Hart, Yvonne Mary; (1993) The early prognosis and medical care of people with epilepsy. Doctoral thesis (M.D), UCL (University College London).

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Abstract

The work consists of two major studies designed to examine the early prognosis and medical care of people with epilepsy. The National General Practice Study of Epilepsy is a prospective community-based cohort study undertaken to investigate the clinical phenomenology of newly diagnosed epilepsy and its early course, including the risk of a second seizure and the factors affecting this, the temporal patterns of seizure recurrence, factors affecting remission, and the medical treatment of people developing epilepsy in an unselected population. Patients with neonatal seizures or a previous diagnosis were excluded. Two hundred and seventy-five general practitioners registered 1091 people developing or suspected of developing seizures, 564 of whom were classified as having definite epileptic seizures. The characteristics of the population are described. Follow-up of this cohort has continued for up to 7 years. The overall rate of recurrence (calculated by actuarial analysis) after a first seizure was high, being 67% at one year and 77% at 3 years: factors affecting this are discussed. Eighty-nine per cent of patients had had at least a one year period of remission by 5 years, and sixty-two per cent of people with epilepsy remained in remission of at least one year at 5 years. Factors such as age and aetiology had little effect on long-term remission, although they had some influence on the time of entering remission. The National Epilepsy Survey is a cross-sectional community-based survey of people with epilepsy on treatment, carried out to establish the severity of epilepsy in the community and the overall medical care of people with established epilepsy. Considerable handicap was experienced by this group. The extent of investigation and services received were variable. Standards of care for people with epilepsy are suggested. Possible sources of selection bias in the studies are examined.

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