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Original Investigation |

Efforts in Epilepsy Prevention in the Last 40 Years Lessons From a Large Nationwide Study

Matti Sillanpää, PhD, MD1; Mika Gissler, DrPhil2; Dieter Schmidt, MD3
[+] Author Affiliations
1Departments of Public Health and Child Neurology, University of Turku, Turku, Finland
2National Institute of Health and Welfare, Helsinki, Finland
3Epilepsy Research Group, Berlin, Germany
JAMA Neurol. 2016;73(4):390-395. doi:10.1001/jamaneurol.2015.4515.
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Importance  Prevention of new-onset epilepsy is an important public health issue and presents a pressing unmet need. It is unclear whether progress has been made in preventing new-onset epilepsy.

Objective  To determine whether progress has been made in the prevention of epilepsy in Finland during the last 40 years.

Design, Setting, and Participants  Using a long-term national register study of 5.04 million Finnish individuals, we looked at first-time inpatient admissions in Finland for a diagnosis of epilepsy from 1973 to 2013. Patients with epilepsy were defined by the occurrence of 2 or more unprovoked seizures. This study was conducted on July 29, 2015.

Main Outcomes and Measures  In Finland, patients with epilepsy are routinely hospitalized at time of diagnosis, thus providing evidence for the incidence of epilepsy.

Results  Of the mean 5.04 million Finnish individuals followed up for the development of epilepsy from 1973 to 2013, 100 792 people were identified as having epilepsy. Of these, 46 995 (47%) had focal epilepsy. The mean age for those included in the study was 45 years for men (interquartile range, 24-65 years) and 46 years for women (interquartile range, 23-71 years). We found no change in the incidence of epilepsy in the age range of those younger than 65 years (60 per 100 000 in 1973 and 64 per 100 000 in 2013). However, there was a significant increase in epilepsy among those older than 65 years (from 57 per 100 000 to 217 per 100 000).

Conclusions and Relevance  We found no evidence that progress has been made in preventing new-onset epilepsy in those younger than 65 years in the last 40 years; in fact, there was a nearly 5-fold rise of new-onset epilepsy among the elderly population.

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Figure 1.
Incidence of Epilepsy by Calendar Year

Incidence density per 100 000 person-years of epilepsy by calendar year from 1973 to 2013 among the total population in Finland.

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Figure 2.
Incidence of Epilepsy by Age Group

Incidence density per 100 000 person-years of epilepsy by age group and calendar year from 1973 to 2013 among the total population in Finland.

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Figure 3.
Incidence of Epilepsy by Sex and Calendar Year

Incidence density per 100 000 person-years of epilepsy by sex and calendar year from 1973 to 2013 among the total population in Finland.

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Figure 4.
Incidence of Epilepsy in Infants

Incidence density per 100 000 person-years for infants younger than 1 year by etiology from 1973 to 2013 among the total population in Finland; 3-year moving averages.

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Figure 5.
Temporal Changes in the Incidence of Focal vs Generalized Epilepsies

Temporal changes in the incidence density of focal epilepsy vs generalized epilepsies per 100 000 person-years from 1973 to 2013 in the total population in Finland.

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