Prognosis of epilepsy in a community-based study: 8 Years of follow-up in an Argentine community
Epilepsy Center, Hosp.R.Mejia School of Medicine, University of Buenos Aires, CONICET, Buenos Aires, Argentina. Acta Neurologica Scandinavica
(Impact Factor: 2.4).
01/2006; 112(6):370-4. DOI: 10.1111/j.1600-0404.2005.00519.x
To assess the prognosis of epilepsy, the possibility of achieving remission of seizures, in patients who were identified in a population-based study carried out in Junín, a city of about 70,000 inhabitants in Buenos Aires Province, Argentina. On January 1, 1991 (prevalence day), 106 people had epilepsy, including 64 (60%) with the condition active.
Eight years later, we revisited the patients identified in the prevalence study. We analyzed risk factors in relation to remission of seizures. We also confirmed the specific cause of death.
Ninety-six patients were revisited (10 were completely lost to follow-up). We divided them into two groups: the group in terminal remission (defined as a seizure-free period that extended from prevalence day until the visit day in 1998) which included 64 people (66.7%), and the group of those who continued to have seizures which included 32 (33.3%) patients, of whom eight (25%) died. The overall standardized mortality ratio was 2.45; the rate was two and a half times that of the general national population.
The better prognosis was observed in the group with generalized idiopathic epilepsy syndrome. Patients with epilepsy secondary to underlying structural causes had the worst prognosis, with higher mortality.
Available from: Alessandro Bartoloni
- "Some data, in fact, come from hospital-based studies (Ecuador and Martinique), and a possible selection bias leading to an overrepresentation of severe forms could in part explain the higher SMR. On the other hand, retrospective community-based studies are often carried out in small populations (Mali and Vasai), leading to a possible lack of precision of the reported estimates; furthermore, not all of the populations investigated were effectively ''untreated'' (Argentina, Ecuador, Martinique, and Tanzania) (Carpio et al., 2005; Diop et al., 2005; Kochen & Melcon, 2005). "
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ABSTRACT: To evaluate the natural history and mortality of chronic epilepsy in an untreated prevalence cohort of people with epilepsy (PWE) in a rural area of Bolivia.
During 1994-1996 we carried out an epidemiologic survey in a sample of 9,995 subjects in the Cordillera province. At the end of the survey we identified 130 PWE, of whom 118 were classified as having "active epilepsy." We revisited this cohort 10 years after the prevalence survey.
We were able to trace 103 (87.3%) of the 118 PWE previously identified. Ten of the 103 subjects died during the follow-up period. Of the 93 PWE still alive, adequate information on the occurrence of seizures was available for 71 subjects, of whom 31 (43.7%) were seizure-free for more than 5 years; only 3 of these 31 subjects have taken an antiepileptic drug (AED) for more than 1 year. Generalized seizures were associated with a better prognosis. Mortality rate in our prevalent cohort was 10.0/1,000 person-year at risk [95% confidence interval (CI) 5.5-18.3], without a significant increased risk respect to the general population [standardized mortality rate (SMR) 1.34; 95% CI 0.68-2.39]; a significant increased risk of death was found for patients with remote symptomatic epilepsy (SMR 3.0; 95% CI 1.2-6.3) but not with idiopathic epilepsy. Three of the 10 subjects died of causes possibly related to epilepsy.
Our data suggest that spontaneous remission of epilepsy occurs in a substantial proportion of untreated patients affected by chronic epilepsy; concerning mortality, we found a 3-fold increased mortality in patients with remote symptomatic epilepsy.
Available from: Luciana Dalessio
- "All patients included in this study underwent a complete clinical and neurological assessment, according to a standardized clinical history (epidemiological surveillance program, VIGIA)  . Clinical history data were gathered retrospectively by anamnesis. "
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ABSTRACT: The issue of psychotic disorders in epilepsy has given rise to great controversy among professionals; however, there are not many studies in this area and the physiopathological mechanisms remain unknown. The aim of this study was to describe the spectrum of psychotic disorders in an Argentine population with refractory temporal lobe epilepsy (RTLE) and to determine the risk factors associated with psychotic disorders. Clinical variables of the epileptic syndrome were compared among a selected population with RTLE with and without psychotic disorders (DSM-IV/Ictal Classification of psychoses). Logistic regression was performed. Sixty-three patients with psychotic disorders (Psychotic Group, PG) and 60 controls (Control Group, CG) were included. The most frequent psychotic disorders were brief psychotic episodes (35%) (DSM-IV) and interictal psychosis (50%) (Ictal Classification). Risk factors for psychotic disorders were bilateral hippocampal sclerosis, history of status epilepticus, and duration of epilepsy greater than 20 years.
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ABSTRACT: This paper presents an overview of the ISO/QS-9000 objectives and how they apply to the design of electromagnetic products. ISO/QS-9000 is a methodical approach to product design and development. In addition, it provides the framework for effective management of the product development process. A wide range of disciplined efforts (based on the defined methodology of QS-9000) are described in this paper. These efforts start with a clear understanding of the customer wants and needs, develops a paper and hardware design and ends with a quality product delivered to a satisfied customer
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