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Biomedical subjects

J W Sander

Publications and source records attributed to J W Sander.

At least 109 records · Page 6Linked to original sources
PubMed1996

Neurological disease in a defined population: the results of a pilot study in two general practices.

A pilot study was set up to ascertain incident neurological disorders occurring in 25,000 people attending two general-practice surgeries for a period of 1 year. To achieve completeness of ascertainment and diagnostic validity poses considerable logistical and theoretical difficulties, and these are discussed. The commonest disorders (incidence in parentheses) were headaches (210/100,000), back syndromes (319/100,000), acute cerebrovascular disease (128/100,000), and migraine (64/100,000), with non-specific symptoms the most common problem overall (514/100,000). The incidence of Parkinson's disease was 26/100,000 and that of epilepsy 23/100,000. The pilot study will form the basis for a more comprehensive linkage scheme between the National Hospital for Neurology and Neurosurgery in London and surrounding general practices with a total base population of 100,000.

Brain↗
PubMed1996

Felbamate as add-on therapy.

Felbamate is a novel anti-epileptic drug (AED) which has recently been associated with reports of aplastic anaemia and liver failure. We have conducted an open-label add-on assessment of the tolerability and efficacy of this compound in 111 adult patients with refractory epilepsy attending a tertiary referral centre. The mean follow-up period was 4 months (range 1-8 months). Sixty-three (57%) were ongoing, 38 (34%) had discontinued felbamate and a further 10 (9%) were withdrawing. Reasons for discontinuing felbamate were adverse events in 23 (21%), increase in seizures in 11 (10%) and lack of efficacy in 14 (12%). Behavioural disturbances occurred in 14 patients, being the most likely adverse event to result in discontinuation. No cases of aplastic anaemia or liver failure were observed in this group. Felbamate appears to be a broad-spectrum AED. Seven percent of the patients had more than 95% seizure reduction (2 patients were seizure free), whilst a further 13% had significant improvement ( > 50% reduction in seizure frequency). In conclusion, felbamate seems to be an effective AED. In view of its association with potentially life-threatening complications, its use should however be restricted to patients with medically refractory epilepsy.

Adult↗
PubMed1996

Non-convulsive status epilepticus presenting as a psychiatric condition.

Non-convulsive status epilepticus may present as confusion, behavioural disturbances and psychiatric conditions. We present the case of a 17-year-old man who had episodes of non-convulsive status epilepticus as his only manifestation of epilepsy which was mis-diagnosed as a psychiatric condition for over 10 years. He has had almost complete resolution of his symptoms with the introduction of carbamazepine. Non-convulsive status epilepticus is probably commoner than previously thought, and should be considered as a possible diagnosis in all patients presenting with prolonged episodes of altered consciousness even without other manifestations of epilepsy.

Adolescent↗
PubMed1996

Allergic skin rash with lamotrigine and concomitant valproate therapy: evidence for an increased risk.

Cutaneous rash is one of the commonest adverse events associated with lamotrigine. We assessed whether the risk is increased in patients receiving concomitant valproate therapy in a population of 103 adult patients with intractable epilepsy, who had lamotrigine added to their treatment. Of the 33 patients taking valproate, 10 (30%) developed a rash, whilst of the 70 not taking valproate, only 6 (8%) developed a rash. This suggests a significantly higher risk of cutaneous rash when starting lamotrigine in patients already taking valproate (p < 0.02).

Adolescent↗
PubMed1995

Remission of epilepsy: results from the National General Practice Study of Epilepsy.

Remission of seizures is a crucial measure of outcome in epilepsy. The National General Practice Study of Epilepsy (NGPSE) aimed to investigate the remission of patients with epilepsy and the effect of various factors on the likelihood of remission. The NGPSE is a prospective population-based study free from major selection bias. We enrolled 1091 patients with newly diagnosed or suspected epilepsy who attended one of 275 general practices throughout the UK between 1984 and 1987. Remission was analysed in those patients who were classified after 6 months as having definite epilepsy (n = 564) or possible epilepsy (n = 228). After 9 years from the index seizure, 86% (95% CI 81-90) of patients with definite epilepsy had achieved a remission of 3 years and 68% (61-75) a remission of 5 years. For the complete cohort, including those with possible epilepsy, the remission rates at 9 years were 87% (83-91) for 3-year remission and 71% (65-77) for 5-year remission. The proportion of patients with definite epilepsy who were still in remission at 9 years' follow-up (terminal remission) was 68% (62-74) for 3-year and 54% (48-60) for 5-year remission. 61% (56-68) of patients with idiopathic seizures and 61% (46-75) of those with remote symptomatic epilepsy had achieved 5-year remission by 9 years. Overall, age and seizure type had little effect on the chances of achieving remission. This study confirms the good outcome for seizure control in the majority of patients.

Anticonvulsants↗
PubMed1995

First seizures associated with playing electronic screen games: a community-based study in Great Britain.

Active surveillance by virtually all electroencephalographic departments throughout Great Britain identified 118 patients who had a first seizure while playing an electronic screen game during two 3-month periods. Patients were divided into Group A (46 patients)--those for whom there was thought to be a definite causal relationship (type 4 photoparoxysmal response); Group B (25 patients)--those for whom there was a probable causal relationship (types 1-3 photoparoxysmal response, clinical evidence of photosensitivity, subsequent recurrent seizures on repeat exposure to electronic screen games, and/or occipital spikes in the resting electroencephalogram); and Group C (47 patients)--those for whom there was no apparent causal relationship. The number of patients in Group C did not exceed that expected by the chance occurrence of two common events (playing electronic screen games and incidence of epilepsy). Most (103/118) of the patients were in the age range of 7 to 19 years. Within this age group the annual incidence of first seizures triggered by playing electronic screen games (Groups A and B combined) was estimated to be 1.5/100,000.

Adolescent↗
PubMed1995

Incidence of photosensitive epilepsy: a prospective national study.

We undertook a prospective nationwide study to determine the incidence of photosensitive epilepsy (PE). Virtually all EEG departments in Great Britain (providing approximately 90% coverage of all EEGs performed on people with newly diagnosed seizures) screened cases referred to them over a 3 month period and identified all new cases of epilepsy (defined as one or more recognised seizures) whose first EEG showed a photoparoxysmal response (PPR) on intermittent photic stimulation (IPS). 191 cases were identified, 143 of whom had type 4 PPRs (generalised spike and wave on IPS) on their first EEG. The annual incidence of cases of epilepsy with type 4 PPRs on their first EEG was conservatively estimated to be 1.1 per 100,000, representing approximately 2% of all new cases of epilepsy. When restricted to the age range 7-19 years, the annual incidence rose to 5.7 per 100,000-approximately 10% of all new cases of epilepsy presenting in this age range. To ascertain if there was a significant seasonal variation in PE, 5 EEG departments (which together contributed 15% of cases in the first study period) were visited during a second 3 month study period to identify all new cases of epilepsy with type 4 PPRs on their first EEG. No significant seasonal variation in incidence between summer and winter was found.

Adolescent↗
PubMed1995

Sudden death in epilepsy: a study of incidence in a young cohort with epilepsy and learning difficulty.

Sudden death, often seizure related, may occur in patients with epilepsy. Population-based incidence is probably on the order of 1:1,000/year. The incidence is much higher in selected groups, however. We wished to establish the incidence of sudden unexpected death (SUD) in a young cohort with severe epilepsy and learning difficulties. The study cohort included 310 pupils with epilepsy enrolled at a special residential school between April 1970 and April 1993. The follow-up period totaling 4,135 person-years included a period of residence at the school as well as time after leaving. Age and sex standardized overall mortality ratio was 15.9 [95% confidence interval (CI) 10.6-23.0], with 20 of 28 deaths considered epilepsy related. An incidence of sudden death cases of 1:295/year was noted. All 14 sudden deaths occurred when the pupils were not under the close supervision of the school and most were unwitnessed, which has implications for prevention.

Adolescent↗
PubMed1995

Incidence of sudden unexpected death in an adult outpatient cohort with epilepsy at a tertiary referral centre.

Overall mortality, incidence of sudden unexpected death, and cause of death were determined in 601 adult outpatients with epilepsy at a tertiary referral centre. The patients were followed up from 1990 to 30 June 1993. There were 24 deaths among the 601 patients (1849 patient years) with a standardised mortality ratio of 5.1 (95% confidence interval 3.3-7.6) of which 14 were related to epilepsy. Underlying disease of which epilepsy was a symptom accounted for four deaths only. An incidence of sudden deaths (including seizure related) was of the order of 1:200/year. In conclusion, excess mortality in chronic epilepsy is more likely to be related to the epilepsy itself than to underlying pathology. The relatively high incidence of sudden deaths found in this hospital based cohort has important implications for patient management.

Adolescent↗
PubMed1995

Epilepsy in a population of 6000 re-examined: secular trends in first attendance rates, prevalence, and prognosis.

It is important to document changes in the vital statistics of epilepsy in the general population so that the success or failure of prevention and treatment can be assessed and health provisions planned. A population of 6000 persons was studied 10 years apart to determine secular trends in the prevalence and prognosis of epilepsy. The lifetime prevalence of all patients with one or more afebrile seizures was 20.3/1000 (95% CI 16.9-24.3) in 1983 and 21.0/1000 (95% CI 17.6-25.1) in 1993. The prevalence of active epilepsy was 5.3/1000 (95% CI 3.6-7.5) in 1983 and 4.3 (95% CI 2.8-6.3) in 1993. To assess trends in incidence rates the annual first attendance rates were measured from 1964 to 1993. Annual first attendance rates in children (age < 20 years) have declined from 152.4/100,000 (90% CI 106.0-212.9) in the years 1974-83, to 60.9/100,000 (90% CI 33.0-103.3) in the years from 1984-93, suggesting that the incidence of epilepsy in children is falling. Also noteworthy was the first attendance rates for epilepsy in elderly people (61-80 years) in the years 1984-93, of 82.0 (90% CI 38.5-154.0), higher than in any other age group. This increase in the number of elderly patients with epilepsy is important, and has health planning implications, especially with the overall increase in the total elderly population. There was, however, no evidence that prognosis has significantly altered in the past 40 years.

Adolescent↗
PubMed1995

Levels of stigmatization of patients with previously untreated epilepsy in northern Ecuador.

As part of a population-based study of epilepsy in northern Ecuador, 215 patients with epilepsy and 125 controls were given a questionnaire designed to elicit the degree of stigma associated with epilepsy. Evidence for stigma was also sought from local medical personnel. 144 patients and 98 controls were questioned again 12 months later at study completion to see whether their perceptions had changed. Both intellectual and physical abilities of people with epilepsy were regarded as low by controls, and this opinion did not change over the study period. Observations by medical personnel also suggested stigmatizing attitudes in the community. The number of patients reporting problems with their marriage or childbearing as a result of their epilepsy did not alter over the 12-month period, unlike their estimates of their own intellectual and physical capacities which had significantly improved. Conversely, although their expectations of employment outside the home had diminished, the reasons stated for this related to continuing epilepsy and not to the objections of fellow workers and employers.

Adolescent↗