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Bolle AE, Gaist T, Kuljis AME, Blaabjerg M, Beier CP. NORSE seasonality may vary geographically in adults. Epilepsia Open 2024; 9:1088-1095. [PMID: 38635008 PMCID: PMC11145602 DOI: 10.1002/epi4.12944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024] Open
Abstract
The mechanisms causing new onset refractory status epilepticus (NORSE) are often unknown. Recently, a seasonal variation with NORSE peaking during the summer was described in a mixed cohort of adults and children why we here studied the seasonal variation in a Danish status epilepticus (SE) cohort. This retrospective cohort study comprised SE patients aged ≥18 diagnosed and treated 2008-2017 at the Odense University Hospital. Clinical characteristics and seasonality of patients fulfilling the diagnostic criteria for NORSE were compared with patients with refractory SE (RSE) due to other reasons and with the seasonal variation of autoantibodies associated with autoimmune encephalitis in the Danish autoimmune encephalitis register. In this cohort, 26 patients met NORSE criteria. As compared to RSE patients not fulfilling NORSE criteria (n = 152), NORSE patients were more likely to have symptoms of systemic inflammation (C-reactive protein concentrations ≥10 mg/L or fever ≥38°C) at admission; nine fulfilled the criteria for febrile infection related epilepsy syndrome (FIRES). In contrast to the even seasonal distribution of patients with RSE not fulfilling the NORSE criteria, admissions due to NORSE peaked during the winter (46.1%, p = 0.04 as compared to non-NORSE RSE); six out of nine FIRES episodes occurred in the winter season. The seasonal variation was not explained by a seasonal variation of the detection rates of autoantibodies associated with autoimmune encephalitis (incl. NMDAR, LGI1, CASPR2, GABAR, GFAP) in a Danish nationwide register (n = 259). In conclusion, we confirm the seasonality of NORSE in a Danish cohort, however, with a peak during winter suggesting a geographical variation not solely explained by autoimmune encephalitis associated with known autoantibodies. PLAIN LANGUAGE SUMMARY: The study investigated the seasonal patterns of new-onset refractory status epilepticus (NORSE), i.e. severe seizures that occur without an obvious cause and require very intensive treatment. In contrast to the previously observed peak frequency in summer, this Danish study found that NORSE cases peak in winter. Furthermore, the seasonal variation in NORSE cases was not found to be associated with autoimmune encephalitis caused by known autoantibodies. Together with the high rate of patients showing symptoms of systemic inflammation compared to other status epilepticus patients, the data suggest a link between misdirected immune system responses and NORSE. The study can therefore help in the further search for the currently unknown causes of NORSE.
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Affiliation(s)
- Andrea Enerstad Bolle
- Department of NeurologyOdense University HospitalOdenseDenmark
- BRIDGE – Brain Research Inter Disciplinary Guided ExcellenceOdense University HospitalOdenseDenmark
| | - Thomas Gaist
- Department of NeurologyOdense University HospitalOdenseDenmark
| | | | - Morten Blaabjerg
- Department of NeurologyOdense University HospitalOdenseDenmark
- BRIDGE – Brain Research Inter Disciplinary Guided ExcellenceOdense University HospitalOdenseDenmark
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Christoph Patrick Beier
- Department of NeurologyOdense University HospitalOdenseDenmark
- BRIDGE – Brain Research Inter Disciplinary Guided ExcellenceOdense University HospitalOdenseDenmark
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
- OPEN, Open Patient Data Explorative NetworkOdense University HospitalOdenseDenmark
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Antaya TC, Espino-Alvarado PH, Oiamo T, Wilk P, Speechley KN, Burneo JG. Association of outdoor air and noise pollution with unprovoked seizures and new onset epilepsy: A systematic review and meta-analysis. Epilepsia 2024. [PMID: 38776166 DOI: 10.1111/epi.18010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/24/2024]
Abstract
Research has indicated that certain environmental exposures may increase the risk of unprovoked seizures and new onset epilepsy. This study aimed to synthesize the literature that has estimated the associations between short- and long-term exposure to outdoor air and noise pollution and the risk of unprovoked seizures and new onset epilepsy. We searched Embase, MEDLINE, Scopus, Web of Science, BIOSIS Previews, Latin American and Caribbean Health Sciences Literature, Proquest Dissertations and Theses, conference abstracts, and the gray literature and conducted citation tracing in June 2023. Observational and ecological studies assessing the associations of air and noise pollution with unprovoked seizures or new onset epilepsy were eligible. One reviewer extracted summary data. Using fixed and random effects models, we calculated the pooled risk ratios (RRs) for the studies assessing the associations between short-term exposure to air pollution and unprovoked seizures. Seventeen studies were included, 16 assessing the association of air pollution with seizures and one with epilepsy. Eight studies were pooled quantitatively. Ozone (O3; RR = .99, 95% confidence interval [CI] = .99-.99) and nitrogen dioxide (NO2) exposure adjusted for particulate matter (RR = 1.02, 95% CI = 1.01-1.02) on the same day, and carbon monoxide (CO) exposure 2 days prior (RR = 1.12, 95% CI = 1.02-1.22), were associated with seizure risk. A single study of air pollution and epilepsy did not report a significant association. The risk of bias and heterogeneity across studies was moderate or high. Short-term exposure to O3, NO2, and CO may affect the risk of seizures; however, the effect estimates for O3 and NO2 were minimal. Additional research should continue to explore these and the associations between outdoor air pollution and epilepsy and between noise pollution and seizures and epilepsy.
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Affiliation(s)
- Tresah C Antaya
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Neuroepidemiology Research Unit, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Poul H Espino-Alvarado
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Tor Oiamo
- Department of Geography and Environmental Studies, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Piotr Wilk
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Paediatrics, Western University, London, Ontario, Canada
| | - Kathy N Speechley
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Paediatrics, Western University, London, Ontario, Canada
| | - Jorge G Burneo
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Neuroepidemiology Research Unit, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
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3
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Zheng J, Xu M, Xu H, Ye F, Liu X, Liu Y, Jin X. Acute effects of ambient air pollution on daily neurology clinic visits for vertigo: a time-series study in Wuhan, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:57707-57716. [PMID: 36971932 DOI: 10.1007/s11356-023-26575-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/16/2023] [Indexed: 05/10/2023]
Abstract
This study aimed to disclose the relationship between ambient air pollution and neurology clinic visits (NCVs) for vertigo. A time-series study was conducted to examine relationships between six different criteria air pollutants (SO2, NO2, PM2.5, PM10, CO, and O3) and daily NCVs for vertigo in Wuhan, China, from January 1st, 2017 to November 30th, 2019. Stratified analyses were computed according to gender, age, and season. A total of 14,749 records of NCVs for vertigo were enrolled in this study. Data showed that the increase in daily NCVs for vertigo corresponding to 10 μg/m3 increase of respective pollutants are: SO2 (- 7.60%; 95% CI: - 14.25 to - 0.44%), NO2 (3.14%; 95% CI: 0.23 to 6.13%), PM2.5 (0.53%; 95% CI: - 0.66 to 1.74%), PM10 (1.32%; 95% CI: - 0.36 to 3.06%), CO (0.00%; 95% CI: - 0.12 to 0.13%), and O3 (0.90%; 95% CI: - 0.01% to 1.83%). Males were more susceptible to acute exposure to SO2 and NO2, compared to females (SO2: - 11.91% vs. - 4.16%; NO2: 3.95% vs. 2.92%), whereas the acute effect of O3 exposure was more significantly obvious in females than males (0.94% vs. 0.87%). Moreover, correlations between daily NCVs for vertigo and acute exposure to SO2, NO2, and O3 were all stronger in individuals under 50 years old (SO2: - 12.75% vs. - 4.41%; NO2: 4.55% vs. 2.75%; O3: 1.27% vs. 0.70%). Short-term exposure to PM2.5 was more significantly associated with daily NCVs for vertigo in cool seasons (1.62% vs. - 0.68%), while the correlation between CO exposure and daily NCVs for vertigo was stronger in warm seasons (0.21% vs. - 0.03%). Our study demonstrated acute exposure to ambient NO2 and O3 positively associated with daily NCVs for vertigo. Acute effects of air pollution on daily NCVs for vertigo varied according to gender, age, and season.
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Affiliation(s)
- Jiachen Zheng
- Emergency Center, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
- Hubei Clinical Research Center for Emergency and Resuscitation, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- The Second Clinical School, Wuhan University, Wuhan, 430071, Hubei, China
| | - Min Xu
- Department of Geriatrics, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Haoyue Xu
- The Second Clinical School, Wuhan University, Wuhan, 430071, Hubei, China
| | - Fei Ye
- Department of Neurology, Wuhan Central Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430071, Hubei, China
| | - Xiaozhou Liu
- Department of Neurology, Wuhan Central Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430071, Hubei, China
| | - Yumin Liu
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Xiaoqing Jin
- Emergency Center, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China.
- Hubei Clinical Research Center for Emergency and Resuscitation, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
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Louis S, Carlson AK, Suresh A, Rim J, Mays M, Ontaneda D, Dhawan A. Impacts of Climate Change and Air Pollution on Neurologic Health, Disease, and Practice: A Scoping Review. Neurology 2023; 100:474-483. [PMID: 36384657 PMCID: PMC9990849 DOI: 10.1212/wnl.0000000000201630] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although the international community collectively seeks to reduce global temperature rise to less than 1.5°C before 2100, irreversible environmental changes have already occurred, and as the planet warms, these changes will continue to occur. As we witness the effects of a warming planet on human health, it is imperative that neurologists anticipate how the epidemiology and incidence of neurologic disease may change. In this review, we organized our analysis around 3 key themes related to climate change and neurologic health: extreme weather events and temperature fluctuations, emerging neuroinfectious diseases, and pollutant impacts. Across each of these themes, we appraised and reviewed recent literature relevant to neurologic disease and practice. METHODS Studies were identified using search terms relating to climate change, pollutants, and neurologic disease in PubMed, OVID MEDLINE, EMBASE, PsycInfo, and gray literature. Studies published between 1990 and 2022 were included if they pertained to human incidence or prevalence of disease, were in English, and were relevant to neurologic disease. RESULTS We identified a total of 364 articles, grouped into the 3 key themes of our study: extreme weather events and temperature fluctuations (38 studies), emerging neuroinfectious diseases (37 studies), and pollutant impacts (289 studies). The included studies highlighted the relationships between neurologic symptom exacerbation and temperature variability, tick-borne infections and warming climates, and airborne pollutants and cerebrovascular disease incidence and severity. DISCUSSION Temperature extremes and variability both associated with stroke incidence and severity, migraine headaches, hospitalization in patients with dementia, and multiple sclerosis exacerbations. Exposure to airborne pollutants, especially PM2.5 and nitrates, associated with stroke incidence and severity, headaches, dementia risk, Parkinson disease, and MS exacerbation. Climate change has demonstrably expanded favorable conditions for zoonotic diseases beyond traditional borders and poses the risk of disease in new, susceptible populations. Articles were biased toward resource-rich regions, suggesting a discordance between where research occurs and where changes are most acute. As such, 3 key priorities emerged for further study: neuroinfectious disease risk mitigation, understanding the pathophysiology of airborne pollutants on the nervous system, and methods to improve delivery of neurologic care in the face of climate-related disruptions.
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Affiliation(s)
- Shreya Louis
- From the Lerner College of Medicine (S.L.), Cleveland Clinic, OH; and Neurological Institute (A.K.C., A.S., J.R., M.M., D.O., A.D.), Cleveland Clinic, OH
| | - Alise K Carlson
- From the Lerner College of Medicine (S.L.), Cleveland Clinic, OH; and Neurological Institute (A.K.C., A.S., J.R., M.M., D.O., A.D.), Cleveland Clinic, OH
| | - Abhilash Suresh
- From the Lerner College of Medicine (S.L.), Cleveland Clinic, OH; and Neurological Institute (A.K.C., A.S., J.R., M.M., D.O., A.D.), Cleveland Clinic, OH
| | - Joshua Rim
- From the Lerner College of Medicine (S.L.), Cleveland Clinic, OH; and Neurological Institute (A.K.C., A.S., J.R., M.M., D.O., A.D.), Cleveland Clinic, OH
| | - MaryAnn Mays
- From the Lerner College of Medicine (S.L.), Cleveland Clinic, OH; and Neurological Institute (A.K.C., A.S., J.R., M.M., D.O., A.D.), Cleveland Clinic, OH
| | - Daniel Ontaneda
- From the Lerner College of Medicine (S.L.), Cleveland Clinic, OH; and Neurological Institute (A.K.C., A.S., J.R., M.M., D.O., A.D.), Cleveland Clinic, OH
| | - Andrew Dhawan
- From the Lerner College of Medicine (S.L.), Cleveland Clinic, OH; and Neurological Institute (A.K.C., A.S., J.R., M.M., D.O., A.D.), Cleveland Clinic, OH.
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5
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Tanaka M, Okuda T, Itoh K, Ishihara N, Oguro A, Fujii-Kuriyama Y, Nabetani Y, Yamamoto M, Vogel CFA, Ishihara Y. Polycyclic aromatic hydrocarbons in urban particle matter exacerbate movement disorder after ischemic stroke via potentiation of neuroinflammation. Part Fibre Toxicol 2023; 20:6. [PMID: 36797786 PMCID: PMC9933276 DOI: 10.1186/s12989-023-00517-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/07/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND A recent epidemiological study showed that air pollution is closely involved in the prognosis of ischemic stroke. We and others have reported that microglial activation in ischemic stroke plays an important role in neuronal damage. In this study, we investigated the effects of urban aerosol exposure on neuroinflammation and the prognosis of ischemic stroke using a mouse photothrombotic model. RESULTS When mice were intranasally exposed to CRM28, urban aerosols collected in Beijing, China, for 7 days, microglial activation was observed in the olfactory bulb and cerebral cortex. Mice exposed to CRM28 showed increased microglial activity and exacerbation of movement disorder after ischemic stroke induction. Administration of core particles stripped of attached chemicals from CRM28 by washing showed less microglial activation and suppression of movement disorder compared with CRM28-treated groups. CRM28 exposure did not affect the prognosis of ischemic stroke in null mice for aryl hydrocarbon receptor, a polycyclic aromatic hydrocarbon (PAH) receptor. Exposure to PM2.5 collected at Yokohama, Japan also exacerbated movement disorder after ischemic stroke. CONCLUSION Particle matter in the air is involved in neuroinflammation and aggravation of the prognosis of ischemic stroke; furthermore, PAHs in the particle matter could be responsible for the prognosis exacerbation.
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Affiliation(s)
- Miki Tanaka
- Program of Biomedical Science, Graduate School of Integrated Sciences for Life, Hiroshima University, 1-7-1, Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8521, Japan
- Laboratory for Pharmacotherapy and Experimental Neurology, Kagawa School of Pharmaceutical Sciences, Tokushima Bunri University, Sanuki, Kagawa, 769-2101, Japan
| | - Tomoaki Okuda
- Faculty of Science and Technology, Keio University, Yokohama, Kanagawa, 223-8522, Japan
| | - Kouichi Itoh
- Laboratory for Pharmacotherapy and Experimental Neurology, Kagawa School of Pharmaceutical Sciences, Tokushima Bunri University, Sanuki, Kagawa, 769-2101, Japan
| | - Nami Ishihara
- Program of Biomedical Science, Graduate School of Integrated Sciences for Life, Hiroshima University, 1-7-1, Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8521, Japan
| | - Ami Oguro
- Program of Biomedical Science, Graduate School of Integrated Sciences for Life, Hiroshima University, 1-7-1, Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8521, Japan
| | - Yoshiaki Fujii-Kuriyama
- Medical Research Institute, Molecular Epidemiology, Tokyo Medical and Dental University, Bunkyo, Tokyo, 113-8510, Japan
| | - Yu Nabetani
- Department of Applied Chemistry, Faculty of Engineering, University of Miyazaki, Miyazaki, 889-2192, Japan
| | - Megumi Yamamoto
- Department of Environment and Public Health, National Institute for Minamata Disease, Minamata, Kumamoto, 867-0008, Japan
| | - Christoph F A Vogel
- Department of Environmental Toxicology, University of California, Davis, Davis, CA, 95616, USA
- Center for Health and the Environment, University of California, Davis, Davis, CA, 95616, USA
| | - Yasuhiro Ishihara
- Program of Biomedical Science, Graduate School of Integrated Sciences for Life, Hiroshima University, 1-7-1, Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8521, Japan.
- Center for Health and the Environment, University of California, Davis, Davis, CA, 95616, USA.
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Mizan T, Taghipour S. Medical resource allocation planning by integrating machine learning and optimization models. Artif Intell Med 2022; 134:102430. [PMID: 36462908 DOI: 10.1016/j.artmed.2022.102430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 10/15/2022] [Accepted: 10/19/2022] [Indexed: 12/14/2022]
Abstract
Patients' waiting time is a major issue in the Canadian healthcare system. The planning for resource allocation impacts patients' waiting time in medicare settings. This research focuses on the reduction of patients' waiting time by providing better planning for radiological resource allocation and efficient workload distribution. Resource allocation planning is directly related to the number of patient-arrival and it is hard to predict such uncertain parameters in the future time frame. The number of patient-arrival also varies across different modalities and different timeframes which makes the patient-arrival prediction challenging. In this research, a new three-phase solution framework is proposed where a new multi-target machine learning technique is integrated with an optimization model. In the first phase, a novel Ensemble of Pruned Regressor Chain (EPRC) model is developed and trained offline to predict uncertain parameters, such as patients' arrival. The proposed model is then compared with two popular multi-target prediction methods to evaluate the model's accuracy. In the second phase, the trained model is deployed in the real-time environment to forecast patients' arrival, miss Turn Around Time (miss-TAT) rate, and probable workload count. The forecasted data is used in phase three where a new multi-objective optimization model is developed to determine workload allocation. The Weighted-sum method is used to get efficient solutions. The proposed model is deployed in a Canadian healthcare company and evaluated using real-time healthcare data. It is observed in terms of accuracy, the proposed EPRC model performed 10.81 % better compared to the other multi-target models considered in this study. It is also noticed that the forecasting results have a direct impact on the workload distribution, where the proposed model decreases the total workload by approximately 25 %. Besides, the result shows the efficient workload distribution provided by the proposed framework can reduce the average patients' waiting time by 8.17 %.
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Affiliation(s)
- Tasquia Mizan
- Department of Mechanical and Industrial Engineering, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada.
| | - Sharareh Taghipour
- Department of Mechanical and Industrial Engineering, Ryerson University, 350 Victoria St., Office-EPH 300, Toronto, ON M5B 2K3, Canada.
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Cheng J, Su H, Song J, Wang X. Short-term effect of air pollution on childhood epilepsy in eastern China: A space-time-stratified case-crossover and pooled analysis. ENVIRONMENT INTERNATIONAL 2022; 170:107591. [PMID: 36279736 DOI: 10.1016/j.envint.2022.107591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/24/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Growing studies suggest that air pollution exposure is an emerging driver for neurological diseases, but existing evidence on the association between air pollution and epilepsy is scarce. Here, we aimed to quantitatively estimated the short-term effects of various air pollutants on childhood epilepsy hospitalizations in China. METHODS We obtained daily electronic health records on childhood epilepsy hospitalizations and air pollutants (PM2.5, PM10-2.5, PM10, SO2, NO2, O3) from 2016 through 2018 in 10 cities of Anhui Province in China. In the first stage, a space-time-stratified case-crossover analysis was employed to evaluate the short-term association of childhood epilepsy hospitalizations with each air pollutant in Anhui Province. In the second stage, short-term effect of air pollution on childhood epilepsy morbidity reported in Anhui Province and in previous studies was pooled with a random-effect meta-analysis model to get the overall effect of different air pollutants in eastern China. RESULTS This study included 8,181 childhood epilepsy patients from 10 cities in Anhui province of China. The first stage case-crossover analysis in Anhui province found significant associations between higher concentrations of all air pollutants (except O3) and increased risk of childhood epilepsy hospitalizations. Each 10 μg/m3 increase in PM2.5, PM10-2.5, PM10, SO2, and NO2 concentrations was associated with an increase of 1.1 % [95 % confidence interval (CI): 0.1 %-2.1 %], 1.7 % (95 %CI: 0.5 %-2.9 %), 0.8 % (95 %CI: 0.1 %-1.4 %), 8.5 % (95 %CI: 1.5 %-16.0 %), and 4.3 % (95 %CI: 2.3 %-6.3 %) in epilepsy hospitalizations, respectively. We also observed greater effects of particulate matter in cold season. The second stage meta-analysis that additionally included two prior studies with 43,002 patients from other 11 cities found a marginally significant increase in childhood epilepsy attacks associated with PM2.5, PM10, and NO2 in eastern China. CONCLUSIONS Short-term exposure to both particulate matter and gaseous air pollution was associated with an increased risk of childhood epilepsy exacerbation in eastern China. Our findings suggest that air pollution exposure especially in cold season needs to be considered by children's parents or guardians to prevent epilepsy attacks.
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Affiliation(s)
- Jian Cheng
- School of Public Health, Department of Epidemiology and Biostatistics, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - Hong Su
- School of Public Health, Department of Epidemiology and Biostatistics, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - Jian Song
- School of Public Health, Department of Epidemiology and Biostatistics, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - Xu Wang
- Department of Science and Education, Children's Hospital of Anhui Medical University (Anhui Provincial Children's Hospital), Hefei, Anhui, China.
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8
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Tekin E, Diler Durgut B, Akoğlu HA. Evaluation of Patients Presenting to the Pediatric Emergency Department with Seizures during the COVID-19 Pandemic. JOURNAL OF PEDIATRIC EPILEPSY 2022. [DOI: 10.1055/s-0042-1746429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractThe coronavirus disease 2019 pandemic has led to significant changes in hospital visits worldwide. The admission rates have remarkably decreased. This study investigates the characteristics of 104 patients (54 girls, 50 boys) who presented to our pediatric emergency department (ED) with seizures during the pandemic between May 2020 and May 2021. Regarding seizure type, 84 generalized and 20 focal seizures had occurred. Tonic, tonic–clonic, clonic, and hypomotor seizures were seen in descending order. Thirty-seven patients were diagnosed with epilepsy, and 32 patients with first afebrile, 25 first febrile, and 10 recurrent febrile seizures. No patients had acute symptomatic seizures. In 85 patients, the seizures had stopped before the ED visit; only one lasted >60 minutes. Benzodiazepines were administered as a first-line drug. Demographical features, electroencephalogram (EEG), and cranial imaging findings, laboratory test results, and distribution by month and by the hour of ED visit were analyzed. Study data was in accordance with the literature by seizure types, seizure management, and cranial imaging rates but differed by distribution in terms of month and the hour of ED visit. The EEG abnormality rate was higher among the first afebrile seizure cases. The number of patients with seizures was 69, that is, 0.3% of emergency admissions, for the 4 months of 2019 before the pandemic, and 104, that is, 0.4% of emergency admissions for the whole initial year of the pandemic thereafter. So, the number of patients with seizures had decreased, but their rate had increased, which could be attributed to a decrease in the number of nonurgent presentations to the ED during the pandemic.
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Affiliation(s)
- Emine Tekin
- Pediatric Neurology Division, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Betül Diler Durgut
- Pediatric Neurology Division, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Handan Ayhan Akoğlu
- Department of Pediatrics, Faculty of Medicine, Giresun University, Giresun, Turkey
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9
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Maloney EM, Corcoran P, Costello DJ, O'Reilly ÉJ. Association between social deprivation and incidence of first seizures and epilepsy: a prospective population based cohort. Epilepsia 2022; 63:2108-2119. [PMID: 35611982 PMCID: PMC9544186 DOI: 10.1111/epi.17313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 05/05/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Epidemiologic studies have investigated whether social deprivation is associated with a higher incidence of epilepsy and results are conflicting, especially in children. The mechanisms underlying a potential association are unclear. This study examines whether there is an association between social deprivation and the incidence of first seizures (unprovoked and provoked) and new diagnosis of epilepsy by comparing incidence across an area-level measure of deprivation in a population-based cohort. METHODS Multiple methods of case identification followed by individual case validation and classification were carried out in a defined geographical area (population 542,868) to identify all incident cases of first provoked and first unprovoked seizures and new diagnosis of epilepsy presenting during the calendar year 2017. An area-level relative deprivation index, based on ten indicators from census data, was assigned to each patient according to registered address and categorised into quintiles from most to least deprived. RESULTS The annual incidence of first unprovoked seizures (n=372), first provoked seizures (n=189) and new diagnosis of epilepsy (n=336) was highest in the most deprived areas compared to the least deprived areas (incidence ratios of 1·79 (95%CI 1·26, 2·52), 1·55 (95%CI 1·04, 2·32) and 1·83 (95%CI 1·28, 2·62), respectively). This finding was evident in both adults and children and in those with structural and unknown aetiologies of epilepsy. SIGNIFICANCE The incidence of first seizures and new diagnosis of epilepsy is associated with more social deprivation. The reason for this higher incidence is likely multifactorial.
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Affiliation(s)
- Eimer M Maloney
- Epilepsy Service, Department of Neurology, Cork University Hospital, Ireland.,School of Medicine, University College Cork, Ireland.,School of Public Health, University College Cork, Ireland
| | - Paul Corcoran
- School of Public Health, University College Cork, Ireland
| | - Daniel J Costello
- Epilepsy Service, Department of Neurology, Cork University Hospital, Ireland.,School of Medicine, University College Cork, Ireland.,FutureNeuro SFI Research Centre for Chronic and Rare Neurological Diseases hosted in RCSI, Dublin 2, Ireland
| | - Éilis J O'Reilly
- School of Public Health, University College Cork, Ireland.,Department of Nutrition, Harvard TH Chan School of Public Health, USA.,Environmental Research Institute, University College Cork, Ireland
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Sirikarn P, Tiamkao S, Tiamkao S. The effects of COVID-19 measures on the hospitalization of patients with epilepsy and status epilepticus in Thailand: An interrupted time series analysis. Epilepsia Open 2022; 7:325-331. [PMID: 35403839 PMCID: PMC9110909 DOI: 10.1002/epi4.12600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/13/2022] [Accepted: 04/08/2022] [Indexed: 12/04/2022] Open
Abstract
Objective To investigate the effect of Coronavirus disease 2019 (COVID‐19) measures on the hospitalization of patients with epilepsy and status epilepticus (SE). Methods This interrupted time series design included data from the Thai Universal Coverage Scheme electronic database between January 2017 and September 2020. The monthly hospitalization rate of epilepsy and SE was calculated by the number of hospitalizations divided by the midyear population. Segmented regression fitted by ordinary least squares (OLS) was used to detect the immediate and overtime effects of COVID‐19 measures on the hospitalization rate. Results During January 2017 and September 2020, the numbers of epilepsy and SE patients admitted to the hospital were 129 402 and 15 547 episodes, respectively. The monthly trend of the hospitalization rate in epilepsy decreased immediately after the COVID‐19 measure (0.739 per 100 000 population [95% CI: 0.219 to 1.260]). In particular, the number of children declined to 1.178 per 100 000 population, and the number of elderly individuals dropped to 0.467 per 100 000 population, while there was a nonstatistically significant change in SE. Significance COVID‐19 measures reduced the hospital rate in epilepsy, particularly in children and adults. However, there was no change in SE patients.
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Affiliation(s)
- Prapassara Sirikarn
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.,Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Siriporn Tiamkao
- Department of Pharmacy, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Somsak Tiamkao
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand
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Tomasović S, Sremec J, Košćak Lukač J, Sičaja G, Bačić Baronica K, Ostojić V, Raifi Z, Tomić Sremec N, Plačko-Vršnak D, Srnec L, Mikec K. Weather patterns and occurrence of epileptic seizures. BMC Neurol 2022; 22:33. [PMID: 35062900 PMCID: PMC8780718 DOI: 10.1186/s12883-021-02535-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 12/26/2021] [Indexed: 11/16/2022] Open
Abstract
Background The results of various studies that have so far evaluated the influence of meteorological conditions on seizures are often divergent. No studies have been performed so far that evaluate the possible correlation between the occurrence of seizure-related events, surface and upper level atmospheric conditions and biometeorological forecasts. The aim of this study is to investigate those interactions. Methods Records of “Sveti Duh” University hospital, Zagreb, Croatia between January 2016 and May 2020 were analysed in order to determine number of patients per day who were assessed through Emergency room because of a recent epileptic seizure. The dates were assessed for surface and upper level atmospheric conditions and biometeorological forecasts. Analyses of these factors were performed for two consecutive days preceding that day, the day of seizure, as well as for the following day. Data was analysed using chi-squared test, Mann-Whitney U-test or Kruskal-Wallis test (with Conover’s test for post-hoc analyses), depending on variable type. Additionaly, logistic regression was used to study effects of variables on seizure occurrence. Statistical significance was set to p < 0.05. Results Results showed significant difference between the numbers of patients with seizure depending on upper level type on the following day. We also observed fewer daily patients with seizures when the synoptic situation on the following day was high pressure field then when it was low pressure or non-gradient pressure field (observed just during the colder part of the year), which was supported in our regression analyses. A greater frequency of seizures was observed if the biometerological prognosis was deemed unfavourable on the following day. Furthermore, our results showed significantly larger proportion of days with seizure patients in warmer, than in colder days of the year. Conclusions All of the analyzed weather-related parameters seem to be associated with daily numbers of seizures on the previous day. The reason behind this phenomenon is uncertain; however, the results indicate that weather patterns have a certain influence on patients with epilepsy, but are not yet fully understood or adequately appreciated.
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Yamaguchi H, Nozu K, Ishiko S, Kondo A, Yamamoto N, Tamura A, Aoto Y, Unzaki A, Ishibashi K, Morioka I, Nagase H, Ishida A. Multivariate analysis of the impact of weather and air pollution on emergency department visits for unprovoked seizure among children: A retrospective clinical observational study. Epilepsy Behav 2021; 125:108434. [PMID: 34837841 DOI: 10.1016/j.yebeh.2021.108434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/02/2021] [Accepted: 11/06/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND An unprovoked seizure is a seizure or a cluster of seizures occurring within 24 h in a patient older than 1 month of age without precipitating factors. Recent studies have reported that extrinsic factors, such as meteorological conditions and air pollutants, may be important in seizure occurrence. Thus, this study aimed to examine the association between the number of visits to the emergency department (ED) by children for nighttime unprovoked seizures and exposure to multi-faceted factors, such as meteorological conditions and air pollution. METHODS We conducted a clinical observational analysis and reviewed consecutive patients younger than 16 years of age who visited the primary ED center in Kobe City, Japan, during nighttime (7:30 p.m.-7:00 a.m.) between January 1, 2011 and December 31, 2015. We investigated the effects of meteorological factors and air pollutants on the number of patients with unprovoked seizures using multivariate analysis of Poisson regression estimates. RESULTS In total, 151,119 children visited the ED, out of which 97 patients presented with unprovoked seizures. The mean age of the patients was 4.7 years (range, 1 month to 15.3 years), and 54.6% of them were boys. The total number of patients with unprovoked seizures showed no significant changes with the seasons; however, there were dominant peaks during the fall and fewer visits during the summer. The multivariate analysis of Poisson regression estimates revealed a significant positive relationship between the number of patients presenting with unprovoked seizures and precipitation (+1 patient/87 mm; p = 0.03) and methane (+1 patient/0.14 ppm; p = 0.03) levels and a negative relationship between the number of patients presenting with unprovoked seizures and nitrogen dioxide level (-1 patient/0.02 ppm; p = 0.04). CONCLUSIONS The present study is the first to evaluate the association between the number of children who presented to the ED with nighttime unprovoked seizures and environmental factors after controlling for confounding factors.
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Affiliation(s)
- Hiroshi Yamaguchi
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Shinya Ishiko
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Atsushi Kondo
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Nobuyuki Yamamoto
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Akihiro Tamura
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Yuya Aoto
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Ai Unzaki
- Kobe Children's Primary Emergency Medical Center, 1-4-1 Wakihamakaigandori, Chuo-ku, Kobe, Hyogo 651-0073, Japan
| | - Kazuto Ishibashi
- Kobe Children's Primary Emergency Medical Center, 1-4-1 Wakihamakaigandori, Chuo-ku, Kobe, Hyogo 651-0073, Japan
| | - Ichiro Morioka
- Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1, Oyaguchi, Kami-cho, Itabashi-ku, Tokyo 173-8610, Japan
| | - Hiroaki Nagase
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Akihito Ishida
- Kobe Children's Primary Emergency Medical Center, 1-4-1 Wakihamakaigandori, Chuo-ku, Kobe, Hyogo 651-0073, Japan
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Mousavi A, Yuan Y, Masri S, Barta G, Wu J. Impact of 4th of July Fireworks on Spatiotemporal PM 2.5 Concentrations in California Based on the PurpleAir Sensor Network: Implications for Policy and Environmental Justice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5735. [PMID: 34071796 PMCID: PMC8198140 DOI: 10.3390/ijerph18115735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/03/2021] [Accepted: 05/20/2021] [Indexed: 02/07/2023]
Abstract
Fireworks are often used in celebration, causing short term, extremely high particulate matter air pollution. In recent years, the rapid development and expansion of low-cost air quality sensors by companies such as PurpleAir has enabled an understanding of air pollution at a much higher spatiotemporal resolution compared to traditional monitoring networks. In this study, real-time PM2.5 measurements from 751 PurpleAir sensors operating from June to July in 2019 and 2020 were used to examine the impact of 4th of July fireworks on hourly and daily PM2.5 concentrations at the census tract and county levels in California. American Community Survey (ACS) and CalEnviroScreen 3.0 data were used to identify correlations between PM2.5 measurements and socioeconomic status (SES). A two-step method was implemented to assure the quality of raw PM2.5 sensor data and sensor calibration against co-located reference instruments. The results showed that over 67% and 81% of counties experienced immediate impacts related to fireworks in 2019 and 2020, respectively. Relative to 2019, the peak PM2.5 concentrations on July 4th and 5th 2020 were, on average, over 50% higher in California, likely due to the COVID-19-related increase in the use of household-level fireworks. This increase was most pronounced in southern counties, which tend to have less strict firework-related regulations and a greater use of illegal fireworks. Los Angeles County experienced the highest July 4th daily PM2.5 levels both in 2019 (29.9 µg·m-3) and 2020 (42.6 µg·m-3). Spatial hot spot analyses generally showed these southern counties (e.g., Los Angeles County) to be regional air pollution hotspots, whereas the opposite pattern was seen in the north (e.g., San Francisco). The results also showed PM2.5 peaks that were over two-times higher among communities with lower SES, higher minority group populations, and higher asthma rates. Our findings highlight the important role that policy and enforcement can play in reducing firework-related air pollution and protecting public health, as exemplified by southern California, where policy was more relaxed and air pollution was higher (especially in 2020 when the 4th of July coincided with the COVID-19-lockdown period), and in disadvantaged communities where disparities were greatest.
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Affiliation(s)
- Amirhosein Mousavi
- Program in Public Health, Department of Environmental and Occupational Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA 92697, USA; (A.M.); (Y.Y.); (S.M.)
| | - Yiting Yuan
- Program in Public Health, Department of Environmental and Occupational Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA 92697, USA; (A.M.); (Y.Y.); (S.M.)
| | - Shahir Masri
- Program in Public Health, Department of Environmental and Occupational Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA 92697, USA; (A.M.); (Y.Y.); (S.M.)
| | | | - Jun Wu
- Program in Public Health, Department of Environmental and Occupational Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA 92697, USA; (A.M.); (Y.Y.); (S.M.)
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Scorza FA, Moret MA, de Almeida ACG, Scorza CA, Finsterer J. Is there a seasonal influence on SUDEP? Epilepsy Behav 2021; 118:107913. [PMID: 33810990 DOI: 10.1016/j.yebeh.2021.107913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Fulvio A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil; Centro de Neurociências e Saúde da Mulher "Professor Geraldo Rodrigues de Lima." Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.
| | - Marcelo A Moret
- UNEB- Rua Silveira Martins, 2555, Cabula 41150-000 Salvador, Bahia, Brazil
| | - Antonio-Carlos G de Almeida
- Centro de Neurociências e Saúde da Mulher "Professor Geraldo Rodrigues de Lima." Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil; Laboratório de Neurociência Experimental e Computacional, Departamento de Engenharia de Biossistemas, Universidade Federal de São João del-Rei (UFSJ), Brazil
| | - Carla A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil; Centro de Neurociências e Saúde da Mulher "Professor Geraldo Rodrigues de Lima." Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
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