Summary:Purpose: To evaluate the methodology of incidence studies of epilepsy and unprovoked seizures and to assess the value of their findings by summarizing their results.Methods: A Medline literature search from January 1966 to December 1999 was conducted. In each selected study, key methodologic items such as case definition and study design were evaluated. Furthermore, a quantitative meta-analysis of the incidence data was performed.Results: Forty incidence studies met the inclusion criteria. There was considerable heterogeneity in study methodology, and the methodologic quality score was generally low. The median incidence rate of epilepsy and unprovoked seizures was 47.4 and 56 per 100,000, respectively. The age-specific incidence of epilepsy was high in those aged 60 years or older, but was highest in childhood. Males had a slightly higher incidence of epilepsy (median, 50.7/100,000) than did females (median, 46.2/100,000), and partial seizures seemed to occur more often than generalized seizures. Developing countries had a higher incidence rate of epilepsy (median, 68.7/100,000) than did industrialized countries (median, 43.4/100,000). Similar results were found for unprovoked seizures. The incidence of epilepsy over time appears to decrease in children, whereas it increases in the elderly.Conclusions: The age-specific incidence of epilepsy showed a bimodal distribution with the highest peak in childhood. No definitive conclusions could be reached for the incidence of unprovoked seizures and other specific incidence rates of epilepsy. More incidence studies with an adequate study methodology are needed to explore geographic variations and time trends of the incidence of epilepsy and unprovoked seizures. Key Words: Incidence-Epilepsy-Unprovoked seizuresReview-Epidemiology.Incidence studies provide important information regarding the natural history of epilepsy and its risk factors. During the last three decades, several incidence studies of epilepsy have been performed. These studies indicate that the incidence of epilepsy varies considerably with age and that epilepsy is slightly more common in males. Moreover, recent studies suggest a secular trend in the age-specific incidence, with a decline in children and an increase in elderly people (1,2).However, the available data are difficult to interpret and compare because of methodologic differences (3,4). So far, only one systematic study on the epidemiology of epilepsy has been done (5). In this study (5), the results of incidence and prevalence studies of epilepsy have been described without conducting a meta-analysis of the incidence data. We performed a systematic review and a quantitative meta-analysis of incidence studies of epilepsy and unprovoked seizures (USs) to study the effect of methodologic quality on the incidence reported, on the magnitude of possible geographic differences in incidence, on the epidemiology of different types of seizures, and the possible changes of incidence over time. METHODS Study selectionWe identified previously publi...

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In conclusion, the vessel wall movement detector system has a good technical reproducibility. Intraobserver intrasession and intersession variability are comparable, and are larger in muscular arteries. This might be due to a larger variation in tone of these arteries, which are under permanent neurohumoral control. Interobserver intrasession variability was larger than intraobserver variability and might be influenced by differences in observers' skill and spontaneous variation in vessel wall properties.

Velocity patterns in and distensibility of the carotid artery bulb were studied in younger (20 to 30 years; n -1 1) and older (50 to 60 years; n 9) volunteers without detectable lesions of the cervical carotid arteries by means of a high-resolution, multigate, pulsed Doppler system coupled to a B mode imager. In the bulb the axial velocities were highest on the side of the flow divider, while regions of flow separation and recirculation were observed on the side opposite to this divider. Flow separation and recirculation were less pronounced and less common in the older subjects. Flow separation was not continuously present throughout the cardiac cycle. The distensibility of the carotid arteries was significantly diminished in older subjects, especially in the bulb. The velocity patterns in the carotid artery bulb of younger subjects corroborate the patterns observed in models. The diminished flow separation and recirculation in the older subjects might result from alterations in distensibility at the transition from common to internal carotid artery with increasing age. Circulation 71, No. 3, 500-509, 1985. IN A RECENT STUDY relating data derived from autopsy specimens to flow patterns and shear stresses as assessed in model bifurcation, . ' 2Zarins et al.3 showed that in the carotid artery bulb, maximal intimal thickening and atherosclerotic plaque formation occurred in regions of flow separation and reduced shear stress. These regions were located on the side opposite to the flow divider. Regions with predominantly axial and unidirectional flow velocities and high shear stresses, located on the side of the flow divider, were relatively devoid of these wall changes. A zone of recirculation in the carotid artery bulb opposite to the flow divider was also observed in studies performed on excised human carotid artery bifurcations.4 In these investigations flow patterns were studied under conditions of steady flow, while undistensible materials and Newtonian fluids were used, conditions quite different from the situation in vivo. Although preliminary studies in models indicate that the flow patterns in the carotid artery bulb are similar under steady and pulsaFrom the

For female patients with symptoms of an acute uncomplicated UTI a positive nitrite test or a negative nitrite test with a positive LE test confirmed UTI whereas a negative nitrite together with a negative LE test did not rule out infection. For empirical treatment GPs should take into account the changing aetiology with increasing age. Prudent use of antibiotics in general and more specifically fluoroquinolones remains recommended. As trimethoprim resistance reached 20% it might be advisable to no longer use it as therapy of first choice for acute uncomplicated UTIs in The Netherlands.

The incidence of US and epilepsy (overall, and age-, sex-, seizure-specific) was similar to those reported by other developed countries. The predictive factors found in this study may assist in the early diagnosis of seizures.

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