Phenomenology and epidemiology of impulsive-compulsive behaviours in Parkinson's disease, atypical Parkinsonian disorders and non-Parkinsonian populations

Impulsive-compulsive behaviours are common, quality of life affecting consequences of dopamine replacement therapy which are well recognized in patients with idiopathic Parkinson's disease. Details of the occurrence and nature of these disorders in the atypical parkinsonian neurodegenerative disorders, and in non-Parkinson's patients prescribed dopaminergic stimulation for other disease processes, are slowly emerging. Here we review what is known about the phenomenology, epidemiology and risk factors for impulsive-compulsive behaviours in Parkinson's disease and in other, less well studied, patient groups. By analyzing the available published data, this review identifies potential clues as to the underlying neurobiological mechanism of these disorders, and further identifies critical gaps yet to be addressed

The incidence of first seizures, epilepsy and seizure mimics in a geographically defined area.

To determine the incidence of first seizures, epilepsy and seizure mimics in a geographically defined area using the updated 2014 International League Against Epilepsy (ILAE) definition which allows an epilepsy diagnosis following a single seizure where risk of further seizures over the next 10 years is approximately 60% or more. This replaced the 1993 definition where epilepsy was diagnosed when a person had two or more seizures separated by 24 hours. Using multiple overlapping methods of case ascertainment followed by individual case classification by an epileptologist we identified all first seizures, new diagnosis of epilepsy, and seizure mimics occurring in a defined geographical area (population 542,868) 01/01/2017-12/31/2017. Incidence was age-standardised to the Standard European Population. We compared incidence rates when using the 2014 and 1993 ILAE definitions. When applying the 2014 ILAE definition of epilepsy the incidence of new diagnosis of epilepsy was 62 per 100,000 (age-standardised 74), compared to 41 per 100,000 (age-standardised 48) when applying the 1993 definition, and the difference was more pronounced at older ages. The incidence of all first seizures and of seizure mimics was 102 per 100,000 (age-standardised 123) and 94 per 100,000 (age-standardised 111), respectively. The most frequently encountered seizure mimic was syncope. Application of the 2014 ILAE definition of epilepsy resulted in higher incidence of new diagnosis of epilepsy compared to the 1993 definition. The incidence of seizure mimics almost equals that of all first seizures. Seizures, epilepsy and seizure mimics represent a significant burden to healthcare systems

Application of recent international epidemiological guidelines to a prospective study of the incidence of first seizures, newly-diagnosed epilepsy and seizure mimics in a defined geographic region in Ireland

Studies adherent to international guidelines and epilepsy classification are needed to accurately record the incidence of isolated seizures, epilepsy and seizure-mimics within a population. Because the diagnosis of epilepsy is largely made through clinical assessment by experienced physicians, seizures and epilepsy are susceptible to misdiagnosis. Previous epidemiological studies in epilepsy have not captured â seizure mimicsâ . We therefore sought to quantify the incidence of isolated seizures, epilepsy and seizure-mimics using the International League Against Epilepsy (ILAE) classification system. In this study multiple overlapping methods of case ascertainment were applied to a defined geographic region from January 1 to March 31, 2017 to identify all patients presenting with first seizures (provoked and unprovoked), new diagnoses of epilepsy and seizure mimics. Over a 3 month period, from a population of 542,869 adults and children, 442 potential presentations were identified, and 283 met the inclusion criteria. Radiology databases were the source of the largest number of individual cases (n = 153, 54%), while electroencephalogram (EEG) databases were the source of the highest number of unique-to-source cases (those not identified elsewhere, n = 60, 21%). No single case was picked up in every method of ascertainment. Among the 283 included presentations, 38 (13%) were classed as first provoked seizures, 27 (10%) as first unprovoked seizures, 95 (34%) as new diagnosis of epilepsy and 113 (40%) as seizure mimics. Ten (3%) presentations were indeterminate. We present and apply a rigorous study protocol for investigation of the incidence of first seizures, new diagnosis of epilepsy and seizure mimics in a geographically defined region which is adherent to recently published international guidelines for epidemiologic studies and epilepsy classification. We highlight the challenges in making a diagnosis of new-onset epilepsy in patients presenting with a first seizure using the current ILAE definition of epilepsy, when epilepsy can be diagnosed in situations where the treating physician anticipates the risk of further seizures exceeds 60%

The incidence of first seizures, new diagnosis of epilepsy and seizure mimics in Cork city and county during the calendar year 2017

Introduction: Epidemiologic studies of epilepsy are necessary to define the full public health burden of epilepsy within a population and to set public health and health care priorities. Standardisation of epidemiologic methodology, detailed reporting of results and further studies from geographic regions lacking data have been called for. Furthermore, recently updated International League Against Epilepsy (ILAE) definitions of seizures and epilepsy have not been incorporated into any whole population study. Finally, no study has systematically investigated the occurrence of ‘seizure mimics’ within any population. Methods: Using multiple overlapping methods of case ascertainment, all first seizures, new diagnosis of epilepsy, and seizure mimics occuring in the defined geographical area (population 542,868 adults and children) between 1st January 2017 and 31st December 2017 were identified. Seizures and epilepsy were defined and classified according to the most recent ILAE definitions. Seizure mimics were defined as patients in whom a working diagnosis of seizure was considered, but where an alternate diagnosis was subsequently reached. An area-level relative deprivation index based on 10 indicators from census data was assigned to each patient according to address on record for the purpose of investigating the association between the incidence of each of the four diagnostic categories and relative socioeconomic deprivation. Results: The incidence of all first seizures and of seizure mimics was 102 per 100,000 (age-standardised 123) and 94 per 100,000 (age-standardised 111), respectively. When applying the 2014 ILAE definition of epilepsy, the incidence of new diagnosis of epilepsy was 62 per 100,000 (age-standardised 74) compared to 41 per 100,000 (age-standardised 48) when applying the 1993 definition, and the difference was more pronounced at older ages. The most frequently diagnosed aetiology of epilepsy was structural (54%, n=182). Almost half (n =71, 45%) of all recorded acute symptomatic seizures were related to alcohol (38%) and/or illicit drug use (n=13, 7%). The most frequently encountered seizure mimic was syncope. With regard to socioeconomic deprivation, the annual incidence of first unprovoked seizures, first provoked seizures, new diagnosis of epilepsy and seizure mimics was highest in the most deprived areas compared to the least deprived areas (incidence ratios of 1.79 (95%CI 1.26, 2.52), 1.55 (95%CI 1.04, 2.32), 1.83 (95%CI 1.28, 2.62) and 1.30 (95%CI 1.00, 1.69), respectively). Conclusions: This thesis presents the first epidemiologic study in Ireland investigating the incidence of first seizures, epilepsy and seizure mimics within the geographically defined area of Cork city and county, in accordance with international guidelines for epidemiologic studies and up-to-date international definitions and classifications of epilepsy, in order to address gaps in knowledge and to investigate the effect of updated international definitions on the epidemiologic study of epilepsy. The published results present the first international data on the effect of the updated 2014 ILAE definition of epilepsy on whole population incidence of epilepsy. Furthermore, by applying ILAE classifications to individual cases, this thesis presents detailed data on the aetiology and classification of seizures and epilepsy within the studied population. Finally, this thesis provides further support to international evidence that relatively higher socioeconomic deprivation is associated with an increased incidence of seizures and epilepsy, and presents novel data regarding the association with specific aetiologies of epilepsy and relative socioeconomic deprivation

Association between social deprivation and incidence of first seizures and epilepsy: A prospective population-based cohort

Objective: Epidemiologic studies have investigated whether social deprivation is associated with a higher incidence of epilepsy, and results are conflicting, especially in children. The mechanisms underlying a potential association are unclear. This study examines whether there is an association between social deprivation and the incidence of first seizures (unprovoked and provoked) and new diagnosis of epilepsy by comparing incidence across an area-level measure of deprivation in a population-based cohort. Methods: Multiple methods of case identification followed by individual case validation and classification were carried out in a defined geographical area (population 542 868) to identify all incident cases of first provoked and first unprovoked seizures and new diagnosis of epilepsy presenting during the calendar year 2017. An area-level relative deprivation index, based on 10 indicators from census data, was assigned to each patient according to registered address and categorized into quintiles from most to least deprived. Results: The annual incidence of first unprovoked seizures (n = 372), first provoked seizures (n = 189), and new diagnosis of epilepsy (n = 336) was highest in the most deprived areas compared to the least deprived areas (incidence ratios of 1.79 [95% confidence interval (CI) = 1.26–2.52], 1.55 [95% CI = 1.04–2.32], and 1.83 [95% CI = 1.28–2.62], respectively). This finding was evident in both adults and children and in those with structural and unknown etiologies of epilepsy. Significance: The incidence of first seizures and new diagnosis of epilepsy is associated with more social deprivation. The reason for this higher incidence is likely multifactorial