Epilepsy In Taiwan Research Articles

EPH71 Uses of Antiepileptic Drugs Among Pregnant Women with Epilepsy in Taiwan, a 15-Year Cohort Study

Seizure control is important in pregnant women with epilepsy, but the potential adverse obstetric effects associated with antiepileptic drugs (AEDs) have raised significant concern. A better understanding regarding uses of AEDs among pregnant women with epilepsy is therefore essential to justify the benefits and risks of its use among this population. The aim of this nationwide study was to assess the uses of AEDs in pregnant women with epilepsy in Taiwan from 2004 to 2018.

Prescription patterns and dosages of antiepileptic drugs in prevalent patients with epilepsy in Taiwan: A nationwide retrospective cross-sectional study

ObjectiveTo evaluate the prescription patterns and prescribed daily dose (PDD)/defined daily dose (DDD) ratios of antiepileptic drugs (AEDs) in prevalent patients with epilepsy in Taiwan. Materials and methodsA nationwide retrospective cross-sectional study was conducted for prevalent patients with epilepsy in 2016 using the Taiwanese National Health Insurance Research Database. The prescription records of AEDs of all prevalent patients with epilepsy were retrieved. The mean PDDs and PDD/DDD ratios of AEDs in adult patients were obtained to evaluate dosing adequacy. A chi-square test and two-sample t test were used to analyze the differences in AED prescription patterns and dosages, respectively, among patients with different ages, sexes, comorbidities, and therapeutic approaches. ResultsA total of 118,937 prevalent patients with epilepsy were enrolled. The predominant therapeutic approach was monotherapy, especially in the elder adults, accounting for 82.9% of elder adult patients with epilepsy. The proportion of AED monotherapy was higher in patients with dementia (78.9%) and stroke (80.6%). The top three antiepileptic monotherapies were valproic acid (28.7%), levetiracetam (19.1%), and phenytoin (16.9%); however, oxcarbazepine (22.8%) was substituted for carbamazepine (3.9%) as monotherapy for patients aged 0–17 years. Among adult patients with epilepsy, the PDD/DDD ratio of each AED in monotherapy was less than 1.00. The mean PDD of each AED was higher in polytherapy than in monotherapy (p < 0.01), except for lacosamide. The mean PDDs of all evaluated AEDs in monotherapy were lower in elder adult patients than in younger adult patients, most of which reached statistical significance (p < 0.001). ConclusionsIn Taiwan, valproic acid was the most prescribed AED for prevalent patients with epilepsy. The mean PDDs of most AEDs were lower than the DDDs developed by the World Health Organization.

Analysis of trends and factors determining initial antiseizure medication choice for epilepsy in Taiwan

PurposeTo evaluate the current trends and factors associated with the first anti-seizure medications (ASMs) prescribed for epilepsy in Taiwan. MethodsData for patients with epilepsy were collected from the National Health Insurance Research Database, a population-based claims database. We selected patients with newly diagnosed epilepsy from 2013 to 2016. Multivariate logistic regression was used to examine the factors associated with the selection of newer ASMs for the first prescription. ResultsA total of 73,891 patients with newly diagnosed epilepsy were eligible for the study, and the annual incidence was approximately 0.79 per 1,000 people. The five ASMs most prescribed for monotherapy were valproic acid, phenytoin, levetiracetam, gabapentin, and oxcarbazepine, accounting for nearly 90% of all ASMs. Valproic acid was the most-prescribed ASM (more than 30%), and levetiracetam has replaced phenytoin as the second choice since 2015. Factors associated with the selection of newer ASMs for the first prescription were patients’ year of diagnosis, gender, socioeconomic level, and previous or existing comorbidities and the profiles of the care providers (accreditation level, service volume, geographic location, and degree of urbanization of the surrounding area). ConclusionThe data indicated that the trends in ASMs first prescribed for patients in Taiwan accorded with most of the international epilepsy treatment guidelines. However, there were some differences between our results and those in developed countries. In addition, we observed a large urban-rural disparity in the administration of ASMs.

Evaluation of a self-management intervention for adults with epilepsy in Taiwan: A longitudinal randomized controlled trial

PurposeEpilepsy is a neurological disease that causes recurrent seizures and can have a significant impact on a person’s quality of life (QOL). A self-management intervention (SMI) can allow adults with epilepsy to modify behaviors in order to manage their seizures and evaluate the impact of medication and treatments on their daily lives. The purpose of this study was to investigate the effects of a SMI for adults with epilepsy. MethodsThis was a longitudinal randomized controlled trial. Adults with epilepsy between the age of 20 and 65 years were recruited from a medical center in northern Taiwan. Participants were assigned to an intervention group (IG) or control group (CG) through simple randomization. Data regarding demographic and clinical characteristics were collected at baseline (T0). In addition, participants answered nine validated self-report questionnaires, which were used as outcome measures. Following collection of baseline data, the CG received routine monthly counseling over the next 3 months. The IG received the routine monthly counseling, as well as individual face-to-face health counseling on self-management 1 h/month and remote counseling via the phone or computer network at least twice per month. After the first month (T1) and at the end of the third (T2) and sixth months (T3) participants answered the nine questionnaires again. Differences in outcomes between the IGs and CGs were analyzed by comparing scores for the nine outcome variables at T0 with scores at T1, T2, and T3 with generalized estimating equations. ResultsA total of 210 adults agreed to participate in the study; however, only 155 participants completed the questionnaires for all three time points: 75 in the CG and 80 in the IG. The mean age of the 155 participants was 39.6 years (SD = 10.9). There was no significant difference between demographic or clinical variables between the two groups. The only difference in baseline scores (T0) among the nine self-report questionnaires was in epilepsy knowledge, measured with the Epilepsy Knowledge Profile questionnaire, which were significantly higher for the CG (mean = 32.28, SD = 3.92) than the IG (mean = 23.01, SD = 2.79) (p < 0.001). Generalized estimating equations (GEE) analysis showed scores decreased significantly at T3 from baseline for the CG for epilepsy knowledge and QOL (p < 0.001). Improvements in scores for sleep quality, anxiety, depression, self-efficacy, coping, and social support did not differ between groups.Classification of the IG by gender showed a significantly greater increase for males compared with females from baseline to T3 for epilepsy knowledge (p < 0.001). If we further classified the IGs by seizure frequency, participants with a seizure frequency of ≥1 per year had a more significant increase in epilepsy knowledge and increase in QOL compared with participants with a seizure frequency of <1 per year at T3 compared with T0. ConclusionThe lack of improvement in health-related quality of life (HRQoL) following the SMI may indicate that additional time is required to change behaviors that impact this variable for patients with epilepsy. Additional research should focus on variables associated with medication compliance, epilepsy knowledge, medicine symptom distress, self-efficacy, anxiety, and HRQoL.

A Wide Spectrum of Genetic Disorders Causing Severe Childhood Epilepsy in Taiwan: A Case Series of Ultrarare Genetic Cause and Novel Mutation Analysis in a Pilot Study.

Background: Pediatric epileptic encephalopathy and severe neurological disorders comprise a group of heterogenous diseases. We used whole-exome sequencing (WES) to identify genetic defects in pediatric patients. Methods: Patients with refractory seizures using ≥2 antiepileptic drugs (AEDs) receiving one AED and having neurodevelopmental regression or having severe neurological or neuromuscular disorders with unidentified causes were enrolled, of which 54 patients fulfilled the inclusion criteria, were enrolled, and underwent WES. Results: Genetic diagnoses were confirmed in 24 patients. In the seizure group, KCNQ2, SCN1A, TBCID 24, GRIN1, IRF2BPL, MECP2, OSGEP, PACS1, PIGA, PPP1CB, SMARCA4, SUOX, SZT2, UBE3A, 16p13.11 microdeletion, [4p16.3p16.1(68,345–7,739,782)X1, 17q25.1q25.3(73,608,322–81,041,938)X3], and LAMA2 were identified. In the nonseizure group, SCN2A, SPTBN2, DMD, and FBN1 were identified. Ten novel mutations were identified. The recurrent genes included SCN1A, KCNQ2, and TBCID24. Male pediatric patients had a significantly higher (57% vs. 29%; p < 0.05, odds ratio = 3.18) yield than their female counterparts. Seventeen genes were identified from the seizure groups, of which 82% were rare genetic etiologies for childhood seizure and did not appear recurrently in the case series. Conclusions: Wide genetic variation was identified for severe childhood seizures by WES. WES had a high yield, particularly in male infantile patients.

Statin effects on post-stroke epilepsy and mortality – Taiwan population-based study

ABSTRACT Objectives: Statins have anti–inflammatory effects on several neurological diseases. However, their effects on post-stroke epilepsy and mortality have not been well studied. Method: This is a retrospective cohort study, based on the one-million random data from National Health Insurance Research Database (NHIRD) of Taiwan. We identified stroke inpatients during 2000–2009. They were grouped into statin users and non-users, and followed up to 2010. Excluded were those with in-hospital mortality, in-hospital seizure(s), epileptic history, antiepileptic drug use before admission, or age under 45. The hazard ratios of statin-associated epilepsy and mortality were analyzed separately. Results: There were 16,711 statin non-users and 2246 users. There was no significant differences between the two groups in terms of epilepsy (13.3 vs. 15.7 per 1000 person-years, p = 0.728) and overall mortality (66.3 vs. 104.6 per 1000 person-years, p = 0.351). Subgroup analysis of male patients showed that statin-users had lower mortality risk compared with non-users (60.2 vs. 113.0 per 1000 person-years, p = 0.032). Conclusion: Statins have a modest but non-significant effect in preventing post-apoplectic epilepsy in Taiwan. Statins decrease post-stroke mortality only in men. Further studies are needed to depict their exact roles in these issues.

Prevalence of suicide attempts and their risk factors in school-aged patients with epilepsy: a population-based study.

Suicide prevention is a critical issue for young people. However, no large body of representative data on the risk of suicide attempts in school-aged patients with epilepsy in Taiwan or other developing countries is available. Patients aged≤18years who received a diagnosis of epilepsy between 2000 and 2012 were included in the epilepsy cohort (N=9801). The comparison cohort was matched to the epilepsy cohort at a ratio of 4:1. We calculated the adjusted hazard ratio and 95% confidence intervals (CIs) for suicide attempts after adjustment for age, sex, urbanization level, parental occupation category, comorbidities, and follow-up time. Further analysis was performed to assess the dose-response effect on the risk of attempting suicide based on the average frequency of medical visits for epilepsy. The overall incidence rates of suicide attempts in the epilepsy and comparison cohorts were 15.7 and 5.89 per 100,000 people per year, respectively. The epilepsy cohort had a 2.34-fold higher risk of suicide being attempted (95% CI 2.17-2.52) than did the comparison cohort. Male sex, over 12years of age, and parental occupation of office work were found to be the major risk factors for suicide attempts. Epilepsy might be an independent factor predisposing school-aged patients to suicide attempts. The results of this study could provide clinicians and governments with vital information on suicide prevention for young people with epilepsy in Taiwan and other developing countries.

Antiepileptic drug use among women from the Taiwanese Registry of Epilepsy and Pregnancy: Obstetric complications and fetal malformation outcomes.

To investigate antiepileptic drugs (AEDs) prescription and pregnancy outcomes in pregnancies with epilepsy in Taiwan between 2004 and 2015. We retrospectively reviewed data from the Taiwanese Registry of Epilepsy and Pregnancy (TREP). The TREP registry is a voluntary prospective cohort registry, which tracks pregnant women with epilepsy and AED prescription throughout pregnancy, delivery, and early childhood development. All TREP pregnancies (n = 318) that had completed questionnaires up until delivery or had had an unsuccessful pregnancy were analyzed. Over 94.7% of women had been prescribed AEDs during pregnancy, with 69.0% and 25.7% having received monotherapy, or polytherapy, respectively. Among live births, 12 (3.9%) reported malformation. Cesarean section rate was reported higher than usual (54.5%). In 2004, 73.3% of AEDs prescribed were 1st generation, with 1st generation prescription rates falling to only 8.3% of total prescribed in 2015. AED polytherapy also fell during the study period (40.0% to 20.0%). Cesarean sections were found to be higher for women over 35 years, who had generalized epilepsy, or had experienced an obstetric complication during pregnancy term. Binary logistic regression revealed that Cesarean section was associated with maternal complications (OR = 5.11, CI 95% = 1.11–23.51, p = 0.036), while malformations were associated with obstetric complication (OR = 20.46, CI 95% = 4.80–87.21, p<0.001). Both AED risk types were not associated with complications or malformations. Our sample provides a unique insight into the women with epilepsy with AED use during pregnancy. Cesarean section rate was observed to be higher than usual, but malformation rates remained low. Results indicate a decrease in both 1st generation AEDs and proportion of patients receiving polytherapy over the study period. Obstetric complications were associated with Cesarean section. Fetal malformations were significantly associated with obstetric complications. AED risk factors were not significantly associated with either complications or malformations.

Perampanel as an adjunctive therapy in patients with frontal lobe epilepsy in Taiwan

Perampanel as an adjunctive therapy in patients with frontal lobe epilepsy in Taiwan

Factors affecting quality of life in adults with epilepsy in Taiwan: A cross-sectional, correlational study.

The purpose of this study was to assess eight factors considered important for quality of life in persons with epilepsy in order to determine which of these components affect quality of life in adults with epilepsy in Taiwan. A cross-sectional, correlational study using structured questionnaires assessed 260 patients with epilepsy purposively sampled from a medical center in Northern Taiwan. Health-related quality of life (HRQoL) was evaluated with the Quality of Life in Epilepsy-31 (QOLIE-31) questionnaire. Data also included personal and health-related characteristics, knowledge of epilepsy, efficacy in the self-management of epilepsy, and social support. Scores for the QOLIE-31 were correlated with the following factors: (1) demographic characteristics of age, gender, and income; (2) sleep quality; (3) symptoms of anxiety and depression; (4) epilepsy-specific variables: seizure frequency; types, number, and frequency of antiepileptic drugs (AEDs); and adverse events of AEDs; and (5) social support. Stepwise regression analysis showed that seven factors were predictive for quality of life: anxiety, depression, adverse events of AEDs, social support, seizure frequency of at least once in three months, household income of NT$ 40,001-100,000, and male gender. These factors accounted for 58.2% of the variance of quality of life. Our study assessed multiple factors in an examination of relationships and predictive factors for quality of life in adults with epilepsy in Taiwan. Knowledge of these contributing factors can assist health-care providers when evaluating patients with epilepsy to help target interventions for improving quality of life.

Prevalence and neuro-psychiatric comorbidities of pediatric epilepsy in Taiwan: A national population-based study

ObjectiveChildren with epilepsy may have comorbidities that result in significant disability. Epidemiological information for pediatric patients with epilepsy in Taiwan is scant. This research estimates the prevalence and common neuro-psychiatric comorbidities of children with epilepsy in Taiwan. MethodsPatients aged less than 20 years old who had received a diagnosis of epilepsy and suffered from epileptic seizures in 2005 were identified in the NHIRD based on ICD-9-CM and prescription records for the use of at least one AED. We used cases of epileptic seizure to survey outpatient service data, and identify common neuro-psychiatric comorbidities. The crude prevalence rate and the age- and sex-specific prevalence were estimated. We also examined the effects of urbanization. ResultsThe estimated prevalence of epilepsy was 0.33% in the pediatric population, with 0.29% for girls and 0.36% for boys. The most common neuropsychiatric comorbidities were learning disability and developmental delay, cerebral palsy, and mental retardation. Epilepsy was more prevalent in boys than in girls, especially among infants, preschool children, and those living in rural areas. In addition, boys with epilepsy had a higher rate of neurological comorbidities. The prevalence of psychiatric comorbidities was lower than that reported in previous studies performed in other countries, especially among children with epilepsy living in rural areas. ConclusionThis research provides the largest nationwide, population-based study of childhood epilepsy to estimate the prevalence and the associated neuropsychiatric comorbidities of pediatric epilepsy in Taiwan. Potential rural–urban disparity basing on prevalence and associated neuropsychiatric comorbidities cannot be ignored in Taiwan.

The impact of the use of antiepileptic drugs on the growth of children

BackgroundThis study investigated whether long-term treatment with antiepileptic drugs (AEDs) had negative effects on statural growth and serum calcium levels in children with epilepsy in Taiwan.MethodsChildren with epilepsy treated with one prescription of AEDs (monotherapy) for at least 1 year were selected. The AEDs included valproic acid (VPA; Deparkin) in 27 children (11 boys and 16 girls) aged 4-18 years, oxcarbazepine (Trileptal) in 30 children (15 boys and 15 girls) aged 5-18 years, topiramate (Topamax) in 19 children (10 boys and 9 girls) aged 6-18 years, and lamotrigine (Lamicta) in eight children (5 boys and 3 girls) aged 5-13 years. Patients with a history of febrile convulsions were selected as the controls.ResultsOne year of VPA treatment significantly impaired the statural growth of pediatric patients with epilepsy (p < 0.005) compared with the control group. The underlying mechanism may have been due to the direct effect of VPA on the proliferation of growth plate chondrocytes rather than alterations of serum calcium.ConclusionsThese results raise serious concerns about the growth of pediatric epilepsy patients who use AEDs, and potentially the need to closely monitor growth in children with epilepsy and adolescents under AED treatment, especially VPA.

A Comparison of the Efficacy and Tolerability of Oxcarbazepine Oral Suspension Between Infants and Children with Epilepsy: A Retrospective Chart Review at a Single Medical Center in Taiwan

Few clinical studies have assessed the efficacy and safety of oxcarbazepine (OXC) oral suspension in Asian pediatric patients and particularly in infants. The aim of this study was to investigate and compare the efficacy, tolerability, and side effects of OXC oral suspension in Taiwanese infants and children with various types of epilepsy. A retrospective review of the efficacy, tolerability, and side effects of OXC oral suspension in a tertiary medical center in Taiwan was conducted and included children (1-9 years old) and infants (<1 year old) diagnosed with epilepsy, which was classified into idiopathic partial, symptomatic partial, or multifocal subtypes. The OXC oral suspension (Trileptal(®); Novartis) was given in a gradual dose titration, from an initial 7.5 mg/kg/day to 30 mg/kg/day within 1 month in all cases. A total of 20 infants and 38 children were identified. There were no statistically significant differences between the children and infants in efficacy (75 vs. 82 %, p = 0.734) and adverse effects (30 vs. 21 %, p = 0.525) after OXC oral suspension treatment. The efficacy was significantly correlated with the epilepsy subtype (p < 0.01) and the number of combined antiepileptic drugs (AEDs) before OXC treatment (p < 0.01) in both groups. The patients with idiopathic and symptomatic partial epilepsy responded better to OXC oral suspension than those with multifocal epilepsy. OXC oral suspension is effective and well tolerated in both infants and children with partial epilepsy in Taiwan. Treatment efficacy was related to epilepsy subtype and number of combined AEDs before OXC treatment. Monotherapy had an excellent therapeutic response in partial epilepsy but not in multifocal epilepsy.

Treatment-seeking behavior of people with epilepsy in Taiwan: A preliminary study

To understand the treatment-seeking behavior of people with epilepsy (PWE), 403 PWE were surveyed using structured face-to-face interviews. Nearly half (49.1%) of them had previously tried complementary and alternative medicine (CAM); traditional Chinese medicine (51.5%) and temple worship (48.0%) were the most frequently used forms of CAM. In the 155 patients with adult-onset epilepsy, seeking CAM was substantially more common among females (OR=2.11, 95% CI=1.05–4.24, P=0.036), patients with frequent seizures (OR=2.68, 95% CI=1.30–5.53, P=0.008), patients with less educated parents (OR=2.16, 95% CI=1.06–4.41, P=0.034), and patients with religious beliefs (OR=2.84, 95% CI=1.23-6.56, P=0.015). In the 248 patients with childhood-onset epilepsy, frequent seizures (OR=2.23, 95% CI=1.32–3.77, P=0.003) and lower level of parental education (OR=2.71, 95% CI=1.45–5.06, P=0.002) were significantly associated with CAM use. The patients who seek CAM before receiving conventional medical treatment decreased after implementation of the National Health Insurance (NHI) (34/188 before NHI vs 22/215 after NHI, P=0.023). This study showed that the prevalence of CAM use by PWE in Taiwan is high and that a convenient NHI program can affect treatment-seeking behavior.

Validation of the Chinese version of the Liverpool Adverse Events Profile in patients with epilepsy

The objective of the study was to validate the Chinese version of The Liverpool Adverse Events Profile (LAEP) in patients with epilepsy. The scale was translated from the English version into a Chinese version and was then back-translated to examine its accuracy. Content validity, concurrent validity, and construct validity were then used to examine the overall validity of this scale. A cross-sectional design with convenience sampling was used to recruit participants from three medical centers. The LAEP Chinese version was tested with respect to validity and reliability in 357 patients with epilepsy, and another 28 patients were invited to evaluate the test-retest reliability of the scale in a 2-week interval. There was a good content validity index (CVI=1.0). Patients undergoing polytherapy had more adverse effects (χ(2)=6.10, p<0.01) and higher LAEP scores (t=-2.91, p<0.01) than patients undergoing monotherapy, indicating a good concurrent validity. Factor analysis included three factors classified by symptoms in the 22-item Chinese version of the LAEP. The total variance of these three factors was 39.3% for the scale. Internal consistency (Cronbach's α=0.92) and the intraclass correlation coefficient (ICC=0.80) were satisfactory. Moreover, the LAEP can be completed in a short time, is perceived as easy to complete, and there was no relevant information missing. The results indicated that the Chinese version of the LAEP yielded highly acceptable parameters of validity and reliability and can be used for measuring adverse effects of antiepileptic drugs among Chinese-speaking patients with epilepsy in Taiwan.

Age–period–cohort analysis of mortality from epilepsy in Taiwan, 1971–2005

Background Age–period–cohort (APC) analysis could provide useful insight into the interpretation of time trends for disease rates. This study aimed to determine whether the patterns of age, period and cohort effects on epilepsy mortality in Taiwan were similar to those in the US and in England and Wales. Methods We employed a three-phase APC analysis method developed by Keyes and Li, 7 which conceptualizes the cohort effect as a partial interaction between age and period. The effects of age, period, and cohort were indicated by the relative risk (RR) of mortality rates. Results We found an increase in mortality rates in the elderly from 1981–85 to 2001–05 and no decline in mortality rates for children, adolescents and adults from 1991–95 to 2001–05. According to APC analysis, the RRs increased sharply during adolescence, and leveled off in adulthood, and then increased steeply in the elderly. The RR of period effects decreased from period 1971–1975 to period 1991–1995 and then increased. With the exception of cohort 1911–1915, no significant cohort effects were found. Conclusion Despite the limitations of official published mortality data, we still found prominent age effects according to APC analysis, which were similar to the results of a previous study. However, the patterns of period and cohort effects in relation to epilepsy mortality in Taiwan differed from those in England and Wales and in the US.

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.

Mortality of Epilepsy from National Vital Statistics and University Epilepsy Clinic in Taiwan

Where population-based studies of epilepsy mortality are impossible to conduct, other sources of data must be considered. We provide descriptive data on mortality and causes of death for epilepsy in Taiwan. Two settings in Taiwan were used. First, we evaluated the mortality ratio for epilepsy, using the national vital statistics for 1996 with the total population of Taiwan as the denominator. Second, we evaluated mortality in a cohort of prevalent epilepsy cases from a University outpatient clinic. For both, proportionate mortality was calculated to determine the relative contributions of different causes of death in epilepsy. One hundred and sixty-two deaths were correctly coded under ICD code 345 from the 1975 detailed diagnostic listing during the 1-year period of 1996. Epilepsy was the diagnosis in 0.8 deaths/100,000 population. Over an 11-year period, there were 54 deaths (0.9%) among 1,224 prevalent epilepsy cases from a University clinic during 5,704 person-years of follow-up. The most common underlying cause of death was epilepsy-related death in 129 (79.6%) out of 162 deaths from the vital statistics data. There were 13 deaths unrelated to epilepsy (8.0%). Acute reactive seizure as the cause of death was found in 9 patients (5.6%). The leading cause of death in the epilepsy clinic was disease unrelated to epilepsy in 21 deaths (38.9%), epilepsy-related death in 12 patients (22.2%), and death related to the cause of epilepsy in 9 patients (16.7%). Data derived from vital statistics are inadequate to evaluate mortality in people with epilepsy.

Mortality in adult patients with epilepsy in Taiwan

To investigate mortality in adult patients with epilepsy in Taiwan, a total of 263 patients with epilepsy aged ≥ 17 years, referred to the outpatient epilepsy clinic between 1 Jan and 31 December 1991, were prospectively enrolled and followed up until 31 December 2000. A total of 32 deaths were reported. Overall case‐fatality rate was 12.2%. The age‐adjusted standard mortality ratio (SMR) was calculated to compare the risk of death in patients with epilepsy to the general population. Patients with epilepsy had a 3.5‐fold higher risk of death as compared with the general population (SMR: 3.47, 95% CI: 2.46‐4.91). The Cox proportional hazards regression model was used to assess relevant clinical contributions to death. Patients with an age‐at‐onset ≥ 40 years had a 4‐fold higher risk of death as compared with those with an earlier onset. The multivariate analysis revealed that age‐at‐onset between 40 and 59 years, tumor etiology, and being male increased the risk of death in epilepsy. One‐third of the deaths in patients with age‐at‐onset between 40‐59 years died of liver cirrhosis and hepatoma. Hepatitis B virus infection is endemic in Taiwan, and this is closely associated with liver cirrhosis and hepatoma. Whether anticonvulsants contributed to the hepatotoxicity that led to fatal liver disease in this group needs further investigation.

Boundary ambiguity, coping patterns and depression in mothers caring for children with epilepsy in Taiwan

A descriptive correlational study was designed to examine the relationships between boundary ambiguity, coping strategies and depression in mothers caring for children with epilepsy. A total of 316 mothers were recruited from three medical centers in Taiwan. A pilot study established the reliability and validity of the Chinese language version of the Coping Health Inventory for Parents (CHIP). Results showed that boundary ambiguity was negatively associated with the total score by CHIP for family coping patterns I and II. In addition, family coping patterns I, II, and III were negatively associated with depression in the mothers. These results provide insight into family stress management strategies that are unique to these mothers and are associated with the relationships between boundary ambiguity, family coping patterns and outcome. The results also suggest methods to improve family centered nursing intervention, which may help mothers to establish effective interactions with their epileptic children as well as develop for them effective coping patterns to manage family stress.