Epidemiology Of Epilepsy Research Articles

Epidemiology of epilepsy and its burden in Kolkata, India.

Disability-adjusted life year (DALY) is a time-based measure of disease burden incorporating both disability and mortality. Our study aimed to determine the DALY lost from epilepsy in an Indian metropolis. A population-based prospective study on epilepsy was conducted over 5years (2003-8) in Kolkata, India, on randomly selected 100,802 subjects (males 53,209, females 47,593) to assess prevalence as well as to capture incident cases of epilepsy and those incident cases that died. Standard case definitions were used. The data were used to estimate years of life lost (YLL) due to premature mortality, years of life lived with disability (YLD), and DALY, utilizing the prevalence-based Global Burden of Disease (GBD) 2010 approach. Age- and gender-specific figures were computed. During 2003-2004, a total of 476 subjects with active epilepsy were detected and the age-adjusted prevalence rate was 4.71 per 1000. Over 5years, there were 197 incident cases of epilepsy of whom 26 died. The age-adjusted annual incidence rate of epilepsy was 38.3 per 100,000. The all-cause standardized mortality rate (SMR) of epilepsy was 2.4. The burden of epilepsy in the year 2007-8 revealed the overall YLL was 755 per 100,000, and the overall YLD ranged from 14.45 to 31.0 per 100,000 persons depending on the clinical severity of the epilepsy. Both YLL and YLD values were higher in males than in females. The overall DALY lost due to epilepsy in 2007-8 was found to be 846.96 (males 1183.04, females 463.81) per 100,000. This is the first study in India to determine the DALY of epilepsy using GBD 2010. The results reveal a substantial burden of epilepsy in our setting. Similar such studies are needed in other parts of India in both urban and rural settings.

An unknown quantity--the worldwide prevalence of epilepsy.

The reported incidence (rate of new cases in a population) of epilepsy is consistently lower in high-income than in lower-income economies, whereas opinions vary regarding comparative prevalence rates (proportion of the population with epilepsy). For any condition that does not influence mortality, lifetime prevalence should approximate to the cumulative incidence. We suspected that epilepsy prevalence might be uniform throughout the world, whereas incidence is higher in resource-poor countries. To test whether our suspicion was reasonable, we conducted a Medline search to estimate the prevalence of active and lifetime epilepsy in different economic areas throughout the world. We found that the range of estimated prevalence of epilepsy may be broadly similar throughout the world, but comparison is limited by lack of door-to-door studies in high-income economies and by variations in the definitions of active epilepsy. We contend that any inconsistencies between incidence and prevalence are due largely to the excess premature death rate in people with epilepsy in lower-income economies. Much of the variability in epidemiologic indices arises from differences in study methodology, definitions, and risk factors. The epidemiology of epilepsy, and particularly its mortality, needs thorough investigation using uniform definitions that do not include antiepileptic drug use; causes of death should be identified and actions, including treatment and education, should be taken to avoid preventable deaths.

Epidemiology of epilepsy in older adults with an intellectual disability in Ireland: associations and service implications.

There are limited studies on the prevalence of epilepsy and co-morbid conditions in older adults with an ID. To begin to address this prevalence of epilepsy was estimated for participants in the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing. Associations with demographic variables and co morbid health conditions were examined. It was found that prevalence was high (30.7%); but declined as people aged. Those with epilepsy were less likely to live with family, independently or in community settings, rates of refractory epilepsy were high and, despite medication over half of those with epilepsy still reported experiencing seizures. Given these findings, people with ID and their careers have considerable needs for information about epilepsy management, and for support from specialist ID and epilepsy services.

Epidemiological aspects of epilepsy in Brazil from 2008 to 2012

Background: Epilepsy is the commonest neurological condition affecting people of all ages, race and social class. There are about 50million people with epilepsy in the world, 40million in developing countries with little or no access to treatment. There are few studies on the epidemiology of epilepsy in Brazil, despite being an important public health problem.

Epidemiology of epilepsy in ruralBenin: Prevalence, incidence, mortality, and follow‐up

Epilepsy is a major clinical and social issue in Africa. This study was conducted to estimate the prevalence, incidence, mortality, and therapeutic outcome in rural Djidja in Benin. This was a two-phase study with a cross-sectional phase and 18months of follow-up. In the first phase, information was obtained using door-to-door surveys, reports from key informants, and medical sources. People were interviewed using a validated screening questionnaire for epilepsy in tropical regions. The diagnosis of epilepsy was confirmed by a neurologist. We used a capture-recapture method to estimate the number of people with epilepsy (PWE). PWE were followed every month for 18months after the cross-sectional survey. We asked the health services, the general population, and village leaders in the study area to identify suspected cases of epilepsy occurring during the follow-up. New cases were updated every month after confirmation. Antiepileptic drugs were prescribed to PWE. We surveyed 11,668 subjects (male-to-female ratio 0.9) and identified 123 PWE, yielding a prevalence of 10.5 per 1,000 (95% confidence interval (CI) 8.8-12.6/1,000). Combining the three sources, we found 148 PWE and a prevalence of 12.7 per 1,000 (95% CI 10.7-14.9/1,000). After application of the capture-recapture method, the prevalence was estimated to be as high as 38.4 per 1,000 (95% CI 34.9-41.9/1,000). The cumulative incidence was 104.2 per 100,000 and the mean annual incidence was 69.4 per 100,000. The mean annual mortality was 20.8 per 1,000. After treatment, 45% of PWE had total seizure remission and 35% had a decrease in the number of seizures. This study shows that door-to-door survey findings could be improved by using information from other sources. The follow-up suggests that epilepsy could be controlled. Continuous drug delivery and regular follow-up are key.

Validation of a short useful questionnaire in Spanish for the epidemiological screening of epilepsy in Spain: EPIBERIA Questionnaire

IntroductionThere is a major gap in knowledge about the epidemiology of epilepsy in Mediterranean countries. The EPIBERIA group was formed with the aim of promoting the conducting of epidemiological studies in this area in order to improve this situation. This paper deals with the validation of a brief questionnaire for screening of patients with epilepsy in general population. MethodsWe selected an English language questionnaire previously validated by the Ottman group. It was translated, modified to suit the characteristics of the Spanish population, and administered to a sample of 200 patients (93 epileptics and 107 non-epileptic patient controls) sampled consecutively from 5 Epilepsy Units scattered throughout Spain. Both groups were homogeneous in demographic variables, and the control group was representative of the general population. ResultsWe obtained a sensitivity of 100% and a specificity of 74.77% for the less rigorous correction criteria of the questionnaire, with a sensitivity of 94.62% and a specificity of 99.07% for the most stringent ones. The positive predictive values (PPVs) ranged from 7.48% for the first case to 69.49% in the second, assuming a prevalence for epilepsy of 2%. ConclusionsThe questionnaire EPIBERIA is a valid Spanish tool for epilepsy screening of epilepsy in the general population in Spain.

The validation of a three-stage screening methodology for detecting active convulsive epilepsy in population-based studies in health and demographic surveillance systems

BackgroundThere are few studies on the epidemiology of epilepsy in large populations in Low and Middle Income Countries (LMIC). Most studies in these regions use two-stage population-based screening surveys, which are time-consuming and costly to implement in large populations required to generate accurate estimates. We examined the sensitivity and specificity of a three-stage cross-sectional screening methodology in detecting active convulsive epilepsy (ACE), which can be embedded within on-going census of demographic surveillance systems.We validated a three-stage cross-sectional screening methodology on a randomly selected sample of participants of a three-stage prevalence survey of epilepsy. Diagnosis of ACE by an experienced clinician was used as ‘gold standard’. We further compared the expenditure of this method with the standard two-stage methodology.ResultsWe screened 4442 subjects in the validation and identified 35 cases of ACE. Of these, 18 were identified as false negatives, most of whom (15/18) were missed in the first stage and a few (3/18) in the second stage of the three-stage screening. Overall, this methodology had a sensitivity of 48.6% and a specificity of 100%. It was 37% cheaper than a two-stage survey.ConclusionThis was the first study to evaluate the performance of a multi-stage screening methodology used to detect epilepsy in demographic surveillance sites. This method had poor sensitivity attributed mainly to stigma-related non-response in the first stage. This method needs to take into consideration the poor sensitivity and the savings in expenditure and time as well as validation in target populations. Our findings suggest the need for continued efforts to develop and improve case-ascertainment methods in population-based epidemiological studies of epilepsy in LMIC.

Epidemiology of epilepsy in New Valley Governorate, Al Kharga District, Egypt

Epilepsy is one of the serious neurological disorders which results in profound morbidity and mortality. Although epilepsy has no geographical boundaries, understanding cultural, social, and economic backgrounds is a very important step for interpretation of its epidemiological characteristics. This work aims to study the epidemiological profile of epilepsy in New Valley Governorate and to estimate its magnitude of treatment gap. It was conducted in a door to door survey, including all inhabitants (62,583 subjects), by 3 neurologists to detect any suspected case of focal or generalized epilepsy. All suspected cases were subjected to detailed history, clinical examination, EEG, neuroimaging studies, and estimation of serum drug level if needed. The study revealed that life time prevalence of epilepsy in Al Kharga district is 6.76/1000, with highest peak during early child hood, while that of active epilepsy is 4.99/1000 population. The annual incidence rate is 43.14/100,000, and age specific incidence rate has a U-shaped pattern with two peaks of incidence at early infancy and elderly. Localization-related epilepsy is the most frequently encountered type (53.7%). However the treatment gap of epilepsy in New Valley is similar to that in developing countries (61.5%). Prevalence and Incidence Rate of epilepsy in New Valley are similar to that in industrialized countries.

Epidemiology of epilepsy in adults: Implementing the ILAE classification and terminology into population‐based epidemiologic studies

The new proposal for Revised Terminology for Organization of Seizures and Epilepsies published in 2010 poses challenges to all fields of epilepsy including epidemiology. We describe efforts to incorporate the new terminology and classification into population-based health registers in Denmark in order to provide the background for assessment of the quality of epilepsy care, epidemiologic studies of epilepsy, and clinical trials in adults.

Validación en castellano de un cuestionario breve útil para cribado epidemiológico de epilepsia en España: Cuestionario EPIBERIA

IntroductionThere is a major gap in knowledge about the epidemiology of epilepsy in Mediterranean countries. The EPIBERIA group was formed with the aim of promoting the conducting of epidemiological studies in this region in order to improve this situation. This paper deals with the validation of a brief questionnaire for screening patients with epilepsy in the general population. MethodsWe selected an English-language questionnaire previously validated by the Ottman group. It was translated, modified to suit the characteristics of the Spanish population, and administered to a sample of 200 patients (93 epileptics and 107 non-epileptic patient controls) sampled consecutively from 5 epilepsy units in different cities in Spain. Both groups were homogeneous in demographic variables and the control group was representative of the general population. ResultsWe obtained a sensitivity of 100% and a specificity of 74.77% for the least rigorous correction model for the questionnaire, with a sensitivity of 94.62% and a specificity of 99.07% for the most stringent correction model. The PPV ranged from 7.48% for the first case to 69.49% in the second, assuming an epilepsy prevalence of 2%. ConclusionsThe questionnaire EPIBERIA is a valid Spanish tool for epilepsy screening in the general population in Spain.

AN EPIDEMIOLOGIC STUDY OF 389 CHILDREN WITH EPILEPSY IN SOUTHERN IRAN

AN EPIDEMIOLOGIC STUDY OF 389 CHILDREN WITH EPILEPSY IN SOUTHERN IRAN

10-Year outcome of childhood epilepsy in well-functioning children and adolescents

Background A population based study of epilepsy in children from a Swedish county including all children aged 1 month to 16 years was reported in 2006. Aim To describe the medical outcome, seizure types, epilepsy syndromes, treatment, individual and family history in children from this study who were well-functioning in January 1997 and the outcome after 10 years. Methods Forty-five individuals, 11–21 years, 19 females, and their parents responded to a questionnaire and the hospital records were reviewed. Results At the end of the 10-year period 75.6% of the patients were in remission. Focal seizures and focal seizures with secondary generalization were found in 57.8%. Rolandic epilepsy had been diagnosed in 33.3%, other idiopathic focal epilepsies in 11.0%, cryptogenic and symptomatic focal epilepsies in 22.2%, childhood absence epilepsy in 8.9%, juvenile absence epilepsy and Jeavons syndrome in each 2.2%, West syndrome in 4.4%, and other “generalized” epilepsies in 15.5%. The patients had a history of simple febrile seizures in 15.6% and of primary headache in 24.4%. Monotherapy with antiepileptic drugs was used by 64.4%, and valproate was the most common first drug of choice. A family history of epilepsy was found in 44.4%, febrile seizures in 17.7%, and primary headache in 57.8%. A coincidence of focal and generalized epilepsy phenotypes was found in some families. Conclusions Longitudinal studies are of importance in epilepsy epidemiology. Our results reflect the selection of only well-functioning individuals with epilepsy from the population based original study.

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.

Response: Comorbidity of Epilepsy

To the Editor: We are grateful to Neville and Gillberg for pointing out the semantic problems in using the word “comorbidity” in the context of a heterogeneous condition like epilepsy, and we would like to comment. In our understanding, comorbidity in epilepsy refers to associated conditions and not to symptoms, medication side effects, or specific pathologies, such as hemiplegia, dizziness, or hippocampal sclerosis. In this respect, brain dysfunction associated with a syndromic diagnosis (e.g., Landau–Kleffner and West syndrome) would not count as comorbid, as it is usually part and parcel of the same condition. Strictly speaking, comorbidity in epilepsy should refer only to conditions that are not known causal factors for epilepsy. They may or may not share a common mechanism predisposing to the development of both disorders. It is not, however, always possible to differentiate between cause and effect in epidemiologic studies (1, 2). Neville and Gillberg close by saying, Comorbidity may be a useful term in the epidemiology of epilepsy, in helping to define the support services required and raising research questions and hypotheses about why—for example—there is overall a high rate of autism spectrum disorder in a range of early onset epilepsies and why psychoses are overrepresented, as is illustrated in the study in question. This in an important statement and further emphasizes the importance of the study of the comorbidity of epilepsy.

Comorbidity of Epilepsy

To the Editor: The study of the comorbidities of epilepsy, reported in December 2004, is important for what it reports of the health problems of people with epilepsy, but it also raises the issue of the use of the term “comorbidity.” In this study of adults with epilepsy, it is used as an epidemiologic description of conditions that have an increased prevalence in the specific disease that is being studied. No necessary causal relation is implied by such an association, and both CNS- and non-CNS–based impairments are included. However, the causes of these associations may already be understood or be at the hypothesis stage. From the pediatric perspective, these associations are many, and subsume much of what makes pediatric epileptology so complex. The term comorbidity is perhaps tending to be used to describe any associated condition. Examples: One caused by the primary pathogenesis of the epilepsy (e.g., hemiplegia caused by hemimegalencephaly). One caused by epilepsy (i.e., secondary brain damage, which is permanent; e.g. mesial temporal sclerosis, after febrile status epilepticus). Brain dysfunction, caused by epilepsy (epileptic encephalopathy), which may be treatable (e.g., selective, or global, or cognitive). Deterioration in Landau–Kleffner syndrome and West syndrome, respectively. Problems caused by treatment, particularly antiepileptic drugs. Problems caused by social disadvantage associated with epilepsy. Problems in which the connection is uncertain. Thus for specific problems/conditions/syndromes, an increasing trend is to describe as many features of the phenotype as possible and, where possible, the pathogenesis of each aspect. To take two examples, Landau–Kleffner syndrome is identified by its seizure, cognitive, and (we would suggest) behavioral characteristics, with the implication that the latter features are caused by epileptic activity and constitute an epileptic encephalopathy. West syndrome would similarly be defined by seizures, EEG, and the cognitive and social impairments, with the latter also being at least in part an epileptic encephalopathy. However, in West syndrome, fixed primary cognitive and motor impairments may well be consequent on the initial cerebral defect that also subsequently caused the epilepsy. In these contexts, the term comorbidity does not help us. Comorbidity may be a useful term in the epidemiology of epilepsy, in helping to define the support services required, and raising research questions and hypotheses about why—for example—overall a high rate of autism-spectrum disorder is found in a range of early-onset epilepsies and why psychoses are overrepresented, as is illustrated in the study in question.

The epidemiology of epilepsy in Europe – a systematic review

Population-based epidemiological studies on epilepsy are available mainly from the UK and the Nordic, Baltic and western Mediterranean countries. No studies were identified from large areas of Europe, especially from the former eastern Europe (except the Baltic countries) and the eastern Mediterranean countries. Based on the prevalence of epilepsy in different studies and accounting for incomplete case identification the estimated number of children and adolescents in Europe with active epilepsy is 0.9 million (prevalence 4.5-5.0 per 1000), 1.9 million in ages 20-64 years (prevalence six per 1000) and 0.6 million in ages 65 years and older (prevalence seven per 1000). Approximately 20-30% of the epilepsy population have more than one seizure per month. Based on the age-specific incidence rates in European studies, the estimated number of new cases per year amongst European children and adolescents is 130,000 (incidence rate 70 per 100,000), 96,000 in adults 20-64 years (incidence rate 30 per 100,000) and 85,000 in the elderly 65 years and older (incidence 100 per 100,000). The proportion of both new and established cases with epilepsy in the young, adults and elderly in individual countries may differ substantially from total European distribution because of differences in age structure.

0222 Genetic epidemiology of epilepsy in northwest India: A study in biomedical anthropology

0222 Genetic epidemiology of epilepsy in northwest India: A study in biomedical anthropology

Epidemiology

Epidemiology

Epidemiology of epilepsy in India.

The article briefly reviews literature pertinent to the incidence, prevalence, prognosis, etiology, and treatment gap of epilepsy in India. Despite defective methodology, Indian studies have shown prevalence rates comparable with those from other countries. No incidence studies exist. Prognosis for those with epilepsy is worse in developing countries. The role of infection, especially neurocysticercosis, in the etiology of epilepsy has still to be fully worked out, as must the relative contributions of the other known etiological factors. Neuroimaging is needed to calculate attributable risk. Reasons for the treatment gap are discussed briefly, pointing out that in India, people seek alternative forms of treatment concurrently. The occurrence and effects of stigma are mentioned. The article ends with the author's opinion on how and where the epidemiology of epilepsy should proceed in the future.

The treatment gap and primary health care for people with epilepsy in rural Gambia.

To study primary-level management for people with epilepsy in rural Gambia by means of community surveys. After population screening was carried out, visits were made by a physician who described the epidemiology of epilepsy and its management. Gaps between required management and applied management were investigated by conducting interviews and discussions with people with epilepsy and their communities. The lifetime prevalence of epilepsy was 4.9/1000 and the continuous treatment rate was less than 10%. The choice of treatment was shaped by beliefs in an external spiritual cause of epilepsy and was commonly expected to be curative but not preventive. Treatment rarely led to the control of seizures, although when control was achieved, the level of community acceptance of people with epilepsy increased. Every person with epilepsy had sought traditional treatment. Of the 69 people with active epilepsy, 42 (61%) said they would like to receive preventive biomedical treatment if it were available in their local community. Key programme factors included the local provision of effective treatment and community information with, in parallel, clarification of the use of preventive treatment and genuine integration with current traditional sources of treatment and advice. Primary-level management of epilepsy could be integrated into a chronic disease programme covering hypertension, diabetes, asthma and mental health. Initial diagnosis and prescribing could take place away from the periphery but recurrent dispensing would be conducted locally. Probable epilepsy etiologies suggest that there is scope for primary prevention through the strengthening of maternal and child health services.