Standards for epidemiologic studies and surveillance of epilepsy (original) (raw)
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The Lancet Neurology, 2019
Background Seizures and their consequences contribute to the burden of epilepsy because they can cause health loss (premature mortality and residual disability). Data on the burden of epilepsy are needed for health-care planning and resource allocation. The aim of this study was to quantify health loss due to epilepsy by age, sex, year, and location using data from the Global Burden of Diseases, Injuries, and Risk Factors Study. Methods We assessed the burden of epilepsy in 195 countries and territories from 1990 to 2016. Burden was measured as deaths, prevalence, and disability-adjusted life-years (DALYs; a summary measure of health loss defined by the sum of years of life lost [YLLs] for premature mortality and years lived with disability), by age, sex, year, location, and Socio-demographic Index (SDI; a compound measure of income per capita, education, and fertility). Vital registrations and verbal autopsies provided information about deaths, and data on the prevalence and severity of epilepsy largely came from population representative surveys. All estimates were calculated with 95% uncertainty intervals (UIs). Findings In 2016, there were 45•9 million (95% UI 39•9-54•6) patients with all-active epilepsy (both idiopathic and secondary epilepsy globally; age-standardised prevalence 621•5 per 100 000 population; 540•1-737•0). Of these patients, 24•0 million (20•4-27•7) had active idiopathic epilepsy (prevalence 326•7 per 100 000 population; 278•4-378•1). Prevalence of active epilepsy increased with age, with peaks at 5-9 years (374•8 [280•1-490•0]) and at older than 80 years of age (545•1 [444•2-652•0]). Age-standardised prevalence of active idiopathic epilepsy was 329•3 per 100 000 population (280•3-381•2) in men and 318•9 per 100 000 population (271•1-369•4) in women, and was similar among SDI quintiles. Global age-standardised mortality rates of idiopathic epilepsy were 1•74 per 100 000 population (1•64-1•87; 1•40 per 100 000 population [1•23-1•54] for women and 2•09 per 100 000 population [1•96-2•25] for men). Age-standardised DALYs were 182•6 per 100 000 population (149•0-223•5; 163•6 per 100 000 population [130•6-204•3] for women and 201•2 per 100 000 population [166•9-241•4] for men). The higher DALY rates in men were due to higher YLL rates compared with women. Between 1990 and 2016, there was a non-significant 6•0% (-4•0 to 16•7) change in the age-standardised prevalence of idiopathic epilepsy, but a significant decrease in age-standardised mortality rates (24•5% [10•8 to 31•8]) and age-standardised DALY rates (19•4% [9•0 to 27•6]). A third of the difference in age-standardised DALY rates between low and high SDI quintile countries was due to the greater severity of epilepsy in low-income settings, and two-thirds were due to a higher YLL rate in low SDI countries. Interpretation Despite the decrease in the disease burden from 1990 to 2016, epilepsy is still an important cause of disability and mortality. Standardised collection of data on epilepsy in population representative surveys will strengthen the estimates, particularly in countries for which we currently have no or sparse data and if additional data is collected on severity, causes, and treatment. Sizeable gains in reducing the burden of epilepsy might be expected from improved access to existing treatments in low-income countries and from the development of new effective drugs worldwide. Funding Bill & Melinda Gates Foundation.
Neurologic Clinics, 1996
Epilepsy and seizures represent a common neurologic occurrence. Through epidemiologic studies, much has been learned about the frequency, causes, and natural history of epilepsy and seizures. This knowledge has, in turn, had a significant impact on the treatment and management of individuals with seizures. The following is a review of the history of epilepsy prior to and since the advent of modern epidemiologic methods, and of ways in which epidemiologic data have altered greatly our understanding of this heterogeneous class of disorders. In addition, some of the recent changes that have occurred in public health, medicine, and neurodiagnostic methods and how these changes may be affecting the epidemiology and prognosis of epilepsy are reviewed. Such changes require the continued epidemiologic monitoring of epilepsy so that we may have an accurate understanding of the current forms of the disorder.
The epidemiology of epilepsy revisited
Epidemiology is the study of the dynamics of a medical condition in a population. There are many shortcomings in the understanding of the epidemiology of epilepsy mostly caused by methodological problems. These include diagnostic accuracy, case ascertainment, and selection bias. In this article recent progress in this area is discussed and suggestions for future research are made.
Future directions for epidemiology in epilepsy
Epilepsy & Behavior, 2011
This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues.
The Epidemiology of the Epilepsies: Future Directions
Epilepsia, 1997
Epidemiology can provide understanding about the incidence, prevalence, associated mortality, natural history, and potential risk factors for the epilepsies. It can also be used to assist in planning health services for people with epilepsy. Several problems exist in the interpretation of the available data, in part due to methodological problems (1-3). We address some of these issues and highlight areas in which future epidemiological research is required. PREVALENCE Many studies have been made of the prevalence of epilepsy in diverse settings (4-14). Current data indicate that the prevalence of active epilepsy ranges from 4-10 in 1,000 (2.3). Much of the variation in prevalence is explained by differences in the methodology used to assess it. A few studies, primarily conducted in the developing world have shown prevalence rates above this range (15-18). These have usually been small studies from isolated geographic areas where unique genetic or environmental factors may be important (3).
International League Against Epilepsy, and the World Health Organization
2015
Summary: In North America, overall epilepsy incidence is ap-proximately 50/100,000 per year, highest for children below five years of age, and the elderly. The best data suggest prevalence of 5–10/1000. Potential effects of gender, ethnicity, access to care and socioeconomic variables need further study. Studies of epilepsy etiology and classification mainly were performed without modern imaging tools. The best study found an overall standardized mortality ratio (SMR) for epilepsy relative to the general population of 2.3. There is evidence to suggest a greater increase in patients with symptomatic epilepsy, particularly chil-dren. People with epilepsy are more likely to report reduced Health-related Quality of Life than controls. They have reduced income, and are less likely to have full-time employment. They suffer from persistent stigma throughout the region, in developed as well as developing countries. Poor treatment access and health
The Prevalence, Incidence and Etiology of Epilepsy
International Journal of Clinical and Experimental Neurology, 2014
Epilepsy is a neuronal disorder that is observed globally but still it is not explored very well in most parts of the world. This disease is linked to different provocative causes and affects almost all generation, ethnicity and age population. Therefore, the aim of this article is to systemically review the literature about the prevalence, incidence and etiology of epilepsy to find possible approaches to control epilepsy. The worldwide prevalence of epilepsy is variable and varied among countries. High prevalence is found in adolescent and early age group population. In North America, Central and South America high prevalence is found in male except in New York, Bolivia, Honduras and Argentina where prevalence is high in female. In Asian countries such as China, India, Turkey and Saudi Arabia the prevalence is high in Male except in Pakistan here prevalence is high in female similarly to European countries where also prevalence is high in female. The prevalence of epilepsy in male and female is variable in African countries. Generalized seizure is high in America, Asia, Europe, and Africa than the other types of epilepsies. Very limited data is available about the incidence of epilepsy especially from low and lower middle income countries. The incidence rate of epilepsy is higher in the developing countries than the industrialized countries. Similarly, the incidence is also higher in male than female. Head injury, birth trauma, cerebrovascular disease, and intracranial infections (neurocysticercosis or meningoencephalitis) and genetic factors are the main causes of epilepsy.
Epilepsia, 2017
Since previous reviews of epidemiologic studies of premature mortality among people with epilepsy were completed several years ago, a large body of new evidence about this subject has been published. We aim to update prior reviews of mortality in epilepsy and to reevaluate and quantify the risks, potential risk factors, and causes of these deaths. We systematically searched the Medline and Embase databases to identify published reports describing mortality risks in cohorts and populations of people with epilepsy. We reviewed relevant reports and applied criteria to identify those studies likely to accurately quantify these risks in representative populations. From these we extracted and summarized the reported data. All population-based studies reported an increased risk of premature mortality among people with epilepsy compared to general populations. Standard mortality ratios are especially high among people with epilepsy aged <50 years, among those whose epilepsy is categorize...