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Beghi E, Giussani G, Costa C, DiFrancesco JC, Dhakar M, Leppik I, Kwan P, Akamatsu N, Cretin B, O'Dwyer R, Kraemer G, Piccenna L, Faught E. The epidemiology of epilepsy in older adults: A narrative review by the ILAE Task Force on Epilepsy in the Elderly. Epilepsia 2023; 64:586-601. [PMID: 36625133 DOI: 10.1111/epi.17494] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/21/2022] [Accepted: 12/15/2022] [Indexed: 01/11/2023]
Abstract
In an aging world, it is important to know the burden of epilepsy affecting populations of older persons. We performed a selective review of epidemiological studies that we considered to be most informative, trying to include data from all parts of the world. We emphasized primary reports rather than review articles. We reviewed studies reporting the incidence and prevalence of epilepsy that focused on an older population as well as studies that included a wider age range if older persons were tabulated as a subgroup. There is strong evidence that persons older than approximately 60 years incur an increasing risk of both acute symptomatic seizures and epilepsy. In wealthier countries, the incidence of epilepsy increases sharply after age 60 or 65 years. This phenomenon was not always observed among reports from populations with lower socioeconomic status. This discrepancy may reflect differences in etiologies, methods of ascertainment, or distribution of ages; this is an area for more research. We identified other areas for which there are inadequate data. Incidence data are scarcer than prevalence data and are missing for large areas of the world. Prevalence is lower than would be expected from cumulative incidence, possibly because of remissions, excess mortality, or misdiagnosis of acute symptomatic seizures as epilepsy. Segmentation by age, frailty, and comorbidities is desirable, because "epilepsy in the elderly" is otherwise too broad a concept. Data are needed on rates of status epilepticus and drug-resistant epilepsy using the newer definitions. Many more data are needed from low-income populations and from developing countries. Greater awareness of the high rates of seizures among older adults should lead to more focused diagnostic efforts for individuals. Accurate data on epilepsy among older adults should drive proper allocation of treatments for individuals and resources for societies.
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Affiliation(s)
- Ettore Beghi
- Laboratory of Neurological Disorders, Department of Neuroscience, Mario Negri Institute of Pharmacological Research, Scientific Institute for Research and Health Care, Milan, Italy
| | - Giorgia Giussani
- Laboratory of Neurological Disorders, Department of Neuroscience, Mario Negri Institute of Pharmacological Research, Scientific Institute for Research and Health Care, Milan, Italy
| | - Cinzia Costa
- Section of Neurology, Santa Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Jacopo C DiFrancesco
- Department of Neurology, Istituto di Ricovero e Cura a Caraterre Scientifico, San Gerardo Foundation, University of Milan-Bicocca, Monza, Italy
| | - Monica Dhakar
- Department of Neurology, Brown University, Providence, Rhode Island, USA
| | - Ilo Leppik
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Naoki Akamatsu
- Division of Neurology, Neuroscience Center, Fukuoka Samo Hospital, International University of Health and Welfare, Fukuoka, Japan
| | - Benjamin Cretin
- Neuropsychology Unit, Department of Neurology of the University Hospitals of Strasbourg, Strasbourg, France
| | - Rebecca O'Dwyer
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | | | - Loretta Piccenna
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Edward Faught
- Department of Neurology, Emory University, Atlanta, Georgia, USA
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Kang KW, Lee H, Shin JY, Moon HJ, Lee SY. Trends in Prescribing of Antiseizure Medications in South Korea: Real-World Evidence for Treated Patients With Epilepsy. J Clin Neurol 2022; 18:179-193. [PMID: 35274836 PMCID: PMC8926764 DOI: 10.3988/jcn.2022.18.2.179] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 11/21/2022] Open
Abstract
Background and Purpose We investigated the trends in the prescribing of antiseizure medication (ASM) over a 9-year period, and provide real-world data regarding ASM prescriptions of patients with epilepsy in South Korea. Methods This study used data in the Korean National Health Information Database for the period from 2009 to 2017. We included 18 oral ASMs, which were classified into older and newer ASMs based on them first becoming available on the market before or after 1991, respectively. The annual trends in ASM prescriptions were plotted over the 9-year study period, and changes in these trends were evaluated as average annual percentage changes (AAPCs) using Poisson regression. Age- and sex-stratified analyses were also conducted. Results Overall, the proportion of prescriptions involving polytherapy with three or more ASMs increased from 10.08% in 2009 to 10.99% in 2017 (AAPC=0.9%, p<0.001) over the 9-year study period. Among monotherapies, although valproate (VPA) was the most frequently prescribed ASM, the prescription rate of levetiracetam (LEV) steadily increased regardless of age and sex over the study period. The monotherapy prescription trends differed depending on age and sex. In the five most frequently used ASM combination regimens, the prescription rates of VPA/LEV, LEV/oxcarbazepine, and LEV/lamotrigine regimens showed increasing tendencies. In contrast, prescription rates for all combined regimens of older ASMs declined over time in all age groups. Conclusions This is the first epidemiological study of the changes in prescription trends for ASM in South Korea based on nationwide data from 2009 to 2017. We found progressive increases in the use of newer ASMs for both monotherapy and duotherapy, and for polytherapy with three or more ASMs over the 9-year study period.
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Affiliation(s)
- Kyung Wook Kang
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Hyesung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, Korea
- Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Hye-Jin Moon
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Seo-Young Lee
- Department of Neurology, Kangwon National University School of Medicine, Chuncheon, Korea
- Medical Bigdata Convergence, Kangwon National University, Chuncheon, Korea
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Sunwoo JS, Jo H, Kang KW, Kim KT, Kim D, Kim DW, Kim MJ, Kim S, Kim W, Moon HJ, Park HR, Byun JI, Seo JG, Lim SC, Chu MK, Han SH, Hwang KJ, Seo DW. Survey on Antiepileptic Drug Therapy in Patients with Drug Resistant Epilepsy. J Epilepsy Res 2021; 11:72-82. [PMID: 34395226 PMCID: PMC8357558 DOI: 10.14581/jer.21010] [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: 05/24/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 12/03/2022] Open
Abstract
Background and Purpose Individualized anti-epileptic drug (AED) selection in patient with epilepsy is crucial. However, there is no unified opinion in treating patients with drug resistant epilepsy (DRE). This survey aimed to make a consolidate consensus with epileptologists’ perspectives of the treatment for Korean DRE patients by survey responses. Methods The survey was conducted with Korean epilepsy experts who have experience prescribing AEDs via e-mail. Survey questionnaires consisted of six items regarding prescription patterns and practical questions in treating patients with DRE in Korea. The research period was from February 2021 to March 2021. Results The survey response rate was 83.3% (90/108). Most (77.8%) of the responders are neurologists. The proportion of patients whose seizures were not controlled by the second AED was 26.9%. The proportion of patients who had taken five or more AEDs is 13.9%, and those who are currently taking five or more AEDs are 7.3%, of which 54.5% and 37.9% reported positive effects on additional AED, respectively. The majority (91.1%) of respondents answered that the mechanism of action was the top priority factor when adding AED. Regarding data priority, responders considered that expert opinion should have the top priority, followed by clinical experiences, reimbursement guidelines and clinical evidence. Responders gave 64.9 points (range from 0 to 100) about overall satisfaction on reimbursement system of Health Insurance Review and Assessment Service for AED. Conclusions This study on AED therapy for DRE patients is the first nationwide trial in Korean epilepsy experts. In five drug failure, the top priorities on AED selection are mechanism of action and expert opinion. These findings might help to achieve consensus and recognize the insight on optimal therapy of AED in DRE.
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Affiliation(s)
- Jun-Sang Sunwoo
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Hyunjin Jo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Wook Kang
- Department of Neurology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Keun Tae Kim
- , KoreaDepartment of Neurology, Keimyung University School of Medicine, Daegu
| | - Daeyoung Kim
- Department of Neurology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Dong Wook Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea
| | - Min-Jee Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Saeyoon Kim
- Department of Pediatrics, College of Medicine, Yeungnam University, Daegu, Korea
| | - Woojun Kim
- Department of Neurology, The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Korea
| | - Hye-Jin Moon
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Ha Ree Park
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jung-Ick Byun
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jong-Geun Seo
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sung Chul Lim
- Department of Neurology, The Catholic University of Korea St. Vincent's Hospital, Suwon, Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Seoul, Korea
| | - Su-Hyun Han
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyoung Jin Hwang
- Department of Neurology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Dae-Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Cardoso-Vera JD, Elizalde-Velázquez GA, Islas-Flores H, Mejía-García A, Ortega-Olvera JM, Gómez-Oliván LM. A review of antiepileptic drugs: Part 1 occurrence, fate in aquatic environments and removal during different treatment technologies. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 768:145487. [PMID: 33736324 DOI: 10.1016/j.scitotenv.2021.145487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 06/12/2023]
Abstract
Antiepileptic drugs (AEDs) are the main treatment for people with epilepsy. However, in recent years, more and more people are using them for other indications such as: migraine, chronic neuropathic pain, and mood disorders. Consequently, the prescriptions and consumption of these drugs are increasing worldwide. In WWTPs, AEDs can resist degradation processes, such as photodegradation, chemical degradation and/or biodegradation. Until now, only constructed wetlands and photocatalysis have shown good removal rates of AEDs from wastewater. However, their effectiveness depends on the specific conditions used during the treatment. Since the consumption of AEDs has increased in the last decade and their degradation in WWTPs is poor, these drugs have been largely introduced into the environment through the discharge of municipal and/or hospital effluents. Once in the environment, AEDs are distributed in the water phase, as suspended particles or in the sediments, suggesting that these drugs have a high potential for groundwater contamination. In this first part of the AEDs review is designed to fill out the current knowledge gap about the occurrence, fate and removal of these drugs in the aquatic environment. This is a review that emphasizes the characteristics of AEDs as emerging contaminants.
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Affiliation(s)
- Jesús Daniel Cardoso-Vera
- Laboratorio de Toxicología Ambiental, Facultad de Química, Universidad Autónoma del Estado de México, Paseo Colón intersección Paseo Tollocan s/n, Col. Residencial Colón, 50120 Toluca, Estado de México, Mexico
| | - Gustavo Axel Elizalde-Velázquez
- Laboratorio de Toxicología Ambiental, Facultad de Química, Universidad Autónoma del Estado de México, Paseo Colón intersección Paseo Tollocan s/n, Col. Residencial Colón, 50120 Toluca, Estado de México, Mexico
| | - Hariz Islas-Flores
- Laboratorio de Toxicología Ambiental, Facultad de Química, Universidad Autónoma del Estado de México, Paseo Colón intersección Paseo Tollocan s/n, Col. Residencial Colón, 50120 Toluca, Estado de México, Mexico
| | - Alejandro Mejía-García
- Laboratorio de Toxicología Ambiental, Facultad de Química, Universidad Autónoma del Estado de México, Paseo Colón intersección Paseo Tollocan s/n, Col. Residencial Colón, 50120 Toluca, Estado de México, Mexico
| | - José Mario Ortega-Olvera
- Laboratorio de Toxicología Ambiental, Facultad de Química, Universidad Autónoma del Estado de México, Paseo Colón intersección Paseo Tollocan s/n, Col. Residencial Colón, 50120 Toluca, Estado de México, Mexico
| | - Leobardo Manuel Gómez-Oliván
- Laboratorio de Toxicología Ambiental, Facultad de Química, Universidad Autónoma del Estado de México, Paseo Colón intersección Paseo Tollocan s/n, Col. Residencial Colón, 50120 Toluca, Estado de México, Mexico.
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Jeon JY, Lee H, Shin JY, Moon HJ, Lee SY, Kim JM. Increasing Trends in the Incidence and Prevalence of Epilepsy in Korea. J Clin Neurol 2021; 17:393-399. [PMID: 34184447 PMCID: PMC8242311 DOI: 10.3988/jcn.2021.17.3.393] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE There have been few reports on recent trends in the occurrence of epilepsy. The aim of this study was to estimate the incidence and prevalence of epilepsy and analyze their annual trends in Korea over the period 2009-2017. METHODS This nationwide population-based study was carried out using the National Health Insurance Service of Korea database. A prevalent case was defined as one of a patient receiving a prescription of anticonvulsants under the diagnostic codes for epilepsy or seizure. An incident case was ascertained by confirming the absence of any epilepsy-related diagnostic codes and anticonvulsant prescription for 2 years or more before the operational definition for a prevalent case was met. Alternative operational definitions for epilepsy were tested. The temporal trends of the incidence and prevalence of epilepsy were analyzed using a Poisson regression model, and are expressed as average annual percentage changes (AAPCs). RESULTS The incidence of epilepsy increased from 28.7/100,000 persons in 2009 to 35.4/100,000 persons in 2017. The prevalence increased gradually from 3.4/1,000 persons in 2009 to 4.8/1,000 persons in 2017. These increasing trends were more evident among elderly subjects aged ≥75 years and in those who had codes for epilepsy or seizure as an additional diagnosis. Age standardization revealed a less prominent but still increasing trend in both incidence (AAPC=0.48%) and prevalence (AAPC=3.11%). CONCLUSIONS There have been increasing trends in both the prevalence and incidence of epilepsy in Korea between 2009 and 2017. This finding appears to be related to societal aging and the high incidence of symptomatic epilepsy in the elderly population.
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Affiliation(s)
- Ji Ye Jeon
- Department of Neurology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyesung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Ju Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea.,Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Hye Jin Moon
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
| | - Seo Young Lee
- Department of Neurology, College of Medicine, Kangwon National University Chuncheon, Korea.,Interdisciplinary Graduate Program in Medical Bigdata Convergence, Kangwon National University, Chuncheon, Korea.
| | - Jae Moon Kim
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
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Jung I, Kwon H, Park SE, Han KD, Park YG, Rhee EJ, Lee WY. The Prevalence and Risk of Type 2 Diabetes in Adults with Disabilities in Korea. Endocrinol Metab (Seoul) 2020; 35:552-561. [PMID: 32693567 PMCID: PMC7520589 DOI: 10.3803/enm.2020.653] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 06/16/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND People with disabilities are at risk of secondary conditions such as diabetes. The aim of this study was to evaluate the prevalence and risk of type 2 diabetes in South Korea, especially among people with all types of disabilities. METHODS We conducted a cross-sectional study using data from the Korean National Health Insurance Service, with two disabilityfree controls matched for each participant with disabilities by age and sex. Information regarding the type, severity and grade of disabilities was obtained based on the National Disability Registry. Diagnosis of type 2 diabetes was defined according to the following criteria: presence of International Classification of Diseases, Tenth Revision, Clinical Modification codes E11, E12, E13, or E14 and claims for at least one oral anti-diabetic agent or insulin at baseline, or fasting glucose level ≥126 mg/dL. RESULTS We included 1,297,806 participants with disabilities and 2,943,719 control. Out of 4,241,525 participants, 841,990 (19.9%) were diagnosed with diabetes. The prevalence of diabetes was higher in the disability group compared with individuals without disabilities (23.1% vs. 18.4%). The odds of having diabetes was higher in the disability group compared with the control group (adjusted odds ratio, 1.34; 95% confidence interval, 1.33 to 1.34). The results showed higher prevalence of diabetes in the mildly disabled group (23.2%) than in the severely disabled group (22.7%). CONCLUSION The prevalence and risk of diabetes were higher in people with disabilities compared with the general population. Physicians and public health authorities should focus on people with disabilities for proper diabetes management.
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Affiliation(s)
- Inha Jung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyemi Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Eun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Yong-Gyu Park
- Department of Biostatistics, Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun-Jung Rhee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Corresponding authors: Eun-Jung Rhee Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea Tel: +82-2-2001-2485, Fax: +82-2-2001-1588, E-mail:
| | - Won-Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Won-Young Lee Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea Tel: +82-2-2001-2579, Fax: +82-2-2001-2049, E-mail:
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Byun JI, Kim DW, Kim KT, Yang KI, Lee ST, Seo JG, No YJ, Kang KW, Kim D, Kim JM, Cho YW. Treatment of epilepsy in adults: Expert opinion in South Korea. Epilepsy Behav 2020; 105:106942. [PMID: 32163888 DOI: 10.1016/j.yebeh.2020.106942] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to gather the expert opinions of Korean epileptologists regarding the treatment of adult patients with epilepsy. METHODS A total of 42 neurologists who specialized in epilepsy were surveyed. They completed an online questionnaire describing multiple patient scenarios. Using these scenarios, they evaluated treatment strategies and gave their preference for specific antiepileptic drugs (AEDs) used to treat genetically mediated generalized epilepsy and focal epilepsy. RESULTS Initial AED monotherapy, followed by a second form of alternative monotherapy or an add-on combination therapy, was the preferred treatment strategy. The experts reached consensus for 87.2% of the items. The most commonly selected AEDs for the initial monotherapy for patients with generalized epilepsy were levetiracetam or valproate. For those with focal epilepsy, levetiracetam, oxcarbazepine, or lamotrigine were the most popular selections. Ethosuximide was the treatment of choice only for patients with generalized epilepsy with prominent absence seizures. Levetiracetam was preferred as an add-on therapy for both generalized and focal epilepsy. For special populations of patients, such as elderly adults or those with comorbid diseases, levetiracetam or lamotrigine was selected as the treatment of choice. CONCLUSION Most of the survey results were in accordance with the US expert opinion survey published in 2016. This survey can assist clinicians in making clinical decisions when treating individual adult patients with epilepsy.
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Affiliation(s)
- Jung-Ick Byun
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University, School of Medicine, Seoul, South Korea
| | - Dong Wook Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, South Korea
| | - Keun Tae Kim
- Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea
| | - Kwang Ik Yang
- Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jong-Geun Seo
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | | | - Kyung Wook Kang
- Department of Neurology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, South Korea
| | - Daeyoung Kim
- Department of Neurology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Jae Moon Kim
- Department of Neurology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Yong Won Cho
- Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea.
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Kim HK, Kim DY, Bae EK, Kim DW. Adverse Skin Reactions with Antiepileptic Drugs Using Korea Adverse Event Reporting System Database, 2008-2017. J Korean Med Sci 2020; 35:e17. [PMID: 31997613 PMCID: PMC6995813 DOI: 10.3346/jkms.2020.35.e17] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 12/05/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Severe and life-threatening drug eruptions include drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). One class of medications that has been highly associated with such drug eruptions is antiepileptic drugs (AEDs). We attempt to investigate drug eruptions associated with AEDs as a class, as well as with individual AEDs, in Korea. METHODS We used the Korea Institute of Drug Safety and Risk Management - Korea Adverse Event Reporting System (KIDS-KAERS) database, a nationwide database of adverse events reports, between January 2008 and December 2017 to investigate the reporting count of all drug eruptions and calculated the ratio of DRESS/SJS/TEN reports for each AED. RESULTS Among a total of 2,942 reports, most were of rash/urticaria (2,702, 91.8%), followed by those of DRESS (109, 3.7%), SJS (106, 3.6%), and TEN (25, 0.85%). The common causative AEDs were lamotrigine (699, 23.8%), valproic acid (677, 23%), carbamazepine (512, 17.4%), oxcarbazepine (320, 10.9%), levetiracetam (181, 6.2%), and phenytoin (158, 5.4%). In limited to severe drug eruptions (DRESS, SJS, and TEN; total 241 reports), the causative AEDs were carbamazepine (117, 48.8%), lamotrigine (57, 23.8%), valproic acid (20, 8.3%), phenytoin (15, 6.3%), and oxcarbazepine (10, 4.2%). When comparing aromatic AED with non-aromatic AED, aromatic AEDs were more likely to be associated with severe drug eruption (aromatic AEDs: 204/1,793 versus non-aromatic AEDs: 37/1,149; OR, 3.86; 95% CI, 2.7-5.5). Death was reported in 7 cases; DRESS was the most commonly reported adverse event (n = 5), and lamotrigine was the most common causative AED (n = 5). CONCLUSION Although most cutaneous drug eruptions in this study were rash or urticaria, approximately 8% of reports were of severe or life-threatening adverse drug reactions, such as SJS, TEN, or DRESS. When hypersensitivity skin reactions occurred, aromatic AEDs were associated with 4 fold the risk of SJS/TEN/DRESS compared with non-aromatic AEDs. Our findings further emphasize that high risk AEDs should be prescribed under careful monitoring, and early detection and prompt interventions are needed to prevent severe complications.
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Affiliation(s)
- Hyun Kyung Kim
- Department of Neurology, National Medical Center, Seoul, Korea
| | - Dae Yeon Kim
- Department of Neurology, National Medical Center, Seoul, Korea
| | - Eun Kee Bae
- Department of Neurology, Inha University Hospital, Incheon, Korea
| | - Dong Wook Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea.
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Park JE, Son WS, Ryu Y, Choi SB, Kwon O, Ahn I. Effects of temperature, humidity, and diurnal temperature range on influenza incidence in a temperate region. Influenza Other Respir Viruses 2019; 14:11-18. [PMID: 31631558 PMCID: PMC6928031 DOI: 10.1111/irv.12682] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/13/2019] [Accepted: 09/13/2019] [Indexed: 01/13/2023] Open
Abstract
Background The effect of temperature and humidity on the incidence of influenza may differ by climate region. In addition, the effect of diurnal temperature range on influenza incidence is unclear, according to previous study findings. Objectives The aim of this study was to analyze the effects of temperature, humidity, and diurnal temperature range on the incidence of influenza in Seoul, Republic of Korea, which is located in a temperate region. Methods We used Korean National Health insurance data to assess the weekly influenza incidence between 2010 and 2016, and used meteorological data from Seoul. To investigate the effect of temperature, relative humidity, and diurnal temperature range levels on influenza incidence, we used a distributed lag non‐linear model. Results The risk of influenza incidence was significantly increased with low daily temperatures of 0‐5°C and low (30%–40%) or high (70%) relative humidity. We found a positive significant association between diurnal temperature range and influenza incidence in this study. Conclusions Influenza incidence increased with low temperature and low/high humidity in a temperate region. Influenza incidence also increased with high diurnal temperature range, after considering temperature and humidity.
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Affiliation(s)
- Ji-Eun Park
- Korea Institute of Oriental Medicine, Daejeon, Korea.,Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Korea
| | - Woo-Sik Son
- Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Korea.,National Institute for Mathematical Science, Daejeon, Korea
| | - Yeonhee Ryu
- Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Soo Beom Choi
- Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Korea.,Biomedical Prediction Technology Laboratory, Korea Institute of Science and Technology Information, Daejeon, Korea
| | - Okyu Kwon
- Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Korea.,National Institute for Mathematical Science, Daejeon, Korea
| | - Insung Ahn
- Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Korea.,Biomedical Prediction Technology Laboratory, Korea Institute of Science and Technology Information, Daejeon, Korea.,Department of Data-centric Problem Solving Research, Korea Institute of Science and Technology Information, Daejeon, Korea
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10
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Jung B, Lee JK, Kim J, Kang EK, Han SY, Lee HY, Choi IS. Synthetic Strategies for (-)-Cannabidiol and Its Structural Analogs. Chem Asian J 2019; 14:3749-3762. [PMID: 31529613 DOI: 10.1002/asia.201901179] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/13/2019] [Indexed: 12/14/2022]
Abstract
(-)-Cannabidiol ((-)-CBD), a non-psychoactive phytocannabinoid from Cannabis, and its structural analogs have received growing attention in recent years because of their potential therapeutic benefits, including neuroprotective, anti-epileptic, anti-inflammatory, anxiolytic, and anti-cancer properties. (-)-CBD and its analogs have been obtained mainly based on extraction from the natural source; however, the conventional extraction-based methods have some drawbacks, such as poor quality control along with purification difficulty. Chemical-synthetic strategies for (-)-CBD could tackle these issues, and, additionally, generate novel (-)-CBD analogs that exhibit advanced biological activities. This review concisely summarizes the historic and recent milestones in the synthetic strategies for (-)-CBD and its analogs.
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Affiliation(s)
| | - Jungkyu K Lee
- Department of Chemistry, Green-Nano Materials Research Center, Kyungpook National University, Daegu, 41566, Korea
| | - Jungnam Kim
- Department of Chemistry, KAIST, Daejeon, 34141, Korea
| | - Eunhye K Kang
- Department of Chemistry, KAIST, Daejeon, 34141, Korea
| | | | - Hee-Yoon Lee
- Department of Chemistry, KAIST, Daejeon, 34141, Korea
| | - Insung S Choi
- Department of Chemistry, KAIST, Daejeon, 34141, Korea
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11
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Lee SK, Lee SA, Kim DW, Loesch C, Pelgrims B, Osakabe T, Lee B. A randomized, open-label, multicenter comparative trial of levetiracetam and topiramate as adjunctive treatment for patients with focal epilepsy in Korea. Epilepsy Behav 2019; 97:67-74. [PMID: 31195326 DOI: 10.1016/j.yebeh.2019.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this trial was to compare the effectiveness of levetiracetam (LEV) and topiramate (TPM) as adjunctive treatment for patients with focal seizures in Korea. METHODS In this Phase IV, open-label, multicenter trial (NCT01229735), adults were randomized to treatment with LEV (1000-3000 mg/day) or TPM (200-400 mg/day). Only patients achieving LEV ≥1000 mg/day or TPM ≥100 mg/day after a 4-week up-titration entered the 20-week dose-finding and subsequent 28-week maintenance periods. The primary outcome was the 52-week retention rate; others included safety and exploratory efficacy outcomes. RESULTS Of 343 randomized patients (LEV 177; TPM 166), 211 (61.5%) completed the trial. In the full analysis set (FAS), retention rate was 59.1% with LEV vs 56.6% with TPM (p = 0.7007), while in the prespecified sensitivity analysis, based on data from patients who received drug doses in the recommended range (LEV 176; TPM 113), it was 59.1% with LEV vs 42.5% with TPM (p = 0.0086). In the FAS, median percent reduction in seizure frequency from baseline was 74.47% with LEV and 67.86% with TPM (p = 0.0665); ≥50% responder rate was 69.0% vs 64.8% (p = 0.4205), and the 6-month seizure-freedom rate was 35.8% vs 22.3% (p = 0.0061). In the sensitivity analysis, differences between groups were greater, favoring LEV. Incidences of treatment-emergent adverse events (TEAEs) were 70.6% with LEV vs 77.1% with TPM; most frequently somnolence (20.3%), dizziness (18.1%), and nasopharyngitis (13.6%) with LEV; and decreased appetite (15.7%), dizziness (14.5%), and headache (14.5%) with TPM. Discontinuations due to TEAEs were 7.9% with LEV and 12.7% with TPM. CONCLUSIONS In this open-label trial, the 52-week retention rate was not significantly different between LEV and TPM. However, LEV was associated with a substantially higher seizure freedom rate and a more favorable safety profile than TPM in this population of Korean patients with focal seizures.
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Affiliation(s)
- Sang Kun Lee
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang Ahm Lee
- University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong Wook Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | | | | | | | - Byungin Lee
- Injie University Haeundae Paik Hospital, Busan, Republic of Korea.
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12
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Cho H, Kwon JW. Prevalence of anaphylaxis and prescription rates of epinephrine auto-injectors in urban and rural areas of Korea. Korean J Intern Med 2019; 34:643-650. [PMID: 30360025 PMCID: PMC6506728 DOI: 10.3904/kjim.2018.094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 04/19/2018] [Accepted: 06/06/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND/AIMS Despite the clinical importance anaphylaxis and the recent increase in its occurrence, studies regarding the epidemiology of anaphylaxis, risk factors for anaphylaxis, and epinephrine auto-injector (EAI) prescription status for patients with anaphylaxis remain poorly described. Thus, we investigated the prevalence of anaphylaxis and prescription rates of EAI in urban and rural areas in Korea. METHODS We used data from the 2010 to 2014 Health Insurance Review and Assessment database. Anaphylaxis was identified through physician-certified diagnoses using the International Classification of Diseases 10th (ICD-10) codes (T780, T782, T805, T886). Data on prescription rates of EAI were collected from the Korea Orphan & Essential Drug Center, the only pharmacy exclusively dealing with EAI in Korea. The prescription rates of EAI were defined as the number of EAI prescribed against the number of patients with anaphylaxis. RESULTS The prevalence of anaphylaxis over the 5-year period was 0.023%. The annual prevalence of anaphylaxis increased over the 5-year period. Anaphylaxis was more common in males than in females (54% vs. 46%) and in the population aged 50 to 59 years old. For regional analysis, urban areas showed a relatively lower prevalence of anaphylaxis (17.3 per 100,000 individuals) along with higher prescription rates (12.0%) of EAI for patients with anaphylaxis. In contrast, rural areas showed a relatively higher prevalence of anaphylaxis (28.8 per 100,000 individuals) along with lower prescription rates (3.1%) of EAI. CONCLUSION The prevalence of anaphylaxis has increased annually in Korea. There were regional differences in the prevalence of anaphylaxis and prescription rates of EAI between urban and rural areas in Korea.
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Affiliation(s)
- Hyunseok Cho
- Department of Pediatrics, Hwacheon Health Center and County Hospital, Hwacheon, Korea
| | - Jae-Woo Kwon
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
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13
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Lee JY, Cho Y, Hong MH, Kim J, Lee DH, Jung YJ, Kim BG, Lee KL, Kim W. Incidence, inhospital mortality, and readmission among patients with alcoholic hepatitis in Korea: A nationwide study. J Gastroenterol Hepatol 2019; 34:747-754. [PMID: 30345539 DOI: 10.1111/jgh.14513] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/21/2018] [Accepted: 10/10/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Alcoholic hepatitis (AH) ranks among the most costly diseases in South Korea. However, accurate hospitalization incidence rates, mortality rates, and contributing factors have not been investigated in South Korea. This study aimed to provide the nationwide incidence of hospitalization, inhospital mortality, and readmission rates for South Korean patients with AH. METHODS Using the Korean Health Insurance Review and Assessment service database, a total of 39 800 inpatient cases from 2008 to 2012 were identified based on the International Classification of Diseases, 10th Revision diagnosis code for AH (K70.1). Standardized hospitalization incidence and mortality rates were calculated, and logistic regression analysis was performed to identify risk factors for inhospital mortality and readmission. Follow-up data for those admitted in 2008 were collected to assess readmissions. RESULTS The standardized incidence rate for AH hospitalization per 105 person/year decreased from 19 in 2008 to 14 in 2012 (P = 0.001). The annual inhospital mortality rate ranged from 0.2% to 0.5%. Inhospital mortality was significantly higher in older patients (odds ratio [OR], 1.36) and those with cirrhosis (OR, 4.40). The readmission rate for patients admitted in 2008 was 34.0%. Male sex (OR, 1.21) and low economic status (OR, 2.35) were significantly associated with readmission, whereas older age (OR, 0.96), cirrhosis (OR, 0.77), and urban residency (OR, 0.68) were inversely associated with readmission. CONCLUSIONS This study captured a 5-year epidemiologic period in South Korea of patients with AH to reflect the real burden of AH and to provide valuable information to policy-makers assessing public health priorities.
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Affiliation(s)
- Jin Yong Lee
- Department of Health Policy and Management, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yuri Cho
- Department of Internal Medicine, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Min Hee Hong
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.,Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jayeun Kim
- Institute of Health and Environment, Seoul National University, Seoul, Korea
| | - Dong Hyeon Lee
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yong Jin Jung
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Byeong Gwan Kim
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kook Lae Lee
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Won Kim
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
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14
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Seo JH, Kwon JW. Epidemiology of urticaria including physical urticaria and angioedema in Korea. Korean J Intern Med 2019; 34:418-425. [PMID: 29742892 PMCID: PMC6406086 DOI: 10.3904/kjim.2017.203] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 12/04/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND/AIMS Despite the high burden and frequency of urticaria, its epidemiology is not well known. We investigated the epidemiology of various type of urticaria in Korea and changes in its annual prevalence over 5 years. METHODS We used data from the 2010 to 2014 Health Insurance Review and Assessment database, which covers the claims of 97.0% of the South Korean population. Patients aged > 10 years old were included in this study. The presence of urticaria was identified on physician-certified diagnoses using the International Classification of Diseases 10th Revision (ICD-10) codes that include various type of urticaria (L500-L509) and angioedema (T783). Epidemiology of all type of urticaria, physical urticaria and angioedema were investigated. RESULTS The prevalence of all-type urticaria over the 5 years was 4.5% with a peak in individuals, especially females, aged 30 to 59 years. The age-specific prevalence of all-type urticaria increased with age from the 10- to 19-year age group to the 70- to 79-year age group. The prevalence of dermographism, cholinergic urticaria, and angioedema were 0.12%, 0.025%, and 0.027%, respectively. Cholinergic urticaria was most prevalent in those aged 10 to 29 years with male predominance. The annual prevalence of all-type urticaria, dermographism, and angioedema increased over the 5 years. CONCLUSION The prevalence of urticaria has increased annually in Korea. Cholinergic urticaria showed unique distribution in its age and gender, and angioedema showed remarkable increases in annual prevalence, although the prevalence estimation is still exploratory and diagnosis of urticaria based on ICD-10 codes need to be validated.
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Affiliation(s)
- Jeong-Hun Seo
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Jae-Woo Kwon
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
- Department of Allergy and Clinical Immunology, Kangwon National University School of Medicine, Chuncheon, Korea
- Correspondence to Jae-Woo Kwon, M.D. Department of Internal Medicine, Kangwon National University Hospital, 156 Baengnyeong-ro, Chuncheon 24289, Korea Tel: +82-33-258-9370 Fax: +82-33-258-2404 E-mail:
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15
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Vaughan KA, Lopez Ramos C, Buch VP, Mekary RA, Amundson JR, Shah M, Rattani A, Dewan MC, Park KB. An estimation of global volume of surgically treatable epilepsy based on a systematic review and meta-analysis of epilepsy. J Neurosurg 2018:1-15. [PMID: 30215556 DOI: 10.3171/2018.3.jns171722] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 03/12/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEEpilepsy is one of the most common neurological disorders, yet its global surgical burden has yet to be characterized. The authors sought to compile the most current epidemiological data to quantify global prevalence and incidence, and estimate global surgically treatable epilepsy. Understanding regional and global epilepsy trends and potential surgical volume is crucial for future policy efforts and resource allocation.METHODSThe authors performed a systematic literature review and meta-analysis to determine the global incidence, lifetime prevalence, and active prevalence of epilepsy; to estimate surgically treatable epilepsy volume; and to evaluate regional trends by WHO regions and World Bank income levels. Data were extracted from all population-based studies with prespecified methodological quality across all countries and demographics, performed between 1990 and 2016 and indexed on PubMed, EMBASE, and Cochrane. The current and annual new case volumes for surgically treatable epilepsy were derived from global epilepsy prevalence and incidence.RESULTSThis systematic review yielded 167 articles, across all WHO regions and income levels. Meta-analysis showed a raw global prevalence of lifetime epilepsy of 1099 per 100,000 people, whereas active epilepsy prevalence is slightly lower at 690 per 100,000 people. Global incidence was found to be 62 cases per 100,000 person-years. The meta-analysis predicted 4.6 million new cases of epilepsy annually worldwide, a prevalence of 51.7 million active epilepsy cases, and 82.3 million people with any lifetime epilepsy diagnosis. Differences across WHO regions and country incomes were significant. The authors estimate that currently 10.1 million patients with epilepsy may be surgical treatment candidates, and 1.4 million new surgically treatable epilepsy cases arise annually. The highest prevalences are found in Africa and Latin America, although the highest incidences are reported in the Middle East and Latin America. These regions are primarily low- and middle-income countries; as expected, the highest disease burden falls disproportionately on regions with the fewest healthcare resources.CONCLUSIONSUnderstanding of the global epilepsy burden has evolved as more regions have been studied. This up-to-date worldwide analysis provides the first estimate of surgical epilepsy volume and an updated comprehensive overview of current epidemiological trends. The disproportionate burden of epilepsy on low- and middle-income countries will require targeted diagnostic and treatment efforts to reduce the global disparities in care and cost. Quantifying global epilepsy provides the first step toward restructuring the allocation of healthcare resources as part of global healthcare system strengthening.
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Affiliation(s)
- Kerry A Vaughan
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.,5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Christian Lopez Ramos
- 2University of California San Diego School of Medicine, La Jolla, California.,5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Vivek P Buch
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rania A Mekary
- 3Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS University, Boston.,4Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School
| | - Julia R Amundson
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,6Miller School of Medicine, University of Miami, Florida
| | - Meghal Shah
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,7Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Abbas Rattani
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,8Meharry Medical College, School of Medicine, Nashville; and
| | - Michael C Dewan
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,9Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kee B Park
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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16
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Park D, Choi H, Jang M, Chang H, Woo S, Yang W. Simultaneous determination of 18 psychoactive agents and 6 metabolites in plasma using LC-MS/MS and application to actual plasma samples from conscription candidates. Forensic Sci Int 2018; 288:283-290. [PMID: 29793194 DOI: 10.1016/j.forsciint.2018.04.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 04/06/2018] [Accepted: 04/13/2018] [Indexed: 11/18/2022]
Abstract
In Korea, an increasing number of people attempt to evade military conscription by posing as mental health patients. To verify the authenticity of mental illness, there is a need to detect wide range of psychoactive agents in biological specimens of conscription candidates. In this study, we developed and validated a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for simultaneous determination of 18 psychoactive agents and 6 metabolites in human plasma. The method was characterized by the use of a simple, fast and cheap protein precipitation as sample preparation, a rapid run time (11min) and a low volume of plasma sample (200μL). The analytes were monitored under the scheduled multiple reaction monitoring (sMRM) positive and negative mode using electrospray ionization (ESI). The essential validation parameters including selectivity, linearity, accuracy, precision, matrix effect and recovery were satisfactory. The limit of detection ranged from 0.0005 to 0.001μg/mL, and limit of quantitation ranged from 0.005 to 0.025μg/mL. The developed method was successfully applied to 323 actual plasma samples submitted by Korea central physical examination center of military manpower administration in 2016, and is expected to contribute to the rapid and accurate disposition of military service.
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Affiliation(s)
- Dongeun Park
- Daejeon Institute, National Forensic Service, 1524 Yuseongdae-ro, Yuseong-gu, Daejeon 34054, Republic of Korea.
| | - Hyeyoung Choi
- Seoul Institute, National Forensic Service, 139 Jiyang-ro, Yangcheon-gu, Seoul 08036, Republic of Korea.
| | - Moonhee Jang
- Seoul Institute, National Forensic Service, 139 Jiyang-ro, Yangcheon-gu, Seoul 08036, Republic of Korea.
| | - Hyejin Chang
- Daejeon Institute, National Forensic Service, 1524 Yuseongdae-ro, Yuseong-gu, Daejeon 34054, Republic of Korea.
| | - Sanghee Woo
- Daegu Institute, National Forensic Service, 33-14 Hoguk-ro, Chilgok-gun, Waegwan-eup, Gyeongsangbuk-do 39872, Republic of Korea.
| | - Wonkyung Yang
- Seoul Institute, National Forensic Service, 139 Jiyang-ro, Yangcheon-gu, Seoul 08036, Republic of Korea.
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17
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Liu X, Carney PR, Bussing R, Segal R, Cottler LB, Winterstein AG. Trends in Antiepileptic Drug Use in Children and Adolescents With Epilepsy. Pediatr Neurol 2017; 74:32-40. [PMID: 28676250 DOI: 10.1016/j.pediatrneurol.2017.05.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 04/10/2017] [Accepted: 05/22/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVE We describe the trends in antiepileptic drug (AED) use in children and adolescents with epilepsy in the United States. METHODS We undertook a cross-sectional study based on Medicaid Analytic eXtract data set from 26 US states. Children and adolescents aged three to 18 years with at least one year continuous Medicaid fee-for-service coverage after the second outpatient or the first inpatient diagnosis of epilepsy in each calendar year during 1999 to 2009 were included in the study; therefore, 11 cohorts were established. A patient was defined as being exposed to a specific AED if he or she had at least one-day supply of the AED during the 1-year follow-up period. The annual prevalence of AEDs was reported, stratified by gender and age. The trends in AED use were evaluated through linear regression. RESULTS The sample sizes of the 11 cohorts ranged between 17,304 and 22,672. The annual prevalence of valproic acid use declined from 42.4% in 1999 to 26.5% in 2009, and the prevalence of carbamazepine use declined from 37.1% to 10.2%. Meanwhile, the prevalence of levetiracetam use increased from 5.1% to about 32.0% in 2009, and the prevalence of oxcarbazepine use increased from 1.3% to 19.1%. Since 2008, levetiracetam (29.6%) has replaced valproic acid (27.8%) as the most commonly used AED in children and adolescents with epilepsy. The prevalence of diazepam use increased from 11.6% to 28.1%. SIGNIFICANCE Compared with first- and second-generation antiepileptic drugs, third-generation AEDs have fewer adverse side effects, resulting in increased patient treatment adherence. Equally important is the economic impact of these newer AEDs. This first-of-its-kind study underscores the need for large database studies that objectively assess the cost-effectiveness of third-generation AEDs versus first- and second-generation AEDs in the treatment of childhood epilepsy.
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Affiliation(s)
- Xinyue Liu
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida.
| | - Paul R Carney
- Neurology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Regina Bussing
- Psychiatry, College of Medicine, University of Florida, Gainesville, Florida
| | - Richard Segal
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Linda B Cottler
- Epidemiology, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, Florida
| | - Almut G Winterstein
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida; Epidemiology, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, Florida
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18
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Egunsola O, Choonara I, Sammons HM. Anti-epileptic drug utilisation in paediatrics: a systematic review. BMJ Paediatr Open 2017; 1:e000088. [PMID: 29637124 PMCID: PMC5862211 DOI: 10.1136/bmjpo-2017-000088] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/10/2017] [Accepted: 07/10/2017] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES This study aims to determine global anti-epileptic drug (AED) utilisation prevalence and describe utilisation trends in different countries. METHODS Databases Embase (1980-May 2017), Medline (1946-May 2017) and PubMed were searched for original research on AED utilisation. All paediatric national or regional database studies and surveys were included. RESULTS Twenty-one studies were identified. Five were excluded from the analysis as the data were collected before 2005, leaving 16 studies. Monotherapy regimen varied between 58% and 94% in different countries. In several of the studies, sodium valproate was the most frequently prescribed AED. However, there is a trend towards increasing utilisation of new-generation AEDs, particularly levetiracetam, in some countries. CONCLUSION Monotherapy was used in 58%-94%of patients. There is increasing utilisation of the new-generation AEDs, in particular lamotrigine, levetiracetam and topiramate. Old-generation AEDs are still used in the majority of patients. There is a need for up-to-date studies to determine the prevalence of AEDs in children.
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Affiliation(s)
- Oluwaseun Egunsola
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derbyshire Children's Hospital, Derby, UK
| | - Imti Choonara
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derbyshire Children's Hospital, Derby, UK
| | - Helen M Sammons
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derbyshire Children's Hospital, Derby, UK
- Department of Paediatrics, North Devon District Hospital, Raleigh Park, Barnstaple, Devon, UK
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Three-Year Retention Rates of Levetiracetam, Topiramate, and Oxcarbazepine: A Retrospective Hospital-Based Study. Clin Neuropharmacol 2017; 40:56-62. [DOI: 10.1097/wnf.0000000000000204] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Chae KM, Sung HH, Kim DS. A Study on the Relationship between Seizure Recurrence and EEG for Epilepsy. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2016. [DOI: 10.15324/kjcls.2016.48.4.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Kyoung-Min Chae
- Department of Neurology, Seoul National University Hospital, Seoul 03080, Korea
| | - Hyun-Ho Sung
- Department of Clinical Laboratory Science, Dongnam Health University, Suwon 16328, Korea
| | - Dae-Sik Kim
- Department of Clinical Laboratory Science, Dongnam Health University, Suwon 16328, Korea
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Wang Y, Li Z. Utilization of Antiepileptic Drugs on Monotherapy and Polytherapy for Children at Shanghai in China. INT J PHARMACOL 2016. [DOI: 10.3923/ijp.2016.496.504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lee SY, Chung SE, Kim DW, Eun SH, Kang HC, Cho YW, Yi SD, Kim HD, Jung KY, Cheong HK. Estimating the Prevalence of Treated Epilepsy Using Administrative Health Data and Its Validity: ESSENCE Study. J Clin Neurol 2016; 12:434-440. [PMID: 27273925 PMCID: PMC5063869 DOI: 10.3988/jcn.2016.12.4.434] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 02/27/2016] [Accepted: 02/29/2016] [Indexed: 12/03/2022] Open
Abstract
Background and Purpose Few of the epidemiologic studies of epilepsy have utilized well-validated nationwide databases. We estimated the nationwide prevalence of treated epilepsy based on a comprehensive medical payment database along with diagnostic validation. Methods We collected data on patients prescribed of antiepileptic drugs (AEDs) from the Health Insurance Review and Assessment service, which covers the entire population of Korea. To assess the diagnostic validity, a medical records survey was conducted involving 6,774 patients prescribed AEDs from 43 institutions based on regional clusters and referral levels across the country. The prevalence of treated epilepsy was estimated by projecting the diagnostic validity on the number of patients prescribed AEDs. Results The mean positive predictive value (PPV) for epilepsy was 0.810 for those prescribed AEDs with diagnostic codes that indicate epilepsy or seizure (Diagnosis-E), while it was 0.066 for those without Diagnosis-E. The PPV tended to decrease with age in both groups, with lower values seen in females. The prevalence was 3.84 per 1,000, and it was higher among males, children, and the elderly. Conclusions The prevalence of epilepsy in Korea was comparable to that in other East Asian countries. The diagnostic validity of administrative health data varies depending on the method of case ascertainment, age, and sex. The prescriptions of AEDs even without relevant diagnostic codes should be considered as a tracer for epilepsy.
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Affiliation(s)
- Seo Young Lee
- Department of Neurology, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Soo Eun Chung
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Dong Wook Kim
- Department of Neurology, Konkuk University, School of Medicine, Seoul, Korea
| | - So Hee Eun
- Department of Pediatrics, Korea University College of Medicine, Ansan, Korea
| | - Hoon Chul Kang
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Won Cho
- Department of Neurology, Keimyung University School of Medicine, Daegu, Korea
| | | | - Heung Dong Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Young Jung
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.
| | - Hae Kwan Cheong
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea.
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Trends in Antiepileptic Drug Prescriptions for Childhood Epilepsy at a Tertiary Children's Hospital in Korea, 2001-2012. Paediatr Drugs 2015; 17:487-96. [PMID: 26400586 DOI: 10.1007/s40272-015-0147-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Longitudinal prescription patterns of antiepileptic drugs (AEDs) have not been described to date in Korea. Here we aimed to describe AED prescribing trends over a 12-year period and assess age differences in AED prescribing patterns in a pediatric epilepsy population. METHODS We retrieved and analyzed all AED prescribing and dispensing data in 2001-2012 in patients aged 0-18 years with an established diagnosis of epilepsy at the largest tertiary children's hospital in Korea. AEDs included for analysis were classified as older (i.e., carbamazepine, ethosuximide, phenobarbital, phenytoin, and valproic acid) and newer (i.e., gabapentin, lamotrigine, levetiracetam, oxcarbazepine, pregabalin, topiramate, vigabatrin, zonisamide, lacosamide, and rufinamide) on the basis of market availability before versus after 1991. RESULTS A total of 5593 patients with epilepsy were prescribed an AED during the 12-year period. The proportion of newer AED prescriptions was 52.6 % in 2001 and continuously increased to 74.3 % in 2012. Oxcarbazepine was most widely used, followed by valproic acid. While carbamazepine and vigabatrin use progressively decreased over the 12-year period, those of lamotrigine and topiramate rapidly increased. Age differences in prescribing patterns were observed. Polytherapy was observed in 49.7 % of the total population, while 83.9 % of new users were prescribed monotherapy. CONCLUSION This study provided updated information on AED prescription trends for childhood epilepsy. We found a progressive increase in the use of newer AEDs. However, valproic acid, the only prevalent older AED, continued to be widely prescribed. A high rate of polytherapy among the prescriptions overall raises some safety concerns.
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Kim HK, Chin BS, Shin HS. Clinical features of seizures in patients with human immunodeficiency virus infection. J Korean Med Sci 2015; 30:694-9. [PMID: 26028919 PMCID: PMC4444467 DOI: 10.3346/jkms.2015.30.6.694] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 03/18/2015] [Indexed: 11/24/2022] Open
Abstract
Patients with human immunodeficiency virus (HIV) infection have a higher burden of seizures, but few studies have examined seizures in HIV-infected individuals in Korea. A retrospective study was conducted to determine the epidemiology and clinical characteristics of seizures in patients with HIV infection. Among a total of 1,141 patients, 34 (3%) had seizures or epilepsy; 4 of these individuals had epilepsy before HIV infection, and the others showed new-onset seizures. Most patients exhibited moderate (200 to 500, n = 13) or low (below 200, n = 16) CD4 counts. The most common seizure etiology was progressive multifocal leukoencephalopathy (n = 14), followed by other HIV-associated central nervous system (CNS) complications (n = 6). Imaging studies revealed brain lesions in 21 patients. A total of 9 patients experienced only one seizure during the follow-up period, and 25 patients experienced multiple seizures or status epilepticus (n = 2). Multiple seizures were more common in patients with brain etiologies (P = 0.019) or epileptiform discharges on EEG (P = 0.032). Most seizures were controlled without anticonvulsants (n = 12) or with a single anticonvulsant (n = 12). Among patients with HIV infection, seizures are significantly more prevalent than in the general population. Most seizures, with the exception of status epilepticus, have a benign clinical course and few complications.
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Affiliation(s)
- Hyun Kyung Kim
- Department of Neurology, National Medical Center, Seoul, Korea
| | - Bum Sik Chin
- Department of Infectious Diseases, National Medical Center, Seoul, Korea
| | - Hyoung-Shik Shin
- Department of Infectious Diseases, National Medical Center, Seoul, Korea
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Tang DH, Malone DC, Warholak TL, Chong J, Armstrong EP, Slack MK, Hsu CH, Labiner DM. Prevalence and Incidence of Epilepsy in an Elderly and Low-Income Population in the United States. J Clin Neurol 2015; 11:252-61. [PMID: 26022458 PMCID: PMC4507380 DOI: 10.3988/jcn.2015.11.3.252] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 02/10/2015] [Accepted: 02/12/2015] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose The purpose of this study was to estimate the incidence and prevalence of epilepsy among an elderly and poor population in the United States. Methods Arizona Medicaid claims data from January 1, 2008 to December 31, 2010 were used for this analysis. Subjects who were aged ≥65 years and were continuously enrolled in any Arizona Medicaid health plans (eligible to patients with low income) for ≥12 months between January 1, 2008 and December 31, 2009 were considered eligible for inclusion in the study cohort. In addition to meeting the aforementioned criteria, incident and prevalent cases must have had epilepsy-related healthcare claims. Furthermore, incident cases were required to have a 1-year "clean" period immediately preceding the index date. Negative binomial and logistic regression models were used to assess the factors associated with epilepsy incidence and prevalence. Results The estimated epilepsy incidence and prevalence for this population in 2009 were 7.9 and 19.3 per 1,000 person-years, respectively. The incidence and prevalence rates were significantly higher for patients with comorbid conditions that were potential risk factors for epilepsy and were of younger age than for their non-comorbid and older counterparts (p<0.05). The prevalence rates were significantly higher for non-Hispanic Blacks and male beneficiaries than for non-Hispanic Whites and female beneficiaries, respectively (p<0.05). Conclusions This patient population had higher epilepsy incidence and prevalence compared with the general US population. These differences may be at least in part attributable to their low socioeconomic status.
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Affiliation(s)
- Derek H Tang
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA.
| | - Daniel C Malone
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Terri L Warholak
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Jenny Chong
- Department of Neurology, The University of Arizona College of Medicine, Tucson, AZ, USA
| | - Edward P Armstrong
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Marion K Slack
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Chiu Hsieh Hsu
- Department of Epidemiology and Biostatistics, The University of Arizona College of Public Health, Tucson, AZ, USA
| | - David M Labiner
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA.; Department of Neurology, The University of Arizona College of Medicine, Tucson, AZ, USA
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Kim YI, Kim SY, Cho SJ, Park JH, Choi IJ, Lee YJ, Lee EK, Kook MC, Kim CG, Ryu KW, Kim YW. Long-term metformin use reduces gastric cancer risk in type 2 diabetics without insulin treatment: a nationwide cohort study. Aliment Pharmacol Ther 2014; 39:854-63. [PMID: 24612291 DOI: 10.1111/apt.12660] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 11/22/2013] [Accepted: 01/24/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Metformin use has been associated with a decreased incidence and mortality of various cancers. AIM To evaluate the association between metformin use and gastric cancer. METHODS We randomly selected 100 000 type 2 diabetic patients from the 2004 Korean National Health Insurance claim database, and assessed gastric cancer incidence among 39 989 patients (aged 30-97 years) who were regularly treated with anti-diabetic drugs and followed-up from 2004 to 2010. In total, 26 690 patients had used metformin out of 32 978 diabetics who had not regularly used insulin (insulin non-users), and 5855 patients had used metformin out of 7011 regular insulin users. RESULTS Patients who used metformin showed a lower incidence of gastric cancer than those who did not use metformin, in insulin non-users (P = 0.047, log-rank test). However, in patients on regular insulin, there was no difference of gastric cancer incidence according to metformin use. In insulin non-users, the adjusted hazard ratio (AHR) for metformin use was 0.73 (95% confidential interval [CI], 0.53-1.01) with borderline statistical significance (P = 0.059). Duration of metformin use was associated with the reduction in gastric cancer risk (AHR, 0.88; 95% CI 0.81-0.96, P = 0.003), especially in patients who used metformin for more than 3 years (AHR, 0.57; 95% CI, 0.37-0.87; P = 0.009). CONCLUSION Metformin use >3 years in type 2 diabetics who do not use insulin is associated with a significantly reduced gastric cancer risk.
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Affiliation(s)
- Y-I Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
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Kim DW, Lee SY, Chung SE, Cheong HK, Jung KY. Clinical characteristics of patients with treated epilepsy in Korea: a nationwide epidemiologic study. Epilepsia 2013; 55:67-75. [PMID: 24299173 DOI: 10.1111/epi.12469] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Although a number of epidemiologic studies have been conducted on the prevalence and incidence of epilepsy around the world, only a few studies have investigated the clinical characteristics of patients with epilepsy in a population-based sample. The purpose of the present study was to describe the clinical characteristics of treated patients with epilepsy in Korea via a nationwide medical records survey. METHODS The study population was obtained through a nationwide database registered to the Health Insurance Review and Assessment service. Patients were recruited from clinics and hospitals in each cluster according to region and referral level by random selection from a preallocated sample of patients. All patients were being treated with antiepileptic drug medication with or without a diagnosis code for epilepsy or seizure between January 2009 and December 2009. Among the 6,436 selected patients, 2,150 met the diagnostic criteria for epilepsy and were included in our survey on the clinical characteristics of patients who were with treated epilepsy. RESULTS The proportion of male patients with epilepsy in this study was higher (1,226; 57.0%) than that of female patients. In addition, 10.6% of patients were first diagnosed with epilepsy in 2009, and 53.6% of patients experienced at least one seizure over the course of 2009; 78.1% were classified as having localization-related epilepsy, whereas 7.3% were considered to have generalized epilepsy. Thirty-five percent of patients were thus classified as idiopathic or cryptogenic cases. The most common cause of symptomatic epilepsy was trauma (10.0%), followed by stroke (9.6%), central nervous system (CNS) infection (5.7%), and hippocampal sclerosis (4.9%). SIGNIFICANCE This is the first nationwide study of the clinical characteristics of treated epilepsy in Korea using a national database validated by medical records survey. The etiologies of epilepsy and epilepsy syndrome classifications were comparable to those previously reported in other developed countries.
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Affiliation(s)
- Dong Wook Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea
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Jung J, Seo HY, Kim YA, Oh IH, Lee YH, Yoon SJ. The economic burden of epilepsy in Korea, 2010. J Prev Med Public Health 2013; 46:293-9. [PMID: 24349650 PMCID: PMC3859850 DOI: 10.3961/jpmph.2013.46.6.293] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 09/16/2013] [Indexed: 11/11/2022] Open
Abstract
Objectives The purposes of this study were to evaluate the prevalence of epilepsy and to estimate the cost of epilepsy in Korea, 2010. Methods This study used a prevalence based approach to calculate the cost of epilepsy. Claims data from the Korean national health insurance and data from the Korea health panel, the Korea National Statistical Office's records of causes of death, and labor statistics were used to estimate the cost of epilepsy. Patients were defined as those who were hospitalized or visited an outpatient clinic during 2010 with a diagnosis of epilepsy (International Classification of Diseases 10th revision codes G40-G41). Total costs of epilepsy included direct medical costs, direct non-medical cost and indirect costs. Results The annual prevalence of treated epilepsy was 228 per 100 000 population, and higher in men. The age-specific prevalence was highest for teenagers. The total economic burden of epilepsy was 536 billion Korean won (KW). Indirect cost (304 billion KW) was 1.3 times greater than direct cost (232 billion KW). By gender, the male (347 billion KW) were more burdened than the female (189 billion KW). The estimated cost in young age younger than 20 years old was 24.5% of the total burden of epilepsy. Conclusions A significant portion of the economic burden of epilepsy is borne by people in young age. To reduce the economic burden of epilepsy, effective prevention and treatment strategies are needed.
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Affiliation(s)
- Jaehun Jung
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hye-Young Seo
- Graduate School of Public Health, Korea University, Seoul, Korea
| | - Young Ae Kim
- Graduate School of Public Health, Korea University, Seoul, Korea
| | - In-Hwan Oh
- Department of Preventive Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Yo Han Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Seok-Jun Yoon
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
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Kim J, Rhee CK, Yoo KH, Kim YS, Lee SW, Park YB, Lee JH, Oh Y, Lee SD, Kim Y, Kim K, Yoon H. The health care burden of high grade chronic obstructive pulmonary disease in Korea: analysis of the Korean Health Insurance Review and Assessment Service data. Int J Chron Obstruct Pulmon Dis 2013; 8:561-8. [PMID: 24277985 PMCID: PMC3838475 DOI: 10.2147/copd.s48577] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Patients with high grade chronic pulmonary obstructive disease (COPD) account for much of the COPD-related mortality and incur excessive financial burdens and medical care utilization. We aimed to determine the characteristics and medical care use of such patients using nationwide data from the Korean Health Insurance Review and Assessment Service in 2009. MATERIALS AND METHODS Patients with COPD were identified by searching with the International Classification of Diseases-10th Revision for those using medication. Patients with high grade COPD were selected based on their patterns of tertiary institute visits and medication use. RESULTS The numbers of patients with high grade COPD increased rapidly in Korea during the study period, and they showed a high prevalence of comorbid disease. The total medical costs were over three times higher in patients with high grade COPD compared with those without it ($3,744 versus $1,183; P < 0.001). Medication costs comprised the largest portion of medical cost, but most impact came from hospitalization and exacerbation in both groups of patients. COPD grade and hospitalization in the previous year were the major factors affecting medical costs and days of utilizing health care resources. CONCLUSION Patients with high grade COPD impose a high economic burden on the health care system in Korea. Prevention of progression to high grade COPD is important, both clinically and economically.
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Affiliation(s)
- JinHee Kim
- Office of Health Service Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
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Kang BS, Cheong HK, Jung KY, Jang SH, Yoo JK, Kim DW, Chung SE, Lee SY. The validity and reliability of characterizing epilepsy based on an external review of medical records. Epidemiol Health 2013; 35:e2013006. [PMID: 23991344 PMCID: PMC3753460 DOI: 10.4178/epih/e2013006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 07/04/2013] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Our goal is to validate diagnosing and characterizing epilepsy based on a medical record survey by external reviewers. METHODS We reviewed medical records from 80 patients who received antiepileptic drugs in 2009 at two hospitals. The study consisted of two steps; data abstraction by certified health record administrators and then verification by the investigators. The gold standard was the results of the survey performed by the epileptologists from their own hospital. RESULTS The specificity was more than 90.0% for diagnosis and activity, and for new-onset seizures. The sensitivity was 97.0% or more for diagnosis and activity and 66.7-75.0% for new-onset epilepsy. This method accurately classified epileptic syndromes in 90.2-92.9% of patients, causes in 85.4-92.7%, and age of onset in 78.0-81.0%. Kappa statistics for inter-rater reliability and test-retest reliability ranged from 0.641-0.975, which means substantial to near-perfect agreement in all items. CONCLUSIONS Our data suggest that epilepsy can be well identified by external review of medical records. This method may be useful as a basis for large-scale epidemiological research.
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Affiliation(s)
- Bong Su Kang
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
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Abstract
BACKGROUND This study estimates the burden of disease in Korea during 2000-10, using disability-adjusted life years (DALYs). METHODS DALYs are the sum of years of life lost from mortality and years of life lost from disability. DALYs for 24 major diseases in 2000, 2005 and 2010 Korea were calculated based on the Global Burden of Disease Study method. RESULTS As in other advanced nations, the burden of disease in Korea is characterized by an increasing importance of cancer, unipolar depression and ischemic heart disease (1681, 1508 and 562 person-years for Year 2010 in terms of DALYs per 10 0000, respectively). At the same time, unipolar depression, liver cirrhosis and mental and behavioral disorder due to alcohol use (1508, 323 and 535 person-years for 2010, respectively) became much more common in Korea than in other advanced nations. CONCLUSIONS The burden of disease in Korea follows the pattern of other advanced nations in general but also registers some unique characteristics affected by the nation's distinctive epidemiological and sociocultural contexts, e.g. rapid economic growth and dramatic social transition without appropriate policy response. Korea's health and welfare policy might need to incorporate these special conditions for the effective reduction of its disease burden.
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Affiliation(s)
- K S Lee
- Department of Preventive Medicine and Health Services Research Institute, College of Medicine, Yonsei University, Seoul, South Korea
| | - J H Park
- Department of Preventive Medicine and Samsung Biomedical Research Institute, School of Medicine, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do 440-746, South Korea
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