parkinsonism have been assessed in two separate geographic areas in Italy (Arcisate and San Giovanni Rotondo). A total of 28,377 patients of 23 general practitioners (GPs) were the reference population. Fifty-eight patients were traced by the GP as having typical parkinsonian features or being treated with antiparkinson drugs. Among 53 subjects, 21 of them untreated, parkinsonism was subsequently confirmed neurologically. The overall crude prevalence rate was 1.87 cases per 1,000 (Arcisate 1.81; San Giovanni Rotondo 2.01). The age- and sex-adjusted prevalence rates were 1.84 in Arcisate and 2.04 in San Giovanni Rotondo. After exclusion of drug-related parkinsonism, the rates were 1.48 and 1.90, respectively. Even with some inconsistencies within the two study areas, the prevalence tended to be higher in San Giovanni Rotondo, to prevail in women, and to increase significantly with age. Presumed etiological factors for parkinsonism were recorded in 34% of the cases (mostly drugs). In two thirds of the cases the disease ran a mild course. The present study shows that the GP proves a valuable reference for surveys of parkinsonism in Italy.

Aged↗
PubMed1993

A randomized trial on the treatment of the first epileptic seizure. Scientific background, rationale, study design and protocol. First Seizure Trial Group (FIR.S.T. Group).

Observational studies suggest that the sooner treatment is started after the onset of seizures the better is the outcome of the disease. However, when to start antiepileptic treatment is still debated and this may explain the different behaviour of practising physicians. For these reasons, a multicenter randomized controlled trial comparing the treatment of the first seizure and the treatment of the recurrences (the two most common strategies in clinical practice) has been started in Italy. The scientific background, the study rationale and design, and the general characteristics of the study population (498 patients) are presented here.

Adolescent↗
PubMed1993

Recurrence after a first unprovoked seizure. Is it still a controversial issue? First Seizure Trial Group (first).

The decision whether or not to start anticonvulsant treatment after a first unprovoked seizure is still an individual one for the patient concerned. Reliable estimates of the risk of seizure recurrence and identification of patients at a higher risk of recurrence are lacking, as critical comparison of studies is limited by the diversity of the target populations and study designs in published studies. The present review interprets the rates of recurrence after a first unprovoked seizure and prognostic factors and predictors of recurrence in the light of the methods used in individual published studies of seizure recurrence. The impact of drug treatment on the prognosis of the first seizure (prevention of recurrence and enhancement of long-term remission) is also assessed.

Adult↗
PubMed1993

Chronic symmetric polyneuropathy in the elderly. A field screening investigation in two regions of Italy: background and methods of assessment. The Italian General Practitioner Study Group (IGPSG).

There are no data on the prevalence and other epidemiologic characteristics of chronic symmetric polyneuropathy (CSP) in the community. This study was designed to assess the prevalence and risk factors of CSP in well-defined elderly (55 years and older) populations from two separate areas in Italy. Thirty-five general practitioners working in the two areas were invited to interview a random sample of patients requesting consultation. They used a pretested questionnaire which focused on selected symptoms of polyneuropathy, common risk factors for CSP, and current drug treatments. Patients giving affirmative answers to the questions on screening symptoms received a further clinical evaluation by a neurologist. Details are given of the general characteristics of the study areas and populations, the methods of case ascertainment, the validation of the screening instruments, and the results of a pilot study.

Aged↗
PubMed1993

Epilepsy and psychiatric disturbance. A cross-sectional study.

One hundred patients with cryptogenic epilepsy and normal intelligence and 100 age- and sex-matched controls were submitted to psychiatric interview using the Clinical Interview Schedule. Nineteen patients and 15 controls were identified as having psychiatric disorders. Anxiety and depression were the predominating diagnoses in both groups. Personality disorders were occasionally present in subjects with epilepsy. The study shows that patients with cryptogenic epilepsy and normal neuropsychological abilities should not be considered at any higher risk of psychiatric disturbance than a non-neurological patient population.

Adolescent↗