Epilepsy following simple febrile seizure in a rural community in Tanzani

Objective: To study the outcome of subsequent epilepsy following a single uncomplicated febrile seizure in a cohort of children aged six months to six years followed up for a ten year period.Design: Observational prospective cohort studySetting: Mahenge epilepsy clinic, Ulanga district, Morogoro region, Tanzania.Subjects: Children aged six months to six years living in Ulango District, Morogoro Region, Tanzania.Results: A total of 6522 children aged six months to six years lived in the study area. Of these 213 (3%) had experienced one uncomplicated febrile seizures within six months of the commencement of the study. At the end of ten years follow-up period 145(65%) were still living in the study area. Of these 44 (30%) had developed epilepsy giving an equivalent of cumulative incidence rate of 3.8 per 100 person years. The age of onset of first uncomplicated FS between the ages of two to five years was significantly associated with the development of later epilepsy in comparison to other ages X2 26.43; P<0.001. This difference was significantly accumulative with time of follow-up. The number of recurrent febrile seizures significantly influenced the development of later epilepsy.X2 = 32.3; p =<0.001 with relative risk (odds ratio 5.4, 95% CI 2.6-11.41 P<0.001). A positive family history of FS significantly influenced the development of later epilepsy. X2 P<0.001 with relative risk (odds ratio 3.2, 95% CI 2.0-5.1; p<0.001. A positive family history of epilepsy did not significantly influence the development of later epilepsy X2 = 38.1; P <0.212. Conclusion: Cumulative incidence of epilepsy in rural Tanzanian children following a single uncomplicated FS was small but higher than that reported in developed countries. This risk was influenced independently by the number of recurrent FS, family history of FS, and the age of onset of the first ever FS

Frequency of anxiety after stroke: a systematic review and meta-analysis of observational studies.

BACKGROUND AND PURPOSE: Negative psychological outcomes occur frequently after stroke; however, there is uncertainty regarding the occurrence of anxiety disorders and anxiety symptoms after stroke. A systematic review of observational studies was conducted that assessed the frequency of anxiety in stroke patients using a diagnostic or screening tool. SUMMARY OF REVIEW: Databases were searched up to March 2011. A random effects model was used to summarize the pooled estimate. Statistical heterogeneity was assessed using the I(2) statistic. Forty-four published studies comprising 5760 stroke patients were included. The overall pooled estimate of anxiety disorders assessed by clinical interview was 18% (95%confidence interval 8-29%, I(2)  = 97%) and was 25% (95% confidence interval 21-28%, I(2)  = 90%) for anxiety assessed by rating scale. The Hospital Anxiety and Depression Scale-Anxiety subscale 'probable' and 'possible' cutoff scores were the most widely used assessment criteria. The combined rate of anxiety by time after stroke was: 20% (95% confidence interval 13-27%, I(2)  = 96%) within one-month of stroke; 23% (95% confidence interval 19-27%, I(2)  = 84%) one to five-months after stroke; and 24% (95% confidence interval 19-29%, I(2)  = 89%) six-months or more after stroke. CONCLUSION: Anxiety after stroke occurs frequently although methodological limitations in the primary studies may limit generalizability. Given the association between prevalence rates and the Hospital Anxiety and Depression Scale-Anxiety cutoff used in studies, reported rates could in fact underrepresent the extent of the problem. Additionally, risk factors for anxiety, its impact on patient outcomes, and effects in tangent with depression remain unclear