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Papers by Athanasios Gaitatzis
Seizure-european Journal of Epilepsy, Apr 1, 2023
Brain, 2004
Epilepsy carries a risk of premature mortality, but little is known about life expectancy in peop... more Epilepsy carries a risk of premature mortality, but little is known about life expectancy in people with the condition. The UK National General Practice Study of Epilepsy is a prospective, population-based study of people with newly diagnosed epilepsy. A cohort of 564 patients with definite epilepsy has been followed for nearly 15 years and there have been 177 deaths. These data have been used to estimate life expectancy of people in this cohort by employing a parametric survival model based on the Weibull distribution. Life expectancy in people with epilepsy was estimated as a function of age at, and time from, diagnosis according to two broad aetiological groups. These estimates were then compared with life expectancy in people of the same age and sex in the general population. Reduction in life expectancy can be up to 2 years for people with a diagnosis of idiopathic/cryptogenic epilepsy, and the reduction can be up to 10 years in people with symptomatic epilepsy. Reductions in life expectancy are highest at the time of diagnosis and diminish with time. Our model provides broad estimates, but it appears that the higher mortality rates in people with newly diagnosed epilepsy translate into decreased life expectancy.
Journal of Neurology, 2012
− Epilepsy carries a significant mortality that, on average, is 2-3 times higher than in the gene... more − Epilepsy carries a significant mortality that, on average, is 2-3 times higher than in the general population. Causes of death in epilepsy are presented. Mortality in epilepsy is assessed by means of particular parameters; the mortality rate, the standardised mortality ratio, and the proportional mortal-ity rate. An overview of their use and significance is given here. A number of epidemiological studies have assessed mortality in people with epilepsy in the general population and in populations from hospitals, out-patient departments, and epilepsy centres. Methodological issues concerning the study of mortality in these populations are discussed. Epidemiological data are presented to describe the overall and cause-specific mortality, as well as determinants of mortality in epilepsy, such as epilepsy and seizure types, time from diagnosis, and age. It has become clear from population studies with long-term follow-up that epilepsy has a higher mortality in the first few years after...
Paroxysmal Cerebral Disorder
Epilepsia, 2004
To describe the epidemiology of somatic and psychiatric conditions in adults with epilepsy in the... more To describe the epidemiology of somatic and psychiatric conditions in adults with epilepsy in the community and compare it to that of people without epilepsy. A cross-sectional population-based study extracting data from the UK General Practice Research Database for the period 1995-1998. Age- and sex-standardized prevalence rates were estimated for selected conditions and groups of conditions (categorized by ICD-9 chapters) in adults with epilepsy registered with primary care physicians. Results were compared with those in adults without epilepsy in the cohort, and prevalence ratios were calculated according to two broad age groups (16-64 and older than 64 years). Conditions common in the general population also were common in adults with epilepsy. Psychiatric disorders occurred twice as often, and the risk of somatic disorders was increased in people with epilepsy, with the exception of musculoskeletal and connective tissue disorders in older adults. The prevalence ratio of neoplasia, excluding intracranial tumors, was not increased in epilepsy. The prevalence ratio of brain tumors was particularly increased in young adults [prevalence ratio (PR), 70.7] and of meningiomas in older adults (PR, 91.9). Neurodegenerative conditions, particularly dementias and Alzheimer' disease (PR, 6.3 and 8, respectively) and Parkinson' disease (PR, 3.2), appeared more frequently in people with epilepsy. Upper gastrointestinal bleed occurred more frequently in epilepsy (PR, 4.3), as did cardio- and cerebrovascular disorders, fractures, pneumonia and chronic lung diseases, and diabetes. Eczema, osteoarthritis, and rheumatoid arthritis did not occur more frequently in epilepsy. The prevalence ratio of many common psychiatric and somatic conditions is increased in adults with epilepsy who consult a primary care physician in the U.K. These findings may have implications in the diagnosis and management of epilepsy and coexisting conditions, as well as in health care provision.
Epilepsia, 2012
A range of medical and neurologic disorders occurs more frequently in people with epilepsy than i... more A range of medical and neurologic disorders occurs more frequently in people with epilepsy than in the general population and constitutes its somatic comorbidity. Common examples include cardiac, gastrointestinal, and respiratory disorders; stroke; dementia; and migraine. Alzheimer's disease and migraine are not only more common in epilepsy but are also risk factors for the development of seizures, suggesting a bidirectional association and shared disease mechanisms. Less well-appreciated associations with epilepsy include Parkinson's disease and obstructive sleep apnea. The association between epilepsy and other conditions can be due to a variety of interacting genetic, biologic, and environmental factors. We propose an etiologic classification of com-orbidity into uncertain (coincidence or unknown), causal (cause), shared risk factors (common disease mechanisms or shared predisposing risk factors), and resultant (consequence). Co-occurrence of other conditions in a person with epilepsy can complicate diagnosis or have adverse prognostic implications. Management of these conditions may facilitate the treatment of epilepsy, as in the case of obstructive sleep apnea. The presence of somatic disorders in epilepsy is associated with increased health care needs, poorer health-related quality of life, and premature mortality. Prevention, identification, and adequate treatment of comorbid disorders in epilepsy should be an important part of epilepsy management at all levels of care.
Acta Neurologica Scandinavica, 2004
Frontal lobe dysfunction in sporadic hyperekplexia Case study and literature review Abbreviations... more Frontal lobe dysfunction in sporadic hyperekplexia Case study and literature review Abbreviations HE hyperekplexia GLRA1 glycine receptor α1 subunit gene GlyR glycine receptor SPET single photon emission tomography HMPAO hexamethylpropylene-amine-oxime (hexa-metazime) MRSI magnetic resonance spectroscopic imaging NAA N-acetylaspartate EEG electroencephalogram JON
The thesis describes the epidemiology of selected somatic and psychiatric conditions in epilepsy ... more The thesis describes the epidemiology of selected somatic and psychiatric conditions in epilepsy and the health care demands of people with epilepsy, and presents broad estimates of life expectancy in people with epilepsy in the community in comparison to people without epilepsy. A cross-sectional study was conducted extracting data from the General Practice Research Database for the period 1995-1998. Psychiatric disorders occurred twice as often and the risk of groups of most somatic disorders across categories was increased in people with epilepsy. The risk of neoplasia excluding intracranial tumours was not increased in epilepsy. The risk of brain tumours, meningiomas and neurodegenerative disorders was particularly increased. Other conditions occurring more frequently in epilepsy include upper gastrointestinal bleed, cardio- and cerebrovascular disorders, fractures, pneumonia and chronic lung diseases, and diabetes. Analysis of data from the fourth national survey of morbidity i...
Epilepsy carries a significant mortality that, on average, is 2-3 times higher than in the genera... more Epilepsy carries a significant mortality that, on average, is 2-3 times higher than in the general population. Causes of death in epilepsy are presented. Mortality in epilepsy is assessed by means of particular parameters; the mortality rate, the standardised mortality ratio, and the proportional mortality rate. An overview of their use and significance is given here. A number of epidemiological studies have assessed mortality in people with epilepsy in the general population and in populations from hospitals, out-patient departments, and epilepsy centres. Methodological issues concerning the study of mortality in these populations are discussed. Epidemiological data are presented to describe the overall and cause-specific mortality, as well as determinants of mortality in epilepsy, such as epilepsy and seizure types, time from diagnosis, and age. It has become clear from population studies with long-term follow-up that epilepsy has a higher mortality in the first few years after di...
New antiepileptic drugs (AEDs) are necessary for patients with chronic epilepsy and for improving... more New antiepileptic drugs (AEDs) are necessary for patients with chronic epilepsy and for improving upon established AEDs as first-line therapy. Tiagabine, a new AED, was introduced in the early 1990s and has a specific mechanism of action. It is licensed as an adjunctive treatment in patients with refractory partial epilepsy. It underwent an extensive development programme, and a number of controlled studies have demonstrated its efficacy in adults as well as in children. A meta-analysis of these trials suggests that tiagabine is as efficacious as other new AEDs when used for its primary indication. Studies suggest a minimum effective dose of 30 mg/day, with an optimal dose in the range of 30-56 mg/day; this may be lower in monotherapy. In long-term studies, tolerance to the antiepileptic effect of tiagabine has not been observed. The efficacy of tiagabine in patients with primary generalized seizures is limited but it may be effective in children with infantile spasms and in patients with partial seizures secondary to glial tumours. Comparative studies are necessary to determine the exact place of, tiagabine in the treatment of drug-resistant partial epilepsies and its efficacy in other epilepsies. Its effectiveness in monotherapy, as well as in special populations (such as in pregnancy and the elderly) remains to be further delineated.
Neurology, Jan 17, 2015
A 31-year-old man presented with a 3-month history of progressive dysarthria and 1 month of gradu... more A 31-year-old man presented with a 3-month history of progressive dysarthria and 1 month of gradually worsening motor seizures predominantly affecting the right face. Examination was unremarkable except for a mild spastic dysarthria and slow, alternating tongue movements, probably due to a partial opercular syndrome. Seizures captured during EEG recording showed a jacksonian march starting over the opercular aspect of the motor homunculus, 1,2 and anarthria and sialorrhea without EEG correlate (videos 1 and 2 on the Neurology ® Web site at Neurology.org and figure 1). MRI brain showed a left opercular tumor (figure 2, A and B), found to be an anaplastic astrocytoma after resection. The patient has been seizure free for 12 months after treatment with carbamazepine and resective surgery but has residual dysarthria. AUTHOR CONTRIBUTIONS Dr. Extercatte wrote the first draft of the manuscript. Dr. de Haan provided information about final diagnosis and treatment and revised the final manuscript. Dr. Gaitatzis made the initial diagnosis and drafted and revised subsequent manuscripts.
Atlas of Epilepsies, 2010
Seizure-european Journal of Epilepsy, Apr 1, 2023
Brain, 2004
Epilepsy carries a risk of premature mortality, but little is known about life expectancy in peop... more Epilepsy carries a risk of premature mortality, but little is known about life expectancy in people with the condition. The UK National General Practice Study of Epilepsy is a prospective, population-based study of people with newly diagnosed epilepsy. A cohort of 564 patients with definite epilepsy has been followed for nearly 15 years and there have been 177 deaths. These data have been used to estimate life expectancy of people in this cohort by employing a parametric survival model based on the Weibull distribution. Life expectancy in people with epilepsy was estimated as a function of age at, and time from, diagnosis according to two broad aetiological groups. These estimates were then compared with life expectancy in people of the same age and sex in the general population. Reduction in life expectancy can be up to 2 years for people with a diagnosis of idiopathic/cryptogenic epilepsy, and the reduction can be up to 10 years in people with symptomatic epilepsy. Reductions in life expectancy are highest at the time of diagnosis and diminish with time. Our model provides broad estimates, but it appears that the higher mortality rates in people with newly diagnosed epilepsy translate into decreased life expectancy.
Journal of Neurology, 2012
− Epilepsy carries a significant mortality that, on average, is 2-3 times higher than in the gene... more − Epilepsy carries a significant mortality that, on average, is 2-3 times higher than in the general population. Causes of death in epilepsy are presented. Mortality in epilepsy is assessed by means of particular parameters; the mortality rate, the standardised mortality ratio, and the proportional mortal-ity rate. An overview of their use and significance is given here. A number of epidemiological studies have assessed mortality in people with epilepsy in the general population and in populations from hospitals, out-patient departments, and epilepsy centres. Methodological issues concerning the study of mortality in these populations are discussed. Epidemiological data are presented to describe the overall and cause-specific mortality, as well as determinants of mortality in epilepsy, such as epilepsy and seizure types, time from diagnosis, and age. It has become clear from population studies with long-term follow-up that epilepsy has a higher mortality in the first few years after...
Paroxysmal Cerebral Disorder
Epilepsia, 2004
To describe the epidemiology of somatic and psychiatric conditions in adults with epilepsy in the... more To describe the epidemiology of somatic and psychiatric conditions in adults with epilepsy in the community and compare it to that of people without epilepsy. A cross-sectional population-based study extracting data from the UK General Practice Research Database for the period 1995-1998. Age- and sex-standardized prevalence rates were estimated for selected conditions and groups of conditions (categorized by ICD-9 chapters) in adults with epilepsy registered with primary care physicians. Results were compared with those in adults without epilepsy in the cohort, and prevalence ratios were calculated according to two broad age groups (16-64 and older than 64 years). Conditions common in the general population also were common in adults with epilepsy. Psychiatric disorders occurred twice as often, and the risk of somatic disorders was increased in people with epilepsy, with the exception of musculoskeletal and connective tissue disorders in older adults. The prevalence ratio of neoplasia, excluding intracranial tumors, was not increased in epilepsy. The prevalence ratio of brain tumors was particularly increased in young adults [prevalence ratio (PR), 70.7] and of meningiomas in older adults (PR, 91.9). Neurodegenerative conditions, particularly dementias and Alzheimer' disease (PR, 6.3 and 8, respectively) and Parkinson' disease (PR, 3.2), appeared more frequently in people with epilepsy. Upper gastrointestinal bleed occurred more frequently in epilepsy (PR, 4.3), as did cardio- and cerebrovascular disorders, fractures, pneumonia and chronic lung diseases, and diabetes. Eczema, osteoarthritis, and rheumatoid arthritis did not occur more frequently in epilepsy. The prevalence ratio of many common psychiatric and somatic conditions is increased in adults with epilepsy who consult a primary care physician in the U.K. These findings may have implications in the diagnosis and management of epilepsy and coexisting conditions, as well as in health care provision.
Epilepsia, 2012
A range of medical and neurologic disorders occurs more frequently in people with epilepsy than i... more A range of medical and neurologic disorders occurs more frequently in people with epilepsy than in the general population and constitutes its somatic comorbidity. Common examples include cardiac, gastrointestinal, and respiratory disorders; stroke; dementia; and migraine. Alzheimer's disease and migraine are not only more common in epilepsy but are also risk factors for the development of seizures, suggesting a bidirectional association and shared disease mechanisms. Less well-appreciated associations with epilepsy include Parkinson's disease and obstructive sleep apnea. The association between epilepsy and other conditions can be due to a variety of interacting genetic, biologic, and environmental factors. We propose an etiologic classification of com-orbidity into uncertain (coincidence or unknown), causal (cause), shared risk factors (common disease mechanisms or shared predisposing risk factors), and resultant (consequence). Co-occurrence of other conditions in a person with epilepsy can complicate diagnosis or have adverse prognostic implications. Management of these conditions may facilitate the treatment of epilepsy, as in the case of obstructive sleep apnea. The presence of somatic disorders in epilepsy is associated with increased health care needs, poorer health-related quality of life, and premature mortality. Prevention, identification, and adequate treatment of comorbid disorders in epilepsy should be an important part of epilepsy management at all levels of care.
Acta Neurologica Scandinavica, 2004
Frontal lobe dysfunction in sporadic hyperekplexia Case study and literature review Abbreviations... more Frontal lobe dysfunction in sporadic hyperekplexia Case study and literature review Abbreviations HE hyperekplexia GLRA1 glycine receptor α1 subunit gene GlyR glycine receptor SPET single photon emission tomography HMPAO hexamethylpropylene-amine-oxime (hexa-metazime) MRSI magnetic resonance spectroscopic imaging NAA N-acetylaspartate EEG electroencephalogram JON
The thesis describes the epidemiology of selected somatic and psychiatric conditions in epilepsy ... more The thesis describes the epidemiology of selected somatic and psychiatric conditions in epilepsy and the health care demands of people with epilepsy, and presents broad estimates of life expectancy in people with epilepsy in the community in comparison to people without epilepsy. A cross-sectional study was conducted extracting data from the General Practice Research Database for the period 1995-1998. Psychiatric disorders occurred twice as often and the risk of groups of most somatic disorders across categories was increased in people with epilepsy. The risk of neoplasia excluding intracranial tumours was not increased in epilepsy. The risk of brain tumours, meningiomas and neurodegenerative disorders was particularly increased. Other conditions occurring more frequently in epilepsy include upper gastrointestinal bleed, cardio- and cerebrovascular disorders, fractures, pneumonia and chronic lung diseases, and diabetes. Analysis of data from the fourth national survey of morbidity i...
Epilepsy carries a significant mortality that, on average, is 2-3 times higher than in the genera... more Epilepsy carries a significant mortality that, on average, is 2-3 times higher than in the general population. Causes of death in epilepsy are presented. Mortality in epilepsy is assessed by means of particular parameters; the mortality rate, the standardised mortality ratio, and the proportional mortality rate. An overview of their use and significance is given here. A number of epidemiological studies have assessed mortality in people with epilepsy in the general population and in populations from hospitals, out-patient departments, and epilepsy centres. Methodological issues concerning the study of mortality in these populations are discussed. Epidemiological data are presented to describe the overall and cause-specific mortality, as well as determinants of mortality in epilepsy, such as epilepsy and seizure types, time from diagnosis, and age. It has become clear from population studies with long-term follow-up that epilepsy has a higher mortality in the first few years after di...
New antiepileptic drugs (AEDs) are necessary for patients with chronic epilepsy and for improving... more New antiepileptic drugs (AEDs) are necessary for patients with chronic epilepsy and for improving upon established AEDs as first-line therapy. Tiagabine, a new AED, was introduced in the early 1990s and has a specific mechanism of action. It is licensed as an adjunctive treatment in patients with refractory partial epilepsy. It underwent an extensive development programme, and a number of controlled studies have demonstrated its efficacy in adults as well as in children. A meta-analysis of these trials suggests that tiagabine is as efficacious as other new AEDs when used for its primary indication. Studies suggest a minimum effective dose of 30 mg/day, with an optimal dose in the range of 30-56 mg/day; this may be lower in monotherapy. In long-term studies, tolerance to the antiepileptic effect of tiagabine has not been observed. The efficacy of tiagabine in patients with primary generalized seizures is limited but it may be effective in children with infantile spasms and in patients with partial seizures secondary to glial tumours. Comparative studies are necessary to determine the exact place of, tiagabine in the treatment of drug-resistant partial epilepsies and its efficacy in other epilepsies. Its effectiveness in monotherapy, as well as in special populations (such as in pregnancy and the elderly) remains to be further delineated.
Neurology, Jan 17, 2015
A 31-year-old man presented with a 3-month history of progressive dysarthria and 1 month of gradu... more A 31-year-old man presented with a 3-month history of progressive dysarthria and 1 month of gradually worsening motor seizures predominantly affecting the right face. Examination was unremarkable except for a mild spastic dysarthria and slow, alternating tongue movements, probably due to a partial opercular syndrome. Seizures captured during EEG recording showed a jacksonian march starting over the opercular aspect of the motor homunculus, 1,2 and anarthria and sialorrhea without EEG correlate (videos 1 and 2 on the Neurology ® Web site at Neurology.org and figure 1). MRI brain showed a left opercular tumor (figure 2, A and B), found to be an anaplastic astrocytoma after resection. The patient has been seizure free for 12 months after treatment with carbamazepine and resective surgery but has residual dysarthria. AUTHOR CONTRIBUTIONS Dr. Extercatte wrote the first draft of the manuscript. Dr. de Haan provided information about final diagnosis and treatment and revised the final manuscript. Dr. Gaitatzis made the initial diagnosis and drafted and revised subsequent manuscripts.
Atlas of Epilepsies, 2010