Cockerell, Oliver Charles; (1995) The epidemiology of epilepsy: Remission, mortality, secular trends and economic cost. Doctoral thesis (M.D), UCL (University College London).

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Abstract

The work in this thesis is concerned with five major areas of epilepsy epidemiology: remission, mortality rates, mortality risk factors, economic cost, and secular trends. The National General Practice Study of Epilepsy (NGPSE) is a prospective population-based cohort study which identified patients with newly diagnosed patients between 1984-87. 1091 patients with suspected seizures were identified, and follow up has continued to date on the 564 patients with definite, and the 228 with possible seizures. Follow up was continued for up to 9 years. The aim of the study was to determine the prognosis of epilepsy (remission and morality). The overall rate of remission was 85.7[percent] for a three year, and 68.1[percent] for a five year remission. The figures for terminal remission were 10[percent] less. Aetiology, age of onset, and seizure type did not have a major influences on the chances of achieving remission, neither did early seizure pattern or treatment. The early mortality rate of patients with epilepsy was high, and was over two times that expected. The death rate was highest in the first year after diagnosis and was highest in patients with symptomatic epilepsy. Nevertheless the death rate of idiopathic epilepsy was still raised, suggesting that epilepsy itself carries an increased death risk. The causes of the increased deaths due to strokes, cancer and pneumonia were examined in case controlled study. No significant differences were found for the level of smoking, drinking, blood pressure, or body mass index suggesting that these factors are not significant contributors to the death rate in patients with epilepsy. A population of 6000 persons was identified in a GP surgery in Kent, and compared to a similar analysis performed ten years previously The aims of the study were to examine secular trends in the prevalence, incidence and prognosis of epilepsy. The most striking finding was that the incidence of epilepsy in children had fallen over the last decade, and the incidence of epilepsy in the elderly had correspondingly risen. The economic cost of epilepsy was estimated from the NGPSE cohort and compared to a cross sectional cohort of patients with established epilepsy.

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