Secular trends and population differences in the incidence of epilepsy. A population-based study from Saskatchewan, Canada

Hernández-Ronquillo, Lizbeth; Thorpe, Lilian; Pahwa, Punam; Téllez‐Zenteno, José F.

doi:10.1016/j.seizure.2018.05.018

Cited by 18 publications

(10 citation statements)

References 28 publications

(31 reference statements)

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“…The treatment process and timeline for adults with NOE are clinically different. As it is, the lapsed time for epilepsy surgery for adults in Saskatchewan is almost 20 years, similar to other centers which were 22.1 years (29,35). Given that the definition of DRE utilizes a timeline of 2 years, there should be a much more rapid referral to tertiary epilepsy surgical centers in both our province and globally.…”

Section: Percentage Of Dre By Year Of Follow-upsupporting

confidence: 53%

“…For this reason, we chose not to include ethnicity, or indigenous ancestry, as a risk factor in this study. This is a significant limitation given recent publications in Canada showing that indigenous persons are at 2 times the risk for developing epilepsy ( 36 ). It would then be reasonable to assume that it should be included as a risk factor for the progression of the condition as well, along with other ethnicities.…”

Section: Discussionmentioning

confidence: 99%

“…The treatment history and duration of epilepsy are established risk factors for relapse over time and therefore are necessary points of observation in a follow-up study of this nature (34). In total, 2 prior studies, a pediatric and an all-ages prospective cohort study, indicated the latency period between onset of seizures and failure of the second ASM was 9.1 and 9.7 years, respectively (29,35). Most patients in all ages study were <18 years of age, which is an important point to consider when applying such timelines to an adult cohort.…”

Section: Percentage Of Dre By Year Of Follow-upmentioning

confidence: 99%

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Definitions and Risk Factors for Drug-Resistant Epilepsy in an Adult Cohort

et al. 2021

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Background: Less than one-third of people with epilepsy will develop drug-resistant epilepsy (DRE). Establishing the prognosis of each unique epilepsy case is an important part of evaluation and treatment.Most studies on DRE prognosis have been based on a pooled, heterogeneous group, including children, adults, and older adults, in the absence of clear recognition and control of important confounders, such as age group. Furthermore, previous studies were done before the 2010 definition of DRE by the International League Against Epilepsy (ILAE), so data based on the current definitions have not been entirely elucidated. This study aimed to explore the difference between 3 definitions of DRE and clinical predictors of DRE in adults and older adults.Methods: Patients with a new diagnosis of epilepsy ascertained at a Single Seizure Clinic (SSC) in Saskatchewan, Canada were included if they had at least 1 year of follow-up. The first study outcome was the diagnosis of DRE epilepsy at follow-up using the 2010 ILAE definition. This was compared with 2 alternative definitions of DRE by Kwan and Brodie and Camfield and Camfield. Finally, risk factors were analyzed using the ILAE definition.Results: In total, 95 patients with a new diagnosis of epilepsy and a median follow-up of 24 months were included. The median age of patients at the diagnosis of epilepsy was 33 years, and 51% were men. In the cohort, 32% of patients were diagnosed with DRE by the Kwan and Brodie definition, 10% by Camfield and Camfield definition, and 15% by the ILAE definition by the end of follow-up. The only statistically significant risk factor for DRE development was the failure to respond to the first anti-seizure medication (ASM).Conclusion: There were important differences in the percentage of patients diagnosed with DRE when using 3 concurrent definitions. However, the use of the ILAE definition appeared to be the most consistent through an extended follow-up. Finally, failure to respond to the first ASM was the sole significant risk factor for DRE in the cohort after considering the age group.

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Section: Percentage Of Dre By Year Of Follow-upsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Percentage Of Dre By Year Of Follow-upmentioning

confidence: 99%

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Definitions and Risk Factors for Drug-Resistant Epilepsy in an Adult Cohort

et al. 2021

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“…1 A recent study from the adjacent Canadian province of Saskatchewan found that the incidence of epilepsy in the Indigenous population is double the national average. 5 , 9 , 10 , 29 Although ethnicity data were not available on chart review, there is no reason to assume that Indigenous persons do not comprise a similar majority of SE medical evacuations. Recurrent minor seizures (and by extension, epilepsy) in this population may be under‐reported due to understandable enduring mistrust of the healthcare system resulting from extreme historical inequities, 30 stigma against seizures, or cultural interpretation of symptoms.…”

Section: Discussionmentioning

confidence: 99%

Status epilepticus in the Canadian Arctic: A public health imperative hidden in plain sight

Pavlova

2021

Epilepsia Open

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Epilepsy (ILAE), and International Bureau for Epilepsy have called epilepsy a public health imperative, with appropriate emphasis on low-to-middle-income countries (LMIC). Although Canada is a high-income country (HIC), income is not distributed uniformly. Furthermore, epilepsy data from the national statistical agency explicitly overlook the Arctic by excluding these territories. A common neurologic emergency, status epilepticus (SE) is a life-threatening manifestation of epilepsy that demands prompt treatment to avoid death and longterm sequelae. Therefore, we examined the rate of SE in a well-defined Canadian Arctic region.Methods: This study takes epidemiologic advantage of the Kivalliq Region's geographical isolation, which is accessible only by air. All SE patients requiring emergency care are consistently flown 1200-1900 kilometers to a single designated hospital in a distinct southern part of Canada for further management and electroencephalography (EEG). We conducted a retrospective database and chart review at this "bottleneck" hospital to identify patients with seizure(s) severe enough to justify emergency airborne medical evacuation over a 11.25-year period from 2009 to 2020. Results:We screened 40 392 EEGs to yield 117 distinct medical evacuations for "operational SE" from 99 patients to derive estimated SE incidences of 99.9 evacuations per 100 000/year and 84.5 patients per 100 000/year. The average time from seizure onset to EEG was 3.2 days. Only 16.2% of SE patients had known epilepsy. For "confirmed SE" cases meeting ILAE criteria, or cases with persistently epileptiform EEG despite days of empiric treatment, estimated incidence was 77.7 evacuations per 100 000/year and 64.9 patients per 100 000/year. Significance: High SE and epilepsy rates in the Canadian Arctic are consistent with LMIC rather than HIC. Our findings demonstrate the paradox of LMICequivalent epilepsy populations camouflaged within HIC. Our findings also highlight the long-standing plight of these under-served and overlooked populations hidden in plain sight.

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“…Although the composition of the steering group was heterogenous in terms of ethnicity, gender, age, and location in order to represent a range of perspectives, many minority and marginalized groups, as well as those aged under 18 and over 70, were underrepresented in the survey results, and thus the final list of priorities may not fully reflect the views of the diverse Canadian population. Clinical best practices, availability of diagnostic testing, and access to specialists can vary widely across the country, and systematic inequities exist on a regional scale, particularly in the Arctic territories and among Indigenous populations [37].…”

Section: Limitationsmentioning

confidence: 99%