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Biomedical subjects

O C Cockerell

Publications and source records attributed to O C Cockerell.

At least 19 recordsLinked to original sources
PubMed1997

Prognosis of epilepsy: a review and further analysis of the first nine years of the British National General Practice Study of Epilepsy, a prospective population-based study.

PURPOSE: To understand the prognosis of newly diagnosed epilepsy to provide rational therapy and advice for patients and their physicians. METHODS: The National General Practice Study of Epilepsy (NGPSE) is the first large population-based study that has assessed the prognosis of patients with newly diagnosed epilepsy prospectively over a prolonged period. We review the previously published data on the prognosis of epilepsy after 9 years of follow-up. One thousand ninety-one patients with newly diagnosed or suspected epilepsy who were attending 1 of 275 general practices throughout the United Kingdom between 1984 and 1987 were ascertained. Cases in this study were defined as the occurrence of one or more seizures, including provoked seizures. Prognosis in terms of remission of seizures, and mortality, was analyzed in the patients who were classified 6 months after recruitment as having definite epilepsy (n = 564) or possible/probable epilepsy (n = 228). RESULTS: Only 33 patients were completely lost to follow-up. After 9 years, 86% [95% confidence interval (CI) 81, 90] of patients with definite epilepsy had achieved a remission of 3 years, and 68% (CI 61, 75), had achieved a remission of 5 years. For the complete cohort, with possible/probable epilepsy included, the rates increased to 87% (CI 83, 91) for 3-year remission and 71% (CI 65, 77) for 5-year remission. The proportion of patients with definite epilepsy who were still in remission at 9-year follow-up (terminal remission) was 68% (CI 62, 74) for 3-year remission and 54% (CI 48, 60) for 5-year remission. When stratified by etiology, the proportions achieving 5-year remission by 9 years was 69% (CI 60, 77) for idiopathic seizures, and 61% (CI 46, 75) for remote symptomatic epilepsy. Age and seizure type had small effects on the chances of achieving remission, with children experiencing slightly lower rates than older patients, and partial seizures having lower remission rates than generalized seizures. The overall standardized mortality ratio (SMR) for patients with definite or possible/probable epilepsy was 2.5 (CI 2.1, 2.9), and 3.0 (CI 2.5, 3.7) for patients who were classified as having definite epilepsy. The SMR for patients with idiopathic epilepsy was 1.6 (CI 1.0, 2.4), for those with remote symptomatic epilepsy it was 4.3 (CI 3.3, 5.5), and for those with acute symptomatic epilepsy it was 2.9 (CI 1.7, 4.5). CONCLUSIONS: Overall, most patients with epilepsy will enter remission; however, there is a higher than expected risk of death, especially in those with symptomatic epilepsy.

Actuarial Analysis↗
PubMed1996

Acute psychological disorders in patients with epilepsy: a nation-wide study.

Acute psychological disorders (APDs) are more common in epilepsy than in the general population, with estimates varying from 2 to 16% depending on the population of patients sampled. APD has traditionally been classified by seizure activity (ictal), the early post-ictal period (post-ictal) and unrelated to seizure activity (inter-ictal). APD may also occur as a consequence of the use of antiepileptic drugs (AEDs). An ongoing prospective active surveillance system was utilised which surveys all neurologists and associated specialists in the United Kingdom run by the British Neurological Surveillance Unit (BNSU). Incident cases were ascertained, using the BNSU, for a period of 1 year and were defined as patients with epilepsy who developed an acute psychological disorder, whatever the cause, such as a psychosis or depression. Sixty-four cases were ascertained. The ages were between 17 and 69 (mean 36); there were 38 males and 26 females. The majority of patients had location-related epilepsy (52, 81%), either cryptogenic (29, 45%) or secondary to a symptomatic lesion (23, 36%), of which the most common were mesial temporal sclerosis (6, 9%) and trauma (4, 6%). Thirty-one (48%) patients were considered to have APD due to ictal or post-ictal activity. Thirty-three (52%) were inter-ictal. Carbamazepine was the most common AED prescribed (42, 66%), and of the new AEDs lamotrigine was prescribed in 17 patients (27%) and vigabatrin in 16 (25%). The APD in 19 (30%) patients was reported by the referring physician as being secondary to an AED. In 12 patients this was attributed to vigabatrin. However, the relative frequency of APD due to AEDs, or to the different new AEDs, could not accurately be calculated as this was not a true incidence study. In the 19 drug-related APD patients, there was no change in seizure frequency in 8 (42%) and in 7 (37%) the seizure frequency had decreased (in 3 (16%), ceasing altogether prior to the APD). In 4 of the 19 patients (21%) the seizure frequency increased. The overall outcome was good with 17/19 (89%) of the AED attributed cases resolving.

Adolescent↗
PubMed1996

A cost minimization study comparing vigabatrin, lamotrigine and gabapentin for the treatment of intractable partial epilepsy.

Epilepsy is one of the commonest of the serious neurological disorders. The total economic burden of epilepsy in the United Kingdom has been estimated to be 1930 m pounds, with around 32 m pounds spent on antiepileptic drug therapy alone. Despite the high level of expenditure on drug therapy for epilepsy there is very little information regarding the relative cost-effectiveness of the different drugs available. It is important to establish the relative cost-effectiveness of therapies to provide decision makers with the information necessary to allocate resources in a rational manner and thus achieve the highest benefit for available resources. In this study the cost-effectiveness of lamotrigine, vigabatrin and gabapentin was estimated by a cost minimization analysis for the first year of drug therapy using data based on published studies. In general, there was little difference between the initial direct costs of treatment, however, the fewer side-effects associated with gabapentin is reflected in the lower total costs of treatment in the first year resulting in savings of 18.52 pounds per patient compared with lamotrigine and 47.18 pounds compared with vigabatrin. Based on incidence data estimates this translates to estimated direct cost savings to the UK of between 166,680 pounds and 424,620 pounds per annum.

Acetates↗
PubMed1996

Clinical and physiological features of epilepsia partialis continua. Cases ascertained in the UK.

Epilepsia partialis continua (EPC) is defined clinically as a syndrome of continuous focal jerking of a body part, usually localized to a distal limb, occurring over hours, days or even years. The anatomical and physiological origin of EPC has been the subject of much speculation. It has been argued that EPC is a form of focal cortical myoclonus, but subcortical mechanisms have also been proposed. We describe a series of 36 patients ascertained over a period of 1 year in the UK using the British Neurological Surveillance Unit. The commonest aetiologies identified were Rasmussen's syndrome (n = 7; 19%) and cerebrovascular disease (n = 5; 14%). Rasmussen's syndrome was the most common diagnosis in patients under 16 years. In seven patients the cause remained unknown. Eight patients (22%) had focal epileptiform scalp EEG abnormalities, and 56% had generalized background scalp EEG disturbances. Lesions on MRI or CT were found in 20 cases (56%), half of whom showed predominant cortical involvement. The muscle jerking resolved in four patients (with no treatment in one), with a partial response to treatment in seven (19%) patients. A cognitive or neurological decline had been noted retrospectively in 13 (36%) patients (and in all of the patients with Rasmussen's syndrome). We personally saw 16 patients who underwent detailed clinical and neurophysiological assessments. Only six of the patients had EEG and EMG evidence for a cortical origin of their jerks; five others had indirect evidence for a cortical origin, from EMG, magnetic stimulation, and other investigations. Two patients did not have myoclonus of cortical origin, but some other source (brainstem and basal ganglia). The origin in the remaining three patients was uncertain. The clinical appearance of the muscle jerks was similar in all patients despite the different origins. We propose that the definition of EPC is best restricted to "continuous muscle jerks of cortical origin'. Continuous muscle jerking that arises from other sites in the nervous system should be termed "myoclonia continua'.

Adolescent↗
PubMed1996

The mortality of epilepsy.

The overall risk of premature death in patients with epilepsy has recently been quantified and is two to three times that of the general population. Most of the increased risk is directly related to the cause of the epilepsy itself. A small number of deaths in the general population of patients with epilepsy are epilepsy-related deaths, which includes those deaths caused by a seizure or accidents during or immediately after a seizure, as well as sudden unexpected death, for which no cause of death can be identified. Sudden unexpected deaths are more common in patients with intractable epilepsy. Recent studies suggest that improved seizure control, advice and help to avoid the hazards that occur during a seizure, as well as increased supervision of institutionalized patients, may help reduce the risks of epilepsy-related death occurring.

Epilepsy↗
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

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↗
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

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

The British Neurological Surveillance Unit: a nation-wide scheme for the ascertainment of rare neurological disorders.

The British Neurological Surveillance Unit was set up in January 1993 with the aim of co-ordinating and improving the ascertainment of rare neurological disorders in the United Kingdom by using a system of nation-wide active surveillance. The unit provides a service for individual investigators who must first submit possible studies to a scientific advisory committee. Once accepted the condition is listed on a report card which is sent to every member of the British neurological community every month. The cards are easy to use, and all the reporting neurologist has to do is tick a box indicating whether a case has (or has not been) seen. At the end of every month the individual investigators then initiate further follow-up by contacting the reporting neurologists. In the first year of operation the scheme has assisted in the surveillance of 6 disorders and the following number of verified cases have so far been ascertained: polio in adults (n = 0); acute psychological disorders in patients with epilepsy (n = 75); Guillain-Barré syndrome in the south of England (n = 32); epilepsia partialis continua (n = 40); amyloid neuropathy (n = 12), and agenesis of the corpus callosum (n = 24). The monthly response rates are between 65 and 75%, with the eventual aim of achieving over 90% after the scheme has become more established.

Amyloid Neuropathies↗
PubMed1994

Mortality from epilepsy: results from a prospective population-based study.

Patients with epilepsy may be subject to an increased risk of premature death from the underlying cause, or from the epilepsy itself. The extent and nature of this risk has been insufficiently investigated. Standard mortality ratios (SMRs) of patients with newly diagnosed epilepsy were determined in a prospective national population-based study. 1091 patients with newly diagnosed or suspected epilepsy were ascertained who were attending one of 275 UK general practices from 1984-1987. 1091 patients were classified after 6 months as definite epilepsy (564), possible epilepsy (228), febrile seizures (220), or not epilepsy (79). Over a median follow up of 6.9 years the SMR for patients with definite or possible epilepsy was 2.5 (95% CI 2.1-2.9), and 3.0 (2.5-3.7) for definite epilepsy. The SMR was highest during the first year after diagnosis 5.1 (3.8-6.5), declined to 2.5 (1.5-3.9) at 3 years, and 1.3 (0.7-2.0) at 5 years. The commonest causes of death were pneumonia (SMR 7.2), cancer (3.5), and stroke (3.7). The SMR for patients with idiopathic epilepsy was 1.6 (1.0-2.4), remote symptomatic epilepsy 4.3 (3.3-5.5), and acute symptomatic epilepsy 2.9 (1.7-4.5). Mortality in patients with newly-diagnosed epilepsy was high, mainly due to the underlying cause. The SMR for idiopathic epilepsy was also raised, suggesting that epilepsy per se may carry a small risk of death.

Adolescent↗
PubMed1994

The cost of epilepsy in the United Kingdom: an estimation based on the results of two population-based studies.

Epilepsy has important socio-economic costs to a population. It is important to assess these costs so that health care priorities can be set. We assessed the burden of illness of epilepsy at the community level, and from this we were able to estimate costs for an individual and the cost to the United Kingdom (UK) as a whole. Cost analysis was based on two different populations of patients with epilepsy, a prevalent and an incident population. Patients with established epilepsy (n = 1628), who were identified from general practices throughout the UK as part of the National Epilepsy Survey (NES), and patients with newly diagnosed epilepsy (n = 602), from the National General Practice Study of Epilepsy (NGPSE), which is a prospective longitudinal cohort study of epilepsy. Indirect and direct costs were assessed in the NES, and direct costs in the NGPSE. A longitudinal cost profile of epilepsy was calculated, with an average initial direct costs of 611 pounds (US$917) per patient per annum which decreased after eight years of follow up to 169 pounds (US$254) per patient per annum. The cost to the UK of newly diagnosed epilepsy in the first year of diagnosis was 18 million pounds (US$27 million). The total annual cost of established epilepsy to the UK was estimated at 1930 million pounds (US$2895 million), over 69% of which was due to indirect costs (unemployment and excess mortality). The cost of active epilepsy per patient was approximately 4167 pounds (US$6251), and of inactive epilepsy 1630 pounds (US$2445) per patient per annum. Methodological issues in cost studies of epilepsy are reviewed.

Adult↗