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Biomedical subjects

Ettore Beghi

Publications and source records attributed to Ettore Beghi.

At least 19 recordsLinked to original sources
PubMed2006

Treatment of the first tonic-clonic seizure does not affect long-term remission of epilepsy.

We followed 419 patients with a first, unprovoked, primarily or secondarily generalized tonic-clonic seizure, randomized to immediate antiepileptic treatment or to treatment only in the event of seizure recurrence. The probability of achieving a 2-year remission was 72 vs 57% at 3 months, 84 to 79% at 3 years, and 85 to 86% at 10 years (p = NS). The probability of entering 5-year remission was 47 to 40, 58 to 58, and 64 to 64% (p = NS). Early treatment does not affect the long-term prognosis of epilepsy.

Adolescent↗
PubMed2006

Predictors of delay in the diagnosis and clinical trial entry of amyotrophic lateral sclerosis patients: a population-based study.

BACKGROUND: The El Escorial and the revised Airlie House diagnostic criteria for amyotrophic lateral sclerosis (ALS) were introduced to select patients for clinical trials. Heterogeneity of clinical presentation at onset and delay in diagnosis may decrease the likelihood for trial entry. OBJECTIVE: Identify risk factors for delay in the diagnosis and trial exclusion. METHODS: ALS incident cases were identified with El Escorial (EEC) and Airlie House criteria (AHC) through a population-based registry established in Puglia, Southern Italy, in the years 1998-99. RESULTS: 130 ALS incident cases were diagnosed with a median interval between onset of symptoms and diagnosis of 9.3 months and not different across both EEC and AHC categories. Twenty percent of cases were not eligible for clinical trials according to the AHC. About 5% of subjects in this series died with only lower motor neuron signs. Predictors for delay in the diagnosis were age between 65 and 75 years and spinal onset while fasciculations and cramps as first symptoms were predictors of exclusion from trials. CONCLUSIONS: In this population-based series, diagnostic delay was longer in subjects with spinal onset and age between 65 and 75 and fasciculation as first symptoms. About 80% of incident cases were trial eligible with AHC criteria. However, a significant number of subjects with ALS, characterized by a limited spread of signs, were not trial eligible while alive.

Adult↗
PubMed2006

Surgery for epilepsy: assessing evidence from observational studies.

The effectiveness of epilepsy surgery is mostly based on the results of observational studies because an experimental design in surgical patients has several ethical implications. However, observational studies suffer from methodological drawbacks, which prevent meaningful conclusions and represent a serious limitation when data from different reports are pooled for systematic reviews and meta-analyses. These include the retrospective design, the use of referral populations, the small sample size, the enrolment of patients at differing inception points, the use of differing inclusion criteria, differing definitions of prognostic predictors and outcome measures, the unmasked assessment of outcome, the short follow-up, the changing technologies and surgical procedures, and the inadequate statistical methods. With these limitations in mind, a systematic review was performed of epilepsy surgery studies aiming at identifying the positive and negative prognostic predictors of surgical outcome. In this review, extent of surgical resection, abnormal MRI, mesial temporal sclerosis, febrile seizures, EEG/MRI concordance, and tumor were in decreasing order the principal indicators of the success of surgery of epilepsy. By contrast, intracranial monitoring and post-operative discharges tended to predict an unfavorable prognosis. Although the heterogeneity of the study results was fairly low, the results may be affected by pooling of data from heterogeneous reports (different patient series assessed with differing methods) or unexamined or unknown confounders. These data must be considered preliminary and cannot replace well-conducted prognostic studies (representative study populations, well-defined inception cohorts, satisfactory and complete follow-up, prospective design, and standard definition of prognostic factors).

Empirical Research↗
PubMed2006

Accidents at work among people with epilepsy. Results of a European prospective cohort study.

Studies on accidents at work in people with epilepsy are scarce and the evidence that epilepsy carries an increased risk of accidents at work is mostly anecdotal. The present survey is a multicentre prospective cohort study of everyday life risks recently conducted in eight European countries (Estonia, Germany, Italy, the Netherlands, Portugal, Russia, Slovenia and United Kingdom) comparing referral children and adults with epilepsy to age- and sex-matched non-epileptic controls. In this context, every accident occurring during work over a 1-3 year follow-up was prospectively reported by patients and controls. Six hundred and thirty-one adult patients with epilepsy and 592 controls from this cohort have been studied here. Each patient and his/her control received a diary to record any accident or illness, with severity, circumstances, causes, consequences (including days off-work) and (for the cases) the possible relation to a seizure. A slightly higher number of unskilled workers were present among patients with epilepsy than in controls. Twenty-two patients with epilepsy and nine controls reported accidents during work (p<0.05). Only two cases reported seizure-related accidents. In both groups the injuries were mild (only one requiring hospitalization) and caused abstention from work to the same extent. In patients with epilepsy, the risk of accidents was unaffected by seizure type and frequency. This study confirms that patients with epilepsy are at higher risk of accidents compared to the general population. However, injuries provoked by work accidents are generally mild and unrelated to seizures.

Absenteeism↗
PubMed2006

Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations.

BACKGROUND CONTEXT: Acute back pain and sciatica are major sources of disability. Many medical interventions are available, including manipulations, with conflicting results. PURPOSE: To assess the short- and long-term effects of spinal manipulations on acute back pain and sciatica with disc protrusion. STUDY DESIGN/SETTING: Randomized double-blind trial comparing active and simulated manipulations in rehabilitation medical centers in Rome and suburbs. PATIENT SAMPLE: 102 ambulatory patients with at least moderate pain on a visual analog scale for local pain (VAS1) and/or radiating pain (VAS2). OUTCOME MEASURES: Pain-free patients at end of treatment; treatment failure (proportion of patients stopping the assigned treatment for lack of effect on pain); number of days with no, mild, moderate, or severe pain; quality of life; number of days on nonsteroidal anti-inflammatory drugs; number of drug prescriptions; VAS1 and VAS2 scores; quality of life and psychosocial findings; and reduction of disc protrusion on magnetic resonance imaging. METHODS: Manipulations or simulated manipulations were done 5 days per week by experienced chiropractors, with a number of sessions which depended on pain relief or up to a maximum of 20, using a rapid thrust technique. Patients were assessed at admission and at 15, 30, 45, 90, and 180 days. At each visit, all indicators of pain relief were used. RESULTS: A total of 64 men and 38 women aged 19-63 years were randomized to manipulations (53) or simulated manipulations (49). Manipulations appeared more effective on the basis of the percentage of pain-free cases (local pain 28 vs. 6%; p<.005; radiating pain 55 vs. 20%; p<.0001), number of days with pain (23.6 vs. 27.4; p<.005), and number of days with moderate or severe pain (13.9 vs. 17.9; p<.05). Patients receiving manipulations had lower mean VAS1 (p<.0001) and VAS2 scores (p<.001). A significant interaction was found between therapeutic arm and time. There were no significant differences in quality of life and psychosocial scores. There were only two treatment failures (manipulation 1; simulated manipulation 1) and no adverse events. CONCLUSIONS: Active manipulations have more effect than simulated manipulations on pain relief for acute back pain and sciatica with disc protrusion.

Acute Disease↗
PubMed2006

Evidence for a rapid action of levetiracetam compared to topiramate in refractory partial epilepsy.

The objective of this observational study was to compare the efficacy of levetiracetam and topiramate during the first 15 days of add-on treatment in adults with refractory partial epilepsy. Two cohorts of patients with > or =3 simple or complex partial seizures with or without secondary generalisation per month over an 8-week baseline period received levetiracetam or topiramate in two distinct phases, in addition to standard antiepileptic treatment. During the first 15 days of the therapy, levetiracetam was added at the dosage of 250 mg b.i.d. or topiramate at 25mg o.i.d. Efficacy parameters included number of seizure-free days (SFDs), mean and percent reduction in seizure frequency (in general and by type), and number of seizure-free patients in the first 15 days of treatment compared to last 15 days of the baseline period. Sixty-one patients received levetiracetam and 61 topiramate. The general characteristics of the two treatment groups were similar. The total number of SFDs during 15 days before treatment was 637 with levetiracetam and 621 with topiramate; in the 15-day evaluation period the SFDs increased to 748 (17.4%) and 668 (7.6%), respectively (ANOVA, p<0.05). Twenty-six patients (42.6%) taking levetiracetam were seizure free compared to 10 (16.4%) receiving topiramate (chi-square, p=0.003). This open-label non-controlled study suggests an early efficacy of levetiracetam as add-on therapy in patients with refractory partial epilepsy: these results appear to confirm previous indications of a rapid onset of action and seem to suggest first evaluation of the patient at the dose of 500 mg/day before increasing to the considered minimum standard dose of 1000 mg/day, as some patients could respond to the starting dose.

Adolescent↗
PubMed2006

Learning disorders in epilepsy.

Learning disorders (LD) are disorders interfering with academic performance or with daily living activities requiring reading, writing, or mathematical abilities in subjects with a normal intelligence quotient. The prevalence of LD in the general population has been found to be 2-10% and reading disorders are the most frequent subtype. Epilepsy is one of the commonest neurological disorders in childhood with an estimated prevalence in 4-5/1,000. Epilepsy is considered to be idiopathic or cryptogenic in approximately two-thirds of cases. LD are more common in people with epilepsy than in the general population: about 25% of patients with epilepsy are said to have LD. Various psychosocial, medication-related, and epilepsy-related factors may be associated with LD in epilepsy. LD can be either permanent or state-dependent. Permanent LD are caused by a brain lesion and/or a stable brain dysfunction. In contrast, state-dependent LD are potentially reversible and treatable; they are caused by epilepsy-related factors. If allowed to persist for a long period, a state-dependent LD may become permanent.

Adolescent↗
PubMed2006

Correlation between cognition and behavior in epilepsy.

Cognitive function is more frequently impaired in people with epilepsy than in the general population, and the degree of cognitive impairment varies according to the epilepsy syndrome. Behavioral disorders are also more frequent in people with epilepsy than in individuals who do not have epilepsy. Behavioral disturbance is observed more frequently in people with drug-resistant epilepsy, frequent seizures, and/or associated neurological or mental abnormalities. In children and adolescents, many data suggest a close link between behavior/cognition and some specific epilepsy syndromes. For example, aspects of mood, behavior, personality, and cognition may be related to temporal lobe epilepsy or juvenile myoclonic epilepsy. Behavioral disorders may precede, occur with, or follow a diagnosis of epilepsy; they differ between children and adults. Predictors of behavioral disorders in children with epilepsy are the epilepsy itself, treatment, the underlying lesion, and personal reactions to epilepsy. More specifically, conditions in which behavioral disorders may be associated with epilepsy include depression, psychosis, particular personality traits, aggression, anxiety, and attention deficit and hyperactivity disorder.

Adult↗
PubMed2006

Idiopathic generalized epilepsies of adolescence.

The prevalence of idiopathic generalized epilepsies (IGEs) has been assessed as being 15-20% of all epilepsies. The seizure types in IGEs are typical absences, myoclonic jerks, and generalized tonic-clonic seizures (TCS), alone or in varying combinations and with variable severity. The seizures tend to be more frequent on awakening and with sleep deprivation. This group of clinical conditions includes among others, age-related epilepsy syndromes of adolescence such as juvenile absence epilepsy (JAE), juvenile myoclonic epilepsy (JME), and IGE with generalized TCS or epilepsy with grand mal on awakening (EGMA). The classification of IGEs follows two schools of thought; one maintains that IGEs are a group of different and separate syndromes while the other suggests that IGEs are one biological continuum. Patients with IGEs may have mild impairment of cognitive functions, especially verbal memory and other frontal lobe functions, despite a normal IQ, and some seem to have characteristic personality traits, although further studies are needed to support this theory. They appear to lack a degree of self-control, to neglect their physical needs, and are poorly compliant with therapy. Some patients become obstinate and are impressionable. The cognitive and behavioral aspects of these patients suggest an involvement of frontal lobes.

Adolescent↗
PubMed2006

Epileptogenic drugs: a systematic review.

A wide range of substances, including drugs and illicit compounds, increase the risk of epileptic seizures. In this systematic review, the authors address the issue of the epileptogenic potential of marketed drugs, with the aims of providing criteria for the assessment of the cause-effect relationship between drug exposure and the risk of seizures; and to identify the compounds better fulfilling the requirements of an epileptogenic drug. Finding a correlation between drug exposure and occurrence of seizures does not necessarily establish a causal association. In light of the available evidence, even with these limitations, some conclusive remarks can be made on the epileptogenic potential of some active principles. Drugs with high epileptogenic potential include meperidine, sevoflurane, clozapine, phenothiazines and cyclosporine. Drugs with intermediate epileptogenic potential include propofol, maprotiline, tricyclic antidepressants and chlorambucil. Drugs with low epileptogenic potential include fluorquinolones, carbapenems, bupropion and iodinated contrast media. Drugs with minimal or inconclusive epileptogenic potential include interferon alpha.

Drug-Related Side Effects and Adverse Reactions↗
PubMed2005

Validity and reliability of the Italian version of the Quality-of-Life in Epilepsy Inventory (QOLIE-31).

PURPOSE: To develop an Italian adaptation of the shortened version of the Quality-of-Life in Epilepsy Inventory (QOLIE-31). METHODS: The study population comprised 503 consecutive ambulatory patients with epilepsy from 44 centers. Internal validity was tested by factor analysis, to detect similarities to and differences from the original version, and by multitrait/multi-item analysis, to assess item convergent and discriminant validity. External validity testing included correlation to the SF-36 Inventory, to check the properties of the epilepsy-specific dimensions. Validity testing was completed by analysis of variance (ANOVA) of QOLIE-31 dimension scores against demographic and clinical variables, including age, sex, seizure frequency and number of drugs. RESULTS: The domains showing the highest internal consistency and the best discriminant validity were Medication effect, and Seizure worry. Social functioning had the lower discriminant validity. With reference to the SF-36 scores, the study patients were slightly but constantly below the population values, mostly for General health and Role physical domains. All QOLIE-31 dimensions were sensitive to almost any demographic and clinical variable, except for Medication effects (sensitive to number of drugs) and Energy-fatigue (sensitive to age). CONCLUSIONS: Except for Social functioning, the psychometric properties of the Italian adaptation of the QOLIE-31 Inventory are fairly good and similar to the American version and the Spanish translation. Social functioning scale suffers shortcomings because of life constraints caused by epilepsy (with missing values for regular job and driving license).

Adolescent↗
PubMed2005

Cluster headache prevalence in the Italian general population.

BACKGROUND: Prevalence of cluster headache (CH) is estimated at 56 to 69 per 100,000. OBJECTIVE: To calculate the CH lifetime prevalence in a sample representative of the Italian general population over age 14 years. METHODS: Possible CH cases according to the diagnostic criteria of the 1988 International Headache Society classification were screened from a sample of 10,071 patients (5,311 women and 4,760 men; mean age 50.4 years, SD 19.7 years) registered in the lists of seven Parma-based general practitioners (GPs), using a previously validated, specially designed, self-administered questionnaire. RESULTS: Seven thousand five hundred twenty-two subjects (74.7%; 3,971 women and 3,551 men; mean age 50.8 years, SD 19.0 years) responded to the questionnaire in their GP's office (n = 3,338; 1,885 women and 1,453 men) or at home by mail (n = 1,914; 1,030 women and 884 men) or by phone (n = 2,270; 1,056 women and 1,214 men). Of the 111 suspected cases (76 women and 35 men), 105 were seen by a neurologist and 6 were contacted on the phone. The diagnosis of CH was confirmed in 21 (9 women and 12 men), including 7 already followed at the authors' center for CH. Seventeen patients had episodic CH, and four (all men) had chronic CH. The estimated prevalence rate was 279 per 100,000 (95% CI 173 to 427), 227 per 100,000 (95% CI 104 to 431) in women, and 338 per 100,000 (95% CI 175 to 592) in men. CONCLUSION: These results point to a higher cluster headache lifetime prevalence than previous reports.

Adult↗