Leisure time and social activity after a newly diagnosed unprovoked epileptic seizure in adult age. A population-based case-referent study.

PURPOSE: To investigate leisure time activity and factors that influence it in an adult cohort having newly diagnosed unprovoked epileptic seizures. PATIENTS AND METHODS: A cohort of 62 patients > or =17 years with a newly diagnosed unprovoked epileptic seizure during 1985-87 and 93 sex- and age-matched referents were followed up regarding leisure time activity, marital status and driver's license for 10 years till 1996. Data were questionnaire derived. RESULTS: Patients became significantly less physically active, traveled abroad less often and were generally less active during their leisure time than referents. No other significant differences were observed. CONCLUSION: After a newly diagnosed unprovoked epileptic seizure in adult age, most leisure time activities, marital status and holding of driver's license are not affected. Patients become physically less active than referents. The role of seizures for this difference is unclear and other medical and social factors should be considered.

Seizure recurrence in adults after a newly diagnosed unprovoked epileptic seizure.

PURPOSE: To investigate the risk of seizure recurrence after a newly diagnosed unprovoked epileptic seizure in an adult population-based cohort. MATERIAL AND METHODS: A total of 107 patients aged >or=17 years with a newly diagnosed unprovoked epileptic seizure (index seizure) were prospectively identified for the period 1985-87. Patients were followed until the date of death or to the end of 1996 with a median follow-up of 10.3 years for surviving cases. Overall cumulative recurrence rates and possible influencing variables were calculated. RESULTS: At 750 days after the index seizure the recurrence was 58%, and after that no events occurred. Recurrence risk was significantly higher when index seizure was remote symptomatic or preceded by two or more seizures. No other study variable predicted seizure recurrence. CONCLUSION: Etiology and the occurrence of seizures before the index seizure after a newly diagnosed unprovoked epileptic seizure predict seizure recurrence. Thus, particular consideration should be given to these factors in the decision of whether or not to initiate antiepileptic treatment.

Remission of seizures in a population-based adult cohort with a newly diagnosed unprovoked epileptic seizure.

PURPOSE: To investigate the probability of achieving remission of seizures after a newly diagnosed unprovoked epileptic seizure in an adult population-based cohort. METHODS: 107 patients aged 17 years or older with a newly diagnosed unprovoked epileptic seizure (index seizure) in 1985 through 1987 were followed up until the date of death or to the end of 1996. The proportion of cases during follow-up that attained a 1-year, 3-year, 5-year remission was calculated by actuarial analyses. Variables for stratification were age at diagnosis, seizure type, etiology, EEG, and the occurrence of seizures within 1 year of initiation of antiepileptic drug (AED) therapy. RESULTS: Cumulative 1-, 3- and 5-year remission rates were 68, 64, and 58%. There was no statistically significant difference regarding time points of achieving a 1-year remission after epilepsy diagnosis and the subsequent probability during follow-up of attaining a 5-year remission. Having seizures within 1 year after beginning with an AED was a statistically significant predictor of never achieving 1-year remission of seizures during follow-up (refractory seizures). Other stratified variables were not statistically significant predictors. CONCLUSIONS: Seizure prognosis for the majority of patients with newly diagnosed epilepsy is good. The time required after epilepsy diagnosis to achieve a 1-year remission of seizures does not affect the probability of additionally achieving a 5-year remission. Patients with refractory seizures can be identified within a few years from diagnosis of epilepsy. These patients must be targeted early for optimization of pharmacologic treatment, possible surgery, and psychosocial intervention.

Mortality risk in an adult cohort with a newly diagnosed unprovoked epileptic seizure: a population-based study.

PURPOSE: We sought to investigate mortality risk in an adult cohort with newly diagnosed unprovoked epileptic seizures. METHODS: One hundred seven patients who were at least 17 years old and had newly diagnosed unprovoked epileptic seizures were prospectively identified during a period of 20 months between 1985 and 1987. Patients were followed until the date of death or the end of 1996. The standard mortality ratio (SMR) was analyzed in the whole cohort and in the portion of the cohort with recurrent seizures at inclusion. The influences on the SMR of time since diagnosis, sex, age at diagnosis, seizure cause, seizure type, and cause of death were also investigated. RESULTS: The SMR was significantly increased (SMR, 2.5; 95% confidence interval [CI], 1. 2-3.2). This significantly increased risk was found during the first 2 years after diagnosis (year 1: SMR, 7.3; 95% CI, 4.4-12.1; year 2: SMR, 3.6; 95% CI, 1.6-8.1) and at years 9-11 (SMR, 5.4; 95% CI, 2. 7-11.2). The increased mortality risk was most pronounced when the seizures occurred before the age of 60 years. Mortality risk was elevated among patients with remote symptomatic epilepsy (SMR, 3.3; 95% CI, 2.4-4.5) but not idiopathic epilepsy. CONCLUSIONS: There is increased mortality risk in an adult cohort with newly diagnosed unprovoked epileptic seizures. This increase is found in symptomatic patients, young patients, and during the first 2 years after the diagnosis.

Clinical epidemiology of Guillain-Barré syndrome in adults in Sweden 1996-97: a prospective study.

We described clinical manifestations, outcomes, prognostic indicators and clinico-epidemiological subgroups for 53 adult patients with Guillain-Barré syndrome (GBS) in Sweden during the period 1996-97. These patients were identified from a population of 2.8 million inhabitants and prospectively followed up for one year by a network of neurologists. An additional 10 cases, of whom five were adults who had not been prospectively followed up, were not included in the analyses. At 6 months after onset 80% of the patients could walk without aid, while at 1 year 46% were fully recovered, 42% had mild residual signs or symptoms, 4% had moderate and 6% severe disabilities, and 2% had died. Intravenous human immunoglobulin or plasmapheresis were used in 72% of the patients. The sum of the Medical Research Council (MRC) score at nadir was found as the only significant predictor for residual signs at 1 year in a multivariate model. Three subgroups, with different clinico-epidemiological characteristics, were identified by using cluster analysis. In conclusion, GBS in Sweden is frequently preceded by a respiratory infection, is often treated with immunomodulatory therapies, and exhibits a high recovery rate and a low fatality rate.

[Hemicraniectomy in malignant mid-cerebral infarction. Further trials needed before its acceptance in clinical practice]. / Hemikraniektomi vid malign media-infarkt. Flera prövningar före allmän acceptans i klinisk praxis.

In cases of completed middle cerebral artery territory stroke, prognosis is very poor and the clinical course is characterised by a rapid decline in consciousness and signs of herniation 2-4 days after the onset of symptoms due to a space-occupying mass. Failure of conservative therapy is the rule, and herniation is the usual cause of death, occurring in almost 80 per cent of cases. Recently published results have suggested that hemicraniectomy may improve survival in patients with massive hemisphericstroke, decreasing mortality to less than 35 per cent. The article presents what is probably the first case to be reported in Sweden, where hemicraniectomy was performed on a 45-year-old woman with right hemispheric completed middle cerebral artery infarction.