Burden Of Epilepsy Research Articles

Detection of Taenia solium Taeniasis Coproantigen Is an Early Indicator of Treatment Failure for Taeniasis

Taenia solium causes taeniasis and cysticercosis, a zoonotic complex associated with a significant burden of epilepsy in most countries. Reliable diagnosis and efficacious treatment of taeniasis are needed for disease control. Currently, cure can be confirmed only after a period of at least 1 month, by negative stool microscopy. This study assessed the performance of detection by a coproantigen enzyme-linked immunosorbent assay (CoAg-ELISA) for the early evaluation of the efficacy of antiparasitic treatment of human T. solium taeniasis. We followed 69 tapeworm carriers who received niclosamide as standard treatment. Stool samples were collected on days 1, 3, 7, 15, 30, and 90 after treatment and were processed by microscopy and CoAg-ELISA. The efficacy of niclosamide was 77.9% (53/68). Thirteen patients received a second course of treatment and completed the follow-up. CoAg-ELISA was therefore evaluated for a total of 81 cases (68 treatments, 13 retreatments). In successful treatments (n = 64), the proportion of patients who became negative by CoAg-ELISA was 62.5% after 3 days, 89.1% after 7 days, 96.9% after 15 days, and 100% after 30 days. In treatment failures (n = 17), the CoAg-ELISA result was positive for 70.6% of patients after 3 days, 94.1% after 7 days, and 100% after 15 and 30 days. Only 2 of 17 samples in cases of treatment failure became positive by microscopy by day 30. The presence of one scolex, but not multiple scolices, in posttreatment stools was strongly associated with cure (odds ratio [OR], 52.5; P < 0.001). CoAg-ELISA is useful for the assessment of treatment failure in taeniasis. Early assessment at day 15 would detect treatment failure before patients become infective.

Epilepsy is common in the elderly, but where does it go?

Epidemiologic studies generally show an increase in the risk of epilepsy starting around 60–70 years of age, yet relatively little is known about the burden of epilepsy in the elderly or demographic factors associated with its occurrence. In this issue of Neurology ®, Faught et al.1 provide a national estimate of the incidence and prevalence of epilepsy in Medicare recipients (>65 years). This study is timely, as the dearth of knowledge about epilepsy in the elderly becomes all the more pressing with the aging of the population. This issue was raised more than once at a recent meeting of an Institute of Medicine panel on the Public Health Dimensions of the Epilepsies (Los Angeles, CA, March 21, 2011) and at the Interagency Collaboration for Research on Epilepsy meeting held at NIH (June 27, 2011). The authors found a prevalence among seniors of 10.8/1,000 and an estimated yearly incidence of new-onset epilepsy of 2.4/1,000. Men and women had highly similar prevalence and incidence figures. Relative to Caucasians, African Americans had almost twice the prevalence (10.2 vs 18.7/1,000) and incidence rates (2.3 vs 4.1/1,000). Asians (5.5 prevalence, 1.6 incidence) and Native Americans (7.7 prevalence, 1.1 incidence), by contrast, had much lower frequencies of epilepsy than Caucasians. In the general …

The International League Against Epilepsy at the threshold of its second century: Year 2

In July 2009, the International League against Epilepsy (ILAE) developed its four-year strategic plan. This is the second year progress report, prepared by the management committee and the chair of the Strategic Task Force, with input from several key leaders, to highlight progress toward achieving the plan’s goals. Additional information regarding our activities can be found at our renovated website (www.ilae-epilepsy.org).

Compromised Health-Related Quality of Life in Patients With Low-Grade Glioma

To investigate the generic and condition-specific health-related quality of life (HRQL) of patients with low-grade glioma (LGG). A total of 195 patients with LGG, which was diagnosed, on average, 5.6 years before the study, were compared with 100 patients with hematologic (non-Hodgkin's) lymphoma and chronic lymphatic leukemia cancer (NHL/CLL) and 205 general population controls who were comparable with patients with LGG at the group level for age, sex, and education (healthy controls). Generic HRQL was assessed with the Short Form-36 (SF-36) Health Survey, and condition-specific HRQL was assessed with the Medical Outcomes Study cognitive function questionnaire and the European Organisation for Research and Treatment of Cancer brain cancer module. Objective neurocognitive functioning was assessed with a standardized battery of neuropsychological tests. No statistically significant differences were observed between patients with LGG and patients with NHL/CLL in SF-36 scores. Patients with LGG scored significantly lower than healthy controls on six of eight scales and on the mental health component score of the SF-36. Approximately one quarter of patients with LGG reported serious neurocognitive symptoms. Female sex, epilepsy burden, and number of objectively assessed neurocognitive deficits were associated significantly with both generic and condition-specific HRQL. Clinical variables, including the time since diagnosis, tumor lateralization, extent of surgery, and radiotherapy, did not show a consistent relationship with HRQL. Patients with LGG experienced significant problems across a broad range of HRQL domains, many of which were not condition-specific. However, the neurocognitive deficits and epilepsy that were relatively prevalent among patients with LGG were associated with negative HRQL outcomes and, thus, contributed additionally to the vulnerability of this population of patients with cancer.

Prevalence of Childhood Epilepsy in Canada

Few data exist on the frequency and burden of childhood epilepsy in Canada and on the impact in the general population. We have assessed the point prevalence of childhood epilepsy in Canada. We analyzed data from the National Longitudinal Survey of Children and Youth (N=20 025 for Cycle 2, and N= 31 960 for cycle 3). Each cycle was collected over a two year period (2: 1996-1997, 3: 1998-1999). In the survey the following specific question was asked to the person most knowledgeable in the household: "Does the child have any of the following long-term conditions that have been diagnosed by a health professional?" The list of responses included Epilepsy and certain co-morbid conditions. In addition, a subsequent question identified whether the condition was treated by means of a specific anticonvulsant medication. (anticonvulsants or anti-epileptic pills?). Prevalence was based on the national standard population at the time of each survey. In Cycle 2, 80 of 20 025 subjects from 0 to 13 years old were described to have the diagnosis of epilepsy, yielding a weighted point prevalence of 4.03 per 1 000. In Cycle 3 161 of 31 960 children from 0 to 15 were described as having epilepsy, yielding a weighted point prevalence of 5.26 per 1 000. The rate of epilepsy was higher for males and increases with age. The overall rates for this age cohort are consistent with those obtained in other developed countries and seem to coincide with rates for youth and adults in Canada.

Standards for epidemiologic studies and surveillance of epilepsy

Worldwide, about 65 million people are estimated to have epilepsy. Epidemiologic studies are necessary to define the full public health burden of epilepsy; to set public health and health care priorities; to provide information needed for prevention, early detection, and treatment; to identify education and service needs; and to promote effective health care and support programs for people with epilepsy. However, different definitions and epidemiologic methods complicate the tasks of these studies and their interpretations and comparisons. The purpose of this document is to promote consistency in definitions and methods in an effort to enhance future population-based epidemiologic studies, facilitate comparison between populations, and encourage the collection of data useful for the promotion of public health. We discuss: (1) conceptual and operational definitions of epilepsy, (2) data resources and recommended data elements, and (3) methods and analyses appropriate for epidemiologic studies or the surveillance of epilepsy. Variations in these are considered, taking into account differing resource availability and needs among countries and differing purposes among studies.

Journal Club: Estimating risk for developing epilepsy

This initial Journal Club article looks at a study from Hesdorffer and colleagues1 who have calculated the lifetime risk of developing epilepsy. The study provides an elegant example of proper epidemiologic methods and results in data that have important implications for public health. When addressing public health aspects of epilepsy, it is essential to obtain an unbiased estimate of the lifetime risk of epilepsy. With this assessment, the economic burden of epilepsy, including health care expenditures, productivity loss, intangible costs such as those associated with stigma, and additional costs from medical comorbidities of epilepsy can be extrapolated.2,3 Similarly, the patient-perceived burden of epilepsy, including associations between epilepsy and poor health, unemployment, lower annual incomes, lower health-related quality of life, smoking, and obesity, can be better evaluated.4 Given this information and the proportion of the aging population that is at risk for epilepsy, the limited number of specialists able to care for epilepsy patients is a growing concern. Nearly 35% of adults with self-reported active epilepsy reported not having seen a neurologist or epileptologist in the previous year4 and the Workforce Task Force of the American Academy of Neurology predicts a shortfall of neurologists in the years to come.5 With these broad consequences of epilepsy, the questions that Hesdorffer and colleagues pose in their study are relevant to neurologic practice. What is the risk of developing epilepsy over the course of a lifetime? How much does this risk increase with age? How does the incidence of epilepsy differ among age groups? To answer these critical epidemiologic questions, Hesdorffer and colleagues performed a population-based retrospective cohort study using medical records from Southeastern Minnesota. The study population was limited to those who developed epilepsy between January 1, 1960, and December 31, 1979, as documented through the …

Predictors of health-related quality of life and costs in adults with epilepsy: A systematic review

Given the high burden of epilepsy on both health-related quality of life (HRQoL) and costs, identification of factors that are predictive of either reduced HRQoL or increased expenditure is central to the better future targeting and optimization of existing and emerging interventions and management strategies for epilepsy. Searches of Medline, Embase, and Cochrane Library (up to July 2010) to identify studies examining the association between demographic, psychosocial, and condition-related factors and HRQoL, resource utilization or costs in adults with epilepsy. For each study, predictor factor associations were summarized on the basis of statistical significance and direction; the results were then combined across studies. Ninety-three HRQoL and 16 resource utilization/cost studies were included. Increases in seizure frequency, seizure severity, level of depression, and level of anxiety and presence of comorbidity were strongly associated with reduced HRQoL. The majority of studies were cross-sectional in design and had an overall methodologic quality that was judged to be "moderate" for HRQoL studies and "poor" for health care resource or costs studies. In the 53 multivariate studies, age, gender, marital status, type of seizure, age at diagnosis, and duration of epilepsy did not appear to be associated with HRQoL, whereas the predictive influence of educational and employment status, number of antiepileptic drugs (AEDs) and AED side effects was unclear. The association between predictive factors and HRQoL appeared to be consistent across individuals whether refractory or seizures controlled or managed by AEDs. There were insufficient multivariate studies (five) to reliably comment on the predictors of resource utilization or cost in epilepsy. In addition to seizure control, effective epilepsy management requires the early detection of those most at risk of psychological dysfunction and comorbidity, and the targeting of appropriate interventions. There is need for more rigorous studies with appropriate multivariate statistical methods that prospectively investigate the predictors of HRQoL, resource utilization, and costs in epilepsy.

Cost of epilepsy in children attending a tertiary centre in Nigeria

Epilepsy is one of the leading paediatric neurological disorders in Nigeria and many other parts of the world. There is very little documented on the economic costs of epilepsy in Nigeria and other countries in sub-Saharan Africa. This study was carried out to estimate the total cost of childhood epilepsy in a cohort of Nigerian children and therefore provide essential information on the economic burden of childhood epilepsy in Nigeria. A cost of illness study was performed on a cohort of 215 consecutive cases of epilepsy seen and treated at the University College Hospital, Ibadan, Nigeria. Data on demographics, clinical characteristics, utilization of resources and costs were collected. The total annual cost of epilepsy ranged from Nigerian naira (N)23 200 (US$155) to N3 298 500 (US$21,900) with a median of N107 600 (US$717) per patient per year. Direct medical and non-medical costs accounted for 71.8% of the total mean annual cost of epilepsy. Anti-epileptic drug therapy and in-patient care accounted for 21.8% and 33.0% of the mean total annual cost respectively and more than half of the families expended over 20% of their total family income on the care of the child with epilepsy. The economic burden of childhood epilepsy in Nigeria is enormous with very high out-of-pocket expenses.

Economic implications of three strategies for the control of taeniasis

To evaluate the cost-effectiveness of three strategies for the control of taeniasis in a community, in terms of cost per case treated. A study was conducted in South India to determine the prevalence of taeniasis by screening stool samples from 653 randomly chosen subjects, for coproantigens. The costs incurred in the project were used to estimate the cost per case screened and treated. A one-way sensitivity analysis was carried out for varying rates of taeniasis, different screening strategies and mass therapy. Further sensitivity analysis was carried out with different manpower and test costs. The rate of taeniasis as detected by ELISA for coproantigen was 3 per 1000 (2 of 653 samples). Our study showed that mass therapy without screening for taeniasis would be the most economical strategy in terms of cost per case treated if field workers are employed exclusively for either mass therapy or screening. For each strategy, costs per case treated are higher at low prevalence of taeniasis, with a sharp rise below 15%. In places that are endemic for taeniasis and neurocysticercosis, mass therapy or screening for taeniasis should be considered. Screening by stool microscopy is not cost-effective in terms of cost per case of taeniasis treated owing to its low sensitivity. Although the cost per case of taeniasis treated is high at low prevalence of taeniasis for all options, incorporating mass therapy into existing mass drug distribution programmes might prove to be the most cost-effective control strategy.

Depression in epilepsy: a critical review from a clinical perspective

Depression is a serious and frequent comorbidity of epilepsy and other neurological conditions. Here, we review recent studies on the relationship between epilepsy and depression with regard to diagnostic criteria, epidemiology, etiology and treatment. Depression in epilepsy can be described in the general framework of the diathesis-stress model: chronic stress exposure owing to the 'burden of epilepsy' and learned helplessness due to the threat of recurrent seizures as unpredictable aversive events represent psychological risk factors for the development of depression. Epilepsy-related factors (for example, focus site or side) have shown little effect on mood. Nonepileptic individuals who are adversely affected by seizures (for example, parents of pediatric patients with epilepsy, and patients with psychogenic nonepileptic seizures) show increased levels of depression, similar to patients with epilepsy. However, seizures, subclinical hypersynchronous neural discharges and some antiepileptic drugs may cause acute states of depressive mood or depression on a purely neurobiological basis. Antidepressant drugs and psychotherapy have shown moderate efficacy in the treatment of depression comorbidity, but randomized controlled trials in patients with epilepsy are lacking, especially for drugs.

Accounting for comorbidity in assessing the burden of epilepsy among US adults: results from the National Comorbidity Survey Replication (NCS-R)

Although epilepsy is associated with substantial role impairment, it is also highly comorbid with other physical and mental disorders, making unclear the extent to which impairments associated with epilepsy are actually due to comorbidities. This issue was explored in the National Comorbidity Survey Replication (NCS-R), a nationally representative household survey of 5,692 US adults. Medically-recognized epilepsy was ascertained with self-report, comorbid physical disorders with a chronic conditions checklist, and comorbid DSM-IV mental disorders with the Composite International Diagnostic Interview (CIDI). Lifetime epilepsy prevalence was estimated at 1.8%. Epilepsy was comorbid with numerous neurological and general medical conditions and with a sporadic cluster of mental comorbidities (panic, PTSD, conduct disorder, and substance use disorders). Although comorbid disorders explain part of the significant gross associations of epilepsy with impairment, epilepsy remains significantly associated with work disability, cognitive impairment, and days of role impairment after controlling comorbidities. The net association of epilepsy with days of role impairment after controlling for comorbidities is equivalent to an annualized 89.4 million excess role impairment days among US adults with epilepsy, arguing that role impairment is a major component of the societal costs of epilepsy per se rather than merely due to disorders comorbid with epilepsy. This estimated burden is likely conservative as some parts of the effects of epilepsy are presumably mediated by secondary comorbid disorders.

Infectious causes of seizures and epilepsy in the developing world

Central nervous system (CNS) infections are the main cause of seizures and acquired epilepsy in the developing world. Geographical variations determine the common causes in a particular region. Acute seizures are common in severe meningitis, viral encephalitis, malaria, and neurocysticercosis, and in most cases are associated with increased mortality and morbidity, including subsequent epilepsy. Neuronal excitability secondary to proinflammatory signals induced by CNS infections are an important common mechanism for the generation of seizures, in addition to various other specific mechanisms. Newer insights into the neurobiology of these infections and the associated epilepsy could help in developing neuroprotective interventions. Management issues include prompt treatment of acute seizures and the underlying CNS infection, correction of associated predisposing factors, and decisions regarding the appropriate choice and duration of antiepileptic therapy. Strategies for the prevention of epilepsy in CNS infections such as early anti-infective and anti-inflammatory therapy need scientific exploration. Prevention of CNS infections is the only definitive way forward to reduce the burden of epilepsy in developing countries.

Considering economic reality in calculating the financial burden of epilepsy in China

Considering economic reality in calculating the financial burden of epilepsy in China

Medical and employment-related costs of epilepsy in the USA

Evaluation of: Ivanova JI, Birnbaum HG, Kidolezi Y et al. Economic burden of epilepsy among the privately insured in the US. Pharmacoeconomics 28(8), 675–685 (2010).Epilepsy is a chronic condition characterized by recurrent unprovoked seizures. Epilepsy is typically treated with antiepileptic drugs, although surgery is superior to medical therapy for those who are resistant to medications, and is more more cost effective when successful. The discussion article examines the direct medical costs of epilepsy and the rate of medically related absenteeism compared with a matched control group in the USA. Individuals with epilepsy were found to have significantly higher medical costs and more short- and long-term disability days. This article demonstrates that claims data can be used to assess the indirect impact of epilepsy on employment; however, the addition of other datasets is necessary to more comprehensively assess the impact of epilepsy on employment-related outcomes.

Epilepsy Care in Developing Countries: Part II of II

Although 80% of people with epilepsy reside in resource poor, developing countries, epilepsy care in these regions remains limited and the majority of epilepsy patients go untreated. Cost-effective, sustainable epilepsy care services, delivering first-line antiepileptic drugs through established primary health care facilities, are needed to decrease these treatment gaps. Neurologists with local experience and knowledge of the culture, who are willing to serve as educators, policy advisors, and advocates, can make a difference. This is Part II of a two-part article. Part I reviewed the burden of epilepsy and the current state of resources for treatment in developing countries, while Part II will now discuss various aspects of care in these countries.

Economic Burden of Epilepsy among the Privately Insured in the US

The direct cost burden of epilepsy in the US from a third-party payer perspective has not been evaluated. Furthermore, no study has quantified the indirect (work-loss) cost burden of epilepsy from an employer perspective in the US. To assess the annual direct costs for privately insured US patients diagnosed with epilepsy, and indirect costs for a subset of employees from an employer perspective. A retrospective analysis of a claims database for the privately insured, including employee disability claims from 1999 through 2005 and comprising 17 US companies, was conducted. A total of 4323 patients aged 16-64 years (including 1886 employees) with at least one epilepsy diagnosis (International Classification of Diseases, 9th edition, Clinical Modification [ICD-9-CM] code 345.x) over the period 1999-2004 were included. The control group was a demographically matched cohort of randomly chosen beneficiaries without an epilepsy diagnosis. All had continuous health coverage during 2004 (baseline) and 2005 (study period). Main outcome measures included annual direct (medical and pharmaceutical) costs and, for employees, indirect (disability and medically related absenteeism) and total costs for the study period. Wilcoxon rank-sum tests were used for univariate comparisons of annual direct costs, indirect costs (costs for the subset of employees with these data), and total (direct and indirect) costs during the study period. Two-part multivariate models that adjusted for patient characteristics were also used to compare costs between the study and control groups. Patients with epilepsy were an average age of 43 years and 57% were female. They had more co-morbidities than controls. On average, direct annual costs were significantly higher per patient with epilepsy than per control ($US10 258 vs $US3862, respectively; p < 0.0001) [year 2005 values], with an annual per-patient difference of $US6396. Epilepsy-related costs ($US2057) accounted for 20% of direct costs for patients with epilepsy. Annual indirect costs were significantly higher for employees with epilepsy than for employed controls ($US3192 vs $US1242, respectively; p < 0.0001), with a difference of $US1950. Total direct plus indirect costs for employees with epilepsy were also higher than those for employed controls ($US13 595 vs $US5338, respectively; p < 0.0001), with a difference of $US8257. Epilepsy was associated with significant economic burden. The excess direct costs in patients with epilepsy are underestimated when only epilepsy-related costs are considered.

Detecting spatial clusters of Taenia solium infections in a rural block in South India

Neurocysticercosis (NCC) is a major cause of seizures/epilepsy in countries endemic for the disease. The objectives of this study were to spatially map the burden of active epilepsy (AE), NCC, taeniasis, seroprevalence for cysticercal antibodies and positivity to circulating cysticercal antigens in Kaniyambadi block (approximately 100 villages comprising 100 000 population) of Vellore district and to detect spatial clusters of AE, NCC, taeniasis and seroprevalence. Using geographic information system (GIS) techniques, all 21 study villages with over 8000 houses (population of 38 105) were mapped. Clustering of different indices of Taenia solium infection was determined using a spatial scan statistic (SaTScan). There was a primary spatial cluster of AE with a log likelihood ratio (LLR) of 10.8 and relative risk (RR) of 22.4; however, no significant clustering for NCC was detected. Five significant spatial clusters of seropositivity for cysticercal antibodies, two clusters of seropositivity for cysticercal antigens and one for taeniasis were detected (LLR of 8.35 and RR of 36.67). Our study has demonstrated the use of GIS methods in mapping and identifying ‘hot spots’ of various indices of T. solium infection in humans. This spatial analysis has identified pockets with high transmission rates so that preventive measures could be focused on an intensive scale.

Epilepsy Care in Developing Countries: Part I of II

Although 80% of people with epilepsy reside in resource poor, developing countries, epilepsy care in these regions remains limited and the majority of epilepsy patients go untreated. Cost-effective, sustainable epilepsy care services, delivering first-line antiepileptic drugs through established primary health care facilities, are needed to decrease these treatment gaps. Neurologists with local experience and knowledge of the culture, who are willing to serve as educators, policy advisors, and advocates, can make a difference. This is Part I of a two-part article. Part I reviews the burden of epilepsy and the current state of resources for treatment in developing countries, while Part II (to be published in Epilepsy Currents issue 10.5) will provide an "Overview of Care" in these countries.

Sociocultural and psychological features of perceived stigma reported by people with epilepsy in Benin

Stigma is a major burden of epilepsy. In sub-Saharan Africa the few studies that addressed epilepsy stigma emphasize enacted, rather than perceived, stigma. This inattention may compromise clinical management and delay help seeking, thereby contributing to the treatment gap. We assessed perceived stigma and identified sociocultural and psychological factors explaining greater stigma among people with epilepsy (PWE) in Benin. PWE included in this study were ascertained using a door-to-door survey in the general population in a Beninese rural area. We applied both qualitative and quantitative research methods to assess stigma and patient's experience and beliefs. An Explanatory Model Interview Catalogue (EMIC) and verbally administered questionnaires provided data for demographic, clinical, and sociocultural features. Sociocultural features were evaluated in terms of illness-related experience and sociocultural representations of epilepsy. Depression and anxiety were also screened. Eighty PWE were included. About 68.7% reported feeling stigmatized. Multivariate regression revealed that factors independently associated with perceived stigma were experience of social isolation (p < 0.001), experience of marital problems (p < 0.01), and presence of anxiety disorder (p < 0.01). Perceived stigma is an important issue in epilepsy in Benin. Social factors seem to be more influential than sociocultural representation of epilepsy. Insofar as research is needed in other African countries to determine the nature and relevant features of stigma to improve treatment and control.