Prevalence of epilepsy. A door-to-door survey in the sicilian community of riposto

In a door-to-door survey of common neurological disorders in Sicily (SNES Project), we administered a screening symptoms questionnaire and a brief neurological examination to detect epileptic patients. All of the subjects effectively resident in the community of Riposto on 1 November 1987 (prevalence day) were investigated (n=9956). The subjects with a positive questionnaire or a previous diagnosis of epilepsy were extensively examined by a neurologist and then definitively classified for epilepsy by a panel of senior neurologists. The crude prevalence of active and non-active epilepsy was 3.21/1000; the prevalence of active epilepsy alone was 2.71/1000. Of the 27 active cases, sixteen were affected by genralized tonic-clonic seizures, four by absences and four by complex partial attacks. All except two were being treated with antiepileptic drugs, most with phenobarbital. Our prevalence rate is lower than that reported by most authors, but similar to the rates in other Sicilian communities.

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Sommario Nell'ambito di un'indagine porta a porta su alcune comuni malattie neurologiche in Sicilia (Progetto SNES), abbiamo somministrato un questionario di screening mirato sui sintomi ed un breve esame neurologico allo scopo di individuare i pazienti epilettici. Tutti i soggetti effettivamente residenti al 1° novembre 1987 (giorno di prevalenza) nel comune di Riposto sono stati studiati (N=9956).Quelli positivi al questionario o con una diagnosi precedente di epilessia sono stati accuratamente valutati da un neurologo e quindi rivalutati per la diagnosi definitiva da un gruppo di neurologi esperti. Il tasso di prevalenza grezzo di tutte le epilessie (attive e non attive) à risultato di 3,21/1000; la prevalenza delle sole forme attive era di 2,71/1000. Su 27 casi di epilessia attiva, 16 erano affetti da crisi generalizzate tonico-cloniche, 4 da assenze, 4 da crisi parziali complesse. Tutti tranne due pazienti erano in trattamento con farmaci antiepilettici, la gran parte con fenobarbital. Il nostro tasso di prevalenza è inferiore a quelli riportati dalla maggior parte degli autori, ma molto vicino ai valori riscontrati in altri comuni siciliani.

     

Prevalence and characteristics of epilepsy in the Aeolian islands

PURPOSE: To estimate the prevalence and define the clinical characteristics of epileptic disorders in the 13,431 residents of the Sicilian Aeolian archipelago, on June 1, 1999. METHODS: All established or suspected cases were identified by the neurologists of our working group from available medical information sources. Possible epilepsy cases were then evaluated by the epileptologists by using a standardized questionnaire. The patients were further reviewed by the whole research team to confirm the clinical diagnosis. For a more detailed syndromic definition, some patients underwent EEG or neuroradiologic investigations or both. RESULTS: The crude point prevalence rate of active epilepsy was 3.13 (95% confidence interval, 2.2-4.2). The prevalence rate age-adjusted to the 2001 Italian population was 3.01. Females had a slightly higher prevalence rate than did males. The highest age-specific prevalence was found in patients aged 5 to 14 years (5.05) and in those aged 65 to 74 years (5.41). Partial seizures with or without secondary generalization were more common (61.7%) than were generalized seizures. Eighty-three percent of cases had symptomatic or cryptogenic localization-related epilepsies, and 8.5% had idiopathic (generalized or partial) epilepsies. Epilepsy was unclassified in 8.5% of cases. CONCLUSIONS: The prevalence of active epilepsy in the Aeolian islands is lower than that in other developed areas, including northern Italy, but is similar to that in Sicily. Partial seizures were the most common type, and localization-related symptomatic epilepsies were the largest syndromic category.     

Prevalence, knowledge, attitude, and practice of epilepsy in Kerala, South India

PURPOSE: To ascertain the prevalence and pattern of epilepsy and to characterize and quantify knowledge, attitude, and practice (KAP) toward epilepsy among the people of the state of Kerala, which is distinguished from the rest of India by a high level of literacy and health awareness of its population. METHODS: We conducted a door-to-door survey covering the entire population of 238,102 people residing in 43,681 households in a semiurban area of central Kerala. The screening questionnaire administered by medical social workers had a sensitivity of 100% for identifying persons with epilepsy. Neurologists examined all the individuals suspected of having epilepsy. We evaluated KAP toward epilepsy among 1,118 subjects (439 males and 679 females; mean age, 33.3 years; age range, 15-85 years) from households without epilepsy in the study area. RESULTS: Through a three-phased survey, we ascertained 1,175 cases (616 males and 559 females) with active epilepsy, providing a crude point prevalence ratio of 4.9 cases per 1,000 people and an age-adjusted prevalence ratio of 4.7 cases per 1,000 population. The highest age-specific prevalence rate of 6.5 per 1,000 occurred in the 10- to 19-year-old age group. Sex-specific prevalence rates did not significantly differ. The proportion of generalized and localization-related epilepsies was 58.8% and 30.6%, respectively. Ninety-nine percent of the KAP respondents had read or heard about epilepsy. Thirty-one percent and 27% thought epilepsy was a hereditary disorder and a form of insanity, respectively. About 40% of the respondents felt that individuals with epilepsy could not be properly educated or employed. Eleven percent would object to their children having contact with epileptic children. CONCLUSIONS: The prevalence and pattern of epilepsy in central Kerala, South India, do not differ from that of developed countries. Although the awareness of epilepsy among the people of Kerala was comparable to that of developed countries, the attitudes were much more negative. The need for educating the people of Kerala on epilepsy and for incorporating an adequate knowledge of epilepsy in the school curricula cannot be overemphasized.     

Prevalence of Epilepsy in Rochester, Minnesota: 1940–1980

The prevalence of epilepsy in Rochester, Minnesota has been determined for a specific date in each of 5 decennial census years. Individuals with a diagnosis of epilepsy (recurrent unprovoked seizures) who were known to have experienced a seizure or who had received antiepileptic medication in the preceding 5 years were considered active prevalence cases. By this definition, the age-adjusted prevalence per 1,000 population, increased steadily from 2.7 in 1940 to 6.8 in 1980. At each of five prevalence dates, for all prevalence cases, 60% had epilepsy manifest by partial seizures, and 75% had no known etiology. Prevalence was higher for males than females for all except the last prevalence day. After 1950, prevalence tended to increase with advancing age and was highest in the oldest age groups. On the average, the 1980 prevalence cases had epilepsy less than 10 years and greater than 50% had their first diagnosis in the first 20 years of life.     

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.     

A prospective study of smoking,caffeine, and alcohol as risk factors for seizures or epilepsy in young adult women: Data from the Nurses’ Health Study II

Purpose: Seizures and epilepsy are associated with significant disability and substantial treatment costs, yet little is known about primary prevention. We prospectively examined the association of cigarette smoking, caffeine use, and alcohol intake with risk of seizure or epilepsy among women, aged 25–42 years, in the Nurses’ Health Study II. Methods: Participants provided dietary and cigarette smoking information on multiple questionnaires beginning in 1989. Among 116,363 women at‐risk for incident seizure or epilepsy, we confirmed 95 cases of seizure and 151 cases of epilepsy occurring from 1989–2005 using information from a detailed supplementary questionnaire and medical records. Multivariable‐adjusted relative risks (RRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression. Results: Compared with never smoking, current cigarette smoking was associated with an increased risk of seizure (RR 2.60, 95% CI 1.53–4.42), after adjustment for stroke and other potential confounding factors. Past smoking was not associated with risk of seizure, but was associated with modestly increased risk of epilepsy (RR 1.46, 95% CI 1.01–2.12). Long‐term caffeine and moderate alcohol intake were not associated with seizure or epilepsy. Discussion: Cigarette smoking may be associated with increased risk of seizure. More prospective studies are needed to investigate potential factors to ultimately prevent the development of seizures or epilepsy.     

Prevalence and Pattern of Epilepsy (Lath/Mirgi/Laran) in Rural Kashmir, India

The rural population of 63,645 living in the mountainous Kuthar Valley of South Kashmir, Northwest India was surveyed to determine the prevalence of major neurologic disorders, including epilepsy (called Lath/Mirgi/Laran in the local language). The survey was done according to a World Health Organization protocol (1981). House-to-house screening was done by Anganwadi workers to identify people with possible epilepsy. The screening questionnaire was translated into local vernacular. Persons who had some indication of a history of seizures or other neurologic disease were subsequently examined by a neurologic team. The diagnostic criteria of Hauser and Kurland (1975) were used to define cases of active epilepsy and seizure classification (ILAE, 1981) was done only with clinical data. One hundred fifty-seven cases of active epilepsy were detected, giving a crude prevalence rate of 2.47/1,000 general population. In those aged less than 14 years, prevalence was 3.18/1,000. Ninety-five (60.5%) of all cases were male; 91% of active epilepsy cases had onset of seizures before age 30 years. Mean age of onset in males was 5.3 years, and in females it was 7.1 years. Mean duration of seizures was 6 years; 78.9% cases had generalized seizures, 74.5% cases were receiving no specific treatment, 99.4% cases were born of home delivery, and 8.9% cases had a positive family history of seizures. Mental retardation was the most common associated abnormality in 22.9% of cases.     

Prevalence and risk factors of epilepsy among school children in Kayseri City Center,an urban area in Central Anatolia,Turkey

PurposeTo investigate the prevalence of epilepsy in schoolchildren aged 7–17 in the province of Kayseri together with the accompanying risk factors.MethodsTen thousand individuals selected using the “stratified cluster sampling method” from a total population of 259,428 students within the borders of Kayseri city center constituted the study sample. A questionnaire was prepared in line with the epidemiological studies protocol recommended by the International Epilepsy Union Epidemiology and Prognosis Committee in 1993. Data were analyzed on IBM SPSS Statistics 20. Significance was set at p < 0.05.ResultsOf the 15,000 questionnaires distributed, 72% (n = 10,742) were returned fully completed. Eighty-three students had been or were still being monitored with a diagnosis of epilepsy. The raw prevalence of epilepsy was 6/1000 in females, 9/1000 in males and 8/1000 in both groups together. Prevalence of active epilepsy was 4/1000 in females, 7/1000 in males and 6/1000 in both groups together. Premature birth increased the risk of epilepsy 2.6 times, and average and poor family income levels increased the risk of epilepsy 3.3 and 1.6 times, respectively. A history of febrile convulsion increased the risk of epilepsy 15.1 times.ConclusionThe prevalence of epilepsy in the 7–17 age group in Kayseri is closer to that in developed rather than developing countries. We conclude that the risk factors for epilepsy, and particularly febrile convulsion, and the true prevalence rates need to be determined through studies involving wide socioeconomic strata.     

Prevalence and Incidence of Epilepsy in Ulanga, a Rural Tanzanian District: A Community-Based Study

Summary: A random cluster sample survey of approximately 18,000 people in 11 villages was performed in Ulanga, a Tanzanian district with a population of approximately 139,000 people. Well-instructed fourth-year medical students and neurologic and psychiatry nurses identified persons with epilepsy using a screening questionnaire and sent them to a neurologist for detailed evaluation. Identified were 207 subjects (88 male, 119 female) with epilepsy; of these, 185 (89.4%) (80 male, 105 female) had active epilepsy. The prevalence of active epilepsy was 10.2 in 1,000. Prevalence among villages varied, ranging from 5.1 to 37.1 in 1,000 (age-adjusted 5.8-37.0). In a 10-year period (1979–1988) 122 subjects living in the 11 villages developed epilepsy, with an annual incidence of 73.3 in 100,000. Generalized tonic-clonic seizures (GTCS) accounted for 58% and partial seizures accounted for 31.9%, whereas in 10.1% seizures were unclassifiable. Of the partial seizures, secondarily generalized seizures were the most common. Possible etiologic or associated factors were identifiable in only 25.3% of cases. Febrile convulsions were associated in 13.4 of cases. Other associated factors included unspecified encephalitis (4.7%), cerebral malaria (1.9%), birth injury (1.4%), and other (3%). In 38% of the cases, there was a positive family history of epilepsy.     

Prevalence of active epilepsy and health-related quality of life among adults with self-reported epilepsy in California: California Health Interview Survey, 2003

PURPOSE: To examine the prevalence of self-reported epilepsy and active epilepsy, associated burden of impaired health-related quality of life, risk factors, and access to care in adults with self-reported epilepsy, and those classified as having active epilepsy with and without recent seizures. METHODS: We analyzed data from adults aged >or=18 years (n = 41,494) who participated in the 2003 California Health Interview Survey (CHIS). RESULTS: In California, 1.2% of adults reported ever being told they had epilepsy or seizure disorder, and 0.7% were classified as having active epilepsy. About three-fourths of adults with active epilepsy with recent seizures reported fair or poor health status. Adults with active epilepsy with recent seizures reported almost two weeks of poor physical or mental health and activity limitation days compared with two to 4 days per month in those without epilepsy. Among adults with active epilepsy and recent seizures, about one-quarter reported not taking any medicine to control their seizure disorder or epilepsy. About one-third reported physical disability/unable to work compared to a small proportion of the general population. The majority of adults with active epilepsy reported having a regular source of medical care. CONCLUSION: Our findings highlight the burden of epilepsy among adults in California. CHIS serves as a model demonstrating the value of including questions about epilepsy on public health surveillance systems to ascertain the burden of the disorder and to guide intervention research and public policy to improve HRQOL in people with epilepsy.     

Prevalence, characteristics and comorbidities of anxiety disorders in France: Results from the “Mental Health in General Population” Survey (MHGP)

Purpose

Only a few European countries have carried out large, community-based, national surveys about psychiatric morbidity. Here is presented the first national French survey, aiming to estimate the prevalence of anxiety disorders and associated comorbidities according to sociodemographic characteristics.

Materials and methods

The Mental Health in General Population (MHGP) database is derived from a representative national survey of the French adult population (n = 36,105), conducted between 1999 and 2003. Data collection was done using an anonymous face-to-face interview. The presence of anxiety disorders (generalized anxiety disorder, panic disorder, agoraphobia, social phobia and post-traumatic stress disorder) was assessed using the Mini International Neuropsychiatric Interview.

Results

The overall prevalence of anxiety disorders was estimated to be 21.6%, generalized anxiety disorder being the most prevalent one (12.8%). Women, young people, and people earning low income were identified as the more at risk. Major depressive episode, alcohol abuse and drug addiction frequently co-occur with anxiety disorders (28.3, 4.4 and 2.8% respectively).

Conclusion

The MHGP study showed that anxiety disorders are highly prevalent in France with a high frequency of comorbidities. Our results highlight the need for considering anxiety disorders as a public health priority in France as well as in other European countries.     

抽动障碍临床、24小时脑电监测和SPECT的研究

目的探讨抽动－秽语综合征（ＴＳ）和慢性运动性抽动障碍（ＣＭＴＤ）的关系及两者脑电图、局部脑血流（ｒＣＢＦ）的异常。方法对３８例ＴＳ和２５例ＣＭＴ进行临床症状和２４小时脑电监测（ＡＥＥＧ）及部分患儿用单光子发射计算机断层扫描（ＳＰＥＣＴ）观察ｒＣＢＦ的变化。结果ＴＳ的临床症状较ＣＭＴＤ严重，两者ＡＥＥＧ异常率分别为５０％和５２％，均以额区明显，５例有痫样放电。ＴＳ和ＣＭＴＤ的ｒＣＢＦ异常呈降低或增加改变，波及范围广泛，与ＡＥＥＧ异常部位无一致性。结论ＣＭＴＤ是ＴＳ的临床表型，两者的脑电图和ｒＣＢＦ异常与癫痫相似，提示与癫痫有一定关系。     

Prevalence of childhood epilepsy and distribution of epileptic syndromes: a population-based survey in Okayama, Japan

Summary:  Methods: Information on patients younger than 13 years with active epilepsy was collected from medical records. Patients diagnosed with epilepsy according to clinical and EEG findings were put on the list even if those patients had had a single seizure or seizures occurring during febrile episodes.
Results: In total, 2,220 cases were identified from a background population of 250,997. The prevalence rate was 8.8 per 1,000. If we exclude patients who had experienced a single seizure or seizures occurring during febrile episodes to compare our results with previous reports, the prevalence rate was 5.3 per 1,000. Of the 2,220 cases, 2,030 (91.4%) were classified into three major categories by ILAE classification. They consisted of 1,556 (76.7%) with localization-related epilepsy, 453 (22.3%) with generalized epilepsy, and 21 (1.0%) with undetermined epilepsy. Of the 2,030 cases, 309 (15.2%) were classified into epileptic syndrome categories, and 84.8% of the total were nonspecific types of epilepsy.
Conclusions: The prevalence rate of childhood epilepsy was distributed from 5.3 to 8.8 per 1,000. The appearance rate of various types of epileptic syndromes was low. Most cases could not be classified into the detailed categories of the International Classification (ILAE, 1989).     

Use of complementary therapy among internal medical inpatients. Prevalence, costs and association with mental disorders and physical diseases

OBJECTIVES: The aims of this study were to determine the prevalence of complementary therapy/medicine (CT) use among internal medical inpatients. Furthermore, to examine the association between the use of CT and (a) mental disorders, (b) physical diseases, and (c) use of health care. METHODS: A total of 294 consecutive medical inpatients were interviewed about their use of CT. A stratified subsample of 157 people was assessed for current mental disorders, using an extensive, standardized, semistructured interview (Schedules for Clinical Assessment in Neuropsychiatry version 2.1 [SCAN]). Health care use was assessed by use of national patient registers. RESULTS: There were 22.5% CT utilizers. More females than males used CT (P=.033). CT utilization was not associated with age, mental disorders, life-threatening or chronic physical diseases or with use of health care services. CONCLUSIONS: The use of CT is common among medical inpatients. More research is needed to understand why a significant proportion of patients seeks CT.     

Prevalence of interictal psychiatric disorders in patients with refractory temporal and extratemporal lobe epilepsy in Spain. A comparative study

We aim to investigate whether temporal origin of epilepsy increases the risk of developing a psychiatric disorder and more specifically a major depressive disorder. The lack of standardized diagnostic instruments and the methodologic differences between studies highlight the fact that this issue warrants further, systematic, study. Three‐hundred eight patients with complex partial seizures were classified according to temporal or extratemporal origin, following the Commission on Classification and Terminology of the International League Against Epilepsy (ILAE), 1989 localization‐related concept. All patients were assessed using the Structured Interview for DSM‐IV axis I psychiatric disorders (SCID‐I). Lifetime and previous‐year prevalence of psychiatric disorders were compared in temporal and extratemporal subgroups, using multivariate analysis. Previous‐year major depression was significantly associated with temporal lobe origin. Our results do not support the hypothesis that patients with temporal lobe epilepsy (TLE) have more psychiatric illness in general, although they do suggest a specific connection between TLE and major depression.     

Prevalence, diagnosis, and pharmacological treatment of mood disorders in HIV disease.

Human immunodeficiency virus seropositive (HIV+) individuals are at a heightened risk of developing mood disorders and related syndromes. Over the past several decades, increased rates of mood disorders, including depression and mania, have been reported among HIV+ individuals. Because alterations in mood may impact on quality of life and perhaps reduce adherence to antiretroviral treatment regimens that are critical for preventing disease progression, recognition and effective treatment of mood disorders is essential. There are accumulating data showing that antidepressants and mood stabilizers, as well as other novel agents, might benefit HIV+ individuals suffering from a concomitant mood disturbance. This review highlights the relevant studies that have examined prevalence rates of mood disorders in HIV+ individuals, characteristics of HIV disease that influence the diagnosis and psychopharmacologic treatment of mood disorders, including complex interactions with antiretroviral medications, as well as the available evidence regarding the efficacy of agents used to treat depression and mania in the context of HIV disease.