Epilepsy prevalence

Epilepsy is a disorder that afflicts approximately 2 million individuals in the United States, with an age-adjusted prevalence of approximately 4 to 7 cases per 1000 persons.1 The incidence of epilepsy in the United States is estimated at 35 to 75 cases per 100,000 persons per year, which is similar to that of other developed countries.2,3 In developing countries, the incidence is higher at 100 to 190 cases per 100,000 persons per year, possibly related to poor health care and prenatal care, increased risk of neurologic trauma, and increased rates of infections. About 8% of the United States population will experience a seizure during their lifetime. New-onset seizures occur most frequently in infants below 1 year of age and in adults after age 55.4 However, the largest number of patients suffering from epilepsy is between the ages of 15 and 64 years. 

Epilepsy is a chronic often progressive disorder of the central nervous system (CNS). Periodic and unpredictable epileptic seizures caused by the abnormal electrical discharge of neurones in various anatomic structures of the CNS is the characteristic feature. This is an approximate definition based on international classifications of seizures and syndromes which take into account the extremely variable clinical and electroencephalographic expression of the disease. The annual incidence of epilepsy is an estimated 20-70 cases per 100,000 inhabitants with a prevalence of 0.4-0.8%. Globally, incidence is higher during childhood, remaining rather stable... 

Carbamazepine has been shown to be better tolerated as long-term monotherapy than DVP in children with epilepsy or febrile convulsions (Herranz et ah, 1988). Nevertheless, a comparison of the adverse effect profile in the Kowatch sample (Kowatch et ah, 2000) shows that nausea (46%), rash (8%), and dizziness (8%) were more prevalent in youngsters taking CBZ, compared to children on DVP, who experienced overall less nausea (20%), rash (0%), and dizziness (0%). 

Incarcerated individuals have a two to four fold greater prevalence of epilepsy, however, a relationship between criminal acts and seizure activity is seldom demonstrated (Marsh and Krauss, 2000). Aggression in seizure-disordered patients is often directed in nature, occurring during the interictal period, in response to a social context, likely related to general brain dysfunction rather than to seizure activity. Therefore, consideration of the social context in which the behavior occurs and of the sociological and biological risk factors is important. 

A genetic defect in the Cr transporter has been found in more than 50 patients in a period of only 5 years [7,8]. In a study of the prevalence of this defect, 6 affected patients were found in a group of 288 mentally retarded men (2.1%) [8]. The gene encoding the Cr transporter is located on the X-chromosome. Affected male patients show mild to severe mental retardation and epilepsy, with absence of speech. 

Epilepsy and osteoporosis are very common and frequently overlap. Nevertheless, the prevalence of low bone density appears to be disproportionately higher in patients with epilepsy, and patients with epilepsy have an excessive risk of fractures. A meta-analysis of 94 cohort studies and 72 case-control studies has shown that anticonvulsant treatment is highly associated with fractures (relative risk over 2) (117). Other risk factors were low body weight, weight loss, physical inactivity, consumption of corticosteroids, primary hjrperparathjroidism, type 1 diabetes melhtus, anorexia nervosa, gastrectomy, pernicious anemia, and age over 70 years. 

In 117 patients with chronic epilepsy taking carbamaze-pine in residential care the retrospective prevalence of... 

The estimated prevalence of polycystic ovary syndrome in patients with epilepsy is 13-25%, compared with 4-6% in the general population (99). Polycystic ovary syndrome has been described in women with epilepsy taking valproate, especially those who start treatment before 20 years of age (22,103), and the frequency is high in a cross-sectional study of 22 women taking valproate monotherapy, 59% were obese and 64% had polycystic ovaries, hyperandrogenism, or both (22). 

Nousiainen I, Kalviainen R, Mantiyarvi M, Riekkinen PJ. Prevalence of concentric visual field constriction in adult epilepsy patients with vigabatrin treatment. Neurology 1999 52(Suppl. 2) A235-6. 

These are thus measures of incidence. The proportion of a population that will experience at least one seizure or one migraine attack in their lives is a measure of incidence and would likely be expressed as a number per thousand (or per hundred thousand) person-years, whereas the proportion of a population suffering from epilepsy or migraine during the year 2000 is an expression of prevalence. 

Epilepsy is one of the most common neurological disorders, with a prevalence of approximately 0.5—1 % of the world population. It is not ahomogenous disease entity, but a collection of diverse syndromes. These are broadly divided in localization-related (focal, local, partial) epilepsies and generalized epilepsies, which involve the whole... 

In zooo, the prevalence of cerebral palsy in metropolitan Adanta was 3.1 per 1000 8-year-olds. Of 10-year-old children, 23 of every 10,000 had cerebral palsy. Eighty-one percent of these children had spastic cerebral palsy. Seventy-five percent had one or more other disabilities (epilepsy, mental retardation, hearing loss, or vision impairment).7 Like many neurological and neuropsychiatric disorders, a diagnosis of cerebral palsy is a description of symptoms, not an identification of causes. 

In areas of the world with poor health conditions, one in 25 individuals have epilepsy in Western Europe the prevalence is one in 125. 

Clinicians have only recently realized that chronic adverse effects of antiepileptic drugs, mainly those involving central nervous system, may be more disabling to the patient than the seizures themselves. Up to a few years ago, the historical belief that seizure frequency is the major determinant of health-related quality of life and that adverse reactions are merely a secondary end-point was the prevalent opinion. It has been shown that changes in seizure rate among patients with drug-resistant epilepsy are only modestly correlated with quality of life, while adverse reactions and depression are critical determinants of subjective health status [I "]. 

The rate of completed suicides in the general population is 12.0/100 000 [24 ], with a marked predominance in men [25 ], while the lifetime prevalence of suicide attempts is 0.6-4.9% overall [26 ], with a preponderance in women. Epilepsy is co-morbid with suicidality [27 ] and with major depression [28P]. After a diagnosis of epilepsy, the risk of completed suicide increases the overall standardized mortality ratio ranges from 3.5 to 5.0 and is higher in the presence of a known psychiatric diagnosis [29 "]. In addition, suicidal ideation and behavior have been identified as psychiatric phenomena in patients with drug-resistant epilepsy [30 "]. 

Polycystic ovarian syndrome and menstrual irregularities were more prevalent in those taking valproate within a population of 71 women with epilepsy who had taken antiepUeptic drugs for a minimum of 2 years [385. There was no correlation between dose and duration of treatment and the probabilities of such complications. 

The increased prevalence of polycystic ovary sjmdrome associated with valproate has been reviewed [386 ]. The risk seems to be higher in women with epilepsy than in women with bipolar disorders, and this might be due to underljdng neuroendocrine dysfunction related to the seizure disorder. 

Kanner AM, Soto A, Gross-Kanner H. Prevalence and clinical characteristics of postictal psychiatric symptoms in partial epilepsy. Neurology 2004 62 708-13. 

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