Objective To determine the incidence of epilepsy in a general practice population and its variation with socioeconomic deprivation. Design Prospective surveillance for new cases over an 18 or 24 month period. Participants All patients on practice registers categorised for deprivation with the Carstairs score of their postcode. Setting 20 general practices in London and south east England. Main outcome measure Confirmed diagnosis of epilepsy.Results 190 new cases of epilepsy were identified during 369 283 person years of observation (crude incidence 51.5 (95% confidence interval 44.4 to 59.3) per 100 000 per year). The incidence was 190 (138 to 262) per 100 000 in children aged 0-4 years, 30.8 (21.3 to 44.6) in those aged 45-64 years, and 58.7 (42.5 to 81.0) in those aged >65 years. There was no apparent difference in incidence between males and females. The incidence showed a strong association with socioeconomic deprivation, the age and sex adjusted incidence in the most deprived fifth of the study population being 2.33 (1.46 to 3.72) times that in the least deprived fifth (P=0.001 for trend across fifths). Adjustment for area (London v outside London) weakened the association with deprivation (rate ratio 1.62 (0.91 to 2.88), P=0.12 for trend). Conclusions The incidence of epilepsy seems to increase with socioeconomic deprivation, though the association may be confounded by other factors.

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Our findings suggest that the profile of cognitive deficits associated with MTLE is already established as children with temporal lobe epilepsy enter adulthood. While memory and language skills are maximally affected, intellectual function is also compromised in MTLE. This profile appears to remain stable across the adult lifespan, at least until 60 years of age, despite the intractable nature of the seizures. Side of pathology and gender are significant mediating factors in shaping the profile of cognitive deficits associated with childhood-onset MTLE, with people with left-sided HS and female subjects particularly vulnerable to more widespread cognitive dysfunction.

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Summary:This article provides an overview of methods used and findings from economic analyses in epilepsy. Costeffectiveness studies have evaluated different drugs for monotherapy and add-on therapy, and compared alternative treatment modalities for refractory epilepsy. The methodological characteristics of these studies are examined, and their results are compared and interpreted. Health outcome measures are defined and data sources described. Methods for assessing the direct and indirect costs, and/or cost savings, with a treatment's use, are explored. Directions for future research are identified and discussed.

Summary:We undertook an economic appraisal of four drugs used in monotherapy during the f i i t 2 years of treatment for newly diagnosed patients with epilepsy: carbamazepine (CBZ), lamotrigine (LTG), phenytoin (PHT), and valproate (VPA). We adopted the cost-minimization model because, although no single trial compares all four drugs directly, the clinical trials comparing two or more of these drugs in newly diagnosed cases show no significant difference in efficacy between the drugs in terms of seizure frequency: Considered in the cost analyses were frequency of side effects, retention rates, medical consultations, inpatient and accident and emergency costs, laboratory investigations, and drug changes. A Delphi panel provided the treatment pathways, including frequency of clinical consultations, second-line monotherapy, and side-effects management. A sensitivity analysis was performed, varying the assumptions on which the calculations were based. Analysis was completed for a prospective, intention-to-treat perspective and also for those patients continuing the initial drug. The direct medical costs of 2-years therapy (intention-to-treat analysis) calculated for each trial were €795-829 for CBZ, €1,525-2,076 for LTG, €736-768 for PHT, and €868-884 for VPA. A sensitivity analysis provided similar relative estimates. We found that LTG for newly diagnosed patients is significantly more expensive in direct health service costs incurred. This analysis incorporated seizure control, side effects, and tolerability. We recommend that a similar type of analysis be considered as part of all clinical trials of antiepileptic drugs in which efficacy of outcome is similar as a guide to assess optimal cost effectiveness. Key Words: Cost-Economic-Epilepsy is a common neurologic condition. Its annual incidence in the United Kingdom is around 50/100,000 persons and its prevalence is 5-8/1,000 persons (1). The cost of medical services for people with epilepsy has been estimated to be in the region of f100-170 million per year (2). Over recent years there has been increasing use of the "new" antiepileptic drugs (AEDs) which, although initially licensed for adjunctive use, are increasingly used as monotherapy, and thus potentially as firstline treatment for newly diagnosed epilepsy. In Europe, the AEDs most commonly used for monotherapy in newly diagnosed patients with epilepsy are carbamazepine (CBZ), phenytoin (PHT), and valproate (VPA), Lamotrigine (LTG) is the first of the newer AEDs to receive a monotherapy license and is now used in some patients who have been newly diagnosed with epilepsy. We studied the healWeconomic aspects of this widening choice of drugs for use in adult patients newly diagnosed with epilepsy.A consideration in the use of the newer agents by the United Kingdom National Health Service (NHS) is their cost compared to those of the more established AEDs. The annual cost of LTG is approximately fivefold greater than that of VPA, 10-fold greater than that of CBZ, and over 20-fold greater than that of PHT (3). Th...

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