Incidence and case-fatality rate of status epilepticus in the Canton of Geneva.
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Adult↗
Biomedical subjects
P Jallon
Publications and source records attributed to P Jallon.
[Sudden death of epileptic patients].
DEFINITION: Sudden unexpected death in an epileptic patient which no likely cause--head trauma, drowning, grand mal, bronchial aspiration, suffocation--and no anatomic or toxicologic condition which could clearly explain the death. A seizure reported by witnesses or suspected from clinical signs observed prior to death and compatible with the definition raises the problematic of the relationship with sudden death. INCIDENCE AND RISK FACTORS: Sudden death is estimated to occur in 1 out of 450 to 2000 epileptic patients, giving an annual incidence of 0.55 to 9.3 per 1000 patients. Such a wide incidence range can be explained by the difficulties in providing a rigorous definition of sudden death and more importantly by the heterogeneous nature of the population at risk. The risk of sudden death is clearly related to the severity of the epilepsy. It is observed in young adults with symptomatic, often difficult to treat epilepsy. Death is frequently observed during sleep. PATHOPHYSIOLOGICAL HYPOTHESES: The circumstances of sudden death in the epileptic patient illustrate the complex relationships existing between seizures and irreversible cardiorespiratory dysfunction. Neurogenic lung edema is frequently observed at autopsy and has been confirmed by experimental data. Experimental work and clinical observations would suggest that central apnea, associated with cardiac dysrhythmia could be involved. Other risk factors, including sleep, compliance to treatment, arrhythmogenic effect of certain antiepileptics and the consequences of repeated seizures on the myocardium may also play a role.
Adult↗
Semantically-triggered reading epilepsy: an experimental case study.
Primary reading epilepsy (PRE) is a rare syndrome in which epileptic seizures are electively provoked by reading. Cognitive neuropsychology has demonstrated the existence of at least two pathways for reading, the sublexical pathway involved in converting graphemes to phonemes, and the lexical pathway used when meaning is conveyed. Which of these specific pathways is relevant in triggering epileptic discharges remains largely unknown. We report the case of a patient suffering from PRE in which the two routes were distinguished on the basis of the reading material employed. Significantly less epileptic discharges were observed when the patient read non-words than words. In view of our findings, we tentatively contrast a lexical form of PRE, triggered by the activation of semantic knowledge structures, with a sublexical form, triggered by non-word reading. Evidence from the literature suggests that the former is characterized by bilateral EEG activating patterns, whereas the latter involves preferentially the left hemisphere.
Electroencephalography↗
Etiology, neurologic correlations, and prognosis in alpha coma.
OBJECTIVE: To determine the factors affecting prognosis in alpha coma (AC). METHODS: Retrospective review of 36 study patients, 36 control coma patients matched for age and etiology, and meta-analysis of 335 cases in the world literature. RESULTS: Principal causes were cardiorespiratory arrest (CRA) (21 patients); infection, metabolic dysfunction, head trauma (3 each); and drugs, stroke and hypoxia (2 each). Outcome was predicated by EEG reactivity to noxious stimuli. Fourteen of the 15 patients with reactive EEGs, had measurable outcome, 8 awoke - all but two had etiologies other than CRA. Fourteen of 19 patients without EEG reactivity died; two had support discontinued and 3 awoke. Following CRA, 16/21 patients died and 3 had support discontinued. Only 3 patients made a good recovery - all with toxic or metabolic etiologies. Literature meta-analysis of 335 cases showed that overall, AC carried a poor prognosis (76% died). CRA (226 cases) had an 88% mortality; strokes (29 cases), a 90% mortality; hypoxia without cardiac arrest (28 cases), a 61% mortality; drug-induced AC (25 cases), an 8% mortality. CONCLUSIONS: Although the cause of AC largely predicts outcome, EEG reactivity in AC predicted survival: most patients with reactivity awoke; most of those without, died. Few survivors had meaningful recovery.
Adult↗
Idiopathic generalized epilepsy of late onset.
Most idiopathic generalized epilepsies have an onset in childhood or adolescence, with a moderate second incidence peak in the presenium predominantly in women. This study addressed the question of a later onset. The available literature and the records of four personal data sets (two prospective incidence surveys of epileptic seizures, one prevalence study of epilepsy, and one clinical series of individuals with epilepsy) were screened for patients who had experienced a first generalized convulsive seizure with bilateral spike-wave complexes on EEG after 60 years of age. Reports of first idiopathic generalized tonic-clonic seizures occurring after age 60 were extremely rare and none was found in our four cohorts regardless of the methodology involved. Only five case reports were found, all involving a woman. Two had a family history of seizure disorders and two had had at least one seizure earlier in life. Idiopathic generalized epilepsy of late onset, if this condition actually exists, is likely to be the consequence of a genetic predisposition triggered by acquired epileptogenic factors.
Age of Onset↗
[Epilepsy and psychiatric disorders: epidemiological data].
Data about psychiatric disorders associated with epilepsy as well as their risk factors are heterogeneous. The overall prevalence of psychiatric disturbances in epileptic patients can be estimated between 20 and 30 per cent. It is the highest in pharmocoresistant cases seen in specialized centers. Psychotic disorders, depression, and suicide are the three most common among interictal disturbances. Psychoses affect 2 to 9 per cent of patients and are more frequent in cases with aura or altered consciousness, such as in complex partial seizures and absences. They correlate positively with the multiplicity of seizures but often inversely with their frequency. Temporal lobe epilepsy is associated with schizo phrenic-like and paranoid types of psychosis, but frontal lobe epilepsy is also common. A putative association with predominant left or bilateral EEG abnormalities in cases with partial epilepsy remains to be confirmed, as well as the frequency of underlying structural lesions. Depressive disorders affect 20 to 60 per cent of patients. While their occurrence with partial complex seizures and left hemisphere foci is common, the role of temporal lobe involvement still appears controversial. Depression prevails in cases with seizures that occasionally, albeit rarely, secondarily generalize and correlates with the duration of the disease, intractable seizures, and polypharmacy. A genetic factor is likely to play a role. Suicides rates are increased, encountered in 0.2-0.5 per cent of patients and causing deaths in 3-7 per cent of them. The overall risk might be the highest during the first years after diagnosis of epilepsy, as well as in patients with temporal lobe foci, depression, or psychosis. Great variability and discordance in results show the major difficulties encountered in epidemiologic studies. Most of these problems relate to the classification of epileptic disorders as well as that of psychiatric disorders, the variability in the methods and measures which are used, and frequent bias in the selection of patients. We review here data about the frequency of major psychiatric disorders in epileptic patients or the frequency of epileptic disorders in psychiatric patients, and also possible risk factors related to the epileptic disease and its evolution.
Adult↗
[Epileptic seizures, epilepsy and risk factors. Experiences with an investigation in Martinique. Epimart Group].
A prospective incidence study was carried out in the French Caribbean island of Martinique between May 1st 1994 and April 31st 1995. incidence was 80.6 (77.7 when standardized with 1990 U.S. population). This incidence was higher than that observed in the Swiss canton of Geneva where the same methodology was used. The individualized risk factors of first provoked and unprovoked seizures in Martinique were alcoholism, head trauma and cerebro-vascular accidents.
Epilepsy↗
[CAROLE--prospective, multicenter study of first epileptic seizures].
Carole is a prospective cohort survey set up in France by the Observatory for epilepsy. About 2000 patients who had had an initial, undoubtedly epileptic seizure and who had consulted a doctor between 1st May 1995 and 30 June 1996 were admitted. The analysis of the first 1000 cases is presented. The value of this study lies in the attempt it makes to individualize the risk factors of pharmaco-resistance, to assess the procedures used to treat the patients subsequent to an initial seizure and to calculate the direct and indirect costs of the diagnosis and therapy to health insurance.
Adolescent↗
[Effect of antiretroviral treatment on early electroencephalographic and otoneurologic manifestations in HIV infection and prognostic importance of verified perturbations].
Electrophysiologic tests may be abnormal in asymptomatic HIV-1-infected individuals. Our study was aimed at determining whether these findings have a prognostic value and could be corrected by antiviral treatment. In 18 patients, followed for 34 or 43 months, these findings were not progressive. Only one patient developed Aids dementia complex (ADC). Three have died (one with normal, two with abnormal tests at baseline). To study the effect of antiviral treatment, another group of seven asymptomatic patients was included into a cross-over double-blind study with either eight weeks zidovudine or eight weeks placebo, separated by eight more weeks without treatment. Electrophysiological evaluation was also performed in a group of 15 patients before antiviral therapy with zidovudine or didanosine was started and again after a mean of three and 13 months treatment. Results did not suggest that treatment reverses early electroencephalographic and otoneurological changes seen in HIV-1 infection.
Acquired Immunodeficiency Syndrome↗
Incidence of first epileptic seizures in the canton of Geneva, Switzerland.
PURPOSE: We wished to determine the incidence of first provoked and nonprovoked epileptic seizures in the canton of Geneva, Switzerland. METHODS: Between June 1, 1990 and May 31, 1991, we collected all cases of suspected epileptic seizures referred to the two hospitals of the county of Geneva, Switzerland and to the private neurologists of the town. The diagnosis probability was based on clinical data from the patient chart and the EEG data. The classification of risk factors proposed by the International League Against Epilepsy (ILAE) Commission on Epidemiology and Prognosis was used. RESULTS: In all, 273 cases were collected. The age-adjusted incidence rate (U.S. population as standard) is 69.4 in 100,000. We observed a bimodal distribution of the cases with age (71 in the group aged 0-10 years and 107.5 in those aged > 60 years). Ninety-seven cases were classified as having provoked seizures (incidence: 25.2 in 100,000). Alcohol consumption (29.8%) and cerebrovascular diseases were the most frequent causes (16.4%). One hundred seventy-six cases were classified as having unprovoked seizures (incidence: 45.6 in 100,000) with the following distribution: seizures in relation with a stable cerebral condition, 69 cases (incidence: 17.9); seizures in relation with an evolutive cerebral condition, 27 cases (incidence: 7); and seizures of unknown etiology, 80 cases (incidence: 20.8). CONCLUSIONS: The incidence rate of first epileptic seizures in the canton of Geneva is quite similar to that reported in a French study (Epilepsia (1990;31:391-394) in which the same methodology for case ascertainment was used. Our data clearly demonstrate that the classification of risk factors proposed by the ILAE Commission on Epidemiology and Prognosis is useful and particularly easy to use in epidemiological surveys.
Adolescent↗
Epilepsy in developing countries.
On June 6th and 7th, 1996, an international workshop on specific aspects of epilepsy in the developing world was organized in Geneva by the chairman of the ILAE Commission of Epilepsy in Developing Countries, P. Jallon, involving members of the ILAE, the World Health Organization (WHO), and a network of people who work with epilepsy patients in developing countries. Those taking part included all the members of the ILAE Commission on Epilepsy in Developing Countries, the chairmen of the ILAE Commissions on Tropical Diseases, Epidemiology, Education, Economics, and Drugs, as well as the president, treasurer, and past president of the ILAE; and the president of the IBE, Hanneke de Boer. There were representatives from Eastern European countries (Russia, Slovenia, Turkey), South America (Brazil, Colombia, Uruguay, Ecuador, Venezuela), Africa (Ethiopia, Senegal, South Africa, Togo, Tunisia), and Asia (India, Indonesia, Pakistan, Sri Lanka, The Philippines and China). Representatives from WHO joined the meeting on the last day (Drs. L. Prilipko, A. Janca, and C. L. Bolis). Three major topics were considered--epidemiology, medical assessment, and therapeutic aspects as well as some economic and social aspects of the disease. A second mission of this meeting was to work with WHO representatives to develop a program for action to care for people with epilepsy in these countries.
Adolescent↗
The problem of intractability: the continuing need for new medical therapies in epilepsy.
Treatment of epilepsy, one of the most common neurologic disorders, has evolved from "institutional" polytherapy to "dogmatic" monotherapy, and, most recently, to "rational" polypharmacy. The introduction of bromides for the treatment of epilepsy was followed first by phenobarbital and then by phenytoin as therapeutic options. Although attempts to combine medications were legion, none was supported by studies that demonstrated the benefit of such combinations. The issue of adverse effects became a principal argument in favor of monotherapy. Monotherapy, using newly developed drugs, avoided problems due to drug interactions but was ineffective in 20-30% of patients. A greater understanding of basic disease mechanisms and developments in molecular biology have led to an increased number of effective drugs for the estimated 6-12% of patients with epilepsy whose condition is intractable. Clinical research continues to build on the work of basic scientists in attempting to develop treatments based on a desire to move beyond the palliative and to affect the causative mechanisms of the disease. Novel medical approaches now under exploration include the use of drugs with complementary mechanisms of action, stimulation of various components of the nervous system, biochemical manipulations, focal intracerebral drug perfusion, and gene therapy.
Anticonvulsants↗
Patterns of care for patients with epilepsy in France.
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Epilepsy↗
[Epilepsy and the heart].
The relations between epilepsy and heart are complex and expressed in two opposite sides. (1) Cardiac arrhythmias may provoke epileptic seizures but these seizures are, in this case, syncopal attacks. Nevertheless, in the past, these clinical features have been individualized as "cardiac epilepsy" or epilepsy in cardiacs. However, true epileptic seizures could be observed in the course of a syncopal attack and a syncope may complicate the issue of an epileptic seizure. (2) On the other hand, epileptic seizures may provoke severe cardiac arrhythmias. The incidence rate of sudden death in patients with epilepsy is estimated to be 1/1000 patients. The exact neural mechanisms in cardiac arrhythmias seizures could explain only some of the sudden unexpected deaths observed in epileptic patients. The role of antiepileptic drugs on cardiac conduction as well as the effects of seizures or status epilepticus on the myocardium are other enigmatic aspects of the relations between epilepsy and heart.
Arrhythmias, Cardiac↗
[Monotherapy and polytherapy use of anti-epileptic drugs. Development of views].
The evolution of our approach to the treatment of epilepsy has occurred in three stages: at the turn of the century, when epilepsy was increasingly entering into the mainstream of Neurology, pharmacotherapy of epilepsy was limited to the bromides. Subsequently, phenobarbital used in 1912 and then phenytoin, discovered in 1932, remained, for many years, the only therapeutic options. To increase the chances of complete suppression of seizures, it appeared logical to use both medications together. This approach was used for many years despite the advent of carbamazepine and sodium valproate. In 1976, the first studies appeared indicating the advantages of using monotherapy from the start. Not only did this approach show itself to be effective, but there was a marked decrease in the incidence of side-effects engendered by polytherapy. Nevertheless, despite o carefully instituted monotherapy, between 20 and 30 p. cent of patients still had seizures refractory to treatment. A new era in antiepileptic drug development has created new hope in the management of epilepsy. Based on a better understanding of the disease process and scientific development in molecular biology, we are able to provide a more rational polypharmacy, taking into account their pharmacodynamic interactions and their relatively high cost.
Anticonvulsants↗
[Geographical distribution of epilepsy in the world].
Based on more than one hundred epidemiological studies we evaluated the frequency of epileptic seizures and epilepsy itself. Worldwide, there appears to be unequal distribution of disease incidence and prevalence. It seems that the incidence of epilepsy in developing countries would be greater than that in the industrialized world and that the differences in prevalence observed between the developing and the industrialized countries could be epidemiologically significant. Once the methodological biases that might account for these differences have been eliminated, it is probable that the differences in incidence and prevalence could be explained by specific risk factors. Particular regional distribution of the disease would then reflect local risk factors and, therefore represent epidemiological markers of particular regional or endemic infections, hereditary predispositions, early interventions during management of childbirth and childhood development or even the natural course of the disease.
Adult↗