Ain-Elmar Kaasik

Seizure Disorders in Patients with Brain Tumors

The aim of this study was to analyze the clinical data of patients with epileptic seizures and diagnosed brain tumors. Analysis included 711 patients with primary and secondary brain tumors. 165 (23%) patients had experienced at least one seizure before tumor diagnosis. The mean time from the first epileptic seizure to tumor diagnosis was 16 months. The patient’s age, location and pathology of tumor were associated with occurrence of seizures. Seizures were more common in patients aged 30–50 years. Tumors involving the frontal, frontoparietal, temporal and frontotemporal lobes were associated with occurrence of seizures. According to the histological diagnosis, patients with mixed gliomas (62%), oligodendrogliomas (53%) and astrocytomas (42%) experienced seizures most frequently.

Felt stigma and impact of epilepsy on employment status among Estonian people: exploratory study

This article examines the impact of epilepsy and its treatment on employment status and the extent of stigma among patients with epilepsy. Clinical and demographic data concerning patients examined during a recent epidemiological survey were obtained from medical notes and postal self-completed questionnaires. Information was collected from 90 patients aged 16-70 years. A third of the respondents had been seizure-free during the last year. Thirty-nine percent were working full-time, 24% were working part-time and 11% were unemployed. Sixty-three percent from those working part-time or unemployed considered their epilepsy to be a significant reason for this. Overall, 55.4% believed they had been treated unfairly at work or when trying to get a job. Fifty-one percent of respondents felt stigmatized by epilepsy, 14% of them highly so. The level of employment among epileptic people was not lower than in the general population. The percentage of stigmatization in general and the percentage of the severely stigmatized was as high or even higher than in other studies. Occurrence of stigma and its severity depended first and foremost on the type of seizures. The frequency of seizures was not clearly related to this.

Epilepsy in Estonia: A Quality‐of‐Life Study

Summary: Purpose: To study the impact of epilepsy and its treatment on people with epilepsy in Estonia and to analyze how it is affected by the characteristics of epilepsy.

Epidemiology of Primary Central Nervous System Tumors in Estonia

During the period from 1986 to 1996, 1,665 cases of primary central nervous system (CNS) tumors were identified in the resident population of Estonia. Histological verification was available in 81% of the cases. Gliomas were more common in men, while meningiomas and neurinomas were more common in women. No significant difference was observed between the sexes for all primary CNS tumors. The age-specific incidence increased from the age of 30, reached a maximum in the age range of 50–69 years and declined in the elderly which may reflect under-diagnosis. The age-adjusted incidence rate for CNS tumors was 8.5/100,000 population. A comparison of our results with those of a previous study carried out in Estonia revealed a significant histology-specific increase in incidence in all age groups.

Changed Incidence and Case-Fatality Rates of First-Ever Stroke Between 1970 and 1993 in Tartu, Estonia

BACKGROUND AND PURPOSE The incidence of stroke has stabilized or increased in several developed countries recently, but few data about the trends are available from Eastern Europe. The study was designed to evaluate the possible changes of stroke incidence in Estonia. METHODS A population-based stroke registry was conducted in Tartu during 1991 through 1993 (mean population, 110,631) to compare it with the study of 1970 through 1973 (population, 90,459). The majority of stroke patients were recorded prospectively, and most were hospitalized and evaluated by a neurologist. All available medical records were reviewed. Only first-ever stroke cases were registered. RESULTS A total of 667 patients in 1970 through 1973 and 829 patients in 1991 through 1993 were recorded. The total annual incidence per 100,000 rose from 221 to 250 (P = .0173). The total rate for men increased nonsignificantly from 183 to 209 and for women from 258 to 284. Significant increases were observed for men aged 50 to 59 years and for women aged 50 to 69 years; for persons over 70 years, the rates slightly declined. The case-fatality rate at 1 month declined significantly, from 49% to 30%. CONCLUSIONS A remarkable increase in the incidence and decline in the case-fatality rate of first-ever stroke was observed in Tartu, Estonia. The increase of incidence for those younger than 70 years could be due to the increased prevalence of risk factors. The decline in case fatality could theoretically be related to better management of secondary complications.

Survival of patients with primary CNS tumours in Estonia.

We studied a population-based survey that included 1417 patients with a primary central nervous system (CNS) tumour diagnosed in Estonia between 1986 and 1996. Survival rates at 1 and 5 years and median survival by histology and patients age at diagnosis were estimated. Median survival time for all tumours was 33.2 months and 1- and 5-year survival rates were 59.3 and 46.0%, respectively. In multivariate analysis, younger age, better clinical condition (i.e. a Karnofsky Performance Status (KPS) score of 60 and more) and tumour histology were all dependent prognostic factors for better survival. Risk of death was more than 8 times greater for glioblastoma (Risk Ratio (RR) 8.31) and approximately seven times greater for anaplastic astrocytoma (RR 7.22) and other gliomas (RR 5.74) compared with meningiomas. Comparing the first (1986-1989) and the third (1994-1996) time periods, statistically significant improvements in survival occurred for all tumours and astrocytomas. Declines in survival during the second period (1990-1993) were statistically significant for all the tumour groups, but the most striking decrease took place in patients with glioblastoma. Age-specific rates showed that the increase in survival was more evident for patients aged between 45 and 64 years.

Registry of first‐ever stroke in Tartu, Estonia, 1991 through 1993: outcome of stroke

ObjectivesTo provide information about the functional ability of the survivors of first‐ever stroke in Estonia. Patients and methods – A population based epidemiological study 1991 through 1993 in Tartu. Herewith the data for 1991 and 1993 are presented. A total of 519 persons were registered; 82% of them were admitted (mean length 14 days), 66% were discharged home. Results – During 6 months 41% of the patients died, the remaining 305 patients were interviewed about their living conditions, and functional ability using the Barthel ADL Index. Although 58% of patients responded to the questionnaire, no significant differences in several factors between the respondents and non‐respondents were found. Thirty‐eight percent of the patients were totally independent in ADL. Conclusion – The case‐fatality rate at 6 months was high in Estonia and the proportion of totally independent patients 6 months after stroke is slightly lower compared to other studies. The short length of hospital treatment was possibly compensated by sufficient support by relatives after discharge.

Changes of local cerebral blood flow concomitant to lead-exposure in adult rabbits.

Lead is considered a pathogenic factor of atherosclerosis and arterial hypertension, which are main risk factors of cerebrovascular disease. The brain microvasculature preferentially accumulates lead and its function is sensitive to its toxic effect. Influence of inorganic lead‐exposure (20 mg/kg ‐ I group, 40 mg/kg II group) for 10 days on local cerebral blood flow (1CBF) in hypothalamus (HYP) and cerebral cortex (CTX) of rabbits was studied by means of the hydrogen clearance method. Corresponding results were compared to sham operated group (III group). During lead‐exposure 1CBF was reduced in both investigated regions. The reduction of 1CBF in HYP was reduced in both investigated regions. The reduction of 1CBF in HYP was 12.9% (P<0.05) in I and 19.9% (P < 0.001) in II group; corresponding changes in CTX were ‐ 16.9 % (statistically non‐significant ‐ N) in I and 1.4% (NS) in II group. Present finding suggest that inorganic lead induces cerebral microvascular dysfunction with following changes in 1CBF. These alteration have a biphasic character Although these disturbances reveal a tendency towards normalization, it is possible to presume that higher concentrations of ingested lead cause more severe injury to endothelium of brain microvasculature.

The risk of motor neurone disease and multiple sclerosis is different in Estonians and Russians. Data from South Estonia

Epidemiological studies were performed in South Estonia to establish the prevalence rate of multiple sclerosis (MS) and motor neurone disease (MND). The case finding method included information from the hospital records of the central hospital in the region‐the University Hospital (for MS from 1942 to 1989), from all neurologists in the region, from the Estonian MS Society and Association of Muscular Disorders, and from nursing homes in the region. The prevalence day was 31 December 1989. MND incidence was established for the period of 1986–1995. The results demonstrated high prevalence rates of MS among native Estonians (55.3 per 100000), somewhat lower prevalence among native‐born representatives of other nationalities (43.6 per 100 000) and the lowest prevalence rate of MS among non‐Estonian immigrants (26.6 per 100000). The differences were not statistically significant. The results for MND demonstrated the opposite pattern. The mean annual incidence rate of MND for 10 years was statistically significantly higher among people of other nationalities (2.5 per 100000) and Russians (2.6 per 100000), and lower in native‐born Estonians (1.1 per 100 000). No differences in health care or clinical picture were established. The reasons for the demonstrated differences in MND incidence remain unclear.

Lead-induced excessive lipid peroxidation and changes in local cerebral blood flow in rabbit brain

Lead‐poisoning is a disease of environmental origin. The primary target for lead is the nervous system. Lead ions are able to accelerate lipid peroxidation (LP) and, hence, induce cellular damage. Endothelial cell alteration and cerebral microvessel dysfunction are important in lead‐induced encephalopathy. It is possibile that the altered functional state of brain microvasculature cannot ensure the adequate level of local cerebral blood flow (LCBF). The purpose of the present study was to evaluate LP in brain tissue homogenates of the cerebral cortex (CTX) and hypothalamus (HYP) of 15 lead‐exposed vs seven control rabbits after a short‐time lead exposure (5 and 10 days, 40 mg/kg). Another aim was to compare the dynamics of changes in LP and LCBF, detected by the H2 clearance method in another group (seven lead‐exposed rabbits vs seven controls). The basal level of thiobarbituric acid reactive substances (TBARS), the Fe‐stimulated part of the TBARS (Fe‐TBARS) and diene conjugates (DC) were used for the evaluation of LP in the brain tissue. A tendency to the slight enhancement of TBARS and DC concentrations in brain homogenates 5 days after the 10 days lead exposure period was found (CTX p < 0.05). The enhancement of the Fe TBARS was expressed maximally on 1 day after 10 day exposure period (CTX p < 0.05, HYP p < 0.001 compared to controls). The biphasic reaction of changes in LCBF was detected: during (5th day) and in 1 day after a 10 day exposure period a decrease of LCBF in both investigated regions was found (10.5 and 9.3 ml/100g/min i.e. 28.6 and 24.1%, respectively, in CTX, p < 0.05; and 11.2 and 10.1 ml/100g/min i.e. 19.9 and 18.7%, respectively in HYP, p < 0.05); on the 5th day after exposure minimal tendency to increase was found (7.1 ml/100g/min, p < 0.01 in HYP compared with controls). In conclusion, lead induces excessive LP in brain homogenates and disturbances in LCBF. However, the causal relationship between those events remains to be proven.