Sulev Haldre

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.

Irreversible motor impairment in young addicts--ephedrone, manganism or both?

Background –  Parkinsonian syndrome related to intravenous use of a ‘designer’ psychostimulant, derived from pseudoephedrine using potassium permanganate as the oxidant, has been observed in drug addicts in Estonia.

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.

Prevalence of adult epilepsy in Estonia

Epidemiological data about epilepsy from central and eastern Europe is scarce and results are controversial. The aim of this study was to estimate the main prevalence-related characteristics of active epilepsy in an adult population in Estonia. Review of all databases and lists related to epilepsy in Tartu supplemented by re-examination of patients to identify all persons with active epilepsy aged >/=20 years on January 1, 1997. Special attention was paid to the extensive adoption of definitions and criteria proposed by ILAE guidelines for epidemiologic studies. Both, crude and age-adjusted (to the 1970 US population) prevalence rates were 5.3 per 1000. The age-specific rates were constant in age groups 30-69 years and declined in the oldest age groups. Of the seizure types, partial seizures had highest rates, over half were secondarily generalized seizures. The largest syndromic categories were localization-related symptomatic and cryptogenic epilepsies. Risk factors for epilepsy were identified in 39.6% cases. Some 22% of all subjects did not take antiepileptic medication. Prevalence of active epilepsy and other prevalence-related characteristics in the adult population of Tartu was comparable to those reported from the developed countries. The predominance of localization-related syndromes and partial seizures is due to the age distribution of the study.

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.

Manganese-Induced Parkinsonism due to Ephedrone Abuse.

During recent years, a syndrome of hypokinesia, dysarthria, dystonia, and postural impairment, related to intravenous use of a “designer” psychostimulant derived from pseudoephedrine using potassium permanganate as the oxidant, has been observed in drug addicts in several countries in Eastern Europe with some cases also in Western countries. A levodopa unresponsive Parkinsonian syndrome occurs within a few months of abusing the homemade drug mixture containing ephedrone (methcathinone) and manganese. The development of this neurological syndrome has been attributed to toxic effects of manganese, but the role of the psychostimulant ephedrone is unclear. This paper describes the clinical syndrome, results of neuroimaging, and therapeutic attempts.

Clinical, neuroimaging and neurophysiological features in addicts with manganese‐ephedrone exposure

Sikk K, Taba P, Haldre S, Bergquist J, Nyholm D, Askmark H, Danfors T, Sörensen J, Thurfjell L, Raininko R, Eriksson R, Flink R, Färnstrand C, Aquilonius S‐M. Clinical, neuroimaging and neurophysiological features in addicts with manganese‐ephedrone exposure. 
Acta Neurol Scand: 2010: 121: 237–243.
© 2009 The Authors Journal compilation

Incidence of adult epilepsy in Estonia

Purpose – To estimate the main incidence‐related characteristics of epilepsy in an adult population in Estonia. Epidemiologic data about epilepsy from central and eastern Europe is controversial.

Manganese‐induced parkinsonism in methcathinone abusers: bio‐markers of exposure and follow‐up

Methcathinone abuse is a new cause of manganism. The psychostimulant is prepared from pseudoephedrine using potassium permanganate as an oxidant. We describe the clinical, biological, neuroimaging characteristics and follow‐up results in a large Estonian cohort of intravenous methcathinone users.

The Prevalence of Hereditary Spastic Paraplegia and the Occurrence of SPG4 Mutations in Estonia

Background: Hereditary spastic paraplegia (HSP) is a clinically and genetically heterogeneous disorder, with a variable reported prevalence ranging from 0.5 to 12 per 100,000. The aim of this retrospective study was to evaluate the prevalence of HSP and estimate the percentage of SPG4 mutations in the Estonian population. Methods: A simple model with multiple data sources was selected to enable as many patients as possible to be detected. All relevant case histories from Estonian regional neurological centers for the last 20 years were reviewed; all neurologists and general practitioners were contacted. Results: A total of 737 case records were captured for secondary evaluation. Among these cases, 88 potential HSP-affected subjects were identified. During this study 59 patients with HSP were identified, giving a crude prevalence rate of 4.4 per 100,000. Eleven persons (21.6% of all studied Estonian HSP patients) with HSP were found to have mutations in the spastin gene (SPG4). Conclusions: Our epidemiological data are comparable with the results from epidemiological studies performed elsewhere, indicating that the clinical diagnostic management of HSP patients in Estonia is adequate and the chosen methodological approach for data collection was reliable.