Biomedical subjects

W A Hauser

Publications and source records attributed to W A Hauser.

At least 91 records · Page 5Linked to original sources

PubMed1995

Adverse reactions in blood donors with a history of seizures or epilepsy.

BACKGROUND: Individuals with epilepsy or seizure disorders are restricted from donating blood because of concern that they are prone to adverse donor reactions such as syncope and convulsions. A study evaluating whether that concern is warranted is reported. STUDY DESIGN AND METHODS: During a 2-year period beginning in 1987, blood donors in Maryland with a history of seizures were actively recruited by the American Red Cross. Adverse donor reactions were classified as "slight", indicating dizziness and nausea without loss of consciousness; "moderate," denoting syncope; and "severe," indicating convulsive syncope. RESULTS: There were 329,143 satisfactory blood donations; 613 individuals reporting a history of seizures donated blood a total of 723 times. Among donors with seizures, 186 (35.7%) were taking antiepileptic medication, and 61 (8.4%) had had one or more seizures in the preceding year. Individuals with seizures had a low incidence of adverse reactions (3.34%). Although this incidence was slightly higher than that in the entire population (2.24%), the difference was not significant. In particular, the risk of syncope with or without convulsive activity was low for people with seizures (0.21%) and not significantly greater than that in other donors (0.28%). CONCLUSION: Individuals with seizures or epilepsy are not at greater risk for adverse reactions after blood donation, and major restrictions on their participation as blood donors are not warranted.

Adolescent↗

PubMed1995

Incidence of acute symptomatic seizures in Rochester, Minnesota, 1935-1984.

We determined the incidence of seizures due to acute CNS insults for residents of Rochester, Minnesota, U.S.A., from 1935 through 1984. The age-adjusted incidence rates for 1955-1984, the period of most complete case ascertainment, was 39.0/100,000 person-years (United States 1970 population as standard). The age-adjusted incidence was considerably higher in men: 52.0 as compared with 29.5 in women. The 3.6% risk of experiencing an acute symptomatic seizure in an 80-year lifespan approaches that of developing epilepsy. The major causes of acute symptomatic seizures were traumatic brain injury, cerebrovascular disease, drug withdrawal, and CNS infections. Each type of acute symptomatic seizure has age, gender, and time period patterns that reflect the occurrence of the underlying cause.

Adolescent↗

PubMed1995

Risk factors for a first febrile seizure: a matched case-control study.

We conducted a matched case-control study to identify risk factors for first febrile seizures, with special emphasis on characteristics of the acute illness episode. Cases were identified through hospital emergency departments; controls were identified through outpatient clinics and emergency departments. Sixty-nine children with first febrile seizures and no history of previous unprovoked seizures were matched for age (+/- 6 months), site of routine pediatric care, and date of visit (+/- 2 weeks) with 1 or 2 febrile controls who had no history of previous febrile or unprovoked seizures. Medical records for the index visit were reviewed, and parents were interviewed by telephone. Illness characteristics examined included height of temperature, type of underlying illness, contact with a physician during the illness but before the index visit, and use of acetaminophen or decongestants. Family history of febrile and of unprovoked seizures, sociodemographic characteristics, daycare use, and selected pre- and perinatal variables were also studied. On multivariable analysis, significant independent risk factors were height of temperature, history of febrile seizures in a first- or in a higher degree relative. Gastroenteritis as the underlying illness had a significant inverse (i.e., protective) association with febrile seizures. Maternal smoking during pregnancy was a marginally significant predictor of febrile seizures.

Acetaminophen↗

PubMed1995

Secular trends and birth cohort effects in unprovoked seizures: Rochester, Minnesota 1935-1984.

The incidence of idiopathic/cryptogenic epilepsy and isolated unprovoked seizures has been relatively stable in the population of Rochester, Minnesota, for the 50-year period 1935 through 1984. In each decade, the age-specific rates exhibited a consistent U-shaped pattern of decreasing rates from infancy to age 40-49 and a progressive increase thereafter to a second peak at age 70 years. Males had a 15% higher incidence of cryptogenic unprovoked seizures than females. The most pronounced secular trend was a decrease in the incidence in children aged < 10 years for the first 4 decades of the study; however, this trend was interrupted by a slight rebound in the decade 1975-1984. There has been a progressive decrease in the incidence of cryptogenic unprovoked seizures in individuals aged > or = 50 from 1965 through 1984. This decrease paralleled the decrease in cerebrovascular disease in the community. The decrease in idiopathic unprovoked seizures may be related to a concurrent trend in "silent stroke." Plots and Poisson regression analysis did not show patterns in the incidence of idiopathic unprovoked seizures related to successive birth cohorts. However, significantly lower incidence rates were observed for the 1930-1934 birth cohort, about half that of all others, between the ages of 5 and 54 years.

Adult↗

PubMed1995

Recent developments in the epidemiology of epilepsy.

Epidemiological incidence data are important to determine those who are at risk of epilepsy and to understand the aetiology of the condition. A number of studies have been reported recently, which allow comparisons across populations. There appears to be geographical variation in the incidence of epilepsy, with a higher incidence in rural South America than in developed countries: no large scale incidence studies have yet been carried out in Africa or Asia. A consistent pattern suggesting that the onset of epilepsy occurs at the extremes of life has also been shown. Although a number of factors are often identified as causes of epilepsy, studies have identified a definitive aetiology in only one-third of all newly diagnosed cases. Epidemiological studies have, however, confirmed the importance of postnatal insults and quantified the risk. Family history may also be considered a risk factor for epilepsy in epidemiological terms.

Adolescent↗

PubMed1995

Neurological correlates of fetal cocaine exposure: transient hypertonia of infancy and early childhood.

OBJECTIVE: To assess whether prenatal cocaine exposure has any long-term effects on neurodevelopment. DESIGN: A prospective cohort study with examiners blind to drug exposure and human immunodeficiency virus (HIV) status. SUBJECTS: Of 144 high-risk infants enrolled in a perinatal HIV neurodevelopmental study, 119 (83%) infants with both neurological and urine toxicology measures were followed up to age 24 months. METHODS: Neurological and developmental assessments were analyzed at 6-month intervals grouped according to the presence of cocaine in urine toxicology: 51 infants were cocaine-positive. Adjusted odds ratios (ORs) and 95% confidence interval (CI) were obtained by logistic regression equations that adjusted for perinatal variables, including measures of fetal growth, gestation, HIV status, and infant toxicology results. SETTING: Harlem Hospital Center from 1988 to 1992. RESULTS: At age 6 months, 21 of 51 (41%) cocaine-positive children exhibited hypertonia of any type (hypertonic tetraparesis, hypertonic diparesis, and hypertonic hemiparesis) compared with 17 of 68 (25%) cocaine-negative infants (OR = 2.1, CI = 1.0-4.6). Cocaine-positive infants were four times more likely to show hypertonic tetraparesis (HTP) than cocaine-negative infants (OR = 4.0; CI = 1.5-10.8). The association remained significant in multivariate analyses. Hypertonia, consistent with cerebral palsy, diminished over time in both groups. In 97% of affected infants hypertonia resolved by 24 months. Arm hypertonia abated first; leg hypertonia remained in some children up to age 18 months. No differences in development scores between cocaine-positive and cocaine-negative were noted at any age interval. However, among cocaine-positive infants those with early HTP showed significantly lower mean developmental scores at 6 and 12 month compared to infants without HTP. CONCLUSION: Cocaine positivity urine toxicology at birth is associated with hypertonia during infancy. Such cocaine-induced effects are usually symmetrical, transient, and the majority of exposed children outgrow hypertonia by 24 months of life. Among cocaine-positive infants, HTP may be a marker for later developmental impairments.

Adult↗

PubMed1995

Epidemiology of epilepsy in children.

The convulsive disorders are among the more frequently occurring neurologic disorders of childhood, affecting more than 4% of all children. The most frequently occurring disorder, febrile convulsions, shows wide geographic variation and is usually benign. Children with epilepsy (which affects about 1% of the population by age 20) generally have an excellent prognosis. The small proportion of patients whose epilepsy is not controlled after two years of treatment should be considered for alternative therapies.

Adolescent↗

PubMed1994

Pleocytosis after status epilepticus.

OBJECTIVE: To determine the incidence of pleocytosis in patients experiencing status epilepticus (SE), regardless of seizure type or cause. DESIGN: A retrospective medical chart review. SETTING: Columbia-Presbyterian Medical Center, New York, NY. PATIENTS: Of 217 patients seen by the Neurology Service for SE during a 3-year period, 138 had a cerebrospinal fluid (CSF) analysis performed and were included in the study. All seizure types and etiologies were included. MAIN OUTCOME MEASURES: Status epilepticus was defined as a seizure or a series of continuing seizures lasting longer than 30 minutes. An abnormal CSF specimen was defined as a white blood cell (WBC) count of 6 x 10(6)/L or greater or one or more polymorphonuclear leukocytes present. RESULTS: Overall, 22.5% of patients demonstrated abnormal WBC count or morphology. There were 21 patients (15%) with a WBC count of 6 x 10(6)/L or greater, and another 10 patients with a normal WBC count, who had polymorphonuclear leukocytes present. Among patients with illnesses usually associated with pleocytosis (such as meningitis or acute head trauma), a large proportion had abnormal CSF WBC counts. Among patients with conditions usually associated with normal CSF (including idiopathic epilepsy), a small proportion had abnormal CSF WBC counts, and the abnormalities were less severe. The highest CSF WBC count in patients with no acute insult was 28 x 10(6)/L. CONCLUSIONS: The most important influence on the CSF WBC count is the underlying cause of the SE. Although minor elevations in WBC count can occur after SE of any type, pleocytosis should not be attributed to SE alone unless all other causes have been eliminated.

Blood Cell Count↗

PubMed1994

Discontinuing antiepileptic drugs in children with epilepsy: a prospective study.

In a prospective study, antiepileptic drugs were discontinued in 264 children with epilepsy after a mean seizure-free interval of 2.9 years. They were then followed for a mean of 58 months to ascertain whether seizures recurred. Seizures recurred in 95 (36%) of the children. Etiology was a significant predictor of outcome (relative risk [RR] = 1.81). On multivariable analysis, significant factors in the idiopathic group included age at onset above 12 years (RR = 5.4), a family history of seizures (RR = 3.1), the presence of slowing on the electroencephalogram prior to medication withdrawal (RR = 2.4), and a history of atypical febrile seizures (RR = 2.8). Specific epileptic syndromes such as juvenile myoclonic epilepsy and benign rolandic epilepsy were also significant predictors of outcome. In the remote symptomatic group, significant predictors of outcome included age at onset older than 12 years (RR = 3.6), moderate to severe mental retardation (IQ < 50) (RR = 2.8), a history of atypical febrile seizures (RR = 2.0), and a history of absence seizures (RR = 0.4). The majority of children with epilepsy in remission while on antiepileptic drug therapy will remain seizure free when medications are withdrawn. A few readily available parameters distinguish those with a good prognosis from those in whom seizures are likely to recur. These data provide the framework for the clinical decision making for withdrawal of medications in these children.

Anticonvulsants↗

PubMed1994

The prevalence and incidence of convulsive disorders in children.

Each year, about 150,000 children and adolescents in the United States will come to medical attention for evaluation of a newly occurring seizure disorder of some type. Between 2% and 4% of all children in Europe and the United States experience at least one convulsion associated with a febrile illness before the age of 5 years. The cumulative incidence of febrile convulsions among children ranges from about 1% in China to more than 8% in Japan and 14% in Guam. The peak incidence of a first febrile convulsion occurs in the second year of life. Between 0.5% and 1% of children and adolescents experience a seizure associated with other acute metabolic or neurologic insults; most of these occur in the neonatal period. The incidence of epilepsy (recurrent unprovoked seizures) in children and adolescents seems relatively consistent across all populations studied, ranging from 50 to 100/100,000. The highest incidence of epilepsy is in the first year of life. West syndrome accounts for about 2% of all childhood epilepsy. Lennox-Gastaut syndrome for 1-2%, childhood absence epilepsy (pyknolepsy) for 10-15%, juvenile myoclonic epilepsy for 5%, and idiopathic localization-related epilepsy for 10%. Between 0.5 and 1% of children experience a nonrecurrent, single, unprovoked convulsive episode. Following are the estimated numbers of children and adolescents with newly diagnosed convulsive disorders in the United States for the year 1990: febrile seizures, 100,000; neonatal seizures, 4,000; other provoked seizures, 6,000; single unprovoked seizures, 10,000; and epilepsy, 30,000.

Adolescent↗

PubMed1994

Status epilepticus and antiepileptic medication levels.

To investigate the association between withdrawal from antiepileptic drugs (AEDs) and status epilepticus (SE), we evaluated AED levels at the time of, and prior to, an episode of SE in 65 patients with epilepsy. At least one AED was therapeutic in 65% of patients at the time of SE, and all prescribed AEDs were therapeutic in 48%. Ten patients had subtherapeutic AED levels before, and at the time of, SE. Sixteen patients with previously therapeutic levels (25%) had one or more subtherapeutic AED level at the time of SE. Many of the patients had other acute or remote factors that could be associated with SE, and 46 had had previous episodes of SE. Low AED levels or withdrawal can explain only some cases of SE. Citing AED irregularity as the major cause of SE in patients with epilepsy oversimplifies a complex, poorly understood situation.

Anticonvulsants↗

PubMed1994

Risk of dementia after stroke in a hospitalized cohort: results of a longitudinal study.

Stroke is considered the second most common cause of dementia, but the magnitude of the risk posed by stroke has not been fully clarified. The aim of this study was to determine the long-term risk of developing dementia after stroke onset in a hospitalized cohort. We prospectively examined 185 nondemented patients aged > or = 60 years hospitalized with ischemic stroke and 241 age-matched nondemented controls without stroke from the same community using neurologic, neuropsychological, and functional assessments given annually. Using criteria modified from the DSM-III-R, we diagnosed incident dementia based on the annual examination findings. We used life-table methods to estimate incidence in the two groups, Kaplan-Meier analysis to determine the proportion surviving without dementia, and Cox proportional-hazards analysis to compute the relative risk (RR) of dementia after 1 to 4 years of follow-up. The incidence of dementia was 8.4 per 100 person-years in the stroke group and 1.3 per 100 person-years in the control group. After 52 months of follow-up, the cumulative proportion (+/- SE) surviving without dementia was 66.3 +/- 5.5% for stroke and 90.3 +/- 4.3% for control subjects. The RR of dementia associated with stroke compared with controls was 5.5 (95% CI, 2.5 to 11.1) after adjusting for demographic factors. Older age at stroke onset and fewer years of education were significant covariates, but sex and race were not. A low score on the Mini-Mental State Examination at baseline was a significant predictor when added to this model.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1994

Comorbidity of migraine: the connection between migraine and epilepsy.

Although an association between migraine and epilepsy has long been discussed, it has rarely been studied systematically. According to the evidence from the large epidemiologic study reviewed in this article, individuals with epilepsy are 2.4 times more likely to develop migraine than their relatives without epilepsy. Risk of migraine is elevated in patients with partial-onset and generalized-onset seizures. The comorbidity of migraine and epilepsy may be explained by a state of neuronal hyperexcitability that increases the risk of both disorders. Clinical and EEG features useful in the differential diagnosis of migraine and epilepsy as well as in the diagnosis of both conditions when they occur concurrently are reviewed. When migraine and epilepsy occur together, therapy with agents effective for both conditions should be considered.

Adult↗

PubMed1993

Maternal risk factors for congenital syphilis: a case-control study.

This study estimated the strength of association between maternal cocaine use and congenital syphilis after adjustment for other factors, especially the use of prenatal care. The authors reviewed medical chart and laboratory data for 75 liveborn infants treated for congenital syphilis at Harlem Hospital Center (New York City) in 1987, 150 matched control infants, and their mothers. Cocaine use was determined from universal maternal medical histories and infant toxicology screenings, and the sensitivity of each method of ascertainment was evaluated. With the use of either maternal history or positive infant urine toxicology as evidence of cocaine use, 66.2% (49/74) of case infants versus 16.1% (24/149) of control infants were judged to have been exposed to cocaine in utero (odds ratio (OR) = 9.1, 95% confidence interval (Cl) 4.7-29.2). However, in multiple logistic regression, lack of prenatal care was the single variable with the highest adjusted odds ratio (adjusted OR = 11.0, 95% Cl 1.3-93.1); maternal cocaine use had the second-highest adjusted odds ratio (adjusted OR = 4.9, 95% Cl 1.8-13.0). Thus, despite the emergence of maternal cocaine use as a new risk factor, underutilization of prenatal care remains the strongest predictor of congenital syphilis.

Adult↗

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

Reliability of seizure classification using a semistructured interview.

Methods for standardized classification of epileptic seizures are important for both clinical practice and epidemiologic research. In this study, we developed a strategy for standardized classification using a semistructured telephone interview and operational diagnostic criteria. We interviewed 1,957 adults with epilepsy ascertained from voluntary organizations. To confirm and expand the seizure history, we also interviewed a first-degree relative for 67% of subjects and obtained medical records for 59%. Three lay reviewers used all available information to classify seizures. To assess reliability, each reviewer classified a sample of subjects assigned to the others. In addition, an expert physician classified a sample of subjects assigned to two of the reviewers. Agreement was "moderate-substantial" for generalized-onset seizures, both for the comparisons between pairs of lay reviewers and for the neurologist versus lay reviewers. Agreement was "substantial-almost perfect" for partial-onset seizures, both for pairs of lay reviewers and for the neurologist versus lay reviewers. These results suggest that seizures can be reliably classified by lay reviewers, using operational criteria applied to symptoms ascertained in a semistructured telephone interview.

Adolescent↗

PubMed1993

Hypertension and the risk of new-onset unprovoked seizures.

We tested the a priori hypothesis that hypertension can lead to seizures through vascular brain damage that might or might not involve manifest stroke. A case-control study with 227 patients admitted for a first unprovoked seizure and 294 acute surgical controls was carried out at Harlem Hospital Center, New York City, between 1981 and 1984. History of hypertension was significantly associated with unprovoked seizures, even after adjustment for antecedent stroke and other potential confounders (adjusted odds ratio [OR] = 1.57; 95% confidence limit [CL], 1.0 to 2.44). There was marked synergism between history of stroke and history of hypertension; subjects with a history of both had a fourfold increase in seizure risk compared with subjects with neither (adjusted OR = 4.07; 95% CL, 1.50 to 11.0). In these data, history of hypertension appears to be an independent risk factor for new-onset unprovoked seizures, especially, but not only, in conjunction with a history of stroke.

Adult↗

PubMed1993

Status epilepticus: the interaction of epilepsy and acute brain disease.

We identified 217 patients with status epilepticus (SE), including all seizure types from all etiologies, over a 3-year period. There was a significant interaction between organic brain disease and a history of epilepsy in the development of SE. The majority of patients (59%) had no history of epilepsy. These patients were more likely to have acute precipitants associated with SE and less likely to have had prior brain disease. They were older, were more likely to have generalized convulsive seizures, and had a high proportionate mortality. Among the 88 patients with a history of epilepsy, a higher proportion had prior brain insults, but fewer had acute precipitants. These patients were younger and their mortality was low, but they often had recurrent SE before and after the identified episode. Significant acute or prior brain disease is an important factor in the development of SE, even in patients with a history of epilepsy.

Acute Disease↗