山东省癫流行病学调查研究

目的了解中国山东省的癫病流行现况及其危险因素。方法以调查问卷为基础,运用国际统一癫诊断标准,采用多级分层随机整群抽样方法,逐户进行调查。结果调查人数251 492名,癫患者335例,癫患病率为1.33‰;男性患病率为1.35‰,女性患病率为1.31‰;城市患病率为1.20‰,农村患病率为1.39‰,均差异无统计学意义。癫发病率为18.69/10万。发作类型以全面性发作为主为60.90%;部分性发作为34.33%;发作不能分类为4.78%。首次发病平均年龄为(15.37±15.77)岁。特发性癫为60.90%,症状性癫为39.10%。大部分患者未进行正规治疗,治疗缺口为54.33%。结论山东省癫患病率、发病率处于全国较低水平,治疗缺口与国内文献报道一致。癫发作类型以全面性发作为主;癫发病以特发性癫为主,症状性癫病因中以脑炎为主。     

上海农村地区癫痫流行病学抽样调查

目的了解上海农村地区癫癎患病率和治疗缺口,为开展癫癎治疗和管理工作提供依据.方法以二阶段整群抽样法抽取金山区吕巷镇的5个村作为调查点,实际调查10 777人.癫癎病例经初筛及神经科医生复查后确诊.结果确诊癫癎为65例,终生患病率6.03‰(95%CI5.58‰～6.48‰).活动性癫癎为41例,患病率为3.80‰(95%CI2.64‰～4.96‰).活动性癫癎的治疗缺口为70.73%(95%CI56.80%～84.66%).癫癎患者平均年龄为(44.66±18.73)岁,首次发病的平均年龄为(26.28±18.71)岁,首发年龄在30岁之前的患者占61.54%.癫癎的发作类型以全身强直-阵挛性发作为主,占58.46%.结论农村地区癫癎患病率高于以往的调查结果,应重视对农村儿童和青年期癫癎的治疗和管理.     

扬州市头桥农村地区的癫癎流行病学调查

目的了解扬州市头桥农村地区的癫癎流行病学特征及状况.方法采用随机整群抽样方法,对扬州市头桥农村地区8个自然村人群进行入户见面表格癫癎普查.结果实际被调查的11 118人中,共查出各类型癫癎患者87例,患病率为7.83‰,年发病率为53.4/10万.76例(85.05%)未发现明确病因,仅3例(3.45%)有家族史.首次发病年龄<20岁者33例(37.93%);≥20岁者54例(62.07%);平均病程17.51年;发作类型以全面强直阵挛性发作为主(78.16%),年发作次数在10～29次;87例患者中从未进行抗癫癎治疗50例(57.47%).结论该地区癫癎患病率、发病率均高于国内其他农村地区;发作类型仍以全面强直阵挛性发作为主.癫癎治疗管理水平较低.     

西藏农村地区惊厥性癫(癎)患病率初步调查

目的 初步调查西藏农村地区惊厥性癫(癎)患病率、治疗缺口及患者生活质量.方法 利用统一的调查表,对西藏拉萨市墨竹工卡县工卡镇和扎西岗乡、昌都地区芒康县曲孜卡乡进行整群逐户问卷调查.结果 共调查14 822人,确诊惊厥性癫(癎)患者37例,患病率0.25%,其中活动性癫(癎)患者35例(94.59%),患病率为0.24%.调查前1周内接受西药正规治疗者1例,治疗缺口为97.1%.癫(癎)患者生活质量评定量表-31(QOLIE-31)总评分平均为(42.15±17.63)分,其中各分项得分中发作担忧得分最低[(22.59±20.31)分]、药物影响的评分最高[(85.83±18.59)分].年龄、职业、文化程度、经济状况、起病年龄、发作次数为QOLIE-31低评分的影响因素(P＜0.05).结论 西藏农村地区惊厥性癫(癎)患病率为0.25%,西药治疗缺口大,主要以藏医藏药治疗为主,对西药治疗癫(癎)的了解很少,生活质量评分低.探索藏西医结合防治癫(癎)、提高当地医护人员的癫(癎)防治知识及公众的健康意识迫在眉睫.     

急性脑血管病并发癫（癎）的临床研究

目的 研究急性脑血管病并发癫（癎）的发病机制、疾病特征、治疗与预后.方法 选取2008-01-2011-12我院862例急性脑血管病患者,其中并发癫（癎）患者73例,给予正规原发疾病的治疗以及相应抗癫（癎）治疗,比较分析急性脑血管病并发癫（癎）的发病率、发作类型、发作时间、病死率等.结果 急性脑血管病并发癫（癎）的发病率为8.47%,其中脑梗死占8.03%（37/461）,脑出血占9.87 %（22/223）,蛛网膜下腔出血占9.86%（14/142）;单纯部分性发作病例比例最高（P〈0.05）;急性脑血管病并发癫（癎）患者中早期发作型癫（癎）比例较高;脑出血和蛛网膜下腔出血的患者更易并发早期发作型癫（癎）（P〈0.05）,而脑梗死的患者更容易并发迟发型癫（癎）（P〈0.05）;急性脑血管病并发癫（癎）患者总病死率为36.99%,明显高于未并发癫（癎）患者（P〈0.05）.结论 急性脑血管病并发癫（癎）的发病率为8.47%,以早期发作型癫（癎）比例较高,且病死率较高.     

我国五省农村地区开展人群干预后癫(癎)治疗缺口的变化

目的 检验我国农村地区开展人群干预管理后癫癎治疗缺口的变化，为进一步推广癫癎社区控制经验提供依据。方法 2004年WHO合作项目结束后6个月，在开展项目的5个省农村示范地区，采用与基线调查完全相同的方法和标准随机抽样调查该地区癫癎流行病学状况，并对两次调查结果进行比较，以了解示范区干预前后癫癎患者的治疗情况以及治疗缺口的改变。结果 本次抽样调查5个农村人群共确诊癫癎患者320例，患病率为0．62％。其中活动性癫癎的患病率为0．45％。而基线调查时癫癎患病率和活动性癫癎的患病率分别为0．70％和0．46％。采用正规治疗的癫癎患者由2000年调查时的24．8％上升至39．1％。活动性癫癎的治疗缺口由基线调查时的62．6％下降为49．8％。结论 农村地区的癫癎患者经过WHO示范项目的干预和管理，接受正规或合理治疗的比例明显提高；活动性癫癎的治疗缺口显著下降。从而证明本方案采用的干预对策适用于我国农村地区，并有很好的推广价值。     

睡眠剥夺对癫(癎)发作的影响机制

睡眠剥夺可以改变大脑皮质的兴奋性,造成皮质兴奋和抑制失衡现象.对于几乎所有类型的癫癎,睡眠剥夺是一种强有力的癎性发作激活剂,可有效地激活全面性和部分性发作间期放电,特别是对特发性全面性癫癎[1].现从神经递质和神经肤机制探讨睡眠剥夺对癫癎发作的影响机制.     

全面性强直-阵挛发作间期脑血流量改变的磁共振动脉自旋标记研究

目的应用MRI脉冲式动脉自旋标记（PASL）技术,研究全面性强直．阵挛发作患者发作间期局部脑血流量改变,阐述全面性强直一阵挛发作可能的神经病理生理学机制。方法选择29例诊断明确、病程〉1年且发作〉3次的全面性强直一阵挛发作患者作为研究对象,以年龄、性别、利手性相匹配并例数相当的正常健康志愿者作为对照。通过siemens3．0TMRI扫描仪采集全脑PASL数据,通过两独立样本t检验比较全面性强直．阵挛发作患者发作间期相对正常人脑血流量改变的脑区。结果与对照组相比,全面性强直一阵孪发作患者发作间期脑血流量的改变以降低为主（P〈0．05）,主要包括双侧丘脑、脑干和小脑,以及右侧楔前叶部分皮质区域;而且发作间期双侧丘脑局部脑血流量改变与发作时间（r=-0．090,P=0．643）及发作频率（r=-0．115,P=0．551）无明显相关关系。结论全面性强直-阵挛发作患者在发作间期以丘脑、脑干和小脑等脑区血流灌注降低为主,支持特发性全面性癫癎的“中脑癫癎理论”。这些脑区可能与特发性全面性癫癎的病理生理学机制密切相关。     

中药治疗癫癎的研究进展

癫癎是一组由多种病因引起的以脑部神经元过度同步放电所致的发作性、突然性和短暂性脑功能紊乱。流行病学调查显示其发病率5‰～7‰[1],即全国有650万～910万癫癎患者。目前癫癎应用西药治疗能达到80%的有效控制率,但多数抗癫癎药物长期服用存在不良反应,依从性较差,降     

多中心、随机、双盲、安慰剂对照评价普瑞巴林添加治疗部分性癫癎发作的疗效和安全性

目的 评价普瑞巴林添加治疗部分性癫（癎）发作的疗效和安全性.方法采用随机、双盲、安慰剂对照、多中心平行设计添加治疗的方法,确诊为有部分性癫（癎）发作的225例癫（癎）患者,被随机分配入普瑞巴林治疗组（114例）与安慰剂组（111例）.在6周前瞻性基线期后,采用灵活剂量的普瑞巴林（150～600 mg·d-1）添加治疗成人部分性癫（癎）发作.主要疗效指标：部分性癫（癎）发作28 d-反应率.次要疗效指标：部分性癫（癎）发作28d-减少率、临床疗效评价、16周内癫（癎）无发作和发作减少率≥50％的病例比例、第13～16周癫（癎）无发作和发作减少率≥50％的病例比例以及临床疗效总评量表评分;并观察研究药物的安全性与不良反应情况.结果 普瑞巴林组部分性癫（癎）发作28 d-反应率（-40.24±37.88）％,显著高于安慰剂组（-22.84±37.61）％（F=15.063 9,P=0.000 l）.普瑞巴林组和安慰剂组的不良事件发生率分别为60.53％和47.75％,组间无显著差异;但普瑞巴林组的不良反应发生率较安慰剂组高（45.61％ vs 23.42％,P=0.000 7）,主要不良反应有头晕、嗜睡、视物模糊、乏力等.结论 普瑞巴林组的疗效显著优于安慰剂组.普瑞巴林作为部分性癫（痈）发作的添加药物有确定的疗效,安全耐受性较好,具有一定临床应用价值.     

湖南省岳阳市癫痫流行病学调查

目的了解湖南岳阳癫痫患病率及治疗缺口,为开展防治工作提供依据。方法采用多级整群随机抽样方法确定调查人群,运用WHO建议的癫痫流行病学专项调查问卷,采用国际统一的癫痫诊断标准,由经过统一培训的调查员入户调查,调查确诊或可疑为癫痫者均经神经科医师再次访查确诊。结果共调查32059人,确诊癫痫患者143例,癫痫患病率为4.5‰。男性患病率高于女性(P<0.05)。年龄组患病率分布存在20岁年龄组(8.4‰)和60岁年龄组(5.4‰)两个高峰。农村患病率明显高于城市(P<0.05)。继发全面性强直-阵挛发作占大多数(63.4%)。活动性癫痫的治疗缺口93.4%。结论湖南岳阳癫痫患病率农村地区较高、城市较低,患者中约有90%以上没有得到正确的治疗,应尽快制定合理的干预对策。     

Prevalence and clinical characteristics of active epilepsy in southern Han Chinese

PurposeTo investigate the prevalence and clinical characteristics of active epilepsy in southern Han Chinese.MethodA door-to-door survey about epilepsy was conducted in communities identified by random cluster sampling among 20 villages and 3 communities of Yueyang city. A questionnaire for epilepsy based on the World Health Organization screening questionnaire was used. A final diagnosis of epilepsy was made by neurology specialists with the support of head magnetic resonance imaging (MRI), computed tomography (CT), and electroencephalography (EEG) if available. The prevalence, clinical characteristics, and treatment gap were analyzed in patients with active epilepsy within the past year and the past 5 years.ResultsActive epilepsy was identified in 91 patients within the past year and 117 patients within the past 5 years. The one-year prevalence was 2.8‰, and the five-year prevalence was 3.7‰. The prevalence for epilepsy active within the last year and the last five years was significantly higher in rural areas than in urban areas (P < 0.05). Secondary generalized tonic–clonic seizures (53.8%) were the most common seizure type in patients whose epilepsy had been active in the last year. 34.1% of patients were diagnosed with structural or metabolic epilepsy. The most common cause for epilepsy was cerebrovascular disease (32.3%), followed by traumatic brain injury (29.0%). The treatment gap was 93.4%.ConclusionThe prevalence of epilepsy active within the last one and five years was higher in rural areas than in urban areas of Yueyang city. A large treatment gap exists in this area and a rational intervention strategy is needed.     

Comparative Epidemiology of Epilepsy in Pakistan and Turkey: Population-Based Studies Using Identical Protocols

Summary: Purpose: To determine comparative prevalence rates, demographics, phenomenology, seizure classification, presumptive etiology, treatment status, and selected socioan-thropological aspects of epilepsy in Pakistan and Turkey. Methods: A population-based, cross-cultural comparative study of epilepsy was designed with identical protocols to be performed simultaneously in Pakistan and Turkey. The essential feature of the design was an unselected population, with reference to their previous medical contact, and use of standardized International Community-Based Epilepsy Research Group (ICBERG) protocols to assess cross-cultural differences. Results: In all, 24,130 persons in Pakistan and 11,497 persons in Turkey (both urban and rural, of all ages and both sexes) were studied. The crude prevalence rate of epilepsy was 9.98 in 1,000 in Pakistan and 7.0 in 1,000 in Turkey (14.8 in 1,000 in rural and 7.4 in 1,000 in urban areas of Pakistan; 8.8 in 1,000 in rural and 4.5 in 1,000 in urban areas of Turkey). In both countries, epilepsy was twice as prevalent in rural areas than in urban areas. Mean age of onset of epilepsy was 13.3 years in Pakistan and 12.9 years in Turkey. Overall frequency of seizure types was similar in both countries, with no urban/rural differences. The frequency distribution in Pakistan and Turkey, respectively, was as follows: generalized tonic-clonic, 80.5 and 65.4%; simple partial, 5 and 7.4%; complex partial, 5 and 12.3%; generalized absence, 0.8 and 4.9%; tonic and atonic, 5.8 and 3.7% each; and myoclonic, 5.8 and 1.2%. A putative cause for the epilepsy could be attributed in 38.4% of cases in Pakistan and 35.7% of cases in Turkey. Only 3% of patients in Pakistan, but 71% of patients in Turkey, believed that their illness was due to supernatural causes. The treatment status was very poor. In Pakistan, 27.5% of people with epilepsy in urban areas and 1.9% of people with epilepsy in rural areas were receiving antiepileptic drugs (AEDs) at the time of the survey. In, Turkey 30% of patients were receiving AEDs (marginally higher in rural areas). Conclusions: The prevalence of epilepsy is slightly higher in Pakistan than in Turkey; some marginal differences in age and sex distribution, are not statistically significant. The results are comparable to those in Ecuador, where the same epidemiologic protocol was used.     

Classification of epilepsy syndromes and role of genetic factors

In this report the types of epilepsy syndromes seen in children in a tertiary referral center in Beirut, Lebanon were studied and the importance of consanguinity and family history in the occurrence of these syndromes was investigated. Records of 230 pediatric patients evaluated during a 1-year period with the diagnosis of single seizure, febrile seizure, or epilepsy were reviewed. Each patient was classified according to the International League Against Epilepsy classification. The occurrence of consanguinity, of family history of febrile seizures or epilepsy, and of other variables was noted. Thirty-six percent of patients were diagnosed with localization-related epilepsy, 21.7% with generalized epilepsy, 11.7% with undetermined generalized or focal, and 24.3% with special syndromes. Twelve percent of patients were diagnosed with idiopathic, 15.1% with symptomatic, and 30.3% with cryptogenic epilepsies. Consanguinity was more common in patients with symptomatic and cryptogenic epilepsies than in patients with idiopathic epilepsies or with incidental seizures (P < 0.05). Family history of epilepsy was more common in patients with symptomatic, cryptogenic, and idiopathic epilepsies than in patients with incidental seizures (P < 0.05). Family history of febrile seizures but not consanguinity was more common in patients with febrile seizures (P < 0.05). We conclude that genetic factors are important not only in idiopathic epilepsies and febrile seizures but also in cryptogenic and symptomatic epilepsies.     

Prevalence, classification, and severity of epilepsy in children in western Norway

PURPOSE: To determine prevalence of active epilepsy in school children in a defined area and assess the usefulness of International League Against Epilepsy classification of seizures and epileptic syndromes, with special emphasis on frequency, additional handicaps, and therapeutic problems of severe cases. METHODS: The latest International League Against Epilepsy International Classification of Epileptic Seizures (ICES, 1981) and Epilepsies and Epileptic Syndromes (ICE, 1989) were used for determination of prevalence rates, seizure types, epilepsies and epileptic syndromes, and additional neurological deficits in all 6-to 12-year-old children with epilepsy in a Norwegian county. Children had neuropediatric and EEG examination, intelligence evaluation, and, when necessary, additional investigations. RESULTS: Prevalence of active epilepsy on January 1, 1995, was 5.1 per 1,000. Main seizure type and epilepsy syndrome could be classified in 98% and 90% of patients, respectively. Seizure types/epileptic syndromes were more often partial/localization related than generalized. Among generalized epilepsies, idiopathic forms were more frequent in girls, and cryptogenic and symptomatic forms more frequent in boys. Epileptogenic EEG activity was most often generalized or localized to one or two areas of the brain and was never found in 14% of patients. Symptomatic etiology was found in 46% of all children and in 81% of therapy-resistant cases, respectively. Over the years, 11% of children had never used antiepileptic drugs (AED), 62% had tried one or two AEDs, and 26% had tried from three to 15 AEDs. Twenty-five percent of children were without present AED treatment. Complementary/alternative medicine had been tried by 12% of children. CONCLUSIONS: Although most epilepsies could be classified, the number of cases in non-specific categories was relatively high. Symptomatic etiology was frequent, especially in therapy-resistant cases. Multidisciplinary therapeutic and habilitation approaches are often needed in childhood epilepsy.     

Classification of epilepsies and epileptic syndromes using the 1989 International League against epilepsy classification: A hospital-based study of 1,250 patients in a developing country

The 1989 International Classification of Epilepsies and Epileptic Syndromes (ICE) of the International League Against Epilepsy was used to study the distribution of epilepsies and epileptic sundromes in 1,250 patients attending an Epilepsy Clinic in Sri Lanka. Of this largely adult population, 917 (73.4%) were classified as having localization-related epilepsy, 228 (18.2%) as having generalized epilepsy, and 104 (8.3%) as having epilepsy undetermined as to whether focal or generalized. Only one case was termed special syndromes because the definition of epilepsy excluded situation-related seizures. Of the localization-related epilepsies, the majority (82.9%) were cryptogenic and 14.5% were symptomatic. Of them, approximately one third were temporal lobe epilepsies; about half the cases could not be localized to a specific lobe of the brain. The generalized category consisted of 214 (93.9%) idiopathic and 14 (6.1%) symptomatic epilepsies. Juvenile myoclonic epilepsy (JME) was the most common idiopathic generalized epilepsy (115 cases, 50.4%). Epilepsies with specific modes of seizure precipitation accounted for 6.8% (85 cases) of the total series. All 85 cases were localization-related epilepsies; 76 had eating epilepsy (EE), and 9 had self-induced epilepsy (SIE). Although some overlap occurred between certain subcategories and specific localization of localization-related epilepsies was difficult, the 1989 ICE was relevant and applicable in a clinical setting with limited investigatory facilities.     

Epidemiology of childhood epilepsy in a cohort of 309 Chinese children

The present study describes the characteristics of epilepsy in a cohort of Chinese epileptic children. All children with active epilepsy who were under 15 years of age and residing in the catchment area of Tuen Mun Hospital, Hong Kong were monitored. Etiology, seizure types, and epilepsy syndromes were classified according to the recent guidelines of the International League Against Epilepsy. A total of 309 children were recruited into the study. The etiology of epilepsy was idiopathic in 42% of the children, cryptogenic in 16.8%, and remote symptomatic in 40.8%. Perinatal factors were the most frequently found cause of epilepsy. Seizure types were partial in 48.5% of the children and generalized in 46.9%. Epilepsy syndromes could be classified in all but seven patients, with 48.2% localization related and 49.5% generalized. Generalized seizures were more prevalent in children less than 5 years of age. Additional neuroimpairments affected 36% of our epileptic children. Sixty-nine percent of patients were seizure free for more than 1 year. The authors conclude that the International League Against Epilepsy can be applied successfully to a population-based cohort of Chinese epileptic children. A larger, longitudinal epidemiologic study is needed to answer questions concerning the true prevalence, incidence, types, and etiologies in the Chinese population.     

Generalized spike-and-wave patterns in children: clinical correlates

All electroencephalograms performed in our institution between 1980 and 1990 were reviewed. The clinical characteristics of children with epilepsy and generalized spike-and-wave (SW) patterns were analyzed. The SW patterns were classified according to their frequency. Electroencephalograms of 154 children with epilepsy revealed SW patterns. Absence seizures were the most common first seizure, but partial seizures were frequent. More than 40% had several types of seizures. Sixty percent of the epileptic syndromes were generalized, but almost 25% were partial. The typical SW pattern was associated with absence seizures, a normal examination and computed tomographic scan, idiopathic generalized epilepsies, monotherapy, freedom from seizures, and lack of recurrence. The slow SW pattern was associated with West syndrome; a younger age at seizure onset; atonic, myoclonic, tonic, and partial simple seizures; an abnormal examination and computed tomographic scan; cryptogenic or symptomatic generalized epilepsy or symptomatic partial epilepsy; polytherapy; and poor seizure control. The fast SW pattern was associated with secondary generalized, partial, tonic-clonic, and complex partial seizures; a normal computed tomographic scan; cryptogenic partial epilepsy; isolated seizures; and seizure recurrence. Epilepsy with a typical SW pattern should be considered benign, epilepsy with a slow SW pattern malignant, and epilepsy with a fast SW pattern treacherous.     

Prevalence of idiopathic epilepsy among school children in Gharbia Governorate,Egypt

Background

Epilepsy is one of the most common neurological disorders among children. Data about its prevalence in Egypt is limited. Our aim was to study the prevalence of idiopathic epilepsy among school children in Gharbia governorate, Egypt.

Prevalence of convulsive epilepsy and health-related quality of life of the population with convulsive epilepsy in rural areas of Tibet Autonomous Region in China: an initial survey

OBJECTIVE: The purpose of this study was to establish the prevalence rate of convulsive epilepsy and the treatment gap in some rural areas of Tibet Autonomous Region in China, to evaluate the quality of life (QOL) of patients with epilepsy and identify factors contributing to their QOL. METHODS: A door-to-door epidemiological survey using randomized cluster sampling was conducted in a rural population in Tibet. A screening questionnaire for convulsive epilepsy was used. Clinical and sociodemographic data were collected from patients confirmed as having convulsive epilepsy. QOL was measured with the Quality of Life in Epilepsy inventory (QOLIE-31). Factors associated with QOLIE-31 total and subcomponent scores were analyzed by multiple regression analysis. RESULTS: A total of 14,822 people were screened. Of these, 37 were confirmed to have convulsive epilepsy, which was active in 35. Lifetime prevalence was estimated to be 2.5 per 1000 in this population. Nearly 60% of patients received traditional Tibetan treatment; 97% of the patients with active epilepsy did not receive reasonable antiepileptic therapy in the week before the survey (treatment gap). The mean QOLIE-31 total score was 42.2 (SD 17.6), with the lowest subcomponent score 22.6 (SD 20.3) for Seizure Worry and the highest 85.8 (SD 18.6) for Medication Effects. High seizure frequency, low economic status, advanced age, late seizure onset, and high education level significantly correlated with low QOLIE-31 total and/or subcomponent scores. CONCLUSIONS: The prevalence rate for epilepsy was relatively lower than reported for other rural regions; however, the large treatment gap and poor QOL indicated the pressing needs for medical, financial, and social support in this population.