宁夏农村惊厥性癫痫患者死因分析

目的分析宁夏农村惊厥性癫痫(CE)患者的死亡原因,为早期识别高危患者、制定可行的防范措施提供依据,以降低癫痫患者的死亡风险。方法通过宁夏癫痫防治管理项目办,收集2012年1月1日~2016年1月1日宁夏农村CE患者的死亡资料,采用统一的癫痫患者死亡调查问卷对死亡信息进行调查核对,回顾性分析死亡原因。结果 4年中宁夏农村CE患者共死亡187例,死亡率约为5.2/10万。死因顺位前5位依次为损伤与中毒(25.7%)、癫痫持续状态(SE,21.4%)、癫痫猝死(SUDEP,17.1%)、脑血管病(12.8%)及心脏病(7.5%)。男、女CE患者的死因构成不同(P0.05)。其他疾病组(包括脑血管病、心脏病、恶性肿瘤、呼吸系统疾病、精神障碍、泌尿及生殖系统疾病及消化系统疾病)死亡年龄大于损伤与中毒、SUDEP以及SE组(LSD-t=5.20,P=0.000;LSD-t=4.22,P=0.000;LSD-t=6.07,P=0.000)。不同死因CE患者的死亡年龄构成不同(P0.05)、死亡地点分布不同(P0.05)。结论宁夏农村CE患者的首位死因是损伤与中毒,其次为SE和SUDEP。     

吉林省部分农村地区癫痫流行病学调查

目的通过对吉林省部分农村地区癫痫流行病学调查,掌握吉林省农村地区癫痫的发病率,患病率、死亡率以及治疗缺口情况。方法 (1)选择吉林省3个县为目标县,由吉林大学第一医院神经内科癫痫课题组对当地县级神经内科医生及乡镇医院内科医生进行培训;(2)由当地乡镇医院医生对管区内癫痫患者进行筛查,并由县级医院神经内科医生复查;(3)统计学处理。结果 (1)发病率与患病率:吉林省活动性癫痫患病率大约为3.94‰,总发病率约为每年每10万人口22.55人;(2)患者性别构成:男女比例大约为1.13∶1;(3)年龄构成:患者的年龄多集中在10~60岁之间,以20~50岁患者居多,发病年龄高峰在0~10岁之间;(4)发作类型:全面强直阵挛发作为主要的发作类型;(5)死亡率:死亡率约为0.89%;(6)治疗缺口62.7%。结论吉林省农村地区活动性癫痫发病率及患病率低于以往国内调查的结果,治疗缺口大,提示在农村地区加强癫痫宣教具有重要意义。     

中国农村及少数民族地区流行病学调查死亡资料分析

本文对全国21省(区)农村及少数民族地区流行病学调查死亡资料,进行分析。调查方法按世界卫生组织提供的统一表格,采用逐户家访,共调查246812人,结果发现因各种疾病死亡者1378人,总死亡率为558/10万,其中以心脏病死亡率最高(125/10万),其次恶性肿瘤(94/10万),脑血管病居第三(83/10万)。以上为我国死亡的三大原因。本文就死因顺位及主要疾病的死亡率与美国、日本及北京、上海等地历年的结果作了比较,对不同地区死亡率的差异进行了讨论。     

癫痫的流行病学研究

<正>在美国每年有15万人发生癫痫~([1])。据汇总分析,国内外癫痫的患病率为0.5%~1.0%~([2])。癫痫是一个发作性疾病。据一项对0~16岁活动性癫痫的调查,每天均有癫痫发作的占8%~([3])。癫痫的频繁发作,可以造成严重地神经功能障碍,癫痫持续状态可以造成死亡。英国的Cockerell等~([4])的统计,癫痫相关性神经功能缺失率为50/10万·年。据Wu等~([5])对15601例的统计,癫痫持续状态患者住院死亡率为10.7%。Chen等~([6])统计显示,中国西部癫痫持续状态死亡率为15.9%。因此,加强对癫痫的     

宁夏同心县回族癫痫流行病学调查

目的调查宁夏回族人群癫痫患病率、发病率及治疗缺口,为回族人群癫痫的防治提供依据。方法通过随机、整群抽样,选取宁夏同心县豫海镇和石狮镇,分别作为城镇及农村代表地区进行调查;采用统一的癫痫流行病学调查表进行入户调查,对初步筛查的癫痫患者经由神经科医师再次确诊。结果实际调查11917例,确诊癫痫患者60例,癫痫患病率为5.03‰。其中城镇患病率为6.61‰,农村为3.37‰,城市和农村地区癫痫患病率存在显著性差异;回族男性与女性癫痫患病率无显著差异;回族儿童(≤14岁)癫痫患病率为8.43‰,高于其他年龄组;70%的患者癫痫的首次发作在儿童时期;癫痫患者的年龄在3月~51岁之间,其中儿童占40%(24/60),城镇癫痫患者的平均年龄为16.38±11.78岁,农村癫痫患者的平均年龄为30.05±14.63岁;在活动性癫痫患者中,正规接受抗癫痫治疗的患者为25.9%(15/58),治疗缺口为74.1%;在所有发作类型中,全面强直阵挛发作者46例,占75.0%;回族癫痫发病率为75.5/100000例。结论宁夏回族人群癫痫患病率城镇高于农村,儿童高于其他年龄组;回族癫痫发病率高于全国平均水平;回族癫痫患者治疗缺口大,需要对该地区进行政策支持并加强宣传,提高患者的就诊率,控制癫痫发作。     

世界卫生组织-全球抗癫痫运动中国农村癫痫示范项目结束后四年随访结果

目的了解全球抗癫癎运动中国农村抗癫癎示范项目终止后4年曾接受苯巴比妥治疗的癫癎患者的远期治疗效果及转归,以为我国农村癫癎患者的防治和管理提供参考依据。方法 2008年7-12月由经过培训的乡卫生院医师采用问卷与访谈相结合的形式入户调查,对原示范项目6省(市)共8个县经苯巴比妥治疗管理的2455例惊厥型癫癎患者进行随访。结果接受苯巴比妥治疗的2455例患者中共随访到1780例,其中939例(52.75%)继续服药,无发作和发作减少超过50%(有效)的患者于项目终止后的12、24、36和48个月时所占比例分别为66.77%(627/939)、68.37%(642/939)、71.35%(670/939)和73.06%(686/939);841例(47.25%)停药患者中244例(29.01%)无发作、320例(38.05%)仍然发作但已停药、277例(32.94%)改用其他类型抗癫癎药物。对939例继续服用苯巴比妥与841例停药的癫癎患者进行疗效比较,继续服药者的远期疗效优于停药者(χ~2=12.423,P=0.002)。停药原因分别为发作停止(244例,29.01%)、改用其他抗癫癎药物(277例,32.94%)、未提供免费药物或无钱买药(93例,11.06%)、治疗效果欠佳(92例,10.94%)、当地买不到苯巴比妥(54例,6.42%)等。至2008年随访结束时共有206例患者死亡,标化死亡比达19.10;其中意外事故死亡为59例(28.64%),其次为脑血管病30例(14.56%)、癫癎持续状态窒息死亡28例(13.59%)。结论 "全球抗癫癎运动"中国农村癫癎示范项目开展成功,远期治疗效果良好,值得进一步推广。癫癎人群死亡率高,尤其是意外事故死亡率高,值得引起注意。     

急性脑血管病后癫痫发作

目的:研究急性脑血管病后癫痫发作的发生率、发作时间及类型、有关因素及对预后的影响。方法:除外引起癫痫的其他脑部和代谢障碍疾病后,并除外短暂性脑缺血发作和多发性脑梗塞后,每例均经头部CT或MRI证实的急性脑血管病住院患者,随访其癫痫发作的情况。结果:本研究包括急性脑血管病患者1044例,癫痫发生率为5.36％(56/1044),各病种发生率分别为蛛网膜下腔出血19.35％(12/62),脑出血4.33％(19/440),脑梗塞4.61％(25/542)(其中脑栓塞9.09％,脑血栓形成3.99％,P<0.05)。82.1％的癫痫于发病内两周后发作。癫痫发作的类型蛛网膜下腔出血大部为全身性发作,脑出血和脑梗塞以部分性发作为主。除蛛网膜下腔出血外,癫痫发作与病变部位有关,脑血栓形成患者可能与病变大小有关。脑出血和脑梗塞合并癫痫一月内死亡率较未合并癫痫者死亡率高。结论:急性脑血管病继发癫痫发生率为5.36％,多数于病后两周内发生,发生率以蛛网膜下腔出血较高。癫痫发作与病变部位有关,累及皮层或邻近皮层者为多,可能与病变大小有关。合并癫痫的脑血管病患者急性期死亡率较高。     

难治性癫痫持续状态的治疗进展

<正>癫痫持续状态(status epilepticus,SE)的发病率为10~61/10万,是神经科仅次于急性脑血管病的危急重症。即使给予足够、及时、恰当的抗癫痫药物以及病因治疗等综合处理,仍有约三分之一的患者发作难以控制,进展为难治性癫痫持续状态(refractor]ystatus epilepticus,RSE),其死亡率达16%~39%[1。RSE尚无统一定义,目前比较得到公认,在文献报道中应用较广泛的定义是:给予足够剂量的2~3种一     

癫痫合并短暂性脑缺血发作一例

正在发达国家,脑血管病是导致中老年人癫痫发作最常见的病因~([1])。据报道通常在2%~10%的卒中患者中出现癫痫发作~[2,3]。脑血管病与癫痫发作之间的关系通过卒中后癲痫可明显体现。但是癫痫发作后出现脑血管疾病也值得注意。在临床上,癫痫后合并出现短暂性脑缺血发作的病例报道少见,现将我科收治的1例报道如下。病例介绍患者女,42岁。因"发作性肢体抽搐1年余,发作性言语不清3个月",于2017年     

癫痫诊断与治疗的现状、问题和对策

癫痫是最常见的神经系统疾病之一,文献报道各国癫痫的年发生率为11~230/10万人,现患率为1.5~55/1000人[1]。我国80年代的六省市调查结果为35/10万人。一般认为约70%~80%的癫痫病人通过药物治疗或保守治疗得以完全控制,其余则控制不满意,渐行演变成药物难治性癫痫(或称顽固性癫痫)。这其中约2/3是所谓部分性发作癫痫,余为全身性发作者。按13亿人口估计,我国约有460万癫痫患者,每年还新增约45.5万新病人。估计药物难治性癫痫有近百万之众。由于历史文化原因和专业医疗保健普及较差,实际数字应该更高些。癫痫的高发年龄段是在20岁以前,尤其是在…     

Epilepsy by the Numbers: Epilepsy deaths by age,race/ethnicity,and gender in the United States significantly increased from 2005 to 2014

To inform public health efforts to prevent epilepsy-related deaths, we used the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (WONDER; Wonder.cdc.gov) to examine any-listed epilepsy deaths for the period 2005–2014 by age groups (≤ 24, 25–44, 45–64, 65–84, ≥ 85 years), sex, and race/ethnicity (non-Hispanic White, non-Hispanic African American, Hispanic, Asian/Pacific Islander, or American Indian/Alaska Native). Epilepsy deaths were defined by the International Classification of Diseases, Tenth Revision (ICD-10) codes G40.0–G40.9. The total number of deaths per year with epilepsy as any listed cause ranged from 1760 in 2005 to 2962 in 2014. Epilepsy was listed as the underlying cause of death for about 54% of all deaths with any mention of epilepsy in 2005 and for 43% of such deaths in 2014. Age-adjusted epilepsy mortality rates (as any-listed cause of death) per 100,000 significantly increased from 0.58 in 2005 to 0.85 in 2014 (47% increase). In 2014, deaths among the non-Hispanic Black population (1.42 deaths per 100,000) were higher than among non-Hispanic White (0.86 deaths per 100,000) and Hispanic populations (0.70 deaths per 100,000). Males had a higher mortality rate than females (1.01 per 100,000 versus 0.74 per 100,000 in 2014), and those aged 85 years or older had the highest mortality among age groups. Results highlight the need for heightened action to prevent and monitor epilepsy-associated mortality.     

Premature mortality in people with epilepsy in rural China: a prospective study

BACKGROUND: In China, few studies have described annual mortality associated with epilepsy in a general population and these have provided a range of 3.0-7.9 deaths per 100,000 people. We calculated the case fatality rate (CFR), proportional mortality rate (PMR), and standardised mortality ratio (SMR) to assess mortality in people with epilepsy in rural China. METHODS: The target population was people with epilepsy who participated in an assessment of epilepsy management at primary health level in rural China. Neurologists confirmed the diagnosis using strict criteria in all participants who were then treated with phenobarbital. Demographic data and putative cause of death were recorded for each person whose death was reported. PMRs for each cause of death and SMRs were estimated on the basis of the 2004 Chinese population. FINDINGS: Case fatality rate was 1.4% (35 deaths) among 2455 people with epilepsy. The age-adjusted PMRs for injury, stroke, neoplasm, myocardial infarction, and pneumonia were 30%, 30%, 15%, 6%, and 5%, respectively. The SMR was 3.9 (95% CI 3.8-3.9). Patients aged 15-29 years had higher mortality ratios than did those in other age-groups, with SMRs exceeding 23. INTERPRETATION: Risk for premature death is three to four times higher in people with epilepsy than in the general Chinese population. Furthermore, the risk in young people with epilepsy in China is much higher than previously reported. Injury, stroke, myocardial infarction, and pneumonia are among the leading putative causes of death in patients with epilepsy in rural China.     

Falling status epilepticus mortality rates in England and Wales: 2001–2013?

Status epilepticus (SE) is associated with significant mortality and accounts for ~10% of epilepsy‐related deaths. Epilepsy and SE mortality data from 2001 to 2013, in addition to annual age group populations for England and Wales, were obtained from the Office of National Statistics website ( www.ons.gov.uk ). Age‐adjusted mortality rates for epilepsy and SE with 95% confidence intervals (CIs) were calculated using the European Standard Population. Trends in mortality rates for both epilepsy and SE were investigated using the Spearman coefficient. The crude mean epilepsy mortality rate per 100,000 person‐years between 2001 and 2013 was 1.87 (95% CI 1.83–1.91), with a corresponding SE mortality rate of 0.14 (95% CI 0.13–0.15). The mean age‐adjusted epilepsy mortality rate per 100,000 person years was 3.24 (95% CI 3.12–3.35), with a corresponding SE mortality rate of 0.24 (95% CI 0.21–0.27). All epilepsy deaths significantly decreased from 2001 to 2013 (Spearman's ρ ?0.733, p = 0.004); this decrease was predominantly due to a decrease in SE deaths (Spearman's ρ ?0.917, p < 0.001). In summary, our finding supports the hypothesis that the policy of early and aggressive treatment of SE may be improving the prognosis of this condition in England and Wales.     

Death from suicide versus mortality from epilepsy in the epilepsies: a meta-analysis

OBJECTIVE: Epilepsy is associated with an increased risk of mortality, which, however, is rarely due to the epilepsy itself; suicide, on the other hand, is a chief cause of death among persons with epilepsy. We conducted a meta-analysis to compare data reported in representative studies of suicide mortality in epilepsy with data on mortality from epilepsy in the general population. METHODS: We searched Index Medicus to 2006 through MedLine. We also searched the World Health Statistics Annual to ascertain rates of mortality from epilepsy in the age groups indicated in the studies on patients with epilepsy for specific years and countries. RESULTS: We selected 30 studies comprising 51,216 persons, 188 of whom committed suicide and died. Results obtained for each study were processed together to calculate, per 100,000 individuals in the general population per year, the mean number of suicide deaths expected in persons with epilepsy with respect to the current prevalence of epilepsy. We found that the number of suicide deaths among persons with epilepsy is the same as the number of deaths from epilepsy, suggesting that the former are not included in mortality rates for epilepsy. Also, we found that, according to data derived from cohorts we selected, 32.5% of all deaths of persons with epilepsy are due to suicide and at least 13.5% of all registered suicides are committed by these persons. Study findings may not generalize to other samples, settings, and treatments, thus perhaps tending to exaggerate the phenomenon actually attainable under broader clinical conditions. CONCLUSIONS: Our meta-analysis indicates that suicide deaths in persons with epilepsy are a disturbingly frequent phenomenon that should be addressed to reduce mortality among patients with epilepsy dramatically. In particular, mortality rates for persons with epilepsy do not include mortality from suicide, greatly underestimating death rates and the need for suicide prevention strategies for these patients.     

Influence of Epilepsy on Mortality in Mental Retardation: An Epidemiologic Study

Summary: Purpose : A cohort consisting of all persons with known mental retardation (MR) and living in a Swedish province on December 31, 1985, was followed for 7 years (1987–1992) to study the mortality pattern.
Methods : A file of the cohort was linked to the cause-of-death pattern of the general population in the study area.
Results : One hundred twenty-four deaths (8.4%) occurred among the 1,478 persons with MR. Thirty deaths (10.1%) occurred among the 296 persons with epilepsy and MR. The standardized mortality ratio (SMR) in those with only MR was significantly increased as compared with that of the general population: 1.6 [95% confidence interval (CI) 1.3–2.01; MR and epilepsy, 5.0 (CI 3.3–7.5); and MR, epilepsy, and cerebral palsy (CP), 5.8 (CI 3.4–9.7). Mortality was increased both in patients with partial seizures without seizures secondarily generalized (SMR 3.7, CI 1.0–13.6) and in patients with seizures secondarily generalized (5.0, CI 2.3–11.0). The highest mortality occurred in patients who had seizures that were always generalized from the onset: 8.1 (CI 5.7–11.5). Mortality increased with increasing seizure frequency during the year preceding the prevalence date. In patients with epilepsy and MR, pneumonia was the most common cause of death and a seizure was the probable cause of death in 6.7%.
Conclusions : Epilepsy is associated with a significantly increased mortality in persons with MR. The increase is related to seizure type and seizure frequency. Death in persons with epilepsy and MR is seldom directly due to seizures. Other impairments associated with epilepsy and MR are important causes of death.     

Premature mortality risk in people with convulsive epilepsy: Long follow‐up of a cohort in rural China

Purpose: Detailed data on the mortality of epilepsy are still lacking from resource‐poor settings. We conducted a long‐term follow‐up survey in a cohort of people with convulsive epilepsy in rural areas of China. In this longitudinal prospective study we investigated the causes of death and premature mortality risk among people with epilepsy. Methods: We attempted to trace all 2,455 people who had previously participated in a pragmatic assessment of epilepsy management at the primary health level. Putative causes of death were recorded for those who died, according to the International Classification of Diseases. We estimated proportional mortality ratios (PMRs) for each cause, and standardized mortality ratios (SMRs) for each age‐group and cause. Survival analysis was used to detect risk factors associated with increased mortality. Key Findings: During 6.1 years of follow‐up there were 206 reported deaths among the 1,986 people with epilepsy who were located. The highest PMRs were for cerebrovascular disease (15%), drowning (14%), self‐inflicted injury (13%), and status epilepticus (6%), with probable sudden unexpected death in epilepsy (SUDEP) in 1%. The risk of premature death was 2.9 times greater in people with epilepsy than in the general population. A much higher risk (SMRs 28–37) was found in young people. Duration of epilepsy and living in a waterside area were independent predictors for drowning. Significance: Drowning and status epilepticus were important, possibly preventable, causes of death. Predictors of increasing mortality suggest interventions with efficient treatment and education to prevent premature mortality among people with epilepsy in resource‐poor settings.     

Community-Based Study of Mortality in Children with Epilepsy

Summary: Summary: We used the records of a statewide pediatric mortality surveillance system to determine mortality rates and causes of death in children with epilepsy. Of the 1,095 children aged 1–14 years who died in the state of Victoria during the study period 1985–1989,93 had a history of epilepsy. Six children (6%) had primary epilepsy, and 87 (94%) had secondary epilepsy. Death was (a) directly attributable to epilepsy in 20 (22%), including 11 with sudden unexplained death, (b) not directly attributable to epilepsy in 59 (63%), and (c) of undetermined cause in 14 (15%). No classifiable death occurred as a direct result of status epilepticus. The average annual mortality rates for children with epilepsy were (a) death from all causes, 30.6 in 10,000 [95% confidence interval (CI) 19.7, 47.51, and (b) death attributable to epilepsy, 6.6 in 10,000 (95% CI 3.7, 11.8). Relative to the all-cause mortality rate in children without epilepsy, the all-cause mortality rate ratios were (a) all children with epilepsy, 13.2 (95% CI 8.5, 20.7); (b) primary epilepsy, 1.1 (95% CI 0.5, 2.6); and (c) secondary epilepsy, 49.7 (95% CI 31.7, 77.9). The mortality rate ratios for secondary epilepsy relative to primary epilepsy were (a) death from all causes, 43.5 (95% CI 19.0, 99.5); and (b) death attributable to epilepsy, 9.0 (95% CI 3.3, 24.8). Epilepsy appeared on the death certificate of only 11 of 20 (55%) children whose deaths were attributable to epilepsy. We conclude that (a) there was an increased risk of death during childhood in children with epilepsy; (b) the risk of death was greatest for children with secondary epilepsy; (c) potentially preventable, epilepsy-related deaths occurred in children with primary epilepsy; (d) sudden unexplained death accounted for at least 12% of deaths; and (e) death certification was deficient with respect to recording of epilepsy.     

Premature mortality of epilepsy in low‐ and middle‐income countries: A systematic review from the Mortality Task Force of the International League Against Epilepsy

To determine the magnitude of risk factors and causes of premature mortality associated with epilepsy in low‐ and middle‐income countries (LMICs). We conducted a systematic search of the literature reporting mortality and epilepsy in the World Bank‐defined LMICs. We assessed the quality of the studies based on representativeness; ascertainment of cases, diagnosis, and mortality; and extracted data on standardized mortality ratios (SMRs) and mortality rates in people with epilepsy. We examined risk factors and causes of death. The annual mortality rate was estimated at 19.8 (range 9.7–45.1) deaths per 1,000 people with epilepsy with a weighted median SMR of 2.6 (range 1.3–7.2) among higher‐quality population‐based studies. Clinical cohort studies yielded 7.1 (range 1.6–25.1) deaths per 1,000 people. The weighted median SMRs were 5.0 in male and 4.5 in female patients; relatively higher SMRs within studies were measured in children and adolescents, those with symptomatic epilepsies, and those reporting less adherence to treatment. The main causes of death in people with epilepsy living in LMICs include those directly attributable to epilepsy, which yield a mean proportional mortality ratio (PMR) of 27.3% (range 5–75.5%) derived from population‐based studies. These direct causes comprise status epilepticus, with reported PMRs ranging from 5 to 56.6%, and sudden unexpected death in epilepsy (SUDEP), with reported PMRs ranging from 1 to 18.9%. Important causes of mortality indirectly related to epilepsy include drowning, head injury, and burns. Epilepsy in LMICs has a significantly greater premature mortality, as in high‐income countries, but in LMICs the excess mortality is more likely to be associated with causes attributable to lack of access to medical facilities such as status epilepticus, and preventable causes such as drowning, head injuries, and burns. This excess premature mortality could be substantially reduced with education about the risk of death and improved access to treatments, including AEDs.