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Seizure Nov 2021Psychogenic nonepileptic seizures resemble epileptic seizures but lack the physiological basis of epileptic seizures. We conducted a systematic review to explore whether... (Review)
Review
Psychogenic nonepileptic seizures resemble epileptic seizures but lack the physiological basis of epileptic seizures. We conducted a systematic review to explore whether childhood abuse is a risk factor for subsequent development of PNES. We reviewed only papers with an epilepsy control group, which employed strict criteria for diagnosis of epilepsy and well-validated tools for assessing abuse history. Odds ratios (ORs) for the different categories of childhood abuse and for childhood abuse as a whole were calculated where not previously available, and pooled ORs were calculated where suitable. In papers where OR could not be calculated data are presented as p values. Most Odds Ratios fell between 1.8 and 5.2 with relatively narrow confidence intervals. In 14 out of 18 calculations, 95% confidence intervals did not cross 1. This suggests that the chance of reporting abuse is higher in people with PNES than those with epilepsy and may be a causative factor in developing PNES. Several limitations of the data and directions for future study are discussed.
Topics: Electroencephalography; Epilepsy; Humans; Mental Disorders; Seizures
PubMed: 34555802
DOI: 10.1016/j.seizure.2021.09.009 -
Epilepsia Apr 2022Global action for epilepsy requires information on the cost of epilepsy, which is currently unknown for most countries and regions of the world. To address this...
OBJECTIVE
Global action for epilepsy requires information on the cost of epilepsy, which is currently unknown for most countries and regions of the world. To address this knowledge gap, the International League Against Epilepsy Commission on Epidemiology formed the Global Cost of Epilepsy Task Force.
METHODS
We completed a systematic search of the epilepsy cost-of-illness literature and identified studies that provided a comprehensive set of direct health care and/or indirect costs, followed standard methods of case identification and cost estimation, and used data on a representative population or subpopulation of people with epilepsy. Country-specific costs per person with epilepsy were extracted and adjusted to generate an average cost per person in 2019 US dollars. For countries with no cost data, estimates were imputed based on average costs per person of similar income countries with data. Per person costs for each country were then applied to data on the prevalence of epilepsy from the Global Burden of Disease collaboration adjusted for the treatment gap.
RESULTS
One hundred one cost-of-illness studies were included in the direct health care cost database, 74 from North America or Western Europe. Thirteen studies were used in the indirect cost database, eight from North America or Western Europe. The average annual cost per person with epilepsy in 2019 ranged from $204 in low-income countries to $11 432 in high-income countries based on this highly skewed database. The total cost of epilepsy, applying per person costs to the estimated 52.51 million people in the world with epilepsy and adjusting for the treatment gap, was $119.27 billion.
SIGNIFICANCE
Based on a summary and extrapolations of this limited database, the global cost of epilepsy is substantial and highly concentrated in countries with well-developed health care systems, higher wages and income, limited treatment gaps, and a relatively small percentage of the epilepsy population.
Topics: Cost of Illness; Epilepsy; Health Care Costs; Humans; Income; Poverty; Prevalence
PubMed: 35195894
DOI: 10.1111/epi.17165 -
Epilepsy & Behavior : E&B Jul 2016Epilepsy is a neurological condition that is particularly common in people with intellectual disability (ID). The care for people with both epilepsy and ID is often... (Review)
Review
Epilepsy is a neurological condition that is particularly common in people with intellectual disability (ID). The care for people with both epilepsy and ID is often complicated by the presence of neuropsychiatric disorders, defined as psychiatric symptoms, psychiatric disorders, and behavioral problems. The aim of this study was to investigate associations between epilepsy or epilepsy-related factors and neuropsychiatric comorbidities in patients with ID and between ID and neuropsychiatric comorbidities in patients with epilepsy. We performed a systematic review of the literature, published between January 1995 and January 2015 and retrieved from PubMed/Medline, PsycINFO, and ERIC and assessed the risk of bias using the SIGN-50 methodology. Forty-two studies were identified, fifteen of which were assessed as having a low or acceptable risk-of-bias evaluation. Neuropsychiatric comorbidities were examined in relation to epilepsy in nine studies; in relation to epilepsy-related factors, such as seizure activity, seizure type, and medication in four studies; and in relation to the presence and degree of ID in five studies. We conclude that the presence of epilepsy only was not a clear determinant of neuropsychiatric comorbidity in patients with ID, although a tendency towards negative mood symptoms was identified. Epilepsy-related factors indicating a more severe form of epilepsy were associated with neuropsychiatric comorbidity as was the presence of ID as compared to those without ID in patients with epilepsy, although this should be validated in future research. A large proportion of the studies in this area is associated with a substantial risk of bias. There is a need for high quality studies using standardized methods to enable clear conclusions to be drawn that might assist in improving the quality of care for this population.
Topics: Adult; Comorbidity; Epilepsy; Female; Humans; Intellectual Disability; Male; Qualitative Research; Seizures
PubMed: 27206231
DOI: 10.1016/j.yebeh.2016.04.018 -
Neurology Sep 2011To estimate the pooled incidence of epilepsy from published studies and investigate sources of heterogeneity in the estimates. (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVE
To estimate the pooled incidence of epilepsy from published studies and investigate sources of heterogeneity in the estimates.
METHODS
We searched online databases for incidence studies and used meta-analytic methods to analyze the data.
RESULTS
Thirty-three articles met the entry criteria. The median incidence of epilepsy was 50.4/100,000/year (interquartile range [IQR] 33.6-75.6), while it was 45.0 (IQR 30.3-66.7) for high-income countries and 81.7 (IQR 28.0-239.5) for low- and middle-income countries. Population-based studies had higher incidence estimates than hospital-based studies (p = 0.02) while retrospective study design was associated with lower estimates than prospective studies (p = 0.04).
CONCLUSION
We provide data that could potentially be used to assess the burden and analyze the trends in incidence of epilepsy. Our results support the need for large population-based incidence studies of epilepsy.
Topics: Databases, Factual; Epilepsy; Humans; Incidence
PubMed: 21893672
DOI: 10.1212/WNL.0b013e31822cfc90 -
Neurology Nov 2014We systematically synthesized the epidemiologic literature on mortality in patients with epilepsy (PWE) by epilepsy-related clinical characteristics with an aggregate... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
We systematically synthesized the epidemiologic literature on mortality in patients with epilepsy (PWE) by epilepsy-related clinical characteristics with an aggregate data meta-analysis.
METHODS
We systematically searched 15 electronic databases, browsed reference lists of pertinent publications, and contacted authors in the field. We were interested in cohort studies that reported the relative risk of death in representative epilepsy populations relative to the general population, with exclusion of highly selected subpopulations of PWE, such as patients with intellectual disabilities or epilepsy surgery series. Search, data abstraction, and study quality assessment with the Newcastle-Ottawa Scale were all performed in duplicate.
RESULTS
Pooled mortality was threefold (relative risk 3.33, 95% confidence interval 2.83-3.92) in 38 epilepsy cohorts including 165,879 patients (79.6% from Nordic countries). Among incident cases, idiopathic epilepsies did not associate with materially increased mortality (1.29, 0.75-2.20; 4 studies), whereas mortality was almost twofold in cryptogenic epilepsy (1.75, 1.20-2.54; 5 studies), and highly elevated in patients with symptomatic epilepsy (4.73, 3.27-6.83; 12 studies) and especially in epilepsies due to congenital or developmental causes (10.3, 4.03-26.2; 2 studies). Newly diagnosed patients who attained seizure freedom did not have elevated mortality (0.97, 0.73-1.30; 2 studies).
CONCLUSION
Excess mortality was highly related to the etiology of epilepsy in all ages. In adult patients without neuroradiologic abnormalities or other identifiable cause of epilepsy, only patients with cryptogenic epilepsy exhibited excess mortality. Risk of premature death was lowest in idiopathic epilepsy and in PWE who attained seizure freedom.
Topics: Cause of Death; Cohort Studies; Epilepsy; Humans; Risk Factors
PubMed: 25339211
DOI: 10.1212/WNL.0000000000001005 -
Epilepsy & Behavior : E&B Sep 2019We aimed to review the literature to determine the incidence and prevalence of autism in epilepsy and epilepsy in autism, conditions that are often comorbid.
OBJECTIVE
We aimed to review the literature to determine the incidence and prevalence of autism in epilepsy and epilepsy in autism, conditions that are often comorbid.
METHODS
We adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards, and the protocol was registered with PROSPERO. MEDLINE, Embase, PsycINFO, and the Cochrane Database of Systematic Reviews were searched from inception until July 4, 2016. Studies were included if they reported an incidence or prevalence of autism in epilepsy or epilepsy in autism. These estimates were described using mean, standard deviation, median, and interquartile range.
RESULTS
Seventy-four studies reporting on 283,549 patients were included. The median overall period prevalence of epilepsy in people with autism was 12.1% while the median overall period prevalence of autism in people with epilepsy was 9.0% when including all population types. When excluding studies that investigated patients with syndromic epilepsy or developmental delay, the median overall period prevalence of epilepsy in people with autism was 11.2% while the median overall period prevalence of autism in people with epilepsy was 8.1%. We observed trends for sex as the prevalence of autism in epilepsy was higher in males while the prevalence of epilepsy in autism was higher in females. It is important to interpret these estimates with caution, as there was significant heterogeneity between studies. Meta-regression found no association between study quality and prevalence or incidence estimates (all p-values > 0.05).
CONCLUSIONS
The period prevalence of epilepsy in people with autism, and vice versa, was consistently higher than previously reported estimates of the occurrence of these disorders in the general population. These findings highlight the importance of screening for autism in people who have epilepsy and epilepsy in people who have autism and may help shed light on shared pathogenesis between these conditions.
Topics: Autistic Disorder; Child; Comorbidity; Databases, Factual; Developmental Disabilities; Epilepsy; Female; Humans; Incidence; Male; Prevalence
PubMed: 31398688
DOI: 10.1016/j.yebeh.2019.07.037 -
Seizure Aug 2018This systematic review aims to contrast levels, manifestations and associations of depression in patients with psychogenic non-epileptic seizures (PNES) and those with... (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVES
This systematic review aims to contrast levels, manifestations and associations of depression in patients with psychogenic non-epileptic seizures (PNES) and those with epilepsy.
METHODS
ScienceDirect and Web of Science were searched for primary research reports describing quantitative studies involving separate epilepsy and PNES samples (age 16+) and using a validated measure of depression.
RESULTS
While 34 studies were identified, most were of low quality and had small sample sizes. Studies consistently found higher levels of self-reported depression in the PNES than epilepsy groups, with a meta-analysis demonstrating a significant difference between the groups. Although patients with PNES were also more likely to have a clinical diagnosis of depression than those with epilepsy, the difference between the groups was less pronounced in studies based on such diagnoses rather than self-report. Patients with PNES were more likely to report physical symptoms of depression than those with epilepsy. Interpersonal factors explained more variation in depression levels in patients with PNES than those with epilepsy, for whom illness related factors were more influential, but in both patient groups, depression had a significant impact on health related quality of life.
CONCLUSIONS
This systematic review demonstrates a higher prevalence of depression in patients with PNES compared to patients with epilepsy and suggests differences in the expression and possible causes of depression between these groups.
Topics: Comorbidity; Depression; Epilepsy; Humans; Seizures; Somatoform Disorders
PubMed: 29906707
DOI: 10.1016/j.seizure.2018.05.014 -
PloS One 2024Juvenile Myoclonic Epilepsy (JME) is a prevalent form of epileptic disorder, specifically categorized within the realm of Genetic Generalized Epilepsy (GGE). Its... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Juvenile Myoclonic Epilepsy (JME) is a prevalent form of epileptic disorder, specifically categorized within the realm of Genetic Generalized Epilepsy (GGE). Its hallmark features encompass unprovoked bilateral myoclonus and tonic-clonic seizures that manifest during adolescence. While most JME patients respond favorably to anti-seizure medication (ASM), a subset experiences refractory JME, a condition where seizures persist despite rigorous ASM treatment, often termed "Drug-Resistant Epilepsy" (DRE). This systematic review and meta-analysis aims to determine the prevalence of refractory JME, and further to identify socio-demographic, electrophysiological and clinical risk factors associated with its occurrence. Pinpointing these factors is crucial as it offers the potential to predict ASM responsiveness, enabling early interventions and tailored care strategies for patients.
MATERIAL AND METHODS
The systematic review and meta-analysis followed the Cochrane Handbook and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The study evaluated outcomes post ASM treatment in JME cohorts by searching papers published up to September 2023 in PubMed/MEDLINE, Scopus, and Google Scholar databases. Predefined inclusion criteria were met by 25 eligible studies, forming the basis for analysis.
RESULTS
A total of 22 potential risk factors for refractory JME were documented. Notably, robust risk factors for treatment resistance included Psychiatric Disorder (Odds Ratio (OR), 3.42 [2.54, 4.61] (95% Confidence Inverval (Cl)), Febrile Seizures (OR, 1.83 [1.14, 2.96] (95% Cl)), Alcohol Consumption (OR, 16.86 [1.94, 146.88] (95%Cl)), Aura (OR, 2.15 [1.04, 4.47] (95%Cl)), childhood absence epilepsy (CAE) evolving into JME (OR, 4.54 [1.61, 12.78] (95%CI)), occurrence of three seizure types (OR, 2.96 [1.96, 4.46] (95%CI)), and Focal EEG abnormalities (OR, 1.85 [1.13, 3.01] (95%Cl)). In addition, there were some non-significant risk factors for DRE because of noticeable heterogeneity.
CONCLUSION
In aggregate, over 36% of JME patients demonstrated drug resistance, with seven significant risk factors closely linked to this refractoriness. The interplay between these factors and whether they denote treatment non-response or heightened disease burden remains an open question and more studies would be required to fully examine their influence.
Topics: Adolescent; Humans; Child; Myoclonic Epilepsy, Juvenile; Epilepsy, Absence; Seizures; Drug Resistant Epilepsy; Risk Factors; Electroencephalography; Anticonvulsants
PubMed: 38593118
DOI: 10.1371/journal.pone.0300930 -
Neurosurgical Review Oct 2023Epilepsy is a common condition that affects approximately 1% of the world's population, with about one-third being refractory epilepsy. Temporal lobe epilepsy is the... (Meta-Analysis)
Meta-Analysis Review
Epilepsy is a common condition that affects approximately 1% of the world's population, with about one-third being refractory epilepsy. Temporal lobe epilepsy is the most common type of drug-resistant epilepsy, and laser interstitial thermal therapy (LITT) is an innovative treatment. In this systematic review and meta-analysis, we aimed to summarize the current evidence on outcomes after LITT, including seizure freedom rate, complication rate, and neurocognitive outcome. PubMed and OVID Medline search engines were systematically searched for all indexed publications in the English language up to July15, 2023. The search was limited to human studies. Proportions and 95% confidence interval (CI) values were calculated for seizure, neurocognitive outcome, and complication rate. A total of 836 patients were included. Overall seizure outcomes, regardless of the pathology, included Engel I outcome in 56% (95% CI, 52.4-59.5%), Engel II outcome in 19.2% (95% CI, 15.4-23.6%), Engel III outcome in 17.3% (95% CI, 13.5-21.8%), and Engel IV outcome in 10.5% (95% CI 6.3-17%) of the patients. The overall decline in verbal and visual memory regardless of laterality was 24.2 (95% CI 8.6-52%) and 25.2% (8.3-55.8%). For naming, the decline was 13.4% (6.6-25.4%). The results of the pooled analysis in comparison with available data in the literature showed that seizure outcomes after LITT were slightly inferior to published data after temporal lobectomy. Data on cognitive outcomes after LITT are scarce and heterogeneous.
Topics: Humans; Epilepsy, Temporal Lobe; Treatment Outcome; Laser Therapy; Seizures; Drug Resistant Epilepsy; Epilepsy; Magnetic Resonance Imaging; Lasers
PubMed: 37779130
DOI: 10.1007/s10143-023-02164-4 -
Seizure Oct 2021The majority of patients with epilepsy in resource-poor countries never receive proper treatment, and those who are started on anti-seizure medications quickly... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The majority of patients with epilepsy in resource-poor countries never receive proper treatment, and those who are started on anti-seizure medications quickly discontinue them. Medication noncompliance is extremely common, with estimates ranging from 26 to 79 percent. Non-adherence to antiseizure medications is associated with poor seizure control, increased morbidity, increased hospitalization time, poor quality of life, increased health care costs, and increased mortality in adults.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 guideline was used for this systematic review and meta-analysis. The databases Pub Med, Cochrane Library, Scopus Online, and Google Scholar were all searched. STATA™ version 11 software was used for the meta-analysis. The I test and Egger's tests were used to assess heterogeneity and publication bias. The random-effects method was used to estimate the pooled adherence level with a 95 percent confidence interval.
RESULTS
This meta-analysis included twelve Ethiopian studies involving a total of 3416 epileptic patients. The national pooled prevalence of antiseizure medication non-adherence was 41.96%. Patients who paid for their medications, took them for more than a year, had co-morbidity, and felt stigmatized were more likely to be non-adherent than their counterparts.
CONCLUSION
According to this systematic review and meta-analysis, more than two out of every five epileptic patients did not take their antiseizure medications as prescribed. Clinicians must educate epileptic patients about the importance of medication adherence.
SYSTEMATIC REVIEW REGISTRATION
The review has been registered on an International Prospective Register of Systematic Review with registration number CRD42019142905.
Topics: Adult; Epilepsy; Ethiopia; Humans; Medication Adherence; Prevalence; Quality of Life
PubMed: 34340192
DOI: 10.1016/j.seizure.2021.07.024