Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy,
Neuroepidemiology. 2020;54(2):185-191. doi: 10.1159/000503831. Epub 2019 Dec 18.
Epilepsy is a chronic disease of the brain characterized by an enduring (i.e., persisting) predisposition to generate seizures, unprovoked by any immediate central nervous system insult, and by the neurobiologic, cognitive, psychological, and social consequences of seizure recurrences. Epilepsy affects both sexes and all ages with worldwide distribution. The prevalence and the incidence of epilepsy are slightly higher in men compared to women and tend to peak in the elderly, reflecting the higher frequency of stroke, neurodegenerative diseases, and tumors in this age-group. Focal seizures are more common than generalized seizures both in children and in adults. The etiology of epilepsy varies according to the sociodemographic characteristics of the affected populations and the extent of the diagnostic workup, but a documented cause is still lacking in about 50% of cases from high-income countries (HIC). The overall prognosis of epilepsy is favorable in the majority of patients when measured by seizure freedom. Reports from low/middle-income countries (LMIC; where patients with epilepsy are largely untreated) give prevalence and remission rates that overlap those of HICs. As the incidence of epilepsy appears higher in most LMICs, the overlapping prevalence can be explained by misdiagnosis, acute symptomatic seizures and premature mortality. Studies have consistently shown that about one-half of cases tend to achieve prolonged seizure remission. However, more recent reports on the long-term prognosis of epilepsy have identified differing prognostic patterns, including early and late remission, a relapsing-remitting course, and even a worsening course (characterized by remission followed by relapse and unremitting seizures). Epilepsy per se carries a low mortality risk, but significant differences in mortality rates are expected when comparing incidence and prevalence studies, children and adults, and persons with idiopathic and symptomatic seizures. Sudden unexplained death is most frequent in people with generalized tonic-clonic seizures, nocturnal seizures, and drug refractory epilepsy.
癫痫是一种脑部慢性疾病,其特征为存在持久(即持续存在)的发作倾向,这种发作由任何即时中枢神经系统损伤以外的原因引起,并且与反复发作的癫痫相关的神经生物学、认知、心理和社会后果有关。癫痫影响所有性别和年龄段的人群,具有全球分布特征。癫痫的患病率和发病率在男性中略高于女性,并且在老年人中达到高峰,这反映了该年龄段中风、神经退行性疾病和肿瘤的发病率较高。局灶性发作在儿童和成人中比全身性发作更为常见。癫痫的病因因受影响人群的社会人口统计学特征和诊断工作的范围而异,但在高收入国家(HIC),约有 50%的病例仍缺乏明确病因。大多数患者的癫痫总体预后良好,可通过无发作来衡量。来自低/中等收入国家(LMIC;那里的癫痫患者大部分未得到治疗)的报告显示,患病率和缓解率与 HIC 重叠。由于大多数 LMIC 中癫痫的发病率似乎较高,因此重叠的患病率可以通过误诊、急性症状性发作和过早死亡来解释。研究一致表明,约有一半的病例倾向于实现长期发作缓解。然而,最近关于癫痫长期预后的报告确定了不同的预后模式,包括早期和晚期缓解、缓解-复发过程,甚至恶化过程(表现为缓解后复发和持续发作)。癫痫本身的死亡率较低,但在发病率和患病率研究、儿童和成人、特发性和症状性癫痫患者之间进行比较时,预计死亡率会有显著差异。不明原因的突然死亡在全身性强直阵挛发作、夜间发作和药物难治性癫痫患者中最为常见。
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