W Allen Hauser

We admire Flaherty et al's article on racial differences in incidence of deep versus lobar hemorrhage in Greater Cincinnati/Northern Kentucky.[2] The findings for blacks versus whites in the two studies were broadly similar but the large number of cases in their study permitted further distinction between deep cerebral, brainstem and cerebellar locations.[1, 2]They assert that their study substantiates our hypothesis that prevalence of hypertension would influence risk of deep ICH more than lobar ICH. Thus, in blacks compared to whites, the risk ratio for deep ICH would be greater than the RR for lobar ICH. Flaherty et al did not perform a statistical test to confirm such a difference.

BackgroundStroke is the most common cause of newly diagnosed epilepsy in the elderly, ahead of degenerative disorders, brain tumors, and head trauma. Stroke accounts for 30-50% of unprovoked seizures in patients aged ≥ 60 years. This review discusses the current understanding of epidemiology, risk factors, mechanisms, prevention, and treatment opportunities for post-stroke epilepsy (PSE).MethodsWe performed a literature search in the PubMed and Cochrane Library databases. The keywords “stroke, epilepsy”, “stroke, seizure”, “post-stroke seizure”, “post-stroke epilepsy” were used to identify the clinical and experimental articles on PSE. All resulting titles and abstracts were evaluated, and any relevant article was considered. The reference lists of all selected papers and reference lists of selected review papers were manually analyzed to find other potentially eligible articles.ResultsPSE occurs in about 6 …

Background and objectivesPost-stroke epilepsy (PSE) is a significant concern in the elderly population, with stroke being a leading cause of epilepsy in this demographic. Several factors have shown consistent associations with the risk of developing PSE, including cortical lesions, initial stroke severity, younger age, and the occurrence of early seizures. The primary objectives of this study were two-fold: (1) to determine the incidence of PSE and (2) to identify the risk factors associated with PSE in a prospective cohort of post-stroke patients.MethodsA prospective single-hospital study was conducted, involving patients diagnosed with acute ischemic and hemorrhagic stroke. The patients were followed up for 2 years (or until death) from the time of admission. Data about seizure occurrence and recurrent stroke were collected. Kaplan–Meyer curves were used for the assessment of PSE incidence and mortality. Possible predictors of PSE and mortality were selected from between-group analysis and tested in multivariable regressions.ResultsOur study enrolled a total of 424 patients diagnosed with acute stroke. Among them, 97 cases (23%) experienced early post-stroke seizures, and 28 patients (6.6%) developed PSE. The cumulative risks of developing PSE were found to be 15.4% after hemorrhagic stroke and 8.7% after ischemic stroke. In multivariable fine and gray regression with competitive risk of death, significant predictors for developing PSE in the ischemic cohort were watershed infarction (HR 6.01, 95% CI 2.29–15.77, p < 0.001) and low Barthel index at discharge (HR 0.98, CI 0.96–0.99, p = 0.04). Furthermore, patients who eventually …

In his title Dr. Finsterer raises questions as to the appropriateness of our methodology used in our publication regarding the incidence of COVID-19 in people with epilepsy (PWE)[1]. Without further elaboration, he suggests that “life cohorts” are required to undertake the analyses we have presented. He may confuse a research approach (Life Course Theory) with research design (prospective vs. historical cohort). We are at a loss to identify a role For Life Course Theory in the assessment of the incidence of a newly occurring infectious disease. Since life course relies upon birth and period cohort analyses—most of which use historical cohort methodology, the two concepts are complementary and identification of incident cases of COVID-19 using a historical cohort methodology remains a valid strategy. He then questions our definitions of Incidence. The United States Center for disease control defines Incidence as …

ObjectiveWe hypothesized that PWE have an increased risk to acquire COVID-19. This was a historical cohort study to determine COVID-19 incidence, severity, mortality and risk factors in adults with active epilepsy (PWE) compared to residents of Moscow without epilepsy matched by age, gender, and region of residence – Moscow Community Comparisons (MCC).MethodsSubjects were derived from a cohort of adult PWE and a cohort of age- and gender-matched population-based MCC without epilepsy identified in 2018. Incidence of COVID-19 was compared in each cohort from 01.03.2020 through 28.02.21. Influence of age, gender, comorbidities, and for the PWE cohort, epilepsy type, seizure frequency, and number/class of antiseizure medications was evaluated using Pearson's chi-squared test and logistic regression analysis.ResultsWe found 887 COVID-19 positive people in the two cohorts: 156 in PWE …

Background Pregnancy registries, designed to assess the safety of medications and vaccines for the exposed mother and fetus, have been developed since the 1990s. Malformations present in the exposed liveborn or stillborn infant or fetuses in elective terminations are the outcome of greatest concern. The experiences of the North American AED (antiepileptic drug) Pregnancy Registry (NAAPR) can be used to identify the challenges and limitations of a pregnancy registry in identifying congenital malformations. Methods The NAAPR enrolls pregnant women who are taking one or more AEDs for any medical condition, but primarily to prevent seizures, and an unexposed comparison group. Participants are interviewed by clinical research coordinators (CRCs) at enrollment, later in pregnancy and postpartum. Malformations are identified in the mother's reports and her infant's medical records through age 12 …

BackgroundMental health conditions (MHCs) are frequent comorbidities among people with epilepsy; however, the influence of seizure control on the incidence of MHCs is not well reported. This retrospective observational cohort study based on claims data evaluated the effects of indicators of poor seizure control on the incidence of MHCs among MHC-naïve people with epilepsy. We hypothesized that poor seizure control is associated with new-onset MHC diagnoses and/or new prescription drugs for MHCs.MethodsThis study utilized a sample of patients from HealthVerity Marketplace, which includes more than 150 US commercial, Medicare, and Medicaid payers, to identify a cohort of adults (age ≥18 years) with prevalent epilepsy. Follow-up started on day 1 (January 1) after a 1-year eligibility assessment period occurring in calendar year 2017 or 2018. Patients were followed up until the occurrence of an …

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