Focal nonmotor versus motor seizures: The impact on diagnostic delay in focal epilepsy.
clinical neurology
complex partial seizures
epilepsy semiology
epilepsy/seizures
partial seizures
Journal
Epilepsia
ISSN: 1528-1167
Titre abrégé: Epilepsia
Pays: United States
ID NLM: 2983306R
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
27
07
2020
revised:
07
09
2020
accepted:
07
09
2020
pubmed:
21
10
2020
medline:
4
3
2021
entrez:
20
10
2020
Statut:
ppublish
Résumé
To test the hypothesis that people with focal epilepsy experience diagnostic delays that may be associated with preventable morbidity, particularly when seizures have only nonmotor symptoms, we compared time to diagnosis, injuries, and motor vehicle accidents (MVAs) in people with focal nonmotor versus focal seizures with motor involvement at epilepsy onset. This retrospective study analyzed the enrollment data from the Human Epilepsy Project, which enrolled participants between 2012 and 2017 across 34 sites in the USA, Canada, Europe, and Australia, within 4 months of treatment for focal epilepsy. A total of 447 participants were grouped by initial seizure semiology (focal nonmotor or focal with motor involvement) to compare time to diagnosis and prediagnostic injuries including MVAs. Demographic characteristics were similar between groups. There were 246 participants (55%) with nonmotor seizures and 201 participants (45%) with motor seizures at epilepsy onset. Median time to diagnosis from first seizure was 10 times longer in patients with nonmotor seizures compared to motor seizures at onset (P < .001). The number and severity of injuries were similar between groups. However, 82.6% of MVAs occurred in patients with undiagnosed nonmotor seizures. This study identifies reasons for delayed diagnosis and consequences of delay in patients with new onset focal epilepsy, highlighting a treatment gap that is particularly significant in patients who experience nonmotor seizures at epilepsy onset.
Types de publication
Comparative Study
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2643-2652Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 International League Against Epilepsy.
Références
Firkin AL, Marco DJT, Saya S, Newton MR, O’Brien TJ, Berkovic SF, et al. Mind the gap: multiple events and lengthy delays before presentation with a “first seizure”. Epilepsia. 2015;56(10):1534-41.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)-a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-81.
Saleem MN, Arencibia CA, McKenna K, Cristofaro S, Detyniecki K, Friedman D, et al. Investigation of patient and observer agreement on description of seizures at initial clinical visit. Ann Clin Transl Neurol. 2019;6(12):2601-6.
Fisher RS, Cross JH, D’Souza C, French JA, Haut SR, Higurashi N, et al. Instruction manual for the ILAE 2017 operational classification of seizure types. Epilepsia. 2017;58(4):531-42.
Ngugi AK, Bottomley C, Kleinschmidt I, Sander JW, Newton CR. Estimation of the burden of active and life-time epilepsy: a meta-analytic approach. Epilepsia. 2010;51(5):883-90.
Shorvon SD, Goodridge DMG. Longitudinal cohort studies of the prognosis of epilepsy: contribution of the National General Practice Study of Epilepsy and other studies. Brain. 2013;136(Pt 11):3497-510.
James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789-858.
Greenlund SF, Croft JB, Kobau R. Epilepsy by the numbers: epilepsy deaths by age, race/ethnicity, and gender in the United States significantly increased from 2005 to 2014. Epilepsy Behav. 2017;69:28-30.
Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1736-88.
Kyu HH, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1859-922.
Novy J, Belluzzo M, Caboclo LO, Catarino CB, Yogarajah M, Martinian L, et al. The lifelong course of chronic epilepsy: the Chalfont experience. Brain. 2013;136(Pt 10):3187-99.
Nevalainen O, Ansakorpi H, Simola M, Raitanen J, Isojärvi J, Artama M, et al. Epilepsy-related clinical characteristics and mortality: a systematic review and meta-analysis. Neurology. 2014;83(21):1968-77.
Lee SA, Kim MJ, Lee HW, Heo K, Shin DJ, Song HK, et al. The effect of recurrent seizures on cognitive, behavioral, and quality-of-life outcomes after 12 months of monotherapy in adults with newly diagnosed or previously untreated partial epilepsy. Epilepsy Behav. 2015;53:202-8.
Kalilani L, Faught E, Kim H, Burudpakdee C, Seetasith A, Laranjo S, et al. Assessment and effect of a gap between new-onset epilepsy diagnosis and treatment in the US. Neurology. 2019;92(19):e2197-208.
Fiest KM, Sauro KM, Wiebe S, Patten SB, Kwon CS, Dykeman J, et al. Prevalence and incidence of epilepsy. Neurology. 2017;88(3):296-303.
U.S. Census Bureau. Annual estimates of the resident population by single year of age and sex for the United States: April 1, 2010 to July 1, 2018 (NC-EST2018-AGESEX-RES). 2019. Available at: https://www.census.gov/data/tables/time-series/demo/popest/2010s-national-detail.html. Accessed July 1, 2019
Hauser WA, Annegers JF, Kurland LT. Prevalence of epilepsy in Rochester, Minnesota: 1940-1980. Epilepsia. 1991;32(4):429-45.
Olafsson E, Ludvigsson P, Gudmundsson G, Hesdorffer D, Kjartansson O, Hauser WA. Incidence of unprovoked seizures and epilepsy in Iceland and assessment of the epilepsy syndrome classification: a prospective study. Lancet Neurol. 2005;4(10):627-34.
Appleton RE. Seizure-related injuries in children with newly diagnosed and untreated epilepsy. Epilepsia. 2002;43(7):764-7.
Ting YW, Kwong KL. Seizure-related injuries in newly diagnosed childhood epilepsy. Pediatr Neurol. 2010;42(6):417-21.
Camfield C, Camfield P. Injuries from seizures are a serious, persistent problem in childhood onset epilepsy: a population-based study. Seizure. 2015;27:80-3.
French JA, Kanner AM, Bautista J, Abou-Khalil B, Browne T, Harden CL, et al. Efficacy and tolerability of the new antiepileptic drugs II: treatment of refractory epilepsy: report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2004;62(8):1261-73.
Lawn N, Kelly A, Dunne J, Lee J, Wesseldine A. First seizure in the older patient: clinical features and prognosis. Epilepsy Res. 2013;107(1-2):109-14.
Kirby S, Sadler RM. Injury and death as a result of seizures. Epilepsia. 1995;36(1):25-8.
Pohlmann-Eden B, Hynick N, Legg K. First seizure while driving (FSWD)-an underestimated phenomenon? Can J Neurol Sci. 2013;40(4):540-5.
Thompson AC, Ivey SL, Lahiff M, Betjemann JP. Delays in time to surgery for minorities with temporal lobe epilepsy. Epilepsia. 2014;55(9):1339-46.
Devinsky O, Spruill T, Thurman D, Friedman D. Recognizing and preventing epilepsy-related mortality. Neurology. 2016;86(8):779-86.