Cost of epilepsy in Europe
Cost of epilepsy in Europe
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DOI：
10.1111/j.1468-1331.2005.01191.x
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发表时间：
2005-06-01
影响因子：
5.1
通讯作者：
Ekman, M
中科院分区：
文献类型：
--
作者：
Forsgren, I;Beghi, E;Ekman, M
癫痫是一种以反复无端发作为特征的复杂症状（国际抗癫痫联盟流行病学和预后委员会，1993年）。无诱发性发作是指在没有诱发因素的情况下发生的癫痫发作。相比之下，诱发性（急性症状性）癫痫发作与急性系统性、毒性或代谢性损伤有密切的时间关系，这可能是潜在的原因。非诱发性癫痫发作包括在没有公认的病因或危险因素的情况下发生的事件（特发性和隐源性癫痫发作），以及发生在先前有稳定（无进展）中枢神经系统（CNS）损伤的患者中的事件（远端症状性癫痫发作）。全世界癫痫的年发病率为24 - 53/10万，单次发作的发病率为33 - 44/10万（Hauser， 1997年）。在美国，急性症状性癫痫发作的发生率为40/10万（Annegers et al., 1995）。癫痫是一种相当常见的临床疾病，影响所有年龄段，在欧洲的分布也相当相似。该疾病在男性中的患病率略高于女性，尽管大多数研究显示不同年龄组的性别患病率有所变化（Forsgren et al., 2005）。与患病率一样，男性癫痫的发病率略高于女性，尽管偶尔发现性别之间的发病率相似或女性占优势。癫痫的患病率在儿童和青少年（4.5-5/1000）、成人（6/1000）和老年人（7/1000）中略有不同。相比之下，该疾病的年平均发病率往往因年龄而有显著差异，儿童和青少年约为70/10万，成人约为30/10万，老年人约为100/10万。在基于人群的发病率研究中，癫痫的病因可以在大约三分之一到一半的病例中得到记录，最常见的原因是脑血管疾病（14-21%）、头部创伤（2-16%）、肿瘤（6-10%）、发育障碍（4-7%）、退行性疾病（1-5%）和感染（0-2%）（Forsgren et al., 2005）。在欧洲和发展中国家之间，癫痫的病因可以发现适度的差异，这可能反映了环境因素的不同分布和不同的遗传背景（Beghi, 2004）。癫痫是一种可治疗的临床疾病。约50%的病例在开始治疗后不久发作缓解；在大约25-35%的病例中，经过一次或多次治疗改变后，癫痫发作可以得到控制，但仍有15-25%的患者患有耐药性癫痫（Jallon， 2003年）。在这些病例中，通过手术切除致癫痫病变可获得不同比例的癫痫控制。这种疾病的严重程度因患者而异，但癫痫的社会成本很高，主要是由于很大一部分癫痫患者患有严重癫痫。这使得评估癫痫患者的费用变得非常重要，尤其是近年来引入了几种新的抗癫痫药物。
Epilepsy is a symptom-complex characterized by repeated unprovoked seizures (Commission on Epidemiology and Prognosis, International League Against Epilepsy, 1993). An unprovoked seizure is a seizure occurring in the absence of precipitating factors. By contrast, a provoked (acute symptomatic) seizure is a seizure occurring in close temporal relationship with an acute systemic, toxic or metabolic insult, which is expected to be the underlying cause. Unprovoked seizures include events occurring in the absence of a recognized etiological or risk factor (idiopathic and cryptogenic seizures) and events occurring in patients with antecedent stable (non-progressing) central nervous system (CNS) insults (remote symptomatic seizures). The worldwide annual incidence of epilepsy ranges from 24–53/100 000 and the incidence of single seizures is 33–44/100 000 (Hauser, 1997). In the USA, the incidence of acute symptomatic seizures is 40/100 000 (Annegers et al., 1995). Epilepsy is a fairly common clinical condition affecting all ages and with a fairly similar distribution across Europe. The prevalence of the disease is slightly higher in males than in females, although most studies show shifting rates between sexes in different age groups (Forsgren et al., 2005). As with prevalence, the incidence of epilepsy is slightly higher in males than in females, although similar rates between genders or a female predominance have been occasionally found. The prevalence of epilepsy is slightly different in children and adolescents (4.5–5/1000), adults (6/1000), and in the elderly (7/1000). By contrast, the mean annual incidence of the disease tends to vary significantly according to age, being about 70/100 000 in children and adolescents, 30/100 000 in adults, and 100/100 000 in the elderly. In population-based incidence studies, the etiology of epilepsy can be documented in about one-third to onehalf of the cases, the commonest causes being cerebrovascular disorders (14–21%), head trauma (2–16%), tumours (6–10%), developmental disorders (4–7%), degenerative disorders (1–5%) and infections (0–2%)(Forsgren et al., 2005). Modest differences can be found in the etiology of epilepsy between Europe and developing countries, which may reflect a different distribution of environmental factors and different genetic backgrounds (Beghi, 2004). Epilepsy is a treatable clinical condition. About 50% of cases achieve seizure remission soon after onset of treatment; seizures can be controlled after one or more treatment changes in about 25–35% of cases, leaving 15–25% of patients with drug-resistant epilepsy (Jallon, 2003). Seizure control may be obtained in a variable proportion of these cases by surgical resection of the epileptogenic lesion.The disease severity varies considerably from patient to patient, but the societal costs for epilepsy are high, mainly due to severe epilepsy in a substantial part of the epilepsy population. This makes it important to assess the costs for patients with epilepsy, not least since several new antiepileptic drugs have been introduced in recent years.