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ABSTRACT: To study the risk of developing unprovoked seizures among patients with multiple sclerosis (MS) and systemic lupus erythematosus (SLE), we used 1885 new onset seizure cases, 15,080 controls and defined exposure as a hospital discharge diagnosis of MS or SLE. The odds ratio with 95% confidence interval was 3.7 (CI 1.2-11.0) for MS and 8.0 (2.2-30.0) for SLE, suggesting an increased risk of unprovoked seizures in patients with both these diagnoses.
Epilepsy research 05/2012; 101(3):284-7. · 2.48 Impact Factor
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ABSTRACT: To study hospitalization for psychiatric disorders before and after onset of unprovoked epileptic seizures/epilepsy.
In this population-based case-control study, the cases were 1,885 persons from Stockholm with new onset of unprovoked seizures from September 1, 2000, through August 31, 2008, identified in the Stockholm Epilepsy Register. Controls, in total 15,080, were randomly selected from the register of the Stockholm County population. Odds ratios (ORs) were calculated to assess the risk of developing unprovoked epileptic seizures before and after hospitalization for a psychiatric diagnosis defined as a psychiatric hospital discharge diagnosis using International Classification of Disease codes from the Swedish Hospital Discharge Registry.
The age-adjusted OR (95% confidence interval) for unprovoked seizures was 2.5 (1.7-3.7) after a hospital discharge diagnosis for depression, 2.7 (1.4-5.3) for bipolar disorder, 2.3 (1.5-3.5) for psychosis, 2.7 (1.6-4.8) for anxiety disorders, and 2.6 (1.7-4.1) for suicide attempts. The risk of developing unprovoked epileptic seizures was highest less than 2 years before and up to 2 years after a first psychiatric diagnosis.
The increased rate of psychiatric comorbidity predating and succeeding seizure onset indicates a bidirectional relationship and common underlying mechanisms for psychiatric disorders and epilepsy.
Neurology 02/2012; 78(6):396-401. · 8.31 Impact Factor
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ABSTRACT: To study diabetes, acute myocardial infarction, and stroke as risk factors for unprovoked seizures in a population-based cohort with incident cases of epilepsy.
In this nested case-control study, the cases were 933 patients with newly diagnosed unprovoked seizures from the Stockholm Incidence Registry of Epilepsy. Controls, in total 6,039--matched for gender, year of diagnosis, and catchment area--were randomly selected from the register of the Stockholm County population. A history of diabetes, myocardial infarction, and stroke preceding the date of onset of seizure was determined by search of the Swedish Hospital Discharge Registry. Odds ratios (ORs) were calculated to assess the risk of developing unprovoked seizures after hospital admission for any of these diagnoses.
The age-adjusted OR (95% confidence interval, 95% CI) for unprovoked seizures after a discharge diagnosis of diabetes was 1.9 (95% CI 1.4-2.8) and after acute myocardial infarction 1.7 (95% CI 1.0-2.9). The OR was 9.4 (95% CI 6.7-13.1) after cerebral infarction, 7.2 (95% CI 3.9-13.6) after intracerebral hemorrhage, 7.2 (95% CI 2.9-18.1) after subarachnoid hemorrhage, and 3.2 (95% CI 1.9-5.5) after transient ischemic attack. The population attributable risk percent (PAR%) was <2% for each of the diagnoses except for cerebral infarction, for which the PAR% was 9%. Taken together the studied diagnoses accounted for 15% of the incident cases of unprovoked seizures.
As previously known, the risk for unprovoked seizures and epilepsy after a cerebral infarction was highest the first year after the infarction. This risk remained substantial >7 years after a diagnosis of cerebral infarction.
Epilepsia 11/2010; 52(2):301-7. · 3.96 Impact Factor
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ABSTRACT: To describe and report initial findings of a system for prospective identification and follow-up of patients with newly diagnosed single unprovoked seizures and epilepsy in Stockholm, Sweden, the Stockholm Incidence Registry of Epilepsy (SIRE).
From September 2001 through August 2004, a surveillance system has been in use to identify incident cases of first unprovoked seizures (neonatal seizures excluded) and epilepsy among residents of Northern Stockholm, an urban area with approximately 998,500 inhabitants. Potential cases are identified through multiple mechanisms: Network of health care professionals, medical record screening in specific hospital units, including outpatient clinics, emergency room services, and review of requests for electroencephalography (EEG) examination. Potential cases are classified 6 months after the index seizure based on review of medical records.
After screening approximately 10,500 EEG requests and 3,300 medical records, 1,015 persons met the criteria for newly diagnosed unprovoked seizures (430 single seizures; 585 epilepsy). The crude incidence for first unprovoked seizures and epilepsy was 33.9/100,000 person years, (the same adjusted to the European Standard Million), highest the first year of life (77.1/100,000) and in the elderly. No cause could be identified in 62.4%.
We have established a sustainable system for prospective identification of new onset epilepsy cases in Stockholm. Despite a possible under-ascertainment, the registry provides a useful starting point for follow-up studies.
Epilepsia 09/2008; 50(5):1094-101. · 3.96 Impact Factor
