Incidence Of First Seizure Research Articles

Association between social deprivation and incidence of first seizures and epilepsy: A prospective population-based cohort.

ObjectiveEpidemiologic studies have investigated whether social deprivation is associated with a higher incidence of epilepsy, and results are conflicting, especially in children. The mechanisms underlying a potential association are unclear. This study examines whether there is an association between social deprivation and the incidence of first seizures (unprovoked and provoked) and new diagnosis of epilepsy by comparing incidence across an area‐level measure of deprivation in a population‐based cohort.MethodsMultiple methods of case identification followed by individual case validation and classification were carried out in a defined geographical area (population 542 868) to identify all incident cases of first provoked and first unprovoked seizures and new diagnosis of epilepsy presenting during the calendar year 2017. An area‐level relative deprivation index, based on 10 indicators from census data, was assigned to each patient according to registered address and categorized into quintiles from most to least deprived.ResultsThe annual incidence of first unprovoked seizures (n = 372), first provoked seizures (n = 189), and new diagnosis of epilepsy (n = 336) was highest in the most deprived areas compared to the least deprived areas (incidence ratios of 1.79 [95% confidence interval (CI) = 1.26–2.52], 1.55 [95% CI = 1.04–2.32], and 1.83 [95% CI = 1.28–2.62], respectively). This finding was evident in both adults and children and in those with structural and unknown etiologies of epilepsy.SignificanceThe incidence of first seizures and new diagnosis of epilepsy is associated with more social deprivation. The reason for this higher incidence is likely multifactorial.

Incidence of first seizures, epilepsy, and seizure mimics in a geographically defined area.

To determine the incidence of first seizures, epilepsy, and seizure mimics in a geographically defined area using the updated 2014 International League Against Epilepsy (ILAE) definition, which allows an epilepsy diagnosis after a single seizure when the risk of further seizures over the next 10 years is ≈60% or greater. This replaced the 1993 definition by which epilepsy was diagnosed when a person had ≥2 seizures separated by 24 hours. Using multiple overlapping methods of case ascertainment followed by individual case classification by an epileptologist, we identified all first seizures, new diagnosis of epilepsy, and seizure mimics occurring in a defined geographic area (population 542,868) from January 1, 2017, to December 31, 2017. Incidence was age standardized to the Standard European Population. We compared incidence rates using the 2014 and 1993 ILAE definitions. When the 2014 ILAE definition of epilepsy was applied, the incidence of new diagnosis of epilepsy was 62 per 100,000 (age standardized 74) compared to 41 per 100,000 (age standardized 48) when the 1993 definition was applied, and the difference was more pronounced at older ages. The incidence of all first seizures and of seizure mimics was 102 per 100,000 (age standardized 123) and 94 per 100,000 (age standardized 111), respectively. The most frequently encountered seizure mimic was syncope. Application of the 2014 ILAE definition of epilepsy resulted in a higher incidence of new diagnosis of epilepsy compared to the 1993 definition. The incidence of seizure mimics almost equals that of all first seizures. Seizures, epilepsy, and seizure mimics represent a significant burden to health care systems.

Assocation Between Social Deprivation and the Incidence of First Seizures, New Diagnosis of Epilepsy and Seizure Mimics (2401)

Assocation Between Social Deprivation and the Incidence of First Seizures, New Diagnosis of Epilepsy and Seizure Mimics (2401)

Application of Recent International Epidemiological Guidelines to a Prospective Study of the Incidence of First Seizures, Newly-Diagnosed Epilepsy and Seizure Mimics in a Defined Geographic Region in Ireland

Studies adherent to international guidelines and epilepsy classification are needed to accurately record the incidence of isolated seizures, epilepsy and seizure-mimics within a population. Because the diagnosis of epilepsy is largely made through clinical assessment by experienced physicians, seizures and epilepsy are susceptible to misdiagnosis. Previous epidemiological studies in epilepsy have not captured “seizure mimics”. We therefore sought to quantify the incidence of isolated seizures, epilepsy and seizure-mimics using the International League Against Epilepsy (ILAE) classification system. In this study multiple overlapping methods of case ascertainment were applied to a defined geographic region from January 1 to March 31, 2017 to identify all patients presenting with first seizures (provoked and unprovoked), new diagnoses of epilepsy and seizure mimics. Over a 3 month period, from a population of 542,869 adults and children, 442 potential presentations were identified, and 283 met the inclusion criteria. Radiology databases were the source of the largest number of individual cases (n = 153, 54%), while electroencephalogram (EEG) databases were the source of the highest number of unique-to-source cases (those not identified elsewhere, n = 60, 21%). No single case was picked up in every method of ascertainment. Among the 283 included presentations, 38 (13%) were classed as first provoked seizures, 27 (10%) as first unprovoked seizures, 95 (34%) as new diagnosis of epilepsy and 113 (40%) as seizure mimics. Ten (3%) presentations were indeterminate. We present and apply a rigorous study protocol for investigation of the incidence of first seizures, new diagnosis of epilepsy and seizure mimics in a geographically defined region which is adherent to recently published international guidelines for epidemiologic studies and epilepsy classification. We highlight the challenges in making a diagnosis of new-onset epilepsy in patients presenting with a first seizure using the current ILAE definition of epilepsy, when epilepsy can be diagnosed in situations where the treating physician anticipates the risk of further seizures exceeds 60%.

S179. The incidence of first seizures, new diagnosis of epilepsy and seizure mimics in county cork, Ireland; an Epidemiologic protocol and interim report

Introduction Incidence studies provide valuable information on etiology and natural history of epilepsy wihtin a population. The International League Against Epilepsy (ILAE) has proposed standards for epidemiological studies to ensure rigorous methodology and accurate collection of data ( Thurman et al., 2011 ). The incidence of epilepsy has not been investigated in Ireland. We are currently investigating the incidence of first seizures, new diagnosis of epilepsy and seizure mimics in Cork city and county (population estimate 550,000) over the calendar year 2017 incorporating ILAE guidelines and seizure/epilepsy classifications ( Fisher et al., 2017 , Scheffer et al., 2017 ). Methods We applied multiple overlapping methods of case ascertainment to our study population from January 1st 2017 to identify all patients presenting with suspected first seizure or new diagnosis of epilepsy. Neonatal seizures and febrile seizures are excluded. Case ascertainment methods include daily review of emergency department (ED) triage, radiology, EEG databases, neurology outpatient/inpatient departments, neurosurgical ward, geriatrics wards, oncology wards, paediatric services and community surveillance through survey of general practice and residential care facilities. Results Two hundred and sixty-three cases met our inclusion criteria for the first three months of data collection (Jan-Mar 2017). EEG database review yielded the greatest number of novel cases (n = 60). 26% (n = 69) of cases met criteria for definite new diagnosis of epilepsy. Only 25 % (n = 16) of these had epileptiform abnormalities on routine EEG. The majority of cases were classified as focal epilepsy (75%, n = 52) followed by generalized epilepsy (16%, n = 11) and unknown epilepsy type (9%, n = 6). 40% (n = 114) of identified cases were classified as seizure mimics. Conclusion We present a rigorous study protocol, which is adherent to ILAE recommendations, for the investigation of the incidence of first seizures, new diagnosis of epilepsy and seizure mimics in our study population and present interim results for the first three months of data collection with an emphasis on neurophysiological findings. Results demonstrate a greater proportion of focal epilepsy syndromes than previously reported, which may be in part due to application of the updated ILAE epilepsy classification system.

The Incidence of First Seizures, New Diagnosis of Epilepsy and Seizure Mimics in County Cork, Ireland; An Epidemiologic Protocol (P1.126)

The Incidence of First Seizures, New Diagnosis of Epilepsy and Seizure Mimics in County Cork, Ireland; An Epidemiologic Protocol (P1.126)

Antidepressants and seizures: emphasis on newer agents and clinical implications

Seizures are a known, relatively rare, consequence of antidepressant treatment. Risk estimates vary depending on the study, source of data and patient population, predisposed vs. nonpredisposed. For newer antidepressants (e.g. selective serotonin reuptake inhibitors, bupropion, mirtazepine, etc.), the risk is generally considered to be low (0.0%-0.4%) and not very different from the incidence of first seizure in the general population (0.07%-0.09%). Risk with tricyclic antidepressants at effective therapeutic doses is relatively high (0.4% to 1-2%). Seizure following overdose is a significant and relatively frequent event for some antidepressants. Patients being considered for antidepressant treatment should be screened for predisposition to seizures. Predisposed patients should receive antidepressants cautiously. The seizure potential of antidepressants in patients without a predisposition is low, especially for newer antidepressants. Seizure risk, along with other drug-related considerations, e.g. weight gain, sexual dysfunction and sedation, should be considered when prescribing an antidepressant.

Prospective study of seizures in the elderly in the Marshfield Epidemiologic Study Area (MESA).

To assess the incidence, etiology, antiepileptic drug (AED) use, and quality of life in patients having their first seizure at age 50 years or older. All patients in the Marshfield Epidemiologic Study Area (MESA) aged 50 years or older having their first seizure between July 1, 1996, and June 30, 1998, were identified through the diagnostic coding system. Patients were followed up for 12 months for recurrent seizures. Etiologies, drug treatments, magnetic resonance imaging (MRI), computed tomography (CT), or EEG results and medication adverse effects were recorded. Those patients who reached 1-year follow-up received a quality of life (QOLIE-31) survey. Forty-eight patients having a first seizure were identified (162 of 100,000). Twelve patients had had recurrent seizures, and 36 had a single seizure at the time of study entry. Fourteen of these 36 had had an abnormal MRI, CT, or EEG. The remaining 22 had a single seizure and normal imaging and EEG. Six of these had one or more subsequent seizures, and all six were in the group with normal tests. Etiologies included vascular, neoplasm, trauma, dementia, metabolic, and unknown. Seventy-five percent of the patients achieved seizure control with phenytoin, carbamazepine, and/or valproate. Twenty-seven percent experienced adverse side effects. None had been given second-generation AEDs as an initial treatment. Thirty-one patients received the QOLIE-31 survey; 20 did not complete the survey for various reasons. The mean QOLIE-31 scores for those completing the survey were significantly higher than those of the reference cohort. The incidence of first seizure in MESA is high in the elderly and increases with advancing age. As in other studies, vascular causes accounted for the largest etiology. Use of new AEDs was uncommon. There was a high incidence of untoward side effects related to the traditional AEDs. High morbidity and mortality unrelated to seizures limits follow-up analysis in the elderly. Quality-of-life analysis via QOLIE questionnaires is problematic in this population.

First seizures associated with playing electronic screen games: A community‐based study in Great Britain

Active surveillance by virtually all electroencephalographic departments throughout Great Britain identified 118 patients who had a first seizure while playing an electronic screen game during two 3-month periods. Patients were divided into Group A (46 patients)--those for whom there was thought to be a definite causal relationship (type 4 photoparoxysmal response); Group B (25 patients)--those for whom there was a probable causal relationship (types 1-3 photoparoxysmal response, clinical evidence of photosensitivity, subsequent recurrent seizures on repeat exposure to electronic screen games, and/or occipital spikes in the resting electroencephalogram); and Group C (47 patients)--those for whom there was no apparent causal relationship. The number of patients in Group C did not exceed that expected by the chance occurrence of two common events (playing electronic screen games and incidence of epilepsy). Most (103/118) of the patients were in the age range of 7 to 19 years. Within this age group the annual incidence of first seizures triggered by playing electronic screen games (Groups A and B combined) was estimated to be 1.5/100,000.