Biomedical subjects

W A Hauser

Publications and source records attributed to W A Hauser.

189 records · Page 11Linked to original sources

PubMedDate not supplied

Prevalence of epilepsy in Rochester, Minnesota: 1940-1980.

The prevalence of epilepsy in Rochester, Minnesota has been determined for a specific date in each of 5 decennial census years. Individuals with a diagnosis of epilepsy (recurrent unprovoked seizures) who were known to have experienced a seizure or who had received antiepileptic medication in the preceding 5 years were considered active prevalence cases. By this definition, the age-adjusted prevalence per 1,000 population, increased steadily from 2.7 in 1940 to 6.8 in 1980. At each of five prevalence dates, for all prevalence cases, 60% had epilepsy manifest by partial seizures, and 75% had no known etiology. Prevalence was higher for males than females for all except the last prevalence day. After 1950, prevalence tended to increase with advancing age and was highest in the oldest age groups. On the average, the 1980 prevalence cases had epilepsy less than 10 years and greater than 50% had their first diagnosis in the first 20 years of life.

Adolescent↗

PubMedDate not supplied

Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935-1984.

The incidence of epilepsy and of all unprovoked seizures was determined for residents of Rochester, Minnesota U.S.A. from 1935 through 1984. Age-adjusted incidence of epilepsy was 44 per 100,000 person-years. Incidence in males was significantly higher than in females and was high in the first year of life but highest in persons aged > or = 75 years. Sixty percent of new cases had epilepsy manifested by partial seizures, and two thirds had no clearly identified antecedent. Cerebrovascular disease was the most commonly identified antecedent, accounting for 11% of cases. Neurologic deficits from birth, mental retardation and/or cerebral palsy, observed in 8% of cases, was the next most frequently identified preexisting condition. The cumulative incidence of epilepsy through age 74 years was 3.1%. The age-adjusted incidence of all unprovoked seizures was 61 per 100,000 person-years. Age- and gender-specific incidence trends were similar to those of epilepsy, but a higher proportion of cases was of unknown etiology and was characterized by generalized onset seizures. The cumulative incidence of all unprovoked seizures was 4.1% through age 74 years. With time, the incidence of epilepsy and of unprovoked seizures decreased in children and increased in the elderly.

Adolescent↗

PubMedDate not supplied

Validity of family history data on seizure disorders.

Accurate family histories of seizure disorders are important for both clinical practice and genetic research. This study evaluated validity of seizure histories of parents and siblings, obtained by interviewing 1,957 adults with epilepsy (probands). Probands were asked two questions to screen for occurrence of seizures in each relative; the first asked about epilepsy specifically, the second asked about "other seizures." For each relative who screened positive for seizures, a detailed clinical description was obtained. The final diagnosis was based on a review of all assembled information. Whenever possible, the proband's mother was interviewed independently about the family history, as were eligible relatives reported to have had seizures. Sensitivity, or the proportion of affected relatives who screened positive for seizures, was higher for epilepsy than for other seizures (87% vs. 32% assuming the mother's report to be correct, and 93% vs. 18% assuming self-report to be correct). For epilepsy, estimates of risk in siblings based on the final diagnoses were similar to previously reported findings in Rochester, Minnesota. For both isolated unprovoked seizures and acute symptomatic seizures, however, risk estimates were lower than in Rochester. These findings suggest that adults with epilepsy can report reasonably accurately about epilepsy in their parents and siblings, but isolated unprovoked seizures and acute symptomatic seizures are underreported.

Epilepsy↗

PubMedDate not supplied

Cost of epilepsy in the United States: a model based on incidence and prognosis.

A model of the clinical course of epilepsy from onset until remission or death has been developed for six prognostic groups, including survival, use and cost of medical care, and time lost from work and housekeeping. The model has been used to generate preliminary estimates of the lifetime cost of epilepsy for a cohort of persons diagnosed in 1990 in the United States. The distribution of incident cases among prognostic groups is derived from epidemiologic studies of prognosis in epilepsy. Direct cost is estimated by multiplying nationally representative unit costs by the expected type and frequency of medical care use. The latter were derived by an expert panel, based on inferences from existing literature and on their own clinical experiences. Indirect cost is estimated based on lost earnings associated with projections of restricted activity days, excess unemployment, and excess mortality. Total lifetime cost in 1990 dollars of all persons with epilepsy onset in 1990 was estimated at $3.0 billion, with indirect cost accounting for 62% of the total. Cost per patient ranged from $4,272 for persons with remission after initial diagnosis and treatment to $138,602 for persons with intractable and frequent seizures. Antiepileptic drug (AED) treatment is the most costly category of service. Different assumptions about the amount and type of drug administration cause major changes in overall cost estimates.

Adolescent↗

PubMedDate not supplied

Stressful life events and seizure frequency in patients with epilepsy.

We tested whether unpleasant life events increased seizure occurrence in persons with epilepsy. Forty-six subjects maintained daily diaries for 10-36 weeks in which they recorded seizures and life events. Mean age of subjects was 39 years; 78% were female; 83% had complex partial seizures (CPS). On the average, subjects reported 3.3 seizures a week. Analyses first were conducted within each subject and then in the sample overall. For each person, we tested whether seizure frequency increased within 24 h of the occurrence of unpleasant events, using Poisson regression analyses that adjusted for daily antiepileptic medication, sleep duration and quality, alcohol intake, menstrual status, and pleasant events. Rarity of events precluded analyses in 9 subjects. Events increased seizure frequency in 5 subjects (14%) (p < 0.05). Events decreased seizure frequency in 2 subjects (p < 0.05). When individual risk ratios were aggregated across subjects, unpleasant events were significantly associated with seizure increase only in men (RR = 1.67, 95% Confidence interval 1.09, 2.54). However, this finding must be interpreted with caution because of the limited number of men in the sample. In other aggregate analyses, events and seizures were not associated in subjects grouped by seizure type, age of seizure onset, current age, ethnicity, educational level, or marital status. Identification of factors that distinguish patients with and without event-triggered seizures requires further study.

Adolescent↗

PubMedDate not supplied

EEG abnormalities in children with a first unprovoked seizure.

We examined EEG findings from an ongoing study of 347 children with a first unprovoked seizure. EEGs were available in 321 (93%), and 135 (42%) had an abnormal EEG. EEG abnormalities included focal spikes (n = 77), generalized spike and wave discharges (n = 28), slowing (n = 43), and nonspecific abnormalities (n = 7). Abnormal EEGs were more common in children with remote symptomatic seizures (60%) than in those with idiopathic seizures (38%) (p < 0.003), more common in partial seizures (56%) than in generalized seizures (35%) (p < 0.001), and more common in children age > 3 years (52%) than in younger children (12%) (p < 0.001). Records including both awake and sleep tracings were available in 148 (46%) cases. For 122 (38%) only awake tracings and for 51 (16%) only sleep tracings were available. Fifty-nine (40%) of the 148 patients with both an awake and asleep tracing had abnormal EEGs. Of 50 such EEGs with epileptiform abnormalities, 15 (30%) demonstrated the abnormality either only while awake (n = 8) or only while asleep (n = 7). Of 17 patients with EEG slowing, 8 showed slowing only in the awake tracing and 9 showed slowing in both the awake and asleep tracing. Children with even a single unprovoked seizure have a high incidence of EEG abnormalities. Obtaining a combined awake and sleep EEG significantly increases the yield of EEG abnormalities. In children with an idiopathic first seizure, EEG abnormalities are associated with an increased risk of seizure recurrence.

Adolescent↗

PubMedDate not supplied

Epidemiologic features of infantile spasms in Iceland.

We determined the average annual incidence of epilepsy characterized by infantile spasms (IS) in Iceland based on the 13 cases identified in a 10-year interval (1981-1990). The cumulative incidence was 3 in 10,000 live births. Males were more frequently affected than females. All patients responded completely (10) or partially (3) to ACTH or steroid therapy. At follow-up, all children with cryptogenic IS are seizure-free and have developed normally intellectually. One of the children with cryptogenic IS has mild spastic diplegia. All children in the symptomatic group are mentally retarded, and 5 of 7 continue to have unprovoked seizures. We detected no evidence for familial aggregation, and the incidence of seizures or epilepsy did not appear to be increased in first-degree relatives of cases. The proportion of cases with a favorable outcome was greater than that reported in most clinical series.

Adrenocorticotropic Hormone↗

PubMedDate not supplied

Lack of association between carotid plaque hematoma and ischemic cerebral symptoms.

To investigate the association between carotid plaque hematoma and symptoms of cerebral ischemia a retrospective review of 200 consecutive carotid endarterectomies at the Neurological Institute of New York was carried out. Data analyzed included cerebral ischemic symptoms, angiographic findings, preoperative use of antithrombotic agents, and microscopic pathology of endarterectomy specimens. No association was found between ischemic symptoms ipsilateral to the endarterectomy and presence, size, or age of plaque hematomas. Plaque hematomas were less common among patients who took antithrombotic agents preoperatively than among those who did not. The presence of plaque hematoma was associated with angiographic carotid cross-sectional area stenosis of greater than 75%. Patients with stenosis of less than 75% were more likely than those with stenosis of greater than 75% to have ischemic symptoms ipsilateral to the endarterectomy, suggesting that criteria for surgical treatment of carotid atherosclerosis differ for those who are symptomatic vs. those who are asymptomatic. These results demonstrate the limitation of using a surgical series to extend causal inferences about the relation between plaque hematoma and cerebral ischemic symptoms to the general population of people with carotid atherosclerosis.

Aged↗

PubMedDate not supplied

Secular trends in New York City hospital discharge diagnoses of congenital syphilis and cocaine dependence, 1982-88.

The ecologic relationship between the incidence of reactive serologic tests for syphilis among 2,229 newborns and diagnoses that included cocaine dependence among 17,219 hospitalized women ages 15-44 in New York City was investigated. Citywide, race-specific and zip code-specific annual rates were computed. The residential zip codes were grouped into quartiles by cumulative level of diagnoses that included cocaine dependence, and citywide and race-specific annual rates of congenital syphilis were computed in each quartile. From 1982 to 1988, the citywide rate of congenital syphilis for all races increased from 1.2 to 5.8 per 1,000 live births, while rates of cocaine dependence discharges increased from 23.3 to 423.3 per 100,000 women of all races during the same period. For African American infants, citywide rates of congenital syphilis increased from 1.8 to 10.6 per 1,000 live births. In quartile-specific analyses of African American women and newborns, rates of congenital syphilis increased from 1.9 to 14.6 in the highest cocaine-exposure quartile; from 2.1 to 12.4 in the third; from 1.5 to 7.6 in the second; and, from 1.6 to 2.8 in the lowest cocaine-exposure quartile. This study provides support for the hypothesis that cocaine dependence in women may be associated with congenital syphilis infection.

Adolescent↗