Epilepsy Clinical and Epidemiological Study

Abstract

ABSTRACT
Background: Epilepsy was defined conceptually in 2005 as a disorder of the brain
characterized by an enduring predisposition to generate epileptic seizures. This definition
is usually practically applied as having two unprovoked seizures >24 h apart.
Objectives: To review the clinical presentation, causes, and types of seizure, age and sex
distribution, the effect of antiepileptic drugs, duration of treatment and rate of response,
rate of recurrence after drug discontinuation and the one year prevalence of epilepsy.
Methods: This is a prospective study of (169) patients aged between 1 and 80 years seen
in private neurologic clinic in Mosul city between 1st of Jan 2007 and 31st Dec 2009
complaining from epilepsy diagnosed clinically and according to the classification applied
by the international league against epilepsy (ILAE). Information regarding age, sex,
seizure type, etiology, CT or MRI of head and electroencephalograph done for all patients.
All patients given antiepileptic drugs for at least three years and followed up during this
period and those who became seizure-free during this period given chance of drug
withdrawal and followed up for further one year for recurrence of seizure.
Results: The results showed the one year prevalence rate of disease was 7.5%
(estimated by calculation of epilepsy cases among all patients attend the clinic in one
year), the most common ages are between 10-19 years and the rate of occurrence equal
in both sexes and in almost all ages. The most common types of epilepsy in the study was
generalized tonic- clonic (72%), followed by the partial complex (7%). The causes of
epilepsy in 83% of cases was unknown and the in rest (17%) the causes was presence of
structural brain damage caused by a tumor, cerebral palsy or cerebrovascular events. The
proportion of patients who had positive interictal electroencephalographic changes was
35.5 %. In 90% of patients seizure were controlled using single antiepileptic drug, of those
65% became seizure-free for three years and of these, 70% had no recurrence of seizure
within one year after drug withdrawal, while those on more than one drug only 10%
became seizure-free on three years follow up and all of them had recurrence of seizure
within six months after drugs withdrawal.
Conclusion: Epilepsy is a common disease in our society of 7.5% yearly prevalence, its
occurs in all ages, no significant sex differences seen in almost all ages, and in most
cases no cause could be detected, diagnosis mainly clinical and the interictal
electroencephalographic abnormalities seen in only third of cases, the most common type
of seizure is generalized tonic-clonic followed by partial complex. Most of patient's seizure
can be controlled with single drug especially those with idiopathic causes, and the three
year seizure-free in such patients reach about two thirds. The recurrence rate of seizure
after drug withdrawal is higher in those on more than one antiepileptic drug and depend
also on the presence of structural brain abnormalities, abnormal EEG changes, positive
family history of epilepsy and the type of seizure. We recommend wider population study
and detailed causes for each age.