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<<   作成日時 : 2013/02/10 18:54   >>

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てんかんの子どもが急減/英国医療事情
 英国でてんかんと診断される子どもが過去10年間で激減している。
 欧州諸国や米国でも同様の減少が報告されているという。
 英国では1994年〜2008年の間に発症率が年間4〜9%低下している。1994-1996年と比較して2003-2005年に生まれた子どものてんかんの数は33%少なかった。発生率は47%減少した。ワクチンによる髄膜炎の減少や外傷性脳損傷の減少が貢献している可能性がある。

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3 February 2013 Last updated at 04:44 GMT
'Steep decline' in child epilepsy
http://www.bbc.co.uk/news/health-21295383

The number of children being diagnosed with epilepsy has dropped dramatically in the UK over the past decade, figures show.

A study of GP-recorded diagnoses show the incidence has fallen by as much as half.

Researchers said fewer children were being misdiagnosed, but there had also been a real decrease in some causes of the condition.

Other European countries and the US had reported similar declines, they added.

Epilepsy is caused when the brain's normal electrical activity result in seizures.

Data from more than 344,000 children showed that the annual incidence of epilepsy has fallen by 4-9% year on year between 1994 and 2008.

Overall the number of children born between 2003-2005 with epilepsy was 33% lower then those born in 1994-96.

When researchers looked in more detail and included a wider range of possible indicators of an epilepsy diagnosis the incidence dropped by 47%.

Correct diagnosis
Better use of specialist services and increased caution over diagnosing the condition explains some, but not all, of the decline in the condition, the researchers reported in Archives of Diseases in Childhood.

Introduction of vaccines against meningitis and a drop in the number of children with traumatic brain injuries, both of which can cause epilepsy, has probably also contributed to falling cases, they added.


Study author Prof Ruth Gilbert, director of the Centre for Evidence-based Child Health at University College London, said: "The drop is consistent with what has been seen in other countries so it is reassuring that we are seeing the same pattern.

"We're getting better at diagnosing and deciding who should be treated and then there is also probably an affect of factors like fewer cases of meningitis."

She said in the past, there was an issue with variable diagnosis and some children being treated who did not need to be.

"There is a more rigorous approach and that is partly down to NICE guidance.

"It is very troubling to have a misdiagnosis because once you have a diagnosis it sticks and that does blight the life of a child."

Simon Wigglesworth, deputy chief executive at Epilepsy Action, said: "It may indicate a reduction in misdiagnosis rates in children, which we know to be high. However, our discussions with leading clinicians suggest that this may not be the complete picture.

"They tell us that they are not seeing a reduction in the number of children with epilepsy presenting at their clinics and epilepsy remains one of the most prevalent neurological conditions in children in the UK."


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Arch Dis Child doi:10.1136/archdischild-2012-302237
Original article
Childhood epilepsy recorded in primary care in the UK
Wilhelmine Hadler Meeraus1,2, Irene Petersen2, Richard Frank Chin1,3,4,5, Felicity Knott6, Ruth Gilbert1
+ Author Affiliations

1MRC Centre of Epidemiology for Child Health, Institute of Child Health, University College London, London, UK
2Department of Primary Care and Population Health, University College London, London, UK
3Neurosciences Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK
4Young Epilepsy, Surrey, UK
5Child Life and Health, University of Edinburgh, Edinburgh, UK
6Paddington Green Health Centre, London, UK
Correspondence to
Wilhelmine Hadler Meeraus, MRC Centre of Epidemiology for Child Health, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK; wilhelmine.meeraus.09@ucl.ac.uk
Received 24 April 2012
Revised 5 December 2012
Accepted 17 December 2012
Published Online First 23 January 2013
Abstract
Objective To examine temporal trends in the incidence of epilepsy recorded in UK primary care and to evaluate the impact of recent efforts to improve the specificity of diagnosis in children.

Design Birth cohort study using primary care data from The Health Improvement Network, which includes a representative sample of the UK population of approximately 5%.

Methods We identified epilepsy recorded in primary care using relatively specific through to relatively sensitive indicators to identify epilepsy. Incidence estimates were based on 344?718 children aged 0?14?years with 1?447?760?years’ follow-up between 1994 and 2008. Trends in cumulative incidence were explored with stratified analysis by year-of-birth. Trends in annual incidence were investigated using Poisson regression with adjustment for age, gender and deprivation.

Results Cumulative incidence of recorded epilepsy at age 5?years ranged from 0.38% to 0.68% and annual incidence ranged from 71 to 116/100?000 person-years-at-risk, depending on the indicator used to identify epilepsy. With the most specific indicator for epilepsy, cumulative incidence was 33% lower among children born in 2003?2005 than in children born in 1994?1996, and annual incidence declined by 4% per annum between 2001 and 2008, after adjusting for age, gender and deprivation. Using a more sensitive indicator for epilepsy, the equivalent declines were 47% in cumulative incidence and 9% in annual incidence.

Conclusions The decline since the mid-1990s in epilepsy recorded in primary care may be due to more specific diagnosis, cessation of treatment for some forms of epilepsy, reduced exposure to risk factors or all of these factors.

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