Recognizing and preventing epilepsy-related mortality

Posted on February 23, 2016 by Maurice Preter MD

Recognizing and preventing epilepsy-related mortality

http://tinyurl.com/gp8oojy

Orrin Devinsky, MD, Tanya Spruill, PhD, David Thurman, MD, PhD and Daniel Friedman, MD, MSc

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Correspondence to Dr. Devinsky: od4@nyu.edu

Published online before print December 16, 2015doi:http:/​/​dx.​doi.​org/​10.​1212/​WNL.​0000000000002253Neurology February 23, 2016 vol. 86 no. 8 779-786

ABSTRACT

Epilepsy is associated with a high rate of premature mortality from direct and indirect effects of seizures, epilepsy, and antiseizure therapies. Sudden unexpected death in epilepsy (SUDEP) is the second leading neurologic cause of total lost potential life-years after stroke, yet SUDEP may account for less than half of all epilepsy-related deaths. Some epilepsy groups are especially vulnerable: individuals from low socioeconomic status groups and those with comorbid psychiatric illness die more often than controls. Despite clear evidence of an important public health problem, efforts to assess and prevent epilepsy related deaths remain inadequate. We discuss factors contributing to the underestimation of SUDEP and other epilepsy-related causes of death. We suggest the need for a systematic classification of deaths directly due to epilepsy (e.g., SUDEP, drowning), due to acute symptomatic seizures, and indirectly due to epilep(e.g., suicide, chronic effects of antiseizure medications). Accurately estimating the frequency of epilepsy-related mortality is essential to support the development and assessment of preventive interventions. We propose that educational interventions and public health campaigns targeting medication adherence, psychiatric comorbidity, and other modifiable risk factors may reduce epilepsy related mortality. Educational campaigns regarding sudden infant death syndrome and fires, which kill far fewer Americans than epilepsy, have been widely implemented. We have done too little to prevent epilepsy related deaths. Everyone with epilepsy and everyone who treats people with epilepsy need to know that controlling seizures will save lives.

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Cause of death and predictors of mortality in a community-based cohort of people with epilepsy

Posted on February 23, 2016 by Maurice Preter MD

Cause of death and predictors of mortality in a community-based cohort of people with epilepsy

http://tinyurl.com/hdbgazx

Mark R. Keezer, MDCM, MSc, FRCP(C), Gail S. Bell, MB, ChB, MD, Aidan Neligan, PhD, MRCP, Jan Novy, MD, PhD and Josemir W. Sander, MD, PhD, FRCP

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Correspondence to Dr. Sander: l.sander@ucl.ac.uk

Published online before print January 15, 2016doi:http:/​/​dx.​doi.​org/​10.​1212/​WNL.​0000000000002390Neurology February 23, 2016 vol. 86 no. 8 704-712

ABSTRACT

Objective: The risk of premature mortality is increased in people with epilepsy. The reasons for this and how it may relate to epilepsy etiology remain unclear.

Methods: The National General Practice Study of Epilepsy is a prospective, community-based cohort that includes 558 people with recurrent unprovoked seizures of whom 34% died during almost 25 years of follow-up. We assessed the underlying and immediate causes of death and their relationship to epilepsy etiology. Psychiatric and somatic comorbidities of epilepsy as predictors of mortality were scrutinized using adjusted Cox proportional hazards models.

Results: The 3 most common underlying causes of death were noncerebral neoplasm, cardiovascular, and cerebrovascular disease, accounting for 59% (111/189) of deaths, while epilepsy-related causes (e.g., sudden unexplained death in epilepsy) accounted for 3% (6/189) of deaths. In 23% (43/189) of individuals, the underlying cause of death was directly related to the epilepsy etiology; this was significantly more likely if death occurred within 2 years of the index seizure (percent ratio 4.28 [95% confidence interval 2.63–6.97]). Specific comorbidities independently associated with increased risk of mortality were neoplasms (primary cerebral and noncerebral neoplasm), certain neurologic diseases, and substance abuse.

Conclusions: Comorbid diseases are important causes of death, as well as predictors of premature mortality in epilepsy. There is an especially strong relationship between cause of death and epilepsy etiology in the first 2 years after the index seizure. Addressing these issues may help stem the tide of premature mortality in epilepsy.

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Association between sleep disorders and injury: a nationwide population-based retrospective cohort study

Posted on February 23, 2016 by Maurice Preter MD

Association between sleep disorders and injury: a nationwide population-based retrospective cohort study

http://tinyurl.com/z3ta5z2

Chia-Ling Lin1,2, Chi-Hsiang Chung3, Yu-Hsia Tsai1,4, Wu-Chien Chien5,6

Author Affiliations

1School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
2Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
3Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
4Department of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
5Department of Medical Research, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
6School of Public Health, National Defense Medical Center, Taipei, Taiwan

Correspondence to

Professor Wu-Chien Chien, Address: No. 325, Sec. 2, Cheng-Kung Rd., Neihu Dist., Taipei City 114, Taiwan; chienwu@ndmctsgh.edu.tw

Received 10 September 2015

Revised 5 January 2016

Accepted 22 January 2016

Published Online First 18 February 2016

Abstract

Background The evidence is insufficient for the association between the exposure of sleep disorders and the risk of injury. The aim of this study was to examine the association between patients with sleep disorders and the risk of injury.

Methods This was a population-based retrospective cohort study using Taiwan National Health Insurance Research Database from 2005 to 2010. A total of 15 109 patients with sleep disorders were identified as the study cohort. The non-sleep disorders control cohort comprised 29 955 age- and sex-matched patients. We conducted a Cox proportional hazard regression analysis to estimate the effects of sleep disorders on the risk of injury.

Results The overall incidence of injury was 77.03 per 1000 person-years for patients with sleep disorders, which was significantly higher than that of the control cohort (60.63 per 1000 person-years). Overall, patients with sleep disorders had a higher risk of injury compared with control cohort (adjusted HR=1.27, 95% CI 1.26 to 1.28). Comparing to the control cohort, patients with insomnia had a 12% higher risk for injury (adjusted HR, 1.12 (95% CI 1.01 to 1.41)).

Conclusions Comparing to patients with non-sleep disorders, patients with sleep disorders had a higher risk of injury and the risk was particularly pronounced in those who had insomnia.

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Increasing Benzodiazepine Prescriptions and Overdose Mortality in the United States, 1996–2013

Posted on February 23, 2016 by Maurice Preter MD

Increasing Benzodiazepine Prescriptions and Overdose Mortality in the United States, 1996–2013

http://tinyurl.com/jqlst3n

Marcus A. Bachhuber, MD, MSHP, Sean Hennessy, PharmD, PhD, Chinazo O. Cunningham, MD, MS, and Joanna L. Starrels, MD, MS

Marcus A. Bachhuber, Chinazo O. Cunningham, and Joanna L. Starrels are with Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. Sean Hennessy is with Center for Clinical Epidemiology and Biostatistics and Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.

Correspondence should be sent to Marcus A. Bachhuber, MD, MSHP, 111 E 210 St, Bronx, NY 10467 (e-mail: ). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link.

CONTRIBUTORS

All authors acquired, analyzed, or interpreted the data and critically revised the brief for important intellectual content. M. A. Bachhuber drafted the brief and had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. M. A. Bachhuber and S. Hennessy conceptualized and designed the study and performed statistical analysis. S. Hennessy, C. O. Cunningham, and J. L. Starrels supervised the study.

ABSTRACT

Objectives. To describe trends in benzodiazepine prescriptions and overdose mortality involving benzodiazepines among US adults.

Methods. We examined data from the Medical Expenditure Panel Survey and multiple-cause-of-death data from the Centers for Disease Control and Prevention.

Results. Between 1996 and 2013, the percentage of adults filling a benzodiazepine prescription increased from 4.1% (95% confidence interval [CI] = 3.8%, 4.5%) to 5.6% (95% CI = 5.2%, 6.1%), with an annual percent change of 2.5% (95% CI = 2.1%, 3.0%). The quantity of benzodiazepines filled increased from 1.1 (95% CI = 0.9, 1.2) to 3.6 (95% CI = 3.0, 4.2) kilogram lorazepam equivalents per 100 000 adults (annual percent change = 9.0%; 95% CI = 7.6%, 10.3%). The overdose death rate increased from 0.58 (95% CI = 0.55, 0.62) to 3.07 (95% CI = 2.99, 3.14) per 100 000 adults, with a plateau seen after 2010.

Conclusions. Benzodiazepine prescriptions and overdose mortality have increased considerably. Fatal overdoses involving benzodiazepines have plateaued overall; however, no evidence of decreases was found in any group. Interventions to reduce the use of benzodiazepines or improve their safety are needed. (Am J Public Health. Published online ahead of print February 18, 2016: e1–e3. doi:10.2105/AJPH.2016.303061)

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Magnesium intake decreases Type 2 diabetes Risk through the Improvement of Insulin Resistance and Inflammation

Posted on February 17, 2016 by Maurice Preter MD

Magnesium intake decreases Type 2 diabetes Risk through the Improvement of Insulin Resistance and Inflammation

http://tinyurl.com/zjbvklt

MEDLINE Abstract

Hata A ; Doi Y ; Ninomiya T ; Mukai N ; Hirakawa Y ; Hata J ; Ozawa M ; Uchida K ; Shirota T ; Kitazono T ; Kiyohara Y

AIMS: Early studies have shown that magnesium intake decreases the risk of Type 2 diabetes, but the results are still inconsistent. We prospectively examined the association between magnesium intake and incidence of Type 2 diabetes in a general Japanese population.

METHODS: A total of 1999 subjects without diabetes aged 40-79 years who underwent a 75-g oral glucose tolerance test were followed up prospectively for a mean of 15.6 years.

RESULTS: During the follow-up, 417 subjects developed Type 2 diabetes. The age- and sex-adjusted incidence of Type 2 diabetes significantly decreased with increasing magnesium intake quartile levels (? 148.5, 148.6-171.5, 171.6-195.5 and ? 195.6 mg/day, P for trend = 0.01). In multivariate analyses, after adjusting for comprehensive risk factors and other dietary factors, the hazard ratio of Type 2 diabetes was 0.67 (95% CI 0.49-0.92; P = 0.01) in the third quartile and 0.63 (95% CI 0.44-0.90; P = 0.01) in the highest quartile compared with the first quartile. In addition, the risk of Type 2 diabetes was 14% lower (P = 0.04) for a 1-sd increment of log-transformed magnesium intake in the multivariate-adjusted model. In stratified analysis, there were statistically significant interactions between magnesium intake and levels of homeostasis model assessment of insulin resistance, high sensitivity C-reactive protein or alcohol intake on the risk of Type 2 diabetes (all P < 0.05).

CONCLUSIONS: Our findings suggest that increased magnesium intake was a significant protective factor for the incidence of Type 2 diabetes in the general Japanese population, especially among subjects with insulin resistance, lowgrade inflammation and a drinking habit.

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