Athanasios Gaitatzis - Academia.edu (original) (raw)

Uploads

Papers by Athanasios Gaitatzis

Epilepsia, 2009

Suicide is more common in populations with epilepsy, but estimates vary concerning the magnitude ... more Suicide is more common in populations with epilepsy, but estimates vary concerning the magnitude of the risk. We aimed to estimate the risk using meta-analysis. A literature search identified 74 articles (76 cohorts of people with epilepsy) in whom the number of deaths by suicide in people with epilepsy and the number of person-years at risk could be estimated. Standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated for each cohort, for groups of cohorts, and for the total population. The overall SMR was 3.3 (95% CI 2.8-3.7) based on 190 observed deaths by suicide compared with 58.4 expected. The SMR was significantly increased in people with incident or newly diagnosed epilepsy in the community (SMR 2.1), in populations with mixed prevalence and incidence cases (SMR 3.6), in those with prevalent epilepsy (SMR 4.8), in people in institutions (SMR 4.6), in people seen in tertiary care clinics (SMR 2.28), in people with temporal lobe epilepsy (SMR 6.6), in those following temporal lobe excision (SMR 13.9), and following other forms of epilepsy surgery (SMR 6.4). The SMR was significantly low overall in two community-based studies of people with epilepsy and developmental disability. We confirm that the risk of suicide is increased in most populations of people with epilepsy. Psychiatric comorbidity has been demonstrated to be a risk factor for suicide in the general population and in people with epilepsy, and such comorbidity should thus be identified and treated.

Atlas of Epilepsies, 2010

Journal of Neurology, Neurosurgery & Psychiatry, 2013

ABSTRACT Many physicians request EEG in order to differentiate between syncope and seizure in ind... more ABSTRACT Many physicians request EEG in order to differentiate between syncope and seizure in individuals presenting with transient loss of consciousness (TLOC). This is particularly the case in people taken to hospital following a collapse, where a witness account is not always available. We aim to investigate the usefulness of EEG in the assessment of unexplained TLOC in a large, unselected group of patients presenting in an emergency department. We also assess the risk of seizure development and clinical course following initial presentation. We retrospectively reviewed referral forms of all routine and urgent EEGs performed at Sir Charles Gairdner Hospital, Perth, Western Australia between April 2010 to November 2011 to identify recordings performed for the investigation of suspected syncope or TLOC. Cases with identifiable cause at initial assessment, and cases suggestive of seizure, previous diagnosis of epilepsy and falls without loss of consciousness were excluded. Diagnosis at discharge and EEG reports were obtained through electronic patient records, EEG archive, and case notes as required. EEGs were classified as normal, abnormal (non-epileptiform abnormalities only), and showing definite epileptiform discharges (EDs). Detailed clinical information including subsequent development of seizures or death was collected for a subgroup of patients with 1-year follow-up after first presentation across all hospitals in the greater Perth area through health electronic linkage. General practitioners and patients were also contacted in order to obtain additional information as needed. The death rate and standardised mortality ratio (SMR) were calculated according to standard methods based on life table 2008-2010 of the Australian Bureau of Statistics. We identified 197 cases with unexplained TLOC (age range 18-98 years). No further clinical information was available for 11 cases. The EEG was abnormal in 1/3 of all cases, and in 50% of those over 65 years. EDs were identified in 2 patients (1%); of those, a diagnosis of seizure was made in one patient who was subsequently started on antiepileptic treatment, with no final diagnosis made in the other. Diagnosis at discharge was made in 129 cases (65%) with 23 (18%) of those receiving a seizure diagnosis. The 1-year follow up group consisted of 82 patients (age range 20-95 years); 52 (63%) people were multimorbid (defined as having ≥2 conditions). None of the patients without a seizure diagnosis presented with seizures during follow-up. During this period there were 11 deaths (age range 30-94 years), all in multimorbid people, and none in people with seizure diagnosis. The case fatality rate was 13.4% and SMR 4.27 (95% Fisher's exact CI, 2.13-7.42). This study demonstrates that the EEG has a very low diagnostic yield in patients presenting with unexplained TLOC. EEG was helpful in diagnosis of 1 of 2 cases, while a seizure diagnosis was made on clinical grounds in 22 of 23 cases. The high mortality associated with TLOC almost exclusively affected multimorbid patients above 65 years, suggesting high risk of death from an underlying medical cause and not from seizures in this group of patients.

Epilepsia, 2004

Purpose: To describe the epidemiology of somatic and psychiatric conditions in adults with epilep... more Purpose: 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.

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 . 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. Figure 2 Noncontrast MRI showing a left opercular lesion (A) Axial fluid-attenuated inversion recovery image showing a left opercular lesion. (B) Coronal T2-weighted MRI showing the left opercular lesion with surrounding edema.

Epileptic Disorders International Epilepsy Journal With Videotape, Mar 1, 2004

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 diagnosis that tends to decrease over time. The pattern of mortality in epilepsy can reflect the underlying conditions causing epilepsy or be associated with the effect of seizures. Emphasis is given to preventable causes of death in epilepsy, such as sudden unexpected death in epilepsy and suicide, which are discussed more extensively. The size of the problem and measures to avoid more deaths in epilepsy are discussed in the light of recently published data. is not a direct measurement of the ratio of rates of death between

The Neurologist, 2012

Syncope is a common presenting complaint in Neurology clinics or Emergency departments, but its c... more Syncope is a common presenting complaint in Neurology clinics or Emergency departments, but its causes are sometimes difficult to diagnose. Apart from vasovagal attacks, other benign, neurally mediated syncopes include "situational" syncopes, which occur after urination, coughing, swallowing, or defecation. A healthy 42-year-old male patient presented to the neurology clinic with a long history of faints triggered by spontaneous laughter, especially after funny jokes. Physical and neurological examination, and electroencephalography and magnetic resonance imaging were unremarkable. There was no evidence to suggest cardiogenic causes, epilepsy, or cataplexy and a diagnosis of laughing syncope was made. Laughter-induced syncope is usually a single event in the majority of cases, but may present as recurrent attacks as in our case. Some cases occur in association with underlying neurological conditions. Prognosis is good in the case of neurally mediated attacks. Laughter may not be recognized by physicians as a cause of syncope, which may lead to unnecessary investigations or misdiagnosis, and affect patients' quality of life.

Seizure, 2014

A c c e p t e d Highlights  Epilepsy is an important cause of emergency admissions to hospital ... more A c c e p t e d Highlights  Epilepsy is an important cause of emergency admissions to hospital  There is little previous research on the effects of primary healthcare services  In England the admission rate decreased by 16.5% over the period 7594 0772, fax 020 7594 0854

Epilepsia, 2009

Suicide is more common in populations with epilepsy, but estimates vary concerning the magnitude ... more Suicide is more common in populations with epilepsy, but estimates vary concerning the magnitude of the risk. We aimed to estimate the risk using meta-analysis. A literature search identified 74 articles (76 cohorts of people with epilepsy) in whom the number of deaths by suicide in people with epilepsy and the number of person-years at risk could be estimated. Standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated for each cohort, for groups of cohorts, and for the total population. The overall SMR was 3.3 (95% CI 2.8-3.7) based on 190 observed deaths by suicide compared with 58.4 expected. The SMR was significantly increased in people with incident or newly diagnosed epilepsy in the community (SMR 2.1), in populations with mixed prevalence and incidence cases (SMR 3.6), in those with prevalent epilepsy (SMR 4.8), in people in institutions (SMR 4.6), in people seen in tertiary care clinics (SMR 2.28), in people with temporal lobe epilepsy (SMR 6.6), in those following temporal lobe excision (SMR 13.9), and following other forms of epilepsy surgery (SMR 6.4). The SMR was significantly low overall in two community-based studies of people with epilepsy and developmental disability. We confirm that the risk of suicide is increased in most populations of people with epilepsy. Psychiatric comorbidity has been demonstrated to be a risk factor for suicide in the general population and in people with epilepsy, and such comorbidity should thus be identified and treated.

Atlas of Epilepsies, 2010

Journal of Neurology, Neurosurgery & Psychiatry, 2013

ABSTRACT Many physicians request EEG in order to differentiate between syncope and seizure in ind... more ABSTRACT Many physicians request EEG in order to differentiate between syncope and seizure in individuals presenting with transient loss of consciousness (TLOC). This is particularly the case in people taken to hospital following a collapse, where a witness account is not always available. We aim to investigate the usefulness of EEG in the assessment of unexplained TLOC in a large, unselected group of patients presenting in an emergency department. We also assess the risk of seizure development and clinical course following initial presentation. We retrospectively reviewed referral forms of all routine and urgent EEGs performed at Sir Charles Gairdner Hospital, Perth, Western Australia between April 2010 to November 2011 to identify recordings performed for the investigation of suspected syncope or TLOC. Cases with identifiable cause at initial assessment, and cases suggestive of seizure, previous diagnosis of epilepsy and falls without loss of consciousness were excluded. Diagnosis at discharge and EEG reports were obtained through electronic patient records, EEG archive, and case notes as required. EEGs were classified as normal, abnormal (non-epileptiform abnormalities only), and showing definite epileptiform discharges (EDs). Detailed clinical information including subsequent development of seizures or death was collected for a subgroup of patients with 1-year follow-up after first presentation across all hospitals in the greater Perth area through health electronic linkage. General practitioners and patients were also contacted in order to obtain additional information as needed. The death rate and standardised mortality ratio (SMR) were calculated according to standard methods based on life table 2008-2010 of the Australian Bureau of Statistics. We identified 197 cases with unexplained TLOC (age range 18-98 years). No further clinical information was available for 11 cases. The EEG was abnormal in 1/3 of all cases, and in 50% of those over 65 years. EDs were identified in 2 patients (1%); of those, a diagnosis of seizure was made in one patient who was subsequently started on antiepileptic treatment, with no final diagnosis made in the other. Diagnosis at discharge was made in 129 cases (65%) with 23 (18%) of those receiving a seizure diagnosis. The 1-year follow up group consisted of 82 patients (age range 20-95 years); 52 (63%) people were multimorbid (defined as having ≥2 conditions). None of the patients without a seizure diagnosis presented with seizures during follow-up. During this period there were 11 deaths (age range 30-94 years), all in multimorbid people, and none in people with seizure diagnosis. The case fatality rate was 13.4% and SMR 4.27 (95% Fisher's exact CI, 2.13-7.42). This study demonstrates that the EEG has a very low diagnostic yield in patients presenting with unexplained TLOC. EEG was helpful in diagnosis of 1 of 2 cases, while a seizure diagnosis was made on clinical grounds in 22 of 23 cases. The high mortality associated with TLOC almost exclusively affected multimorbid patients above 65 years, suggesting high risk of death from an underlying medical cause and not from seizures in this group of patients.

Epilepsia, 2004

Purpose: To describe the epidemiology of somatic and psychiatric conditions in adults with epilep... more Purpose: 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.

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 . 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. Figure 2 Noncontrast MRI showing a left opercular lesion (A) Axial fluid-attenuated inversion recovery image showing a left opercular lesion. (B) Coronal T2-weighted MRI showing the left opercular lesion with surrounding edema.

Epileptic Disorders International Epilepsy Journal With Videotape, Mar 1, 2004

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 diagnosis that tends to decrease over time. The pattern of mortality in epilepsy can reflect the underlying conditions causing epilepsy or be associated with the effect of seizures. Emphasis is given to preventable causes of death in epilepsy, such as sudden unexpected death in epilepsy and suicide, which are discussed more extensively. The size of the problem and measures to avoid more deaths in epilepsy are discussed in the light of recently published data. is not a direct measurement of the ratio of rates of death between

The Neurologist, 2012

Syncope is a common presenting complaint in Neurology clinics or Emergency departments, but its c... more Syncope is a common presenting complaint in Neurology clinics or Emergency departments, but its causes are sometimes difficult to diagnose. Apart from vasovagal attacks, other benign, neurally mediated syncopes include "situational" syncopes, which occur after urination, coughing, swallowing, or defecation. A healthy 42-year-old male patient presented to the neurology clinic with a long history of faints triggered by spontaneous laughter, especially after funny jokes. Physical and neurological examination, and electroencephalography and magnetic resonance imaging were unremarkable. There was no evidence to suggest cardiogenic causes, epilepsy, or cataplexy and a diagnosis of laughing syncope was made. Laughter-induced syncope is usually a single event in the majority of cases, but may present as recurrent attacks as in our case. Some cases occur in association with underlying neurological conditions. Prognosis is good in the case of neurally mediated attacks. Laughter may not be recognized by physicians as a cause of syncope, which may lead to unnecessary investigations or misdiagnosis, and affect patients' quality of life.

Seizure, 2014

A c c e p t e d Highlights  Epilepsy is an important cause of emergency admissions to hospital ... more A c c e p t e d Highlights  Epilepsy is an important cause of emergency admissions to hospital  There is little previous research on the effects of primary healthcare services  In England the admission rate decreased by 16.5% over the period 7594 0772, fax 020 7594 0854