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W A Hauser

Publications and source records attributed to W A Hauser.

At least 109 records · Page 6Linked to original sources
PubMed1992

A prospective study of recurrent febrile seizures.

BACKGROUND: Febrile seizures occur in about 2 to 4 percent of all children, approximately one third of whom will have recurrent febrile seizures. Little is known about predictors of recurrence. METHODS: In this prospective study, we identified 347 children (1 month to 10 years of age) who presented with a first febrile seizure at one of four pediatric emergency departments. Information about these children was collected from medical records and interviews with the parents, and the children were followed for a median of 20 months to ascertain whether febrile seizures recurred. RESULTS: Recurrent febrile seizures occurred in 94 of the 347 children (27 percent) with a cumulative risk of 25 percent at one year and 30 percent at two years. The duration of fever before the initial seizure was associated with the risk of recurrence at one year: for fever lasting less than 1 hour, the risk of recurrence was 44 percent; for fever lasting 1 to 24 hours, 23 percent; and for fever lasting more than 24 hours, 13 percent (P less than 0.001). With each degree of increase in temperature (in degrees Fahrenheit), from 101 degrees F (38.3 degrees C) to greater than or equal to 105 degrees F (40.6 degrees C), the risk of recurrence at one year declined, from 35 percent to 30, 26, 20, and 13 percent (P for trend = 0.024). An age of less than 18 months and a family history of febrile seizures were also associated with an increased risk of recurrence. A family history of epilepsy, complex febrile seizures, and neurodevelopmental abnormalities did not increase the risk of recurrent febrile seizures. CONCLUSIONS: A shorter duration of fever before the initial febrile seizure and a lower temperature are associated with an increased risk of recurrence in children who have febrile seizures.

Age Factors↗
PubMed1992

Estimates of the prevalence of childhood seizure disorders in communities where professional resources are scarce: results from Bangladesh, Jamaica and Pakistan.

Although numerous estimates of the prevalence of seizure disorders in populations in the less developed world have now been published, these estimates are difficult to interpret due to lack of comparability of study methods and criteria for case definition. The results reported in this paper are from a large, collaborative study of disabilities in 2- to 9-year-old children in which standard research procedures and case definitions were used in three diverse populations (located in Bangladesh, Jamaica and Pakistan). A two-phase study design (screening followed by professional evaluations) was used in this study allowing for the professional evaluation to serve as the criterion in the estimation of prevalence, even for rare disorders. As a result, the prevalence estimates reported here have a high degree of comparability across populations and exhibit unusually strong validity for population surveys. Febrile seizures were the most common type of seizure history in all three populations, with point estimates of lifetime prevalence ranging from 10.9 to 62.8 per 1000. The lifetime prevalence rates of epilepsy (recurrent unprovoked seizures) ranged from 5.8 to 15.5 per 1000. Lifetime prevalence rates of neonatal, all provoked and all unprovoked seizures, as well as estimates of the prevalence of active epilepsy, are also reported.

Age Factors↗
PubMed1992

Seizure disorders: the changes with age.

Age has a profound influence on our approach to the convulsive disorders. Age is a variable which is an important determinant for risk factors for epilepsy. Age, as a surrogate of brain maturation, is a determinant of the specific characteristics of the seizure disorder in those with epilepsy, and age-related changes in these manifestations can be identified. Age is a determinant for the occurrence of acute symptomatic seizures in several types of metabolic or central nervous system insults. Age is a determinant for prognosis, whether one considers remission, medication withdrawal in those entering remission, relapse following prolonged remission, or mortality. Last, age per se seems to be a risk factor for epilepsy independent of other factors. This seems particularly true for partial seizures.

Adolescent↗
PubMed1992

CT of 338 active professional boxers.

Computed tomography (CT) was performed in 338 active professional boxers. CT scans were abnormal in 25 boxers (7%). The most common CT abnormality was brain atrophy (22 cases). Focal lesions of low attenuation consistent with posttraumatic encephalomalacia were noted in only three boxers. Boxers with abnormal CT scans did not differ from those with borderline or normal CT scans in regard to age, win-loss record, number of bouts, or history of an abnormal electroencephalogram. Thirty-seven boxers with borderline CT scans (49%) and 17 with abnormal CT scans (68%) reported a previous technical knockout (TKO) or knockout (KO), compared with only 89 (37%) of the 238 boxers with normal CT scans (P < .01). Brain atrophy was noted more frequently in boxers with a large cavum septum pellucidum (CSP) than in those with a small or no CSP (P < .05). Boxers with abnormal or borderline CT scans who experienced a TKO or KO were slightly older than those with normal CT scans and a history of a TKO or KO (P < .05).

Adolescent↗
PubMed1992

Dementia after stroke: baseline frequency, risks, and clinical features in a hospitalized cohort.

We determined the frequency of dementia in a cohort of 251 patients aged greater than or equal to 60 years hospitalized with acute ischemic stroke, based on examinations performed 3 months after stroke onset. Using modified DSM-III-R criteria, we found dementia in 66 patients (26.3%). Diagnostic agreement among raters was excellent (kappa = 0.96). In a control sample of 249 stroke-free subjects recruited from the community and matched by age, we found dementia in eight subjects (3.2%). Using a logistic regression model to estimate the risk of dementia associated with stroke in the combined samples, the odds ratio (OR) for stroke patients compared with control subjects was 9.4 (p less than 0.001). Advancing age and fewer years of education were significant, independent correlates of dementia, with a trend evident for race (non-white versus white). Confining the analysis to subjects residing in the Washington Heights-Inwood community of northern Manhattan, the OR was 10.3 (p less than 0.001) with significant age and race effects. We conclude that ischemic stroke significantly increases the risk of dementia, with independent contributions by age, education, and race.

Aged↗
PubMed1992

The natural history of drug resistant epilepsy: epidemiologic considerations.

Approximately 160,000 United States residents will be evaluated for newly identified unproved seizures in 1990. While the majority will have a favorable prognosis and more than 50% will ultimately be able to discontinue medication, about 10,000 will fall into the category 'intractable'. There are well established predictors for seizure remission and for successful withdrawal of medications, including seizure type, etiology, age at onset, neurologic status, and family history. There are few studies which have evaluated predictors for poor outcome, in part because of difficulties with definition. Predictors of poor outcome are not necessarily the converse of predictors of good outcome. Identification of such factors is important to allow earlier referral of patients destined to meet criteria for intractable to allow alternative therapies to be instituted.

Anticonvulsants↗
PubMed1991

Driving and epilepsy. A review and reappraisal.

Driving and epilepsy is a problem that involves physicians as both care providers to patients and consultants to regulatory authorities. Driving restrictions for people with seizure disorders are intended to ensure the public's safety, but such restrictions may unduly harm the welfare of many people with seizures. In the United States, all states now permit some people with epilepsy to drive. In general, only people whose seizures are adequately controlled are licensed to drive. Adequate control has been judged principally by the seizure-free interval, but individual state standards widely vary. There is a trend toward greater liberalization of driving standards for people with seizure disorders, but the appropriateness and application of these standards continue to raise questions, as does the role physicians should have in the licensing process. Our responsibilities to persons with disabilities and advances in our understanding of seizures and the nature of driving risks warrant a reappraisal of the current medical, legal, and social implications of driving and epilepsy.

Accidents, Traffic↗
PubMed1991

Incidence and prognosis of brain abscess in a defined population: Olmsted County, Minnesota, 1935-1981.

The incidence of brain abscess was studied on all cases occurring in residents of Olmsted County, Minn., from 1935 through 1981. Thirty-eight cases (9 cases first diagnosed at autopsy) were identified and followed through the Rochester Olmsted County medical record-linkage system at the Mayo Clinic. The incidence rate was 1.3/100,000 person-years (PY), 1.9 in males and 0.6 in females. Incidence decreased from 2.7 in 1935-44 to 0.9 in 1965-81. Rates were higher in children 5-9 years old (2.4) and after age 60 (2.6 PY). An etiologic agent was identified in 29 cases (76%) with streptococci being the most frequently isolated. Case-fatality ratio was 38% (11/29), stable over time. Concurrent bacterial meningitis was the strongest predictor of death. Neurologic sequelae were observed in 8 (44%) of the 18 surviving patients including epilepsy (5 cases), deafness and motor impairment.

Brain Abscess↗
PubMed1991

Hospitalized stroke in blacks and Hispanics in northern Manhattan.

BACKGROUND AND PURPOSE: The growing black and Hispanic populations in the United States call for studies of the rates and prognosis for cerebral infarction to help plan more focused prevention programs. METHODS: Using the Statewide Planning and Research Cooperative System, we obtained discharge data for 1,034 patients over age 39, who were hospitalized for stroke from 1983 to 1986, using four zip code areas of the ethnically mixed community of Northern Manhattan. RESULTS: Stroke incidence increased with age in both men and women in all three race/ethnic groups. The age-adjusted stroke incidence per 100,000 per year for men greater than or equal to 40 years of age was 567 for blacks, 306 for Hispanics, and 351 for whites. Incidence in women greater than or equal to 40 years was 716 in blacks, 361 in Hispanics, and 326 in whites. Hypertension and diabetes were more prevalent in blacks and Hispanics with stroke, whereas whites had more ischemic cardiac disease. Crude in-hospital mortality was greater in younger blacks and Hispanics compared with whites, whereas 2-year readmission rates, overall and for stroke, were similar in the three groups. CONCLUSIONS: These estimates of hospitalized stroke incidence and mortality substantiate the greater incidence of stroke in blacks and provide new data concerning Hispanics for public health planning.

Adult↗
PubMed1991

One-year outcome after cerebral infarction in whites, blacks, and Hispanics.

Little is known about outcome after cerebral infarction for different ethnic groups. Of 590 stroke patients hospitalized from 1983 to 1986 at the Neurological Institute, cerebral infarction over age 39 years occurred in 135 whites, 177 blacks, and 82 Hispanics. Outcome after cerebral infarction differed by ethnicity. The 1-month mortality rate was similar in whites and blacks and least in Hispanics. Whites had a slightly greater risk of recurrent stroke or death than blacks or Hispanics until 6 months after infarction, when their risk stabilized, while the risk in blacks and Hispanics continued to rise for the entire year of follow-up. By 1 year, the rate of recurrent stroke or death was 34.8 +/- 4.2% in whites, 31.1 +/- 3.6% in blacks, and 21.4 +/- 4.8% in Hispanics (p = 0.04). Differences were found in the distribution of various stroke risk factors in the three ethnic groups. A Cox proportional hazards model demonstrated that the ethnic differences in stroke risk factors and infarct subtype were responsible for the ethnic differences in outcome. An abnormal first electrocardiogram was a risk factor for stroke recurrence or death in all three ethnic groups, while a nonlacunar infarct subtype and a history of diabetes were significant only in Hispanics. Understanding the associations of stroke determinants with ethnicity may lead to more focused secondary prevention of recurrent stroke.

Aged↗
PubMed1990

Nontraumatic coma. Glasgow coma score and coma etiology as predictors of 2-week outcome.

In 1987 and 1988, we carried out a prospective study of patients older than 10 years with nontraumatic coma in the intensive care units of Columbia-Presbyterian Medical Center, New York, NY. Of 188 patients with Glasgow Coma Scale (GCS) determinations within 72 hours, 61% were dead or in persistent coma by 2 weeks from onset. Age, sex, and ethnicity did not influence outcome. The 2-week outcome for patients with initial GCS of 3 to 5 was 14.8% awake; 85.2% were dead or in persistent coma. For the GCS 6 to 8 group, 53.1% were awake and 46.9% were dead or in persistent coma. Hypoxic or ischemic coma had the worst 2-week outcome (79% dead or comatose); coma caused by metabolic disease or sepsis (68%), focal cerebral lesions (66%), and general cerebral diseases (55%) were intermediate, while drug-induced coma had a favorable outcome (27% dead or comatose). The independent predictors of 2-week outcome were the first GCS and drug-induced coma. The predicted probability of waking at 2 weeks was eight times better for drug-induced coma than other causes when GCS was held constant. Patients with an initial GCS score of 6 to 8 were seven times more likely to waken than those with a score of 3 to 5. The motor subscore alone was a significant independent predictor of 2-week outcome. Modification of coma score to include etiology may give more accurate predictions of 2-week outcome after nontraumatic coma.

Adolescent↗
PubMed1990

Recurrence of febrile convulsions in a population-based cohort.

The risk of recurrence after an initial febrile seizure was 25% in a population-based cohort of 639 children followed from their first febrile seizure. Prognostic factors were an increasing risk of recurrence with younger age at first febrile seizure, a first degree relative with febrile seizures and complex features of the first febrile seizure. The effect of complex features was modified by age at first febrile seizure and family history in that complex features alone did not increase risk of recurrence but further increased the risk for children under 18 months at first seizure and/or with a positive family history. The prognostic factors for all febrile convulsions recurrences were also prognostic for having subsequent complex febrile convulsions. Children with none of the prognostic factors had only a 3% risk of a future complex febrile seizure while children under 18 months at first febrile convulsion and a positive family history or complex features had about a 20% risk of a subsequent complex febrile seizure.

Child, Preschool↗
PubMed1990

Predictors of recurrent febrile seizures: a metaanalytic review.

The 1980 National Institutes of Health Consensus Development Conference on Febrile Seizures identified five circumstances in which it might be appropriate to consider anticonvulsant prophylaxis after a first febrile seizure: (1) a focal or prolonged seizure, (2) neurologic abnormalities, (3) afebrile seizures in a first-degree relative, (4) age less than 1 year, and (5) multiple seizures occurring within 24 hours. We performed a metaanalysis of 14 published reports to evaluate the strength of association between each of these indications and recurrent febrile seizures. Young age at onset (less than or equal to 1 year) and a family history of febrile seizures (not listed in the recommendations) each distinguished between groups with approximately a 30% versus a 50% risk of recurrence. Family history of afebrile seizures was not consistently associated with an increased risk. Focal, prolonged, and multiple seizures were associated with only a small increment in risk of recurrence. The data were not adequate to assess the risk associated with neurologic abnormalities. By considering children with combinations of risk factors, some studies were able to distinguish between groups with very low and very high recurrence risks. Only age at onset was consistently predictive of having more than one recurrence. These results suggest that the great majority of children who have a febrile seizure do not need anticonvulsant treatment even if one of the factors listed in the Consensus Statement is present, and that the rationale and indications for treating febrile seizures need to be reconsidered.

Age Factors↗
PubMed1990

Illicit drug use and the risk of new-onset seizures.

The authors studied the use of heroin, marijuana, and cocaine before the onset of a first seizure in 308 patients with seizures and 294 controls at Harlem Hospital Center, New York City, between 1981 and 1984. Heroin use, both past and present, appeared to be a risk factor for all first seizures (adjusted odds ratio = 2.80, 95% confidence interval (CI) 1.53-5.74). For unprovoked seizures, the adjusted odds ratio was 2.58 (95% CI 1.36-4.90) for ever heroin use and 4.70 (95% CI 0.86-25.78) for heroin use within 24 hours of hospitalization. For provoked seizures, respective adjusted odds ratios were 3.65 (95% CI 1.54-8.65) and 27.74 (95% CI 3.57-215.52). Marijuana use appeared to be a protective factor against first seizures in men. For men with unprovoked seizures, the adjusted odds ratio was 0.42 (95% CI 0.22-0.82) for ever marijuana use and 0.36 (95% CI 0.18-0.74) for marijuana use within 90 days of hospitalization. For men with provoked seizures, respective adjusted odds ratios were 1.03 (95% CI 0.36-2.89) and 0.18 (95% CI 0.04-0.84). Cocaine use, while common among study subjects, was not shown to be a significant risk factor either for all first seizures or for subgroups of seizures, regardless of the time of last use. The authors conclude that heroin use is a risk factor and marijuana use a protective factor for new-onset seizures.

Adult↗
PubMed1990

Seizure recurrence after a 1st unprovoked seizure: an extended follow-up.

We followed 208 patients identified on the day of their 1st unprovoked seizure for a mean duration of 4 years. Seizures recurred in 64. Recurrence risks were estimated to be 14%, 29%, and 34% at 1, 3, and 5 years following the 1st episode. A history of previous neurologic insult (remote symptomatic) was associated with a 2.5-fold increased risk of recurrence. Among idiopathic cases, a sibling with epilepsy, a generalized spike and wave EEG, or a history of acute symptomatic seizure increased risk for recurrence. Among remote symptomatic cases, status epilepticus, a prior acute symptomatic seizure, or Todd's paresis increased risk. Depending upon clinical features, recurrence risk at 5 years following a 1st seizure ranged from 23% to 80%. Treatment with anticonvulsant medication was not associated with a decrease in recurrence risks.

Analysis of Variance↗