Approximately 55% of the population of adults receiving treatment for epilepsy have never received specialist advice. Reassessment of these patients uncovers diagnostic uncertainty, failure to classify (leading to sub-optimal therapy) and lack of information and advice about all aspects of epilepsy care. The development of integrated services for people with epilepsy (PWE) must take account of this hidden need. The new General Medical Services contract for general practitioners will bring this need to our attention, and our experience will help predict the measures required to deal with the under-treatent and mistreatment of this group. The majority of PWE, not currently receiving shared care, merit reassessment and approximately one-third will require continued specialist care. Existing services do not have the capacity to process a marked increase in rate of referral. This project informs prioritisation of referrals and service reorganisation.

ObjectiveDespite modern anti-epileptic drug treatment, approximately 30% of epilepsies remain medically refractory and for these patients, epilepsy surgery may be a treatment option. There have been numerous studies demonstrating good outcome of epilepsy surgery in the short to median term however, there are a limited number of studies looking at the long-term outcomes. The aim of this study was to ascertain the long-term outcome of resective epilepsy surgery in a large neurosurgery hospital in the U.K.MethodsThis a retrospective analysis of prospectively collected data. We used the 2001 International League Against Epilepsy (ILAE) classification system to classify seizure freedom and Kaplan-Meier survival analysis to estimate the probability of seizure freedom.ResultsWe included 284 patients who underwent epilepsy surgery (178 anterior temporal lobe resections, 37 selective amygdalohippocampectomies, 33 temporal lesionectomies, 36 extratemporal lesionectomies), and had a prospective median follow-up of 5 years (range 1–27). Kaplan-Meier estimates showed that 47% (95% CI 40–58) remained seizure free (apart from simple partial seizures) at 5 years and 38% (95% CI 31–45) at 10 years after surgery. 74% (95% CI 69–80) had a greater than 50% seizure reduction at 5 years and 70% (95% CI 64–77) at 10 years. Patients who had an amygdalohippocampectomy were more likely to have seizure recurrence than patients who had an anterior temporal lobe resection (p = 0.006) and temporal lesionectomy (p = 0.029). There was no significant difference between extra temporal and temporal lesionectomies. Hippocampal sclerosis was associated with a good outcome but declined in relative frequency over the years.ConclusionThe vast majority of patients who were not seizure free experienced at least a substantial and long-lasting reduction in seizure frequency. A positive long-term outcome after epilepsy surgery is possible for many patients and especially those with hippocampal sclerosis or those who had anterior temporal lobe resections.

Our results suggest that the prevalence of T1D is increased by a factor of four in young adults with IGE. To our knowledge, this is the first published association between the two conditions and expands the diseases known to be associated with T1D.

Summary:Purpose: To describe the clinical, EEG, and imaging data of a series of patients with features of both idiopathic generalized epilepsy (IGE) and partial epilepsy.Methods: A computerized database of all patients attending the regional epilepsy clinic was used to identify all patients with IGE. Case notes were reviewed, and cases with clinical evidence of co-existing partial epilepsy identified.Results: Nine cases with clinical features of a partial and generalized-onset epilepsy and with electrophysiological evidence of IGE are presented. This represented <1% of the overall IGE population in the clinic. Five (55.6%) patients are currently in remission, with successful epilepsy surgery in one patient.Conclusions: The coexistence of IGE and partial epilepsy is uncommon, and if appropriate treatment with a broad-spectrum antiepileptic drug is given, then the prognosis can be good. Surgery should be considered for those cases with medically intractable partial-onset seizures as part of this syndrome.In the classification of the epilepsies (1), one of the clear distinctions is between epilepsy with a focal or a generalized onset. However, a classification exists for patients "with both generalized and focal features." These are further subclassified into severe myoclonic epilepsy in infancy epilepsy, continuous spike-waves during slow-wave sleep, and acquired epileptic aphasia (Landau-Kleffner syndrome). It has been previously recognized, although only rarely described (2-5), that features of a partial epilepsy and some of the typical syndromes of idiopathic generalized epilepsy (IGE) may coexist. The rarity of reports of this phenomenon suggests that it is rare, but it may be that features of IGE are underdiagnosed in patients with a focal epilepsy, as emphasis is placed on the latter.We present a series of nine patients who have clinical and electrophysiological evidence of both IGE and a focal epilepsy. METHODSA computerized database, with prospectively collected data on all patients who have attended the regional epilepsy clinic since 1989, was used to identify all patients with IGE. The case notes of each patient were reviewed, and cases with clinical evidence of coexisting partial epilepsy identified. RESULTSIn total, 962 patients with IGE were identified, with an additional nine patients with both IGE and partial epilepsy.One patient had histologically proven temporal lobe epilepsy and EEG and clinical evidence of IGE. This patient had a febrile convulsion at age 8 months, followed by a transient right hemiparesis, and from this time, partial seizures developed, consisting of an aura of an unpleasant visceral sensation and olfactory and gustatory hallucinations. This was associated with automatisms and postictal aphasia. EEG showed a left temporal spike focus ( Fig. 1) but also generalized spike-wave seizures (GSW) with photic stimulation, and magnetic resonance imaging (MRI) mild left hippocampal atrophy. During video-EEG monitoring with sphenoidal leads, she had three secondarily generalized tonic-cl...

Pressure sores result in patient morbidity and mortality as well as commanding considerable resources within the British National Health Service. To assess the impact of preventive measures, accurate and reliable rates of prevalence and incidence are required. This information is likely to be used as a measure of quality of care as well being included in future purchaser/provider contracting. A number of prevalence studies have been carried out in the United Kingdom using a variety of populations and different methods. The methods employed in these studies need to be considered before any meaningful comparisons can be drawn. In particular, there are variations in the reported rates possibly related to the under-reporting of pressure sore prevalence. This paper describes a recent point prevalence study which suggested that this may be the case. The need for caution when comparing crude rates is highlighted and the importance of standardizing the methods used for determining prevalence rates is discussed.