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PubMed2005

Somatic comorbidity of epilepsy in the general population in Canada.

PURPOSE: There is a notion that people with epilepsy have substantial and often unrecognized comorbidity of chronic conditions. However, most studies focus on selected patient groups; population-based studies are scarce. We compared the prevalence of chronic somatic conditions in people with epilepsy with that in the general population using Canadian, nationwide, population-based health data. METHOD: We examined epilepsy-specific and general population health data obtained through two previously validated, independently performed, door-to-door Canadian health surveys, the National Population Health Survey (NPHS, N = 49,000) and the Community Health Survey (CHS, N = 130882), which represent 98% of the Canadian population. The prevalence of epilepsy and 19 other chronic conditions was ascertained through direct inquiry from respondents about physician-diagnosed illnesses. Weighted prevalence, prevalence ratios (PR), and 95% confidence intervals were obtained for the entire population and for males and females separately. Multivariate analyses assessed the strength of association of comorbid conditions with epilepsy as compared with the general population. RESULTS: People with epilepsy had a statistically significant higher prevalence of most chronic conditions than the general population. Conditions with particularly high prevalence in epilepsy (prevalence ratio > or = 2.0) include stomach/intestinal ulcers (PR, CHS 2.5, NPHS 2.7), stroke (PR, CHS 3.9, NPHS 4.7), urinary incontinence (PR, CHS 3.2, NPHS 4.4), bowel disorders (PR, CHS 2.0, NPHS 3.3), migraine (PR, CHS 2.0, NPHS 2.6), Alzheimer's disease (PR, NPHS 4.3), and chronic fatigue (PR, CHS 4.1). There were no gender-specific differences in prevalence of chronic conditions among people with epilepsy. CONCLUSIONS: People with epilepsy in the general population, not only those actively seeking medical care, have a high prevalence of chronic somatic comorbid conditions. The findings are consistent across two independent surveys, which show that people with epilepsy in the general population have a two- to five-fold risk of somatic comorbid conditions, as compared with people without epilepsy. This patient-centered comorbidity profile reflects health aspects that are important to people with epilepsy, and indicate the need for a more integrated approach to people with epilepsy. The impact of epilepsy relative to other comorbid conditions requires further analysis, as does the contribution of comorbidity to epilepsy intractability and to differential health care needs. Similarly, it remains to be determined whether the observed comorbidity patterns are specific to epilepsy or simply reflect a pattern that is common to chronic illnesses in general.

Adolescent↗
PubMed2001

Mortality in epilepsy in the first 11 to 14 years after diagnosis: multivariate analysis of a long-term, prospective, population-based cohort.

The United Kingdom National General Practice Study of Epilepsy is a prospective, population-based study of newly diagnosed epilepsy. A cohort of 792 patients has now been followed for up to 14 years (median follow-up [25th, 75th percentiles] 11.8 years, range 10.6-11.7 years), a total of 11,400 person-years. These data are sufficient for a detailed analysis of mortality in this early phase of epilepsy. Over 70% of patients in this cohort have developed lasting remission from seizures, although the mortality rate in the long term was still twice that of the general population. The standardized mortality ratio (SMR), the number of observed deaths per number of expected deaths, was 2.1 (95% confidence interval [CI] = 1.8, 2.4). Patients with acute symptomatic epilepsy (SMR 3.0; 95% CI = 2.0, 4.3), remote symptomatic epilepsy (SMR 3.7; 95% CI = 2.9, 4.6), and epilepsy due to congenital neurological deficits (SMR 25; 95% CI = 5.1, 73.1) had significantly increased long-term mortality rates, whereas patients with idiopathic epilepsy did not (SMR 1.3; 95% CI = 0.9, 1.9). This increase in mortality rate was noted particularly in the first few years after diagnosis. Multivariate Cox regression and time-dependent co-variate analyses were utilized for the first time in a prospective study of mortality in epilepsy. The former showed that patients with generalized tonic-clonic seizures had an increased risk of mortality. The hazard ratio (HR), or risk of mortality in a particular group with a particular risk factor compared to another group without that particular risk factor, was 6.2 (95% CI = 1.4, 27.7; p = 0.049). Cerebrovascular disease (HR 2.4; 95% CI = 1.7, 3.4; p < 0.0001), central nervous system tumor (HR 12.0; 95% CI = 7.9, 18.2; p < 0.0001), alcohol (HR 2.9; 95% CI = 1.5, 5.7; p = 0.004), and congenital neurological deficits (HR 10.9; 95% CI = 3.2, 36.1; p = 0.003) as causes for epilepsy and older age at index seizure (HR 1.9; 95% CI = 1.7,2.0; p < 0.0001) were also associated with significantly increased mortality rates. These hazard ratios suggest that epilepsy due to congenital neurological deficits may carry almost the same risk of mortality as epilepsy due to central nervous system tumors and that epileptic seizures subsequent to alcohol abuse may carry almost the same risk of mortality as epilepsy due to cerebrovascular disease. The occurrence of one or more seizures before the index seizure (the seizure that led to the diagnosis of epilepsy and enrolment in the study) was associated with a significantly reduced mortality rate (HR 0.57; 95% CI = 0.42, 0.76; p = 0.00001). Time-dependent co-variate analysis was used to examine the influence of ongoing factors, such as seizure recurrence, remission, and antiepileptic drug use, on mortality rates in the cohort. Seizure recurrence (HR 1.30; 95% CI = 0.84, 2.01) and antiepileptic drug treatment (HR 0.97; 95% CI = 0.67, 1.38) did not influence mortality rate. There were only 5 epilepsy-related deaths (1 each of sudden unexpected death in epilepsy, status epilepticus, burns, drowning, and cervical fracture), suggesting that death directly due to epileptic seizures is uncommon in a population-based cohort with epilepsy.

Adolescent↗
PubMed2001

[Idiopathic absence epilepsy].

UNLABELLED: The International Classification of Epilepsies and Epileptic Syndromes distinguishes four types of idiopathic generalized epilepsies with typical absences: childhood absence epilepsy (CAE), juvenile absence epilepsy (JAE), juvenile myoclonic epilepsy (JME) and epilepsy with generalized grand mal on awakening (EGMA). It is essential in any case when sizures occur to classify the type of epileptic syndrome in order to make prognosis and to choose correct treatment. But it is not always possible to establish diagnosis at the beginning of the disease. Often prolonged observation of the patient and evolution of clinical and EEG features lead to define the epileptic syndrome. The aim of the work was to define the type and frequency of epileptic syndromes and their long-term observation in patients with absences occurred as the first (or the only) type of seizures. SUBJECTS AND METHODS: 31 patients who experienced absences as the first (or the only) type of seizures were selected from the group of 600 subjects suffered from epilepsy admitted to the Neuropediatric Department of the National Research Institute of Mother and Child between 1987 and 1998. Epileptic Syndromes were classified according to the International Classification. RESULTS: There were 31 (5.2%) patients (18 girls and 13 boys) with absences accurred as the first (or the only) type of seizures. The age of the onset of seizures was between 2.5 to 13.5 years (mean 9.3). Seven of them had also tonic-clonic seizures in the course of the observation. They were followed-up for 3 to 9 years (mean 9.2) till the age of 7 to 25 years (mean 18.5). Two epileptic syndromes were established according to the International Classification:--childhood absence epilepsy (CAE) in 27 (4.5%) patients;--juvenile absence epilepsy (JAE) in 4 (0.7%) patients. No one patient showed evolution of disease towards neither juvenile myoclonic epilepsy nor epilepsy with generalized grand mal on awakening during follow-up. CONCLUSIONS: 5.2% of all subjects were patients with idiopathic epilepsies who experienced absences as a first (or the only) type of seizures when absences occur one should consider first of all childhood absence epilepsy and juvenile absence epilepsy. Recognition of juvenile myoclonic epilepsy and epilepsy with generalized grand mal on awakening is less probable.

Adolescent↗
PubMed1998

Is the underlying cause of epilepsy a major prognostic factor for recurrence?

BACKGROUND: We investigated the prognostic value of the type of epilepsies and epileptic syndromes for seizure recurrence. In patients with partial epilepsy, we focused on the prognostic value of any structural brain abnormality and of the location of the epileptogenic region. METHODS: A total of 2,200 adult outpatients were included in a hospital-based observational survey, with a follow-up of 1 to 7 years. Twenty-two percent of the patients exhibited generalized epilepsy, 62% partial epilepsy, and 16% undetermined epilepsy. RESULTS: Seizure control (>1 year without seizure) was achieved in 82% of patients who had idiopathic generalized epilepsy, 35% of those with symptomatic partial epilepsy, 45% of those with cryptogenic partial epilepsy, and 11% of those with partial epilepsy associated with hippocampal sclerosis (HS). Temporal lobe epilepsy (TLE) was the most refractory partial epilepsy, with only 20% of such patients remaining seizure free, compared with 36% of extra-TLE patients. In partial epilepsy, HS, cerebral dysgenesis, and dual pathology (HS and another lesion) were associated with a low rate of seizure-free patients (11%, 24%, and 3%, respectively). No significant difference in seizure control was found between patients with extra-TLE and those with TLE and no HS. CONCLUSIONS: In adults, partial epilepsy is more difficult to treat than idiopathic generalized epilepsy. In patients who have partial epilepsy, the location of the epileptogenic zone does not seem to be a determining factor. Brain abnormalities--especially HS, either alone or associated with another lesion--are a major prognostic factor.

Adolescent↗
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↗
PubMed1998

Attitudes of GPs to the care of people with epilepsy.

BACKGROUND: Most individuals with current epilepsy are solely under the care of the primary care team for follow-up care. Government working party recommendations, expert epilepsy panels and patients have also stressed the central role of the GP in follow-up care. Problems in the provision of care in the community have, however, repeatedly been highlighted. The views of GPs about service provision for people with epilepsy may be an important barrier to providing care, but have not yet been studied in a systematic manner. OBJECTIVES: We aimed to ascertain the views of GPs on service provision for people with epilepsy in primary care and on specific initiatives to improve care. METHOD: A specially designed postal questionnaire was sent to all 262 GPs on the list of West Glamorgan FHSA. It ascertained what GPs felt their role should be in providing care to people with epilepsy, identified their views on the importance of particular problems in providing this care, as well as obtaining their opinions on possible future initiatives to improve epilepsy care in the community. RESULTS: The overall response rate was 70%. Although a majority of responding GPs (55%) agreed that the care of people with epilepsy should be based in general practice, 23% disagreed. A lack of confidence about knowledge of epilepsy (34% responders), unfamiliarity with new drugs (65% responders) and a lack of time (41% responders) were identified as important perceived barriers to providing epilepsy care. Nearly all responding GPs would welcome guidelines for epilepsy care (93% felt they would be very helpful) and an epilepsy liaison nurse in the community was the most popular option in terms of preferred overall strategy for improving care. CONCLUSIONS: Despite 40 years of official recommendations regarding the central role of the GP in the follow-up care of people with epilepsy, a number of GPs have difficulty in providing this care. Many feel that they lack knowledge or are too time pressured to improve the situation. Nearly all GPs say that they would find guidelines for epilepsy care very helpful and over half would find epilepsy liaison nurses helpful. There is scope for more innovative ideas for epilepsy care in the community.

Attitude of Health Personnel↗
PubMed2000

Prevalence, knowledge, attitude, and practice of epilepsy in Kerala, South India.

PURPOSE: To ascertain the prevalence and pattern of epilepsy and to characterize and quantify knowledge, attitude, and practice (KAP) toward epilepsy among the people of the state of Kerala, which is distinguished from the rest of India by a high level of literacy and health awareness of its population. METHODS: We conducted a door-to-door survey covering the entire population of 238,102 people residing in 43,681 households in a semiurban area of central Kerala. The screening questionnaire administered by medical social workers had a sensitivity of 100% for identifying persons with epilepsy. Neurologists examined all the individuals suspected of having epilepsy. We evaluated KAP toward epilepsy among 1,118 subjects (439 males and 679 females; mean age, 33.3 years; age range, 15-85 years) from households without epilepsy in the study area. RESULTS: Through a three-phased survey, we ascertained 1,175 cases (616 males and 559 females) with active epilepsy, providing a crude point prevalence ratio of 4.9 cases per 1,000 people and an age-adjusted prevalence ratio of 4.7 cases per 1,000 population. The highest age-specific prevalence rate of 6.5 per 1,000 occurred in the 10- to 19-year-old age group. Sex-specific prevalence rates did not significantly differ. The proportion of generalized and localization-related epilepsies was 58.8% and 30.6%, respectively. Ninety-nine percent of the KAP respondents had read or heard about epilepsy. Thirty-one percent and 27% thought epilepsy was a hereditary disorder and a form of insanity, respectively. About 40% of the respondents felt that individuals with epilepsy could not be properly educated or employed. Eleven percent would object to their children having contact with epileptic children. CONCLUSIONS: The prevalence and pattern of epilepsy in central Kerala, South India, do not differ from that of developed countries. Although the awareness of epilepsy among the people of Kerala was comparable to that of developed countries, the attitudes were much more negative. The need for educating the people of Kerala on epilepsy and for incorporating an adequate knowledge of epilepsy in the school curricula cannot be overemphasized.

Adolescent↗
PubMed2005

A review of the costs of managing childhood epilepsy.

Epilepsy is a chronic treatable condition for which new diagnostic tools and several new drugs and non-pharmacological treatments are now available. The cost profile of these options is assessed here through an overview of the available literature focusing on studies of childhood epilepsy. Several methodological problems arise when interpreting the results of economic studies in epilepsy, including the variability of the study population and costs items, the reliability of the sources of cost, the limitations of the methods of data collection and the deficiencies of the study designs, with reference to the measures of treatment benefits. International comparisons are then difficult because economic results cannot be compared on account of differences in monetary issues, clinical practice patterns and healthcare system frameworks. The economic aspects of epilepsy are different in children and adults. Differences are detectable in the incidence and expression of epileptic syndromes, social and emotional impact, availability of antiepileptic drugs, hospital admissions, diagnostic tests and referral to specialists, social assistants and other healthcare professionals. In addition, children have access to medical services only with the help of a caregiver, for whom there may be lost work days or under-employment. The mean annual cost per child with epilepsy was USD 1853 for controlled epilepsy and USD 4950 for uncontrolled epilepsy in a Spanish study performed in 1998 and the annual direct costs per child with epilepsy ranged from euro 844 for patients in remission to euro 3268 for patients with drug-resistant epilepsy in an Italian study done between 1996 and 1998. The Spanish study showed that direct costs are the major source of expenditure for children with epilepsy. These studies along with a number of other cost-of-illness studies in combined populations of adults and children showed that service use and costs increase with more severe forms of illness and seizure frequency, this being more marked in adults than in children. Moderate cost differences may be expected between children (higher) and adults (lower), particularly with reference to initial investigations. Costs of epilepsy are mostly explained by hospital admissions and drugs; in particular, drug costs tend to dominate in more well controlled epilepsy, while both hospital admissions and drugs are significant costs in less well controlled epilepsy. Newly diagnosed patients can incur significant hospital and diagnostic costs. Costs for epilepsy tend to be lower for patients cared for in general practice or outpatient settings than in hospital settings. Seizure control by drugs, ketogenic diet or surgery is associated with a significant reduction in the costs of epilepsy.

Adolescent↗
PubMedDate not supplied

[Idiopathic partial epilepsy with occipital paroxysms].

BACKGROUND: The syndrome of idiopathic partial epilepsy with occipital paroxysms in the electroencephalogram (EEG) shows a considerable clinical and prognostic heterogeneity. The semiology of seizures varies considerably among patients and its hallmark, occipital paroxysms blocked by eye opening, may appear in other idiopathic or symptomatic epilepsies of childhood and even in nonepileptic disorders, notably basilar artery migraine. To address these unresolved issues in children with this rare form of epilepsy, the present paper utilized a longitudinal approach and investigated the significance of electrophysiologic and clinical characteristics necessary for the diagnostic and prognostic evaluation during a long-term follow-up. PATIENTS AND METHODS: Over a 9-year period all patients, aged 1-15 years, who showed occipital paroxysms in EEG recordings were included in this study. In addition, clinical correlates were available for all these patients. Neurological, psychiatric and other clinical examinations were done in all patients. Whenever indicated, the neuroimaging of the brain (computerized tomography and/or magnetic resonance) was performed to establish the symptomatic aetiology. The epileptic syndromes were determined according to criteria of the International classification. A detailed EEG analysis of all patients, performed during a 3-12 year follow-up period, included hyperventilation, photic stimulation and a thorough testing of visual reactivity with exclusion of central vision. The incidence of EEG characteristics in patients with various epileptic syndromes was compared and its significance for the differential diagnosis was tested by nonparametric statistical methods. The clinical semiology of epilepsy and/or other associated disorders and EEG findings were compared among the patients with idiopathic partial epilepsy and occipital paroxysms. RESULTS: Occipital epileptiform paroxysms were recorded in EEGs of 76 children with various clinical diagnoses but only 58 patients had seizures. The incidence of epilepsy (39 patients or 51%) was slightly higher than that of various non-epileptic disorders (37 patients or 49%). Two types of these paroxysms were analyzed: reactive (appearing at exclusion of central vision and disappearing on eye opening) or unreactive (persisting in the above situations). The difference in incidence of seizures (in a total of 58 patients) depending on the types of paroxysms was not statistically significant. EEG characteristics in 25 patients with both reactive paroxysms and seizures were compared in relation to the aetiology of epileptic syndromes. Comparing EEG in various types of epilepsy with reactive paroxysms, the statistical analysis (using Fischer's exact test) established that slowed background activity was significantly more frequent in symptomatic partial epilepsy than in idiopathic syndromes. On the other hand, EEG normalization during the follow-up period was a rule in benign epilepsy with centro-temporal paroxysms and in childhood absence epilepsy, and it was significantly more frequent in idiopathic partial epilepsy with occipital paroxysms than in symptomatic partial epilepsy. However, EEG findings per se cound not differentiate idiopathic partial epilepsy with occipital paroxysms from other epileptic syndromes. Neither seizures semiology could distinguish between different forms of occipital lobe epilepsy. Therefore, a correct syndromic and aetiologic classification for each patient with occipital spike-wave paroxysms required the combined and thorough assessment integrating clinical examination, clinical neurophysiological analyses, and neuroimaging studies during the follow-up. Using all above methods during the follow-up of 11 patients with idiopathic partial epilepsy with occipital paroxysms (IPEOP) it was found that this syndrome had often a very favorable prognosis if characterized by rare, nocturnal seizures beginning in preschool age. (ABSTRACT TRUNCATED)

Adolescent↗
PubMed1995

Idiopathic generalized epilepsy of adolescence: are the syndromes clinically distinct?

Juvenile myoclonic epilepsy, juvenile absence epilepsy, and epilepsy with generalized tonic-clonic seizures (GTCS) on awakening are the three syndromes of idiopathic generalized epilepsy of adolescent onset currently included in the classification of epilepsy syndromes of the International League Against Epilepsy (ILAE). Although they differ in their predominant seizure types, the syndromes share several clinical features, thus giving rise to questions of phenotypic overlap and purity. We studied the clinical features of 101 patients with idiopathic generalized epilepsy beginning in adolescence. A standardized interview was used to elucidate seizure phenomenology, precipitants, frequency, and response to treatment. Groups defined by seizure type were compared and their similarities examined. The group with myoclonic but not absence seizures (21 patients) corresponded to the ILAE syndrome of juvenile myoclonic epilepsy, whereas those with absences but not myoclonus (37 patients) resembled juvenile absence epilepsy. Twenty-six patients shared the features of juvenile myoclonic epilepsy and juvenile absence epilepsy. Epilepsy with GTCS on awakening was not a specific syndromic entity; 10 patients had this seizure type alone. Seven patients were without a syndromic diagnosis. In these patients only GTCS occurred, but neither on awakening nor in the evening period of relaxation. We conclude that whilst syndromes of idiopathic generalized epilepsy of adolescence can be recognized, the current classification does not include all patients. In addition, the boundaries between the syndromes are indistinct, suggesting underlying neurobiological, possibly genetic, relationships.

Adolescent↗
PubMed2006

Population-based survey on prevalence of adult patients with epilepsy in Taiwan (Keelung community-based integrated screening no. 12).

PURPOSE: To determine the prevalence rate and patterns of adult patients with epilepsy in Taiwan, we conducted a community-based neuroepidemiological survey. METHODS: Epilepsy was detected by neurologists using one-stage method. It was integrated into a community health screening service and performed from 1 January 2001 to 31 December 2001 in Keelung, a northern city in Taiwan. A total of 13,663 subjects aged 30 years or older participated in this survey. RESULTS: There were 52 patients with epilepsy in this study. Among them, 37 were patients with active epilepsy. The age-adjusted prevalence rate of active epilepsy above 30 years old was 2.77/1000 (to the 1980 US population) with the highest rate in subjects aged 40-49 years (4.0/1000). There was a trend of higher prevalence rate in male than in female. The most common seizure type was complex partial seizure (46.0%). Using one-stage detection method, we found nine (24.3%) patients with active epilepsy who had never been diagnosed before. Among the patients with active epilepsy, 35.1% were symptomatic cases. Head injury (13.5%) is the leading cause, followed by CNS infection (8.1%), stroke (5.4%) and perinatal insult (5.4%). The lifetime prevalence rate of epilepsy (including active epilepsy and epilepsy in remission) was 3.14/1000 for age above 30 years. CONCLUSIONS: Comparing to previous epilepsy survey in 1993, our results showed that the prevalence rate of epilepsy was rather stable over the past decade in northern Taiwan. Head injury is the leading cause responsible for active epilepsy. Improving public safety is an important public health issue which may help to reduce occurrence of epilepsy.

Adult↗
PubMed2001

The costs of childhood epilepsy in Italy: comparative findings from three health care settings.

PURPOSE: To determine the direct costs of epilepsy in a child neurology referral population, stratified by disease, duration, and severity, comparing three different health care settings [i.e., teaching or clinical research (CR) hospitals, general hospitals, and outpatient services]. METHODS: Patients were accepted if they had confirmed epilepsy and were resident in the center catchment area. Eligible subjects were grouped in the following categories: (a) newly diagnosed patients; (b) patients with epilepsy in remission; (c) patients with active non-drug-resistant epilepsy; and (d) those with drug-resistant epilepsy. Over a 12-month period, data regarding the consuming of all resources (i.e., consultations, tests, hospital admissions, drugs), were collected for each patient. Using the Italian National Health Service tariffs, the unit cost of each resource was calculated and indicated in Euros, the European currency. RESULTS: A total of 189 patients was enrolled by two teaching-CR hospitals, two general hospitals, and two outpatient services. The patients were evenly distributed across the four categories of epilepsy. The mean annual cost per person with epilepsy was 1,767 Euros. Drug-resistant epilepsy was the most expensive category (3,268 Euros) followed by newly diagnosed epilepsy (1,907 Euros), active non-drug-resistant epilepsy (1,112 Euros), and epilepsy in remission (844 Euros). Costs were generally highest in teaching-CR hospitals and lowest in outpatient services. Hospital services were the major cost in all epilepsy groups, followed by drugs. CONCLUSIONS: The cost of epilepsy in children and adolescents in Italy tends to vary significantly depending on the severity and duration of the disease Hospitals services and drugs are the major sources of costs. The setting of health care plays a significant role in the variation of the costs, even for patients in the same category of epilepsy.

Adolescent↗
PubMed2005

Gender differences in epilepsy.

PURPOSE: The aim of this study was to look at gender differences in unselected populations of patients with epilepsy classified according to the 1989 International League Against Epilepsy (ILAE) criteria. METHODS: Data were obtained from two sources: (a) the EpiBase database at the outpatient clinic at the Department of Neurology, Aarhus University Hospital, Denmark, confined to adults with epilepsy (n=2,170), and (b) the Danish Twin Registry (n=318). RESULTS: In localization-related epilepsy, no overall gender difference was found in either the EpiBase population (n=1,511; w=750 (50%), m=761 (50%); p=0.80) or in the twin population (n=172; w=86 (50%), m=86 (50%); p=1.00). However, in the EpiBase population, localization-related symptomatic epilepsies were more frequent in men (n=939; w=426 (45%), m=513 (55%); p=0.005); and cryptogenic localization-related epilepsies were more frequent in women (n=572; w=324 (57%), m=248 (43%); p=0.002). In generalized epilepsy, more women than men were diagnosed in both populations [EpiBase: n=480, w=280 (58%), m=200 (42%); p<0.001; twin population: n=105, w=63 (60%), m=42 (40%); p=0.05]. The difference was confined to idiopathic generalized epilepsy [EpiBase: n=437, w=259 (59%), m=178 (41%); p<0.001; twin population: n=94, w=60 (64%), m=34 (36%); p=0.01]. CONCLUSIONS: More women than men were diagnosed with idiopathic generalized epilepsy in two epilepsy populations. Overall, no gender difference was found in localization-related epilepsy, but localization-related symptomatic epilepsies were more frequent in men, and cryptogenic localization-related epilepsies were more frequent in women The results suggest a gender susceptibility to the development of specific epilepsy subtypes.

Adolescent↗
PubMed1996

Relations of genetic and environmental factors in the etiology of epilepsy.

We assessed the relations of genetic and environmental factors in the etiology of epilepsy. The study population comprised 9,705 first-degree relatives of 1,951 adults with epilepsy ascertained from voluntary organizations. We calculated standardized morbidity ratios for specific etiologies of epilepsy in the relatives of probands with the same etiologies, using population incidence rates from Rochester, MN, as the reference. Relatives of probands with idiopathic/cryptogenic epilepsy had increased risk for idiopathic/cryptogenic epilepsy and for epilepsy associated with neurological deficit presumed present at birth (cerebral palsy or mental retardation) but not for symptomatic epilepsy associated with postnatal central nervous system insults. Relatives of probands with neurodeficits had increased risks for idiopathic/cryptogenic epilepsy. Risk for epilepsy was not increased among relatives of probands with postnatal symptomatic epilepsy. The degree of increased risk of idiopathic/cryptogenic epilepsy in relatives of probands with idiopathic/cryptogenic epilepsy diminished with increasing age of the relatives; risk was not increased at age 35 or older. These findings support the possibility of shared genetic susceptibility to epilepsy and cerebral palsy, and suggest that the genetic contributions to postnatal symptomatic epilepsy are minimal.

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↗
PubMed2006

Epilepsy in India: nuptiality behaviour and fertility.

PURPOSE: The study was conducted to assess the marital status and fertility in adults with epilepsy. METHODS: The study group consisted of 240 subjects with epilepsy aged 15 and above, Unmarried males (m) 55, unmarried females (f) 73 and married males 48, married females 64. Data was collected according to standard protocol regarding age, sex, age at marriage and onset of seizure, effect of epilepsy on marriage, type of seizure and control, fertility pattern and abortions. The study group was followed up for 30 months. The data was compared with latest available state and national data using Student's 't'-test, chi square, Fisher Z-test. RESULTS: The mean age of married subjects was 26.19 + 6.2 years and of the unmarried was 24.94 +/- 7.1 years. People with epilepsy had significantly (p < 0.05) higher mean age at marriage, significantly (p < 0.05) lower rate of marriage (m 46.6% f 46.72%), significantly (p < 0.05) higher divorce rate and withheld marriage. Females compared to males had higher divorce rate (f 5.84%) and withheld marriage (m 5.45% f 10.96%). The marriage rate of subjects with onset of epilepsy in the first decade (m 38.71% f 34.09%) and second decade (m 33.33% f 35.42%) was significantly lower (p < 0.05) than that of subjects with age at onset of epilepsy greater than 20 years (m 66.67% f 71.11%). Subjects with epilepsy not in remission had significantly (p < 0.05) higher mean age at marriage, lower marriage rate and lower fertility per person-year of marriage than those in remission. Majority (95.54%) did not disclose epilepsy before marriage. Total fertility rate (TFR) in males (4.56) and females (5.45) with epilepsy was comparable to general population. Abortions per pregnancy were 4.76%. CONCLUSION: Subjects with epilepsy had lower marriage prevalence rate, delayed marriage (especially females), withheld marriage and higher divorce rate compared to general population. Marriage rate was lower in people with age at onset of epilepsy less than 20 years and in whom seizures were not in remission. Majority of people with epilepsy did not disclose epilepsy before marriage. Though fertility was not affected in people with epilepsy as compared to general population, males had lower fertility than females.

Adolescent↗
PubMed2006

Onset of epilepsy and menarche--is there any relationship?

PURPOSE: Women with epilepsy have increased frequency of reproductive health problems compared to women without epilepsy. In puberty, reproductive hormonal changes during sexual maturation may affect epilepsy and induce the debut of seizures as indicated in some studies. On the other hand, epileptic activity affects sex hormone function, which may induce alterations in pubertal endocrine maturation and thereby menarche age. We wanted to investigate the relation between epilepsy and menarche age in a larger population of female epilepsy patients. METHODS: A retrospective, questionnaire study of a cohort of 265 female outpatients from three Norwegian hospitals and 142 controls, aged 18-45 years was conducted. Parameters regarding epilepsy and reproductive health issues were registered. Perimenarche was defined as 2 years before and 2 years after the year of menarche. RESULTS: There was a significantly higher frequency of patients with epilepsy debut between 10 and 18 year compared to 0-9 years (p<0.01). There was, however, no significant difference in occurrence of epilepsy debut in the perimenarche period compared to the 5 year periods before and after perimenarche, and no significant difference in epilepsy debut in the year of menarche compared to the 5 years before or after. Menarche age was not significantly different in those with epilepsy debut before or after menarche. Epilepsy type (idiopathic generalised or partial) did not influence the menarche age. CONCLUSIONS: The study did not confirm the former observations of clustering of epilepsy debut at menarche or in the perimenarche period or alterations in menarche age in girls with epilepsy. However, onset of epilepsy is more frequent in the adolescent years (10-18), than in childhood (0-9).

Adolescent↗
PubMed2000

Antiphospholipid and antinuclear antibodies in patients with epilepsy or new-onset seizure disorders.

PURPOSE: The increased prevalence of autoantibodies in patients with epilepsy has been traditionally regarded to be a consequence of antiepileptic drugs. The purpose of this study was to measure autoantibodies in well-defined groups of patients with seizures to determine the effects of epilepsy and antiepileptic medications on the presence of autoantibodies. PATIENTS AND METHODS: We studied the frequency of antinuclear antibodies, anti-beta2-glycoprotein I antibodies, and anticardiolipin antibodies in 50 patients with therapy-resistant localization-related epilepsy, 50 patients with generalized epilepsy syndromes, 52 patients with a newly diagnosed seizure disorder but no antiepileptic medication, and 83 healthy controls. RESULTS: Compared with controls, newly diagnosed patients had a significantly greater prevalence of immunoglobulin (Ig) G class anticardiolipin antibodies (21% versus 7%); the prevalence was 14% in patients with localization-related epilepsy and 8% in patients with generalized epilepsy. The prevalence of IgM class anticardiolipin antibodies was significantly greater in all seizure groups (60% in localization-related epilepsy, 42% in generalized epilepsies, and 33% in newly diagnosed patients) compared with controls (7%). Antinuclear antibodies were significantly more common in newly diagnosed patients (21%) and localization-related epilepsy (24%) compared with controls (12%). When patients with generalized epilepsy (8%) were used as the reference group, antinuclear antibodies were also significantly more frequent in localization-related epilepsy (relative risk [RR] = 2.9, 95% confidence interval [CI]: 1.1 to 8.2) and newly diagnosed seizures (RR = 3.4, 95% CI: 1.2 to 9.3). There were no consistent associations between autoantibodies and specific antiepileptic medications. CONCLUSIONS: The prevalence of autoantibodies is greater in patients with epilepsy, including newly diagnosed seizure disorder. The increased prevalence of autoantibodies is more strongly associated with epilepsy than with antiepileptic drugs, perhaps indicating that immune dysregulation may be commonly associated with epilepsy.

Adult↗