Diagnostic Yield and Accuracy of Different Metabolic Syndrome Criteria in Adult Patients with Epilepsy

Abstract

IntroductionMetabolic syndrome (MetS) is an emergent problem among patients with epilepsy. Here, we evaluate and compare the diagnostic yield and accuracy of different MetS criteria among adult patients with epilepsy to further explore the best strategy for diagnosis of MetS among patients with epilepsy.Materials and methodsNinety-five epileptic adults from a tertiary epilepsy reference center were prospectively recruited over 22 weeks in a cross-sectional study. MetS was defined according to five international criteria used for the diagnosis of the condition [ATP3, American Association of Clinical Endocrinologists (AACE), International Diabetes Federation (IDF), AHA/NHLBI, and harmonized criteria]. Sensitivity, specificity, positive and negative predictive values (NPVs), and area under the receiver operating characteristic curve (ROC) curve were estimated for each criterion.ResultsIn our sample, adult patients with epilepsy showed a high prevalence of obesity, hypertension, and diabetes. However, the prevalence of MetS was significantly different according to each criterion used, ranging from 33.7%, as defined by AACE, to 49.4%, as defined by the harmonized criteria (p < 0.005). IDF criteria showed the highest sensitivity [S = 95.5% (95% CI 84.5–99.4), p < 0.05] and AACE criteria showed the lowest sensitivity and NPV [S = 68.2% (95% CI 52.4–81.4), p < 0.05; NPV = 75.8% (95% CI 62.3–86.1), p < 0.05]. ROC curve for all criteria studied showed that area under curve (AUC) for IDF criterion was 0.966, and it was not different from AUC of harmonized criterion (p = 0.092) that was used as reference. On the other hand, the use of the other three criteria for MetS resulted in significantly lower performance, with AUC for AHA/NHLBI = 0.920 (p = 0.0147), NCEP/ATP3 = 0.898 (p = 0.0067), AACE = 0.830 (p = 0.00059).ConclusionOur findings suggest that MetS might be highly prevalent among adult patients with epilepsy. Despite significant variations in the yield of different criteria, the harmonized definition produced the highest prevalence rates and perhaps should be preferred. Correct evaluation of these patients might improve the rates of detection of MetS and foster primary prevention of cardiovascular events in this population.

Metabolic syndrome and its associated factors among epileptic patients at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia; a hospital-based comparative cross-sectional study

“…This finding is in line with similar studies conducted in Kigali Rwanda using ATP III (30.6%) [ 7 ], in Estonia using ATP-III (20.3%) [ 22 ], in India by ATP III criteria (29.5%) [ 23 ] and in Istanbul Turkey using IDF criteria (32.6%) [ 24 ]. Conversely, a higher rate of MS as compared to the finding of this study was reported among epileptic patients, 52.6% in South India using the AHA/NHLBI [ 8 ], 47.2% based on IDF Criteria, and 39.3% based on ATP-III criteria in Brazil [ 25 ], 43.5% in Italy using ATP-III [ 26 ] and 47.2% in West China based on AHA/NHLBI criteria [ 27 ]. The possible reason for this discrepancy may be the difference in sample size and sampling technique, the differences in study approaches (different in patient’s selection criteria such as age, weight and anticonvulsants medications), the difference in types of anticonvulsant agents utilized by the patients and the difference in socio-economic status.…”

Frequency of metabolic syndrome and insulin resistance in epileptic patients treated with sodium valproate or carbamazepine monotherapy: A Case-Control Study

“…Cabral et al suggested ,the incidence of MetS was signi cantly different based on each criterion used, the IDF criteria can present higher speci city and sensitivity for the evaluation and determination of the MetS [37].…”

Association of Tourette Syndrome and Chronic Tic Disorder With Metabolic and Cardiovascular Disorders

“…Lifetime comorbid psychiatric diagnoses were obtained from the NPR and included (1) organic disorders (organic brain disorder and epilepsy), (2) obsessive-compulsive disorder, (3) attention-deficit/hyperactivity disorder (ADHD), (4) conduct disorders, (5) Meaning Tourette syndrome and chronic tic disorder are associated with a substantial risk of cardiometabolic disorders; these risks should be carefully monitored in these patients, particularly in those with comorbid attention-deficit/hyperactivity disorder. (6) psychotic and bipolar disorders, (7) anxiety disorders, and (8) depressive disorders.…”

“…Data were obtained by linking several Swedish nationwide administrative registers through the unique personal national identification numbers assigned to Swedish citizens. 22 Registers included (1) the Swedish Total Population Register, containing data on all Swedish inhabitants since 1968, from which demographic data were obtained; (2) the Migration Register, which contains a record on all migration flows in and out of Sweden; (3) the Multi-Generation Register, which connects every person born in Sweden since 1933 and ever registered as living in the country after 1960 with their parents, allowing for the identification of siblings and other relatives 23 ; (4) the Cause of Death Register, which contains information on all deaths since 1952; (5) the National Patient Register (NPR), which includes data on all diagnoses given in both inpatient (since 1969, with good coverage for psychiatric disorders since 1973) 24 and outpatient specialist services (since 2001) based on the International Classification of Diseases (ICD) in its eighth (ICD-8;1969-1986, ninth (ICD-9;1987-1996, and tenth (ICD-10; 1997-2013) revisions; and (6) the Prescribed Drug Register, which includes, since July 1, 2005, a record of all dispensed medications in Sweden, registered using the codes from the Anatomical Therapeutic Chemical Classification System. 25…”

“…Previous research has shown that individuals with neuropsychiatric disorders are more prone to develop health complications, [5][6][7][8][9][10][11][12] which in turn are known to increase the risk of mortality. [13][14][15] Among these complications, metabolic syndrome, a group of risk factors that generally includes abdominal obesity, increased triglyceride concentrations, reduced high-density lipoprotein cholesterol concentrations, hypertension, and hyperglycemia, 16 together with cardiovascular problems, have received the most attention.…”