The socioeconomic, cultural, and emotional implications of starting or withholding treatment in a patient with a first seizure

Heaney, Dominic; Bell, Gail S.; Sander, Josemir W.

doi:10.1111/j.1528-1167.2008.01448.x

Cited by 8 publications

(14 citation statements)

References 26 publications

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“…Diagnosis of epilepsy after a single seizure may engender over‐treatment. The decision to treat or not after a single seizure is complex (Heaney et al., 2008). However, the imperative to offer treatment in the presence of a diagnosis of epilepsy is great.…”

Section: Con: Epilepsy Should Not Be Diagnosed Until a Second Unprovomentioning

confidence: 99%

Debate: When does a seizure imply epilepsy?

Fisher

Leppik

2008

Epilepsia

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SUMMARYEpilepsy recently has been defined conceptually as a condition of at least one seizure, with an enduring predisposition to have seizures. It is not yet clear how to make this definition operational and practical. A diagnosis of epilepsy has potentially serious consequences for health, psychosocial well-being, and economics, and, therefore, it should be made with a high level of certainty. A definite diagnosis of epilepsy can be made with two unprovoked seizures at least 24 h apart. This method has the benefit of simplicity and consistency with past epidemiologic studies. Nevertheless, certain circumstances suggest a high likelihood of having a second seizure, as evidenced by common clinical practice of considering treatment after a first unprovoked seizure in conjunction with additional risk factors (surrogate markers). One unifying approach is an operational definition of ''definite epilepsy'' after two unprovoked seizures at least 24 h apart. An operational definition of ''probable epilepsy'' can be established with one unprovoked seizure and clinical, electroencephalography (EEG), neuroimaging, genetic, or other information to suggest greater than a 50% chance of having another seizure. ''Possible epilepsy'' operationally would exist with a single unprovoked seizure and insufficient evidence to predict a high likelihood of recurrence. Future clinical and epidemiologic evidence would allow refinements of the operational definitions.

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Section: Con: Epilepsy Should Not Be Diagnosed Until a Second Unprovomentioning

confidence: 99%

Debate: When does a seizure imply epilepsy?

Fisher

Leppik

2008

Epilepsia

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“…(Berg et al, 2010, p. 676) Epilepsy is among the most common serious neurological conditions with incidence rates, in highincome countries, ranging between 40 and 70 per 100 000 persons per year and generally higher in young children and in the elderly (Duncan, 2006;MacDonald, 2000). In resource-poor countries, the incidence is usually much higher, often above 120/100 000/year, and in high-income countries, poor people also seem to have a higher incidence (Heaney 2008;. Prevalence studies have reported lifetime rates between 4 and 10/1000 in developed countries (Forsgren, 2005) but data from poor countries suggest prevalence rates of 23.2-32.1/1000 (Bell, 2014) up to 57/1000 in some rural areas (Sander, 1996).…”

Section: Epilepsymentioning

confidence: 99%

Depression in Patients with Epilepsy

Tahirović

2018

Journal of International Scientific Researches

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Depression is the most common psychiatric co-morbidity in people with epilepsy, but often remains unrecognized. The aims of the study were to investigate differences in level and severity of depression between patients with epilepsy and healthy control group. The study explores understanding on specific socio economic factors that might contribute to depression and compare differences among patients with epilepsy and control group. The sample consisted of 100 adult patients with epilepsy from University Clinical Centre Tuzla, Bosnia and Herzegovina and 100 adult volunteers without any diagnosis. Level of depression was measured by Beck Depression Inventory (BDI). The questionnaire about demographic and specific socio economic data (gender, employment, education, marital status) was used.Patients with epilepsy showed significantly higher Beck's depression inventory than controls. The minimal depression was less frequent, but mild, moderate and severe depression was more frequent in subjects with epilepsy.In both group females and males showed similar distribution of BDI. Females and males with epilepsy showed significantly higher BDI than in control group. Patients with epilepsy showed similar distribution among subject regarding education. Employed and unemployed subjects among patients with epilepsy showed similar distribution of BDI. In control group, unemployed subjects showed significantly higher BDI. Beck Depression Inventory had similar distribution regarding marital status in both groups. The subjects that are married, in relationship or without relationship showed significantly lower BDI. There are statistically significant differences in level and severity of depression between epileptic patients and healthy subjects in control group. Hypothesis that there are statistically significant differences in specific socioeconomic factors that are related to depression among patients with epilepsy and control group is partially confirmed.

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“…When faced with a first unprovoked seizure, the patient/family will consider many factors that influence the decision of whether to pursue antiepileptic treatment. 58 Some families are willing to start antiepileptic treatment based on fear or anxiety about the occurrence of the next seizure, lifestyle limitations, employment concerns, or driving restrictions. 58 Others are not willing to seek antiepileptic treatment because of the associated risks: cognitive side effects, physical side effects (ie, weight gain), stigma, and teratogenicity in women of child-bearing age.…”

Section: Management Approachmentioning

confidence: 99%

Diagnostic and Therapeutic Management of a First Unprovoked Seizure in Children and Adolescents With a Focus on the Revised Diagnostic Criteria for Epilepsy

et al. 2017

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By definition, unprovoked seizures are not precipitated by an identifiable factor, such as fever or trauma. A thorough history and physical examination are essential to caring for pediatric patients with a potential first unprovoked seizure. Differential diagnosis, EEG, neuroimaging, laboratory tests, and initiation of treatment will be reviewed. Treatment is typically initiated after 2 unprovoked seizures, or after 1 seizure in select patients with distinct epilepsy syndromes. Recent expansion of the definition of epilepsy by the ILAE allows for the diagnosis of epilepsy to be made after the first seizure if the clinical presentation and supporting diagnostic studies suggest a greater than 60% chance of a second seizure. This review summarizes the current literature on the diagnostic and therapeutic management of first unprovoked seizure in children and adolescents while taking into consideration the revised diagnostic criteria of epilepsy.

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The socioeconomic, cultural, and emotional implications of starting or withholding treatment in a patient with a first seizure

Abstract: SUMMARY

Cited by 8 publications

References 26 publications

Debate: When does a seizure imply epilepsy?

Debate: When does a seizure imply epilepsy?

Depression in Patients with Epilepsy

Diagnostic and Therapeutic Management of a First Unprovoked Seizure in Children and Adolescents With a Focus on the Revised Diagnostic Criteria for Epilepsy

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