Incidence and Direct Medical Cost of Adjustment Disorder and in Korea Using National Health Insurance Service Claims Data From 2011 to 2017

ObjectiveWe aimed to investigate the annual incidence and direct medical cost of adjustment disorder in general population using the National Health Insurance Service Database (NHID) in Korea. MethodsTo examine the incidence, we selected patients who had at least one medical claim for adjustment disorder and had not been diagnosed in the previous 365 days, from 2010 to 2017. ResultsThe number of newly diagnosed cases of adjustment disorder from 2011 to 2017 were total 101,922. Annual incidence of adjustment disorder was ranged from 22.0 to 36.8 per 100,000 persons. The incidence of adjustment disorder was found more in female and highest among 70–79 years of age group and medical aid beneficiaries group. Annual prevalence of adjustment disorder was in the range from 95.4 to 116.4 per 100,000 persons. Estimated annual medical cost per person of adjustment disorder was ranged from 162 to 231.4 US dollars.ConclusionFrom 2011 to 2017, the annual incidence and direct medical cost of adjustment disorder in Korea were increased. Proper information on adjustment disorder will not only allows us to accumulate more knowledge but also lead to more appropriate therapeutic interventions.     

The Epidemiology and Treatment of Chronic and Refractory Epilepsy

Summary: In developed countries, the incidence of epilepsy is 50–100 cases per 100,000 population per year and the prevalence is approximately 5 to 8 cases per 1,000 population. Epilepsy is by far the most prevalent serious neurologic condition. Mortality rates in epilepsy are two to four times those found in matched nonepileptic populations. The prognosis of epilepsy can be classified into at least four categories, with chronic and refractory cases comprising about 40% of all cases. A detailed approach to the management of chronic epilepsy cases is recommended. Approximately 20% of patients cannot achieve seizure control with existing agents and new antiepileptic drugs are required for these patients.     

Incidence,prevalence and aetiology of seizures and epilepsy in children

Aim. To (1) summarize published, peer‐reviewed literature about the incidence and prevalence of epilepsy in children from developed and developing countries around the world, and (2) discuss problems in defining aetiologies of epilepsy in children, and distinguish between seizures and epilepsy. Methods. Review of selected literature with particular attention to systematic reviews. Results. The incidence of epilepsy in children ranges from 41–187/100,000. Higher incidence is reported from underdeveloped countries, particularly from rural areas. The incidence is consistently reported to be highest in the first year of life and declines to adult levels by the end of the first decade. The prevalence of epilepsy in children is consistently higher than the incidence and ranges from 3.2–5.5/1,000 in developed countries and 3.6–44/1,000 in underdeveloped countries. Prevalence also seems highest in rural areas. The incidence and prevalence of specific seizure types and epilepsy syndromes is less well documented. In population‐based studies, there is a slight, but consistent, predominance of focal seizures compared with generalized seizures. Only about one third of children with epilepsy can be assigned to a specific epilepsy syndrome, as defined by the most recently proposed system for organization of epilepsy syndromes. Conclusions. The incidence and prevalence of epilepsy in children appears to be lower in developed countries and highest in rural areas of underdeveloped countries. The reasons for these trends are not well established. Although focal seizures predominate, the incidence and prevalence of specific epilepsy syndromes is not well documented.     

The Epidemiology and Treatment of Chronic and Refractory Epilepsy

Summary: In developed countries, the incidence of epilepsy is 50–100 cases per 100,000 population per year and the prevalence is approximately 5 to 8 cases per 1,000 population. Epilepsy is by far the most prevalent serious neurologic condition. Mortality rates in epilepsy are two to four times those found in matched nonepileptic populations. The prognosis of epilepsy can be classified into at least four categories, with chronic and refractory cases comprising about 40% of all cases. A detailed approach to the management of chronic epilepsy cases is recommended. Approximately 20% of patients cannot achieve seizure control with existing agents and new antiepileptic drugs are required for these patients.     

Sunday July 2, 2006 9:30–11:30Hall 3A Discussion Group SessionLessons learned from local epidemiological studies

¹ A. Õun (   ¹ Department of Neurology and Neurosurgery, University of Tartu, Estonia )
Epidemiological data about epilepsy from central and eastern Europe is controversial. A modern study on prevalence and incidence of epilepsy in Estonia has been carried out on children–prevalence of active epilepsy was 3.6/1,000, and incidence 45/100,000 person-years being essentially similar to those in developed countries. In an adult populaton review of all databases and lists related to epilepsy in Tartu supplemented by re-examination of patients to identify all persons with active epilepsy aged ≥20 years on January 1, 1997. Special attention was paid to extensive adoption of definitions and criteria proposed by Guidelines for epidemiologic studies. The incidence rate was 35/100,000 person-years. The age-specific rates tended to increase with advancing age. The prevalence rate was 5.3/1,000. The largest syndromic categories were localization-related symptomatic and cryptogenic epilepsies, which are very likely due to the age-distribution of the study. The risk factors for epilepsy were identified in 39.6% cases of the prevalent cases. Of the subjects 19% did not take an entiepileptic drug on the prevalence day, 83% of them were taking a single drug. The most common agent was carbamazepine (68%), followed by barbiturates. Epidemiologic rates in the adult, as well as in the total population of Tartu was comparable to those reported from the developed countries. The large percentage of medication-free epileptics, notably small figures for polytherapy, and the associating low aggregate antiepileptic drug sales in Estonia, indicate a tendency for moderate medication in the epileptic population.     

Prevalence, incidence, and clinical characteristics of epilepsy—A community-based door-to-door study in northern Tanzania

Purpose:   The main aim of this door-to-door-study was to determine the prevalence, incidence, and clinical characteristics of epilepsy in northern Tanzania.
Methods:   A total of 7,399 people were screened with a standardized questionnaire using "multistage random sampling."
Results:   The prevalence rate of epilepsy was 11.2/1,000 [95% confidence interval (CI) 8.9–13.9/1,000] and the age-adjusted prevalence rate was 13.2/1,000. The prevalence of active epilepsy was 8.7/1,000 (95% CI 6.7–11/1,000). There was a preponderance of women. The average retrospective incidence including the last 5 years was 81.1/100,000 (95% CI 65–101/100,000). Fifty-four percent (45 of 83) of the people with epilepsy had generalized seizures without any identifiable cause; 71% (59 of 83) of the epilepsy patients had not visited health institutions prior to the study and 76% (63 of 83) had never received treatment.
Discussion:   Our study shows that the prevalence and incidence of epilepsy in northern Tanzania are higher compared to developed countries and that the majority of people with epilepsy do not access treatment.     

Prevalence of Epilepsy in Adults in Northern Sweden

A multisource medical register review identified persons with active epilepsy in northern Sweden. Seven hundred thirteen persons aged greater than or equal to 17 years with epilepsy were determined on the prevalence day, December 31, 1985. The overall prevalence was 553 in 100,000 (566 in 100,000 if adjusted to the 1980 U.S. population). The ratio of males to females was 1.1, with a male prevalence of 575 and a female prevalence of 530 in 100,000. Age-specific prevalences varied between 530-644 in 100,000 except in persons aged greater than or equal to 70 years, for whom the prevalence was 321 in 100,000. Partial seizures were most common, 333 in 100,000, of whom the majority (250 in 100,000) had seizures that occasionally were secondarily generalized. Mental retardation was the foremost coexistent disorder, noted in 23%. The mean yearly seizure frequency was higher in persons with mental retardation than in nonretarded persons. Seventeen percent had seizures during the last week, 57% during the last year, whereas 16% had greater than or equal to 5 years' freedom from seizures. Most had onset of epilepsy before age 20 years. A presumed etiology was noted in 35%, more often in men than in women. Cerebrovascular disease was the most commonly identified presumed cause. Other nonepileptic diseases/disabilities were noted in 47%.     

The Epidemiology of Epilepsy in Rochester, Minnesota, 1935 Through 1967

Other demographic studies of epilepsy have revealed mean annual incidence rates ranging from 17/100,000 (Sato, 1964) to 70/100,000 (Pond et al., 1960) and prevalence rates from 2.8/S, OOO to as high as 15/1,000. Comprehensive review of their methods indicates that, although rates may indeed differ among different populations, a major problem is the wide variation in the completeness of case ascertainment and the definitions of epilepsy used.     

A systematic review of the epidemiology of epilepsy in Arab countries

In this report the epidemiologic aspects of epilepsy in Arab countries are systematically reviewed. MEDLINE and Embase were searched, and six papers were identified: one incidence report from Qatar and five prevalence reports (two from Sudan, and one from each of Libya, Tunisia, and Saudi Arabia). An incidence of 174 per 100,000 persons in 2001 was reported in a hospital-based study from Qatar. Prevalence ranged between 0.9/1,000 in Sudan and 6.5/1,000 in Saudi Arabia, with a median of 2.3/1,000. An approximate 724,500 people with epilepsy live in the Arab world. All the studies report higher prevalence in males, which was statistically significant in the Saudi study. The prevalence is approximately 2-fold higher in children and young adults, compared to the rates in middle age. Two studies showed a high prevalence in individuals older than 60 years of age. Primary generalized seizures are reported in 28–97% of cases, partial seizures in 3–43.8%, and unclassified seizures in 18–51%. Idiopathic epilepsy represents 73.5–82.6% of cases. Early childhood brain damage such as in cerebral palsy and mental retardation represented a major cause of symptomatic epilepsy, whereas infection was the main cause in Sudan. The epidemiologic data from Arab states are lacking, especially from populous countries like Egypt, Algeria, and Syria. Well-designed studies are needed to accurately determine the burden of epilepsy in the Arab world.     

Prevalence and Incidence of Epilepsy in Tokyo

All children 3 years of age on January 1, 1975 in the Fuchu area of Tokyo were neurologically examined for 6 years (number examined: 17,044). The cumulative incidence of epilepsy (i.e., recurrent nonfebrile seizures) was 4.3/1,000 and that of occurrence of a single nonfebrile seizure (NS) was 4.7/1,000. Febrile convulsions (FCs) were observed in 82/1,000 in this population. The population was followed for 6-11 years after the first examination. During the follow-up (a) 4 of 80 children who had a single NS before age 3 years developed recurrence after age 3 years; (b) development of epilepsy was found in three of 1,323 randomly (10%) selected healthy children for comparison (2.3/1,000); (c) among 1,406 children with FCs, epilepsy developed in 24 (17/1,000) and a single NS occurred in 28 (20/1,000); and (d) the total cumulative incidence of epilepsy was 8.2/1,000 in the population aged 9-14 years. Age-specific annual incidence of epilepsy was highest in the age range 0-1 year (1.9/1,000), gradually falling with advancing age. The point prevalence for active epilepsy (having had a seizure within the past 5 years) was 2.8/1,000; that for inactive epilepsy was 5.4/1,000 (total 8.2/1,000). Epilepsy developed by age 14 years in (a) one-half of children with NS, (b) approximately 2% children with FCs, (c) 0.2% of healthy children with no seizure before age 3 years, and (d) an estimated 2% of potential epileptic carriers (having spike EEG abnormality by age 3; 15% of the population) who had not had a seizure by age 3 years.     

Reduction in rate of epilepsy from neurocysticercosis by community interventions: the Salamá, Honduras study

Purpose: Epilepsy is highly prevalent in developing countries like Honduras, with few studies evaluating this finding. This population‐based study evaluated the impact of an 8‐year public health and educational intervention program in reducing symptomatic epilepsies in rural Salamá, Honduras. Methods: We used the capture and recapture method including review of charts, previous databases, key informants from the community, and a second house‐to‐house survey for epilepsy. Epilepsy incidence and prevalence day after the interventions was May 5, 2005. Residents with active epilepsy with onset after May 1997 were offered neurologic evaluation, electroencephalography, and brain tomography. New data over 8 years were compared to preintervention data from the initial baseline 1997 study utilizing prevalence ratios and confidence intervals. Other calculations utilized chi square or Fisher’s exact tests. Key Findings: Thirty‐three of 36 patients with onset of active epilepsy after 1997 accepted evaluations to determine etiology. Symptomatic etiology was found in 58.3%. Neurocysticercosis (NCC) was again the most frequent cause (13.9%), followed by perinatal insults (11.1%). Epilepsy secondary to NCC was significantly reduced from 36.9% in 1997 (p = 0.02). The incidence (35.7/100,000) and prevalence (11.8/1,000) of active epilepsy were not significantly reduced when compared to the incidence (92.7/100,000) and prevalence (15.4/1,000) of active epilepsy in 1997. Significance:   Our cohort appears to indicate that health and educational community interventions can reduce preventable epilepsy from NCC in a hyperendemic population in a low‐resource, developing country. Plans are underway for the Honduran Government to institute this rural model countrywide.     

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.     

Sudden unexpected death in epilepsy in adults with mental retardation

The medical records of residents of a facility for persons with mental retardation from January 1, 1978, through December 31, 1997, were analyzed to identify incidence of sudden unexpected death for groups of 180 individuals with and 125 without comorbid epilepsy. Eighty deaths were identified, with 55 occurring in the epilepsy group and 25 in the nonepilepsy group. The rate of sudden unexpected death was 1.3 deaths per 1,000 patient years in the nonepilepsy group and 3.6 deaths per 1,000 patient years in the epilepsy group. The risk factors for sudden unexpected death in the epilepsy group were nonambulatory status and poorly controlled seizure disorder (increased seizure rate and increased number of antiepileptic drugs).     

Incidence and prevalence of epilepsy in Denmark

PURPOSE: To estimate the occurrence of epilepsy in Denmark between 1977 and 2002, taking gender, age, and secular trends into consideration. METHODS: We used the Danish Civil Registration System to identify all persons born in Denmark and the Danish National Hospital Register to identify persons registered with epilepsy between 1977 and 2002. RESULTS: Between 1977 and 2002 the average incidence of epilepsy was 68.8 new epilepsy patients per 100,000 person-years at risk. However, the incidence changed with calendar time and increased steeply from 1990 to 1995, probably due to changes in diagnostic system and inclusion of outpatients. From 1995 to 2002 the incidence rate was reasonable constant with an average of 83.3 new cases per 100,000 person-years at risk, except for patients over 60 years of age where we observed an increase in incidence with calendar time. The age-specific incidence rates declined from a high level in children to a low level between 20 and 40 years of age, and thereafter a gradual increase was seen. The incidence rate was slightly higher in men than in women except for the age range 10-20 years. About 2% of the population was diagnosed with epilepsy at some point during the first 25 years of life. The overall 5-year prevalence proportion of epilepsy was 0.6% with a slight variation with age and gender between 0.4 and 0.8% of the population. CONCLUSION: The occurrence of epilepsy is age and gender specific. The estimated incidence rate of epilepsy furthermore increased over time for persons older than 60 years of age.