DISSERTATIONES MEDICINAE UNIVERSITATIS TARTUENSIS 106 DISSERTATIONES MEDICINAE UNIVERSITATIS TARTUENSIS 106 EPIDEMIOLOGY OF ADULT EPILEPSY IN TARTU, ESTONIA Incidence, prevalence and medical treatment ANDRE ÕUN TARTU UNIVERSITY PRESS Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia Dissertation is accepted for the commencement of the degree of Doctor of Medical Sciences on March 22, 2005 by the Council of the Faculty of Medicine, University of Tartu, Estonia Opponent: Dr. Tapani Keränen, University of Tampere, Finland Commencement: May 4, 2005 Publication of this dissertation is granted by the Faculty of Medicine, University of Tartu ISSN 1024–395X ISBN 9949–11–034–3 (trükis) ISBN 9949–11–035–1 (PDF)) Autoriõigus Andre Õun, 2005 Tartu Ülikooli Kirjastus www.tyk.ee Tellimus nr. 142 CONTENTS LIST OF ORIGINAL PUBLICATIONS......................................................... 8 ABBREVIATIONS......................................................................................... 9 I. INTRODUCTION ...................................................................................... 10 II. REVIEW OF THE LITERATURE ............................................................ 12 1. General aspects and methodology ......................................................... 12 1.1. Diagnostic accuracy ....................................................................... 12 1.2. Criteria, clinical characteristics and classifications........................ 13 1.2.1. Criteria for the activeness of epilepsy ................................. 14 1.2.2. Clinical characteristics and classifications .......................... 14 1.3. Case ascertainment......................................................................... 16 1.3.1. Reviews of the medical records........................................... 16 1.3.2. Door-to-door studies............................................................ 19 2. Incidence of epilepsy............................................................................. 20 2.1. General aspects of incidence.......................................................... 20 2.2. Age-specific incidence................................................................... 22 2.3. Seizure types .................................................................................. 23 2.4. Risk factors .................................................................................... 24 3. Prevalence of active epilepsy................................................................ 25 3.1. General aspects of prevalence ........................................................ 25 3.2. Age-specific prevalence ................................................................. 26 3.3. Clinical characteristics ................................................................... 27 3.4. Prevalence in Central and Eastern Europe ..................................... 27 4. Treatment of epilepsy............................................................................ 28 4.1. General aspects of antiepileptic treatment..................................... 28 4.2. Population-based reviews of antiepileptic treatment ..................... 29 III. AIMS OF THE STUDY ............................................................................ 33 IV. PATIENTS AND METHODS .................................................................. 34 1. Study area and population ..................................................................... 34 2. Definitions ............................................................................................. 35 2.1. Epileptic seizure and epilepsy........................................................ 35 2.2. Classification of seizure types........................................................ 35 2.3. Risk factors .................................................................................... 36 2.4. Classification of epilepsies and epileptic syndromes..................... 37 3. Case ascertainment and data collection................................................. 37 3.1. Case ascertainment......................................................................... 37 3.2. Collection of general data .............................................................. 38 3.3. Collection of treatment data........................................................... 38 5 4. Statistical analysis................................................................................. 39 5. Ethics..................................................................................................... 39 V. RESULTS................................................................................................... 40 1. Incidence of adult epilepsy ................................................................... 40 1.1. Provisional study group ................................................................. 40 1.2. Incidence rates ............................................................................... 41 1.3. Seizure types.................................................................................. 41 1.4. Risk factors .................................................................................... 41 1.5. Syndromic diagnoses ..................................................................... 45 2. Prevalence of adult epilepsy ................................................................. 46 2.1. Provisional study group ................................................................. 46 2.2. Prevalence rates ............................................................................. 46 2.3. Seizure types.................................................................................. 48 2.4. Risk factors.................................................................................... 48 2.5. Syndromic diagnoses..................................................................... 49 3. Medical treatment ................................................................................. 49 3.1. General characteristics................................................................... 49 3.2. Medication strategies..................................................................... 50 3.3. Utilization of particular drugs........................................................ 50 3.4. Doses of drugs............................................................................... 52 3.5. Speciality of permanent doctors .................................................... 54 VI. DISCUSSION ........................................................................................... 55 1. General aspects and methodology........................................................ 55 2. Incidence of adult epilepsy................................................................... 56 2.1. Incidence rates............................................................................... 56 2.2. Age-specific incidence .................................................................. 56 2.3. Seizure types.................................................................................. 57 2.4. Risk factors.................................................................................... 57 2.5. Syndromic diagnoses..................................................................... 58 3. Prevalence of adult epilepsy................................................................. 59 3.1. Prevalence rates............................................................................. 59 3.2. Age-specific prevalence................................................................ 59 3.3. Seizure types ................................................................................. 60 3.4. Risk factors ................................................................................... 60 3.5. Syndromic diagnoses .................................................................... 61 4. Medical treatment................................................................................. 61 4.1. General characteristics .................................................................. 61 4.2. Medication strategies .................................................................... 62 4.3. Utilization of particular drugs....................................................... 62 4.4. Doses of drugs............................................................................... 63 4.5. Speciality of permanent doctors.................................................... 64 6 VII. CONCLUSIONS...................................................................................... 65 VIII. REFERENCES ....................................................................................... 66 SUMMARY IN ESTONIAN ......................................................................... 74 ACKNOWLEDGEMENTS............................................................................. 79 PUBLICATIONS ............................................................................................ 81 7 LIST OF ORIGINAL PUBLICATIONS I Õun A, Haldre S, Mägi M. Incidence of adult epilepsy in Estonia. Acta Neurologica Scandinavica 2003; 108: 245–251. II Õun A, Haldre S, Mägi M. Prevalence of adult epilepsy in Estonia. Epi- lepsy Research 2003; 52: 233–242. III Õun A, Haldre S, Mägi M. Use of antiepileptic drugs in Estonia: an epidemiologic study of adult epilepsy. European Journal of Neurology (submitted). IV Õun A, Haldre S. Aktiivne epilepsia Tartu täiskasvanutel: epidemioloogi- lised näitajad ja ravi (in Estonian). Eesti Arst