J. Heijbel

Benign epilepsy of childhood with centrotemporal EEG foci: a genetic study.

Nineteen probands with benign epilepsy of childhood and centrotemporal EEG foci (rolan‐dic discharges), 36 of their full parents, and 34 full siblings were included in a genetic study. In these sibships (excluding probands), 15% (5/34) had seizures and rolandic discharges, and 19% (6/32) had rolandic discharges alone. Of the full parents, 11% (5/38) had seizures in childhood but none in adult life. Only 1 parent (3%) of 36 had rolandic discharges. There was no difference with sex. The results were tested against different genetic hypotheses and indicate that an autosomal dominant gene with age‐dependent penetrance is responsible for the EEG trait.

Prevalence and characteristics of epilepsy in children in Northern Sweden

Active epilepsy was assessed in all children aged 0-16 years in an area of northern Sweden with about 250,000 inhabitants and around 50,000 children in the age group. One hundred and fifty-five children fulfilled the criteria of active epilepsy giving a prevalence rate of 4.2/1000. The proportion of boys to girls was 1:1.1. This dominance of girls had also been seen in a prospective study of incidence of epilepsy in the same area. Partial seizures were more common than generalized. Among the syndromes benign childhood epilepsy with centrotemporal spikes occurred in 17.4%, absence epilepsy in 6.5% and Lennox-Gastaut syndrome in 5.8%. Children with neurodeficit (ND) more often had generalized epileptic syndromes while the non-ND groups more often had localisation related syndromes. The aetiology was regarded to be remote symptomatic in 42%, idiopathic in 28% and cryptogenic in 30% of the children. Almost all children were on antiepileptic treatment, three quarters of them on monotherapy. Neurodeficit was noted in 42%. The prevalence of epilepsy and mental retardation was 1.7/1000. Relatively few children with neurodeficit had been seizure free during the last year, 43% had more than one seizures per month compared to 19% in the non-ND group.

A community-based prospective incidence study of epileptic seizures in children

During a 20‐month period, an attempt was made to find all children with unprovoked non‐febrile seizures. The first attendance and incidence rates were 95 and 89/100 000, respectively, in the age group 0–15 years. These figures are lower than those found 10 years earlier in the same area. The highest incidence was during the first year of life and there was a higher proportion of girls (male: female ratio 1:1.4). Generalized seizures dominated in the first year of life. The incidence of benign childhood epilepsy with centro‐temporal spikes was 10.7/100 000 and was the most common epilepsy syndrome found. The incidence of partial seizures increased with age up to the age of 10 yeqars. One in 10 children had a history of febrile convulsions.

Benign Epilepsy of Children with Centro-temporal EEG Foci. Prevalence and follow-up study of 40 patients*

A 10 year material of patients with centro‐temporal EEG foci and seizures was studied retrospectively. 94 patients were found, all children. Estimates of the prevalence in the geographical area under study showed that this type of epilepsy with the accompanying EEG changes is about seven times more common than petit mal.

Epilepsy in a population of mentally retarded children and adults

All mentally retarded (MR) subjects in a northern Swedish county were assessed for the occurrence of active epilepsy on a prevalence day. Active epilepsy was found in 299 subjects (20.2% of those with MR) corresponding to a crude prevalence rate of 1.2/1000 inhabitants. The age-specific prevalence for 0-9 years was higher for females than for males, while in other age groups it was slightly higher for males or showed no difference between the sexes. Epilepsy and MR were the only disorders in 129 subjects (43.1%). Cerebral palsy was the most common associated disorder and occurred in 100 (33.4%). A presumable etiology for epilepsy and MR was identified in 73.2% and 71.9%, respectively. The presumable etiological factors which caused MR occurred prenatally in 35%, perinatally in 10% and postnatally in 9%. The pathogenetic period was unknown in 31%. In 15%, the etiological events occurred during more than one of the above periods. The presumable causes were responsible for both epilepsy and MR in all except 7 cases. MR individuals with epilepsy were significantly more retarded than those without epilepsy. The first seizure occurred during the neonatal period in 11.6% and before 1 year of age in 27.7%. Generalized tonic-clonic seizures were the most common type and occurred in 204 subjects (68.2%). Seventy-one of these also had partial seizure manifestations. Daily to weekly seizures occurred in 26.8% and 32.0% had been seizure-free for the past year.

Incidence of epilepsy in children: a follow-up study three years after the first seizure.

A prospective epidemiological study of the incidence of epilepsy was performed in a Swedish county. The population studied during the incidence period consisted of 52,252 children âged 0–15 years. Seventy‐four children who had had their first seizure during the period February 1, 1973‐January 31, 1974 were reexamined 3 years later. Forty‐three children were classified as having epilepsy at the follow‐up, which gives an incidence of 82/100,000. The most frequent types of epilepsy found were: primary generalized epilepsy, 12/43 (27.9%); partial epilepsies, 11/43 (25.6%); and benign epilepsy of childhood with cen‐trotemporal discharges, 11/43 (25.6%). The prognostic significance of the initial EEG findings in the group with primary generalized epilepsy was low: no differences were found between the number of children who had further seizures and the number of children who had one seizure only. On the basis of clinical and EEG findings some groups tended to run a greater risk of developing recurrent seizures than others. These risk groups were children with perinatal complications or cerebral malformations and psychomotor retardation, children with partial seizures, children with absences and 3/sec spike‐and‐wave discharges, and children with benign epilepsy of childhood.

Community-Based Study of Neurological Disorders in Rural Central Ethiopia

Between 1986 and 1988 a door-to-door survey was conducted on a stable rural population of 60,820 in central Ethiopia. Trained lay health workers made a complete census and identified cases with symptoms and signs of neurological disorders, using specially designed questionnaires which, in a previous pilot study, were found to have a sensitivity of 91% and specificity of 85%. Neurological disorders in the rural population were epilepsy, postpoliomyelitis paralysis, mental retardation, peripheral neuropathy (mainly due to leprosy), and deaf-mutism with prevalence rates (cases/100,000 population) of 520, 240, 170, 150 and 130, respectively. The prevalence rates of the other less common neurological disorders were 62 for hemiparesis (15 of which were for cerebrovascular accidents), 20 for cerebral palsy, 16 for optic atrophy, 12 for perceptive deafness, 10 for tropical spastic paraparesis, 7 for Parkinsons disease and 5 for motor neuron disease, ataxia and chorea/athetosis. Among related non-neurological conditions, blindness, locomotor disability and deafness were predominant. The significance and role of such a neuroepidemiological study in laying the strategies for the prevention of neurological disorders and rehabilitation of patients are discussed in the context of a developing country.

Clinical and electroencephalographic characteristics of epilepsy in rural Ethiopia: a community-based study.

A community-based epidemiological study of neurological disorders was performed in a rural area in Ethiopia. The most prevalent neurological disorder identified was epilepsy, found in 316 persons. The prevalence of epilepsy was 5.2/1000 inhabitants at risk, 5.8 for males, 4.6 for females. The highest age-specific prevalence was found for ages 10-19 years. Generalized tonic-clonic seizures were the most common seizure type and occurred in 81%. On clinical grounds, partial seizures occurred in 20% and in 29% of these secondary generalization followed. During seizures, 8.5% had been injured by burns and 5.7% by trauma. Eighty-four percent had seizures at least monthly. Seizures occurred in 4.8% of siblings. Traditional treatment with local herbs, holy water and amulets was the most common. Only 1.6% had been treated with recognized antiepileptic drugs. Mental retardation was the most common associated disorder, found in 7.9% of the persons with epilepsy. During a period of 2 years, 8 persons died of status epilepticus and 1 from severe burns as a result of falling into a domestic fire during a seizure. EEG was recorded in 73%. Epileptiform activity occurred in 18%.

Benign epilepsy of children with centrotemporal EEG foci. A study of incidence rate in outpatient care.

The incidence rates of epileptic seizures and epileptic seizures with centre‐temporal (Ro‐landic) discharges were found to be 134/100,000 and 21/100,000, respectively. These were determined in an epidemiological study in a population consisting of 52,252 children aged 0–15 years in a county in the northern part of Sweden. Epileptic seizures with Rolandic discharges represented about 16% of all the epileptic seizures (febrile convulsions not included). They were four times more common than classic petit mal with 3/sec spike‐and‐wave activity.

Attitudes of rural people in central Ethiopia toward epilepsy

In the farming community of the sub-district of Meskan and Mareko in central Ethiopia, where the prevalence of epilepsy is known to be 5.2/1000, a door-to-door survey was undertaken in 1546 sampled households to find out public attitudes to epilepsy. Nearly 64% of the respondents were in the age group of 14-50 years, and 58.6% were women. The majority (86%) were illiterate, and 94% had incomes of a subsistence level; 89% had heard or witnessed seizures. Traditional views on the association of evil spirits and superstition was prevalent. By 45% of the interviewees, the disease was believed to be contagious through physical contacts during an attack. Although there was sympathetic concern in the community for the person suffering from epilepsy, negative attitudes were strong on matrimonial associations, sharing of accommodation and physical contacts with affected persons, particularly when there were obvious signs and frequent attacks by seizures. The study demonstrates that the rural community has very poor knowledge of the causes and nature of epilepsy, and this has resulted in social deprivations and at times, rejection of the sufferers.