Biomedical subjects

Massimiliano Beghi

Publications and source records attributed to Massimiliano Beghi.

6 recordsLinked to original sources

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

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↗

PubMed2005

A review of the costs of managing childhood epilepsy.

Epilepsy is a chronic treatable condition for which new diagnostic tools and several new drugs and non-pharmacological treatments are now available. The cost profile of these options is assessed here through an overview of the available literature focusing on studies of childhood epilepsy. Several methodological problems arise when interpreting the results of economic studies in epilepsy, including the variability of the study population and costs items, the reliability of the sources of cost, the limitations of the methods of data collection and the deficiencies of the study designs, with reference to the measures of treatment benefits. International comparisons are then difficult because economic results cannot be compared on account of differences in monetary issues, clinical practice patterns and healthcare system frameworks. The economic aspects of epilepsy are different in children and adults. Differences are detectable in the incidence and expression of epileptic syndromes, social and emotional impact, availability of antiepileptic drugs, hospital admissions, diagnostic tests and referral to specialists, social assistants and other healthcare professionals. In addition, children have access to medical services only with the help of a caregiver, for whom there may be lost work days or under-employment. The mean annual cost per child with epilepsy was USD 1853 for controlled epilepsy and USD 4950 for uncontrolled epilepsy in a Spanish study performed in 1998 and the annual direct costs per child with epilepsy ranged from euro 844 for patients in remission to euro 3268 for patients with drug-resistant epilepsy in an Italian study done between 1996 and 1998. The Spanish study showed that direct costs are the major source of expenditure for children with epilepsy. These studies along with a number of other cost-of-illness studies in combined populations of adults and children showed that service use and costs increase with more severe forms of illness and seizure frequency, this being more marked in adults than in children. Moderate cost differences may be expected between children (higher) and adults (lower), particularly with reference to initial investigations. Costs of epilepsy are mostly explained by hospital admissions and drugs; in particular, drug costs tend to dominate in more well controlled epilepsy, while both hospital admissions and drugs are significant costs in less well controlled epilepsy. Newly diagnosed patients can incur significant hospital and diagnostic costs. Costs for epilepsy tend to be lower for patients cared for in general practice or outpatient settings than in hospital settings. Seizure control by drugs, ketogenic diet or surgery is associated with a significant reduction in the costs of epilepsy.

Adolescent↗

PubMed2004

Primary prevention of epilepsy in patients with different epileptogenic conditions.

Epileptic seizures are a common complication of several clinical conditions affecting the CNS. In these cases, the occurrence of seizures and epilepsy may increase the functional damage provoked by the underlying epileptogenic condition and affect the patient's quality of life to a significant extent. Therefore, the search of effective means for primary prevention of seizures and epilepsy is necessary in these cases. However, the use of antiepileptic drugs for the primary prevention of seizures and epilepsy can be considered only if the ratio between efficacy, safety and tolerability of treatment is favorable, in that the advantages, in terms of seizure prevention, outweigh the disadvantages in terms of adverse effects and overall costs of treatment. In this article, the efficacy, safety and tolerability of antiepileptic drugs for the primary prevention of seizures and epilepsy are reviewed. The areas covered include: the definition of early (provoked) and late (unprovoked) seizures; knowledge of the overall risk of seizures and epilepsy in CNS disorders for which primary prevention of seizures can be attempted; rationale for the use of antiepileptic drugs for the primary prevention of epilepsy; experimental data on the antiepileptogenic properties of antiepileptic drugs; available literature findings on the prevention of early and late seizures, with specific emphasis on randomized clinical trials; and the main problems with experimental trials for the primary prevention of epileptic seizures. On this basis, practice recommendations for the primary prevention of epilepsy will be offered where indicated. Suggestions for future research are also made as concluding remarks, by indicating the areas of investigation and the design of future studies.

Animals↗