Three year outcomes in a cohort of patients with newly-diagnosed epilepsy

Simple item page
dc.check.date2024-09-30
dc.contributor.advisorCostello, Daniel
dc.contributor.advisorO'Reilly, Eilis
dc.contributor.authorStack, Jessicaen
dc.date.accessioned2023-06-15T08:48:03Z
dc.date.available2023-06-15T08:48:03Z
dc.date.issued2022en
dc.date.submitted2022
dc.description.abstractBackground: Epilepsy is a common and internationally recognised neurological disorder with often life-long implications for its sufferers and their families. While a number of studies have assessed the outcomes of epilepsy, there have been none carried out on a well-defined ‘all-comers’ cohort of patients identified in an epilepsy incidence study. Our primary aim was to evaluate the early history and mortality of newly diagnosed epilepsy and the impact of diagnosis on overall quality of life three years after diagnosis. In addition, the incidence of psychogenic non-epileptic seizures arising from the same original cohort was investigated both at the time of initial data collection and at a three-year follow-up point. Methods: The studied cohort had been previously identified and consisted of patients of all ages (excluding neonates) diagnosed with epilepsy and seizure mimics during 2017 among a population of 542,868 in Cork City and County, using already-published methods. Follow-up involved prospective and retrospective collection of data including phone interviews and interrogation of patient’s charts, clinic letters and electronic hospital databases for up-to-date information on seizure outcomes, quality of life indicators and deaths. Incidence rates for PNES were calculated for the initial time of data collection and at the three-year follow-up point to adjust for any changed diagnoses within the epilepsy and PNES cohorts. Data was collected in a pseudonymised format and stored in an encrypted excel file on a secure storage device. Data was analysed using SPSS software. Results: There were 334 definite and probable patients with newly diagnosed epilepsy defined in the 2017 cohort and 40 diagnosed with psychogenic non-epileptic seizures. At three-years, 75.85% of the epilepsy cohort were taking a single ASM with a large proportion (69.92%) reporting seizure freedom of over one year and a smaller number becoming drug-refractory (9.75%). A minority of participants reported negative impact of an epilepsy diagnosis on social outcomes such as driving, relationships, education, employment and mental health. Seventy-two people (21.5%) had died during the three years since diagnosis with a standardised mortality ratio (SMR) of 2.01. A further 13 had died by five years. Those aged 65 and over represented the age group with the highest number of deaths. The majority of deaths were secondary to infections and malignancy with a small number of direct seizure-related deaths. The initial crude incidence rate of possible PNES cases in the 2017 study was 7.37 per 100, 000 people which was recalculated as 7.55 per 100, 000 people at three years to include changed diagnoses within the PNES and epilepsy cohorts. Conclusion: The outcomes of this study are encouraging and indicate that the majority of newly diagnosed epilepsy patients will have good outcomes, with minimal numbers of injuries, hospitalisations, neuropsychiatric complications or other negative impacts on quality of life and a high level of seizure freedom. However, despite this generally favourable prognosis in epilepsy, premature mortality within the newly diagnosed cohort remains a significant concern, particularly for the already vulnerable older population. The incidence of PNES in this study was higher than previously quoted which may reflect the wide-ranging ascertainment methods, providing a more comprehensive assessment of the true incidence rates in Ireland.en
dc.description.statusNot peer revieweden
dc.description.versionAccepted Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationStack, J. 2022. Three year outcomes in a cohort of patients with newly-diagnosed epilepsy. MD Thesis, University College Cork.
dc.identifier.endpage166
dc.identifier.urihttps://hdl.handle.net/10468/14593
dc.language.isoenen
dc.publisherUniversity College Corken
dc.rights© 2022, Jessica Stack.
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectEpilepsyen
dc.subjectOutcomesen
dc.subjectIncidenceen
dc.subjectFollow-upen
dc.titleThree year outcomes in a cohort of patients with newly-diagnosed epilepsy
dc.typeDoctoral thesisen
dc.type.qualificationlevelDoctoralen
dc.type.qualificationnameMD - Doctor of Medicineen
Files
Original bundle
Now showing 1 - 3 of 3
Thumbnail Image
Name:
Full Text E-thesis (Word)
Size:
23.4 MB
Format:
Microsoft Word XML
Thumbnail Image
Name:
StackJ_MD2022.pdf
Size:
3.88 MB
Format:
Adobe Portable Document Format
Description:
Full Text E-thesis
Download
Thumbnail Image
Name:
Submission for Examination Form.pdf
Size:
574.49 KB
Format:
Adobe Portable Document Format
License bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
license.txt
Size:
5.2 KB
Format:
Item-specific license agreed upon to submission
Description:
Download
Collections
Research Theses
College of Medicine and Health - Doctoral Theses
Medicine - Doctoral Theses