Incidence Of Unprovoked Seizures Research Articles

Predictors of unprovoked seizures in intracerebral hemorrhages.

Seizures are a common complication of intracerebral hemorrhage (ICH). We aimed to identify predictors of unprovoked seizures (US) after ICH in a Chinese cohort. We retrospectively included patients with ICH admitted in the Second Hospital of Hebei Medical University between November 2018 and December 2020. Incidence and risk factors of US were identified with univariate and then multiple Cox regression analysis. We used χ2 test to compare incidence of US between groups with or without prophylactic anti-seizure medications (ASM) in patients with craniotomy. A total of 488 patients were included in the cohort, 58 (11.9%) patients developed US within 3years after ICH. Analysis on the 362 patients without prophylactic ASM showed that craniotomy (HR 8.35, 95% CI 3.80-18.31) and acute symptomatic seizures (ASS) (HR 13.76, 95% CI 3.56-53.17) are independent predictors of US. No significant effect of prophylactic ASM use was found on incidence of US in ICH patients with craniotomy (P = 0.369). Craniotomy and acute symptomatic seizures were independent predictors for unprovoked seizures after ICH, suggesting that more attention should be paid for such patients during follow-up. Whether prophylactic ASM treatment benefits ICH patients underwent craniotomy remains uncertain.

Association of Late-Onset Unprovoked Seizures of Unknown Etiology With the Risk of Developing Dementia in Older Veterans

The incidence of unprovoked seizures and epilepsy increases considerably in late life, with approximately one-third of seizures being of unknown etiology. While individuals with dementia have a high risk of developing unprovoked seizures, it is unknown whether older adults with late-onset unprovoked seizures of unknown etiology (LOSU) are at risk of developing dementia. To determine whether incident LOSU is associated with a higher risk of dementia among older US veterans. This retrospective multicenter cohort study was conducted using data from US Veterans Health Administration medical centers from October 2001 to September 2015. Data were generated from all veteran inpatient and outpatient encounters that occurred within Veterans Health Administration facilities. A random sample of 941 524 veterans 55 years and older was generated. A total of 649 262 veterans previously diagnosed (using International Classification of Diseases, Ninth Revision, Clinical Modification codes) with dementia, unprovoked seizures, epilepsy, and conditions that could lead to seizures (brain tumors, trauma, infections, stroke, and neurotoxin exposure) as well as veterans without follow-up data were excluded. Data were analyzed from October 2018 to July 2019. Late-onset unprovoked seizures of unknown etiology were defined as a new diagnosis of epilepsy or unprovoked seizures without a diagnosis of a secondary cause for seizures. Incident LOSU was assessed during a 5-year baseline period. Veterans were assessed for incident dementia diagnosis during an outcome period. Fine-Gray proportional hazards models were used to determine whether LOSU was associated with greater risk of incident dementia. Models were adjusted for demographic variables, cardiovascular risk factors, depression, and traumatic brain injury. Of the 292 262 included veterans, 282 628 (96.7%) were male, and the mean (SD) age was 73.0 [8.8] years. During the baseline period, 2166 veterans developed LOSU. The mean (SD) follow-up after LOSU was 6.1 (2.9) years. After multivariable adjustment, veterans with LOSU had greater risk of dementia compared with veterans without seizures (hazard ratio, 1.89; 95% CI, 1.62-2.20). A sensitivity analysis imposing a 2-year lag between incident LOSU and dementia diagnosis led to similar results. These findings suggest LOSU in older veterans is associated with a 2-fold risk of developing dementia. While seizures are commonly thought to occur in late stages of dementia, these findings suggest unexplained seizures in older adults may be a first sign of neurodegenerative disease.

Incidence of dementia in patients with adult-onset epilepsy of unknown causes

Epilepsy is generally considered to occur most commonly in childhood; however, several epidemiological studies confirmed that its occurrence increases from middle age [ [1] Hauser W.A. Seizure disorders: the changes with age. Epilepsia. 1992; 33: S6-S14 Crossref PubMed Scopus (344) Google Scholar , [2] Olafsson E. Ludvigsson P. Gudmundsson G. Hesdorffer D. Kjartansson O. Hauser W.A. Incidence of unprovoked seizures and epilepsy in Iceland and assessment of the epilepsy syndrome classification: a prospective study. Lancet Neurol. 2005; 4: 627-634 Abstract Full Text Full Text PDF PubMed Scopus (271) Google Scholar ], and is the third most common neurological disease affecting the elderly, following dementia and cerebrovascular disease (CVD) [ [3] Brodie M.J. Kwan P. Epilepsy in elderly people. BMJ. 2005; 331: 1317-1322 Crossref PubMed Scopus (141) Google Scholar , [4] Werhahn K.J. Epilepsy in the elderly. Dtsch Arztebl Int. 2009; 106: 135-142 PubMed Google Scholar ]. These diseases interact with each other in later life. The leading etiology of elderly-onset epilepsy is CVD [ [5] Hauser W.A. Rowan A.J. Ramsay R.E. Epidemiology of Seizures and Epilepsy in the Elderly. Butterworth-Heinemann, Boston1997: 7-18 Google Scholar , [6] Wallace H. Shorvon S. Tallis R. Age-specific incidence and prevalence rates of treated epilepsy in an unselected population of 2,052,922, and age-specific fertility rates of women with epilepsy. Lancet. 1998; 352: 1970-1973 Abstract Full Text Full Text PDF PubMed Scopus (322) Google Scholar ], and CVD is a major risk factor for dementia with neurodegenerative disease, especially Alzheimer's disease (AD) [ [7] Petrovitch H. Ross G.W. Steinhorn S.C. Abott R.D. Markesbery W. Davis D. et al. AD lesions and infarcts in demented and non-demented Japanese-American men. Ann. Neurol. 2005; 57: 98-103 Crossref PubMed Scopus (202) Google Scholar , [8] J. Obrien R. Vascular dementia: atherosclerosis, cognition and Alzheimer's disease. Curr. Alzheimer Res. 2011; 8: 341-344 Crossref PubMed Scopus (13) Google Scholar ]. Adult-onset epilepsy is considered as a consequence of structural damage of the central nervous system (CNS), and the existence of AD, a typical neurodegenerative disease, also increases the occurrence of epilepsy [ [9] Scarmeas N. Honig L.S. Choi H. Cantero J. Brandt J. Blacker D. et al. Seizures in Alzheimer disease: who, when, and how common?. Arch. Neurol. 2009; 66: 992-997 Crossref PubMed Scopus (221) Google Scholar ]. This clinical finding is supported by several basic studies using a transgenic mouse model of AD, which demonstrated that deposited amyloid-β (Aβ) causes epileptiform discharges in the cortex, nonconvulsive seizures, and cognitive dysfunction [ [10] Palop J.J. Chin J. Roberson E.D. Wang J. Thwin M.T. Bien-Ly N. et al. Compensatory remodering of inhibitory hippocampal circuits in mouse models in Alzheimer's disease. Neuron. 2007; 55: 697-711 Abstract Full Text Full Text PDF PubMed Scopus (1121) Google Scholar , [11] Huang Y. Mucke L. Alzheimer mechanisms and therapeutic strategies. Cell. 2012; 148: 1204-1222 Abstract Full Text Full Text PDF PubMed Scopus (1358) Google Scholar ]. Taking into account the evidence that Aβ deposition starts >10 years before clinical signs of AD appear [ [12] Villemagne V.L. Burnham S. Bourgeat P. Amyloid β deposition, neurodegeneration, and cognitive decline in sporadic Alzheimer's disease: a prospective cohort study. Lancet Neurol. 2013; 12: 357-367 Abstract Full Text Full Text PDF PubMed Scopus (1410) Google Scholar ], epilepsy may develop earlier than AD. To test this hypothesis, we retrospectively studied the occurrence of AD in patients with adult-onset epilepsy of unknown causes to elucidate whether these patients are more likely to develop AD than control patients. Moreover, to determine whether an atherosclerotic factor affects the occurrence of AD, we also investigated the occurrence of CVD in both groups.

Role of neuroimaging in children with first unprovoked seizure: A prospective observational study

Objective: Seizure is a common neurologic problem that occurs in 3–5% of children. Seizure may be provoked caused by a brain insult, metabolic or toxic disturbance of brain function or unprovoked. Based on several studies, the prevalence of abnormal neuroimaging in pediatric patients with a new onset afebrile seizure is estimated to be 0 % to 21%. As pointed out by previous reports aetiology and incidence of unprovoked seizures is expected to be different in developing countries like India with a high incidence of infective causes. So, this study was done to find out the proportion of cases with neuroimaging abnormality and the etiology of first unprovoked seizure in children in an Indian setup. Methods: This prospective observational study was conducted at a tertiary care teaching hospital of Northern India. Total 115 cases of 6 months to 14 years of age were enrolled over one year from September 2015 to August 2016 after obtaining written informed consent. Data collection was done on a predesigned case record form. Every enrolled child was subjected to neuroimaging either CT scan head or brain MRI. Results: Out of 115 cases 40(34.8%) had abnormal neuroimaging of which 28(70%) had inflammatory granuloma. Inflammatory granulomas all except one were due to active/calcified focus of neurocysticercosis. Proportion of children having inflammatory granuloma was significantly high in children above 2 years of age in comparison to children below 2 years of age (p=0.003) and in children with focal seizure in comparison to children with generalised tonic clonic seizure(p=0.024). Conclusion: Prevalence of neuroimaging abnormality in children presenting with first unprovoked seizure is high in India due to high prevalence of neurocysticercosis and tuberculosis. So, neuroimaging should be considered in all children with first unprovoked seizure.

Incidence of unprovoked seizures, epilepsies, and epilepsy syndromes in a cohort of children accessing government primary schools and organization of seizures and epilepsies using ILAE 2010 system: A study in south India (P2.247)

Incidence of unprovoked seizures, epilepsies, and epilepsy syndromes in a cohort of children accessing government primary schools and organization of seizures and epilepsies using ILAE 2010 system: A study in south India (P2.247)

The incidence of unprovoked seizures and occurrence of neurodevelopmental comorbidities in children at the time of their first epileptic seizure and during the subsequent six months

To evaluate the incidence of unprovoked seizures in children and the prevalence of related neurodevelopmental comorbidities at the time of the presumed first seizure and six months thereafter. The medical records of all children (0-18 years of age) seeking medical attention as the result of a first unprovoked seizure between September 1, 2001 and December 31, 2006, and registered in the population-based Stockholm Incidence Registry of Epilepsy (SIRE) were reviewed. Neurodevelopmental comorbidities were evaluated on the basis of the medical records from this first visit and from other healthcare during the following six months. The incidence of unprovoked seizures was between 30 and 204/100,000 person years (n=766) in the different age groups. It was highest among the youngest children and lowest among the 18-year-olds with small gender differences. The most common neurodevelopment comorbidities were developmental delay (22%, CI: 19-25%), speech/language and learning difficulties (23%, CI: 20-26%) and intellectual disability (16%, CI: 13-18%). The types of neurodevelopmental comorbidity varied by age at the time of seizure onset, with cerebral palsy being more common among the 0-5-year-olds, attention deficits among the 6-16-year-olds, and autism and psychiatric diagnosis among the older children. An associated neurodevelopmental comorbidity was more common among those experiencing recurrent than single seizures during follow-up six months from the index seizure (42% versus 66%). In 68% (CI: 64-71%) of the children there was no known or suspected neurodevelopmental comorbidity. The incidence of unprovoked, non-febrile seizures among 0-18-year-olds included in the SIRE was 67/100,000 person-years. Neurodevelopmental comorbidities were common already at the time of onset of the seizure disorder, indicating that neither seizure treatment nor seizures were the underlying cause of other neurodevelopmental symptoms in these patients during the period studied.

AN EPIDEMIOLOGIC STUDY OF 389 CHILDREN WITH EPILEPSY IN SOUTHERN IRAN

AN EPIDEMIOLOGIC STUDY OF 389 CHILDREN WITH EPILEPSY IN SOUTHERN IRAN

Accuracy of family history information on epilepsy and other seizure disorders

In epilepsy as in other disorders, family history information is often obtained by asking patients about the medical histories of their relatives rather than interviewing or examining the relatives directly. The accuracy of this type of information for epilepsy and other seizure disorders is unclear. This study used data from the Genetic Epidemiology of Seizure Disorders in Rochester study, a population-based investigation including all Rochester, MN, residents born ≥1920 with incidence of unprovoked seizures from 1935 to 1994 (case probands) and control probands matched by age, gender, and prior Rochester residency period. Seizure disorders in the first-degree relatives of case and control probands were ascertained by reviewing the relatives' medical records. Case and control probands were interviewed about seizures in their first-degree relatives using a validated 9-question screening interview. Interviewers were blinded to case-control status. Sensitivity of the family history (i.e., proportion of relatives with medical record-documented seizures who screened positive in the proband interview) was 62% (32/52) for epilepsy, 50% (7/14) for isolated unprovoked seizures, and 56% (9/16) for febrile seizures. Sensitivity did not differ by case/control status of the proband. Sensitivity was much higher for probands reporting on their offspring or siblings than their parents. Among relatives with epilepsy, 90% of offspring and 80% of siblings but only 32% of parents screened positive. Family histories of epilepsy are reasonably accurate for siblings and offspring, but are underreported in parents. Family histories of other seizure disorders are underreported.

Incidence of unprovoked seizures and epilepsy in Iceland and assessment of the epilepsy syndrome classification: a prospective study

No population-based incidence studies of epilepsy have studied syndrome classification from the outset. We prospectively studied the incidence of a single unprovoked seizure and epilepsy in the population of Iceland, and applied the syndrome classification endorsed by the International League Against Epilepsy to this population. We used a nationwide surveillance system to prospectively identify all residents of Iceland who presented with a first diagnosis of a single unprovoked seizure or epilepsy between December 1995 and February 1999. All cases were classified by seizure type, cause or risk factors, and epilepsy syndrome. The mean annual incidence of first unprovoked seizures was 56.8 per 100,000 person-years, 23.5 per 100,000 person-years for single unprovoked seizures, and 33.3 per 100,000 person-years for epilepsy (recurrent unprovoked seizures). Incidence was similar in males and females. Partial seizures occurred in 40% and a putative cause was identified in 33%. Age-specific incidence was highest in the first year of life (130 per 100,000 person-years) and in those 65 years and older (110.5 per 100,000 person-years). Using strict diagnostic criteria for epilepsy syndromes, 58% of cases fell into non-informative categories. Idiopathic epilepsy syndromes were identified in 14% of all cases. Findings are consistent with incidence studies from developed countries. Although the epilepsy syndrome classification might be useful in tertiary epilepsy centers, it has limited practicality in population studies and for use by general neurologists.

Incidence of epilepsy and predictive factors of epileptic and non-epileptic seizures

To estimate the incidence of unprovoked seizures (US) and epilepsy in a general population from the southern part of the Netherlands, in relation to age, sex, etiology and seizure type, and to identify predictive factors of the epileptic and non-epileptic seizures. All patients aged > or =14 years with a first seizure or who had undiagnosed seizures before the study period were included. Patients were identified from different sources and were independently evaluated and classified by a team of neurologists. A predictive profile for the occurrence of epileptic and non-epileptic seizures was obtained by stepwise logistic regression analysis. The overall annual incidence was 55/100,000 and 30/100,000 for US and epilepsy, respectively. The age-specific annual incidence of US and epilepsy increased with age and reached 120/100,000 and 62/100,000 for the > or =65 years of age group, respectively. The incidence of epilepsy and US in males was higher than in females and partial seizures prevailed over generalized seizures (40 versus 9/100,000). In up to 35% of the cases with US or epilepsy, the etiology was mainly cerebrovascular disease and brain tumors. Predictors for epileptic versus non-epileptic seizures of organic origin were an epileptiform EEG pattern (OR=0.06) versus a history of hypertension (OR=2.8) or cardiovascular disease (OR=5.4). Strong predictors for seizures of non-organic origin were female sex (OR=2.2) and head injury (OR=2.4). The incidence of US and epilepsy (overall, and age-, sex-, seizure-specific) was similar to those reported by other developed countries. The predictive factors found in this study may assist in the early diagnosis of seizures.