Posts Tagged Epidemiology

[BOOK] Epilepsy Across the Spectrum – NCBI Bookshelf

Cover of Epilepsy Across the Spectrum

Epilepsy Across the Spectrum

Promoting Health and Understanding

Institute of Medicine (US) Committee on the Public Health Dimensions of the Epilepsies; Editors: Mary Jane England, Catharyn T Liverman, Andrea M Schultz, and Larisa M Strawbridge.

Washington (DC): National Academies Press (US); 2012.

ISBN-13: 978-0-309-25506-6

Excerpt

Throughout this report, the committee emphasizes the ways in which epilepsy is a spectrum disorder. Epilepsy comprises more than 25 syndromes and many types of seizures that vary in severity. Additionally, people who have epilepsy span a spectrum that includes men and women of all ages and of all socioeconomic backgrounds and races/ethnicities, who live in all areas of the United States and across the globe. The impacts on physical health and quality of life encompass a spectrum as well, with individuals experiencing different health outcomes and having a range of activities of daily living that may be affected, including driving, academic achievement, social interactions, and employment. For some people, epilepsy is a childhood disorder that goes into remission (although the seizures may have lifelong consequences), while for others it is a lifelong burden or a condition that develops later in life or in response to an injury or other health condition. These many complexities of epilepsy make it a challenging health condition to convey to the general public to promote understanding and alleviate stigma. This report aims to provide evidence and impetus for actions that will improve the lives of people with epilepsy and their families.

Contents

via Epilepsy Across the Spectrum – NCBI Bookshelf

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[ARTICLE] Epidemiology of Traumatic Brain Injury in Europe: A Living Systematic Review – Full Text

ABSTRACT

This systematic review provides a comprehensive, up-to-date summary of traumatic brain injury (TBI) epidemiology in Europe, describing incidence, mortality, age, and sex distribution, plus severity, mechanism of injury, and time trends. PubMed, CINAHL, EMBASE, and Web of Science were searched in January 2015 for observational, descriptive, English language studies reporting incidence, mortality, or case fatality of TBI in Europe. There were no limitations according to date, age, or TBI severity. Methodological quality was assessed using the Methodological Evaluation of Observational Research checklist. Data were presented narratively. Sixty-six studies were included in the review. Country-level data were provided in 22 studies, regional population or treatment center catchment area data were reported by 44 studies. Crude incidence rates varied widely. For all ages and TBI severities, crude incidence rates ranged from 47.3 per 100,000, to 694 per 100,000 population per year (country-level studies) and 83.3 per 100,000, to 849 per 100,000 population per year (regional-level studies). Crude mortality rates ranged from 9 to 28.10 per 100,000 population per year (country-level studies), and 3.3 to 24.4 per 100,000 population per year (regional-level studies.) The most common mechanisms of injury were traffic accidents and falls. Over time, the contribution of traffic accidents to total TBI events may be reducing. Case ascertainment and definitions of TBI are variable. Improved standardization would enable more accurate comparisons.

Introduction

Traumatic brain injury (TBI) is among the most severe types of injury in terms of both case fatality1 and long-term implications for survivors.2 Treatment of TBI can be complex and expensive.3 Upon clinical examination, TBI is most commonly sub-divided into mild, moderate, and severe, according to the Glasgow Coma Scale (GCS).4,5 Such categories have been found to be predictive of a patient’s long-term outcome,6 although other measures and models also have been tested.7,8

A previous review of the epidemiology of TBI in Europe concluded that the leading causes of TBI were road traffic collisions, and falls.3 Consequently, in a densely populated and economically advanced area such as the European Union (EU), the potential for prevention of morbidity and mortality is great. The variability in incidence and mechanism of TBI, which may be observed on this mainly contiguous land-mass with a well-developed road network, is also of scientific interest, as it may lead to better prevention of TBI. Countries within the EU adhere to certain multi-national laws and agreements, but nonetheless retain their own law-making and enforcement responsibilities.9 This may add further complexity to the understanding of TBI epidemiology, for example, in the contributions of varying road speed limits or the legal restrictions on the availability of firearms. More generally, the issues relating to the contemporary demographic and lifestyle characteristics of the similar countries or regions suggest that epidemiological trends from EU countries also may be applicable to other high income countries.

Considerable variability has been observed between national rates, largely attributable to significant variability in data collection, case ascertainment, and case definition. This has led to calls for standardized definitions and data collection in population-based studies, and an associated paradigm shift in studying TBI and its impact.10–12

In order to improve the understanding of causes of TBI and the scale of the problem, it is important to analyze the current situation and time trends, using good quality comparable observational studies. One comprehensive systematic review of the epidemiology of TBI in Europe was published nearly ten years ago.3 A recent systematic review,13 published as a follow-up to Tagliaferri (2006),3 addresses similar issues but was more restrictive in dates of publication (1990–2014) and has not been set up as a “living” systematic review (i.e., it is not expected that it will be kept up-to-date as new research is published).13

The overall objective of this systematic review was to provide a comprehensive, up-to-date summary of TBI epidemiology in Europe by reviewing all relevant observational studies. Specific aims were to determine the incidence, mortality, age, and sex distribution of TBI in Europe, along with the severity and mechanism of injury and time trends. […]

 

Continue —> Epidemiology of Traumatic Brain Injury in Europe: A Living Systematic Review

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[WEB PAGE] Resources for Stroke Patients – European Stroke Organisation

Frequently Asked Questions on Stroke Management

1. Introduction to the Management of Stroke

What Is a Stroke?

Stroke is a type of cerebrovascular disease that involves the vessels of the central nervous system. It usually occurs with sudden onset due to a burst of cerebral arteries, hemorrhage or occlusion by a thrombus or other particles ischemia, leading to focal brain dysfunction. Immediately, nerve cells depleted of oxygen in the involved vascular territory will be functionally disturbed and die if the circulation is not promptly restored. Two main mechanisms may lead to ischemic stroke: occlusive or hemodynamic. These two situations decrease the cerebral perfusion pressure and eventually lead to cellular death. But within certain limits, the brain blood flow can be maintained by autoregulation of cerebral arteries and collateral circulation. When occlusion of an artery develops, blood flow in the periphery of the infarct core is usually reduced but still sufficient to avoid structural damage, so that the functional modifications of cells may be reversible if circulation is restored. This ring-like area of reduced blood flow around the ischemic center of infarct has been termed penumbra as an analogy of the half-shaded part around the center of a solar eclipse. It may largely explain the functional improvement occurring after stroke. Indeed, the neurons surviving in this critical area of infarct at reduced blood flow may again function as soon as blood flow and oxygen delivery is restored.

Continue —>  Resources for Stroke Patients – European Stroke Organisation

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[Abstract] Cannabis and other illicit drug use in epilepsy patients – Hamerle – 2013 – European Journal of Neurology.

Abstract

Background and purpose

This study aimed to assess the prevalence of illicit drug use among epilepsy patients and its effects on the disease.

Methods

We systematically interviewed epilepsy outpatients at a tertiary epilepsy clinic. Predictors for active cannabis use were analysed with a logistic regression model.

Results

Overall, 310 subjects were enrolled; 63 (20.3%) reported consuming cannabis after epilepsy was diagnosed, and 16 (5.2%) used other illicit drugs. Active cannabis use was predicted by sex (male) [odds ratio (OR) 5.342, 95% confidence interval (95% CI) 1.416–20.153] and age (OR 0.956, 95% CI 0.919–0.994). Cannabis consumption mostly did not affect epilepsy (84.1%). Seizure worsening was observed with frequent illicit (non-cannabis) drug use in 80% of cases.

Conclusions

Cannabis use does not seem to affect epilepsy; however, frequent use of other drugs increases seizure risk.

Source: Cannabis and other illicit drug use in epilepsy patients – Hamerle – 2013 – European Journal of Neurology – Wiley Online Library

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[WEB SITE] The Epidemiology of Post traumatic Epilepsy

Traumatic brain injury is an important contributor to morbidity and mortality, and results in reduced quality of life and lifespan: An estimated 1.7 million traumatic brain injuries occur annually in the United States alone. Traumatic brain injury carries an increased risk of epilepsy that correlates with the severity of the brain injury.

Posttraumatic epilepsy accounts for less than 10% of epilepsy, but traumatic brain injury is one of only a few potentially preventable causes of epilepsy. Despite several well-controlled human studies, there is no current preventive treatment available for humans. Therefore, primary prevention is the only proven way to prevent posttraumatic epilepsy.

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[REPORT TO CONGRESS] Traumatic Brain Injury in the US – Epidemiology and Rehabilitation – Issuu

Traumatic Brain Injury in the US – Epidemiology and Rehabilitation
This CE course describes: the known incidence of traumatic brain injury, including trends over time; prevalence of traumatic brain injury-related disability; the adequacy of TBI outcome measures; factors that influence differential TBI outcomes; and the current status and effectiveness of TBI rehabilitation services.

via ISSUU – Traumatic Brain Injury in the US – Epidemiology and Rehabilitation by Quantum Units Continuing Education.

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[ARTICLE] Epilepsy in patients with gliomas: Incidence and control of seizures

Abstract

Brain tumor-related epilepsy (BTRE) is a unique condition that is distinct from primary epilepsy. The aim of this retrospective study was to clarify the epidemiology and results of treatment of BTRE in a single institution.

From a database of 121 consecutive patients with supratentorial gliomas treated at Chiba Cancer Center from 2006–2012, the incidence and control of seizures before and after surgery were retrospectively evaluated.Epilepsy occurred in 33.9% of patients before surgery. All patients received prophylactic anti-epileptic drugs (AED) during surgery; however, seizures occurred in 9.1% of patients within the first postoperative week.

During follow-up, seizures occurred in 48.3% of patients. The overall incidence of seizures was

  • 73.7% in patients with World Health Organization Grade II gliomas,
  • 66.7% in those with Grade III and
  • 56.8% in those with Grade IV gliomas.

Levetiracetam was very well tolerated. However, carbamazepine and phenytoin were poorly tolerated because of adverse effects. AED were discontinued in 56 patients. Fifteen of these patients (26.8%) had further seizures, half occurring within 3 months and 80% within 6 months of AED withdrawal. No clinical factors that indicated it was safe to discontinue AED were identified. The unpredictable epileptogenesis associated with gliomas and their excision requires prolonged administration of AED. To maintain quality of life and to safely and effectively control the tumor, it is necessary to select AED that do not adversely affect cognitive function or interact with other drugs, including anti-cancer agents.

via Epilepsy in patients with gliomas: Incidence and control of seizures.

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