Nervous System Disorders
https://oxfordhealth-nhs.archive.knowledgearc.net/handle/123456789/174
2023-07-27T22:18:50ZIncidence of Epilepsy and Seizures Over the First 6 Months After a COVID-19 Diagnosis
https://oxfordhealth-nhs.archive.knowledgearc.net/handle/123456789/1199
Incidence of Epilepsy and Seizures Over the First 6 Months After a COVID-19 Diagnosis
Taquet, Maxime; Harrison, Paul J
Background and Objectives The relationship between COVID-19 and epilepsy is uncertain. We studied the potential association between COVID-19 and seizures or epilepsy in the 6 months after infection.
Methods We applied validated methods to an electronic health records network (TriNetX Analytics) of 81 million people. We closely matched people with COVID-19 infections to those with influenza. In each cohort, we measured the incidence and hazard ratios (HRs) of seizures and epilepsy. We stratified data by age and by whether the person was hospitalized during the acute infection. We then explored time-varying HRs to assess temporal patterns of seizure or epilepsy diagnoses.
Results We analyzed 860,934 electronic health records. After matching, this yielded 2 cohorts each of 152,754 patients. COVID-19 was associated with an increased risk of seizures and epilepsy compared with influenza. The incidence of seizures within 6 months of COVID-19 was 0.81% (95% CI 0.75–0.88; HR compared with influenza 1.55 [1.39–1.74]). The incidence of epilepsy was 0.30% (0.26–0.34; HR compared with influenza 1.87 [1.54–2.28]). The HR of epilepsy after COVID-19 compared with influenza was greater in people who had not been hospitalized and in individuals younger than 16 years. The time of peak HR after infection differed by age and hospitalization status.
Discussion The incidence of new seizures or epilepsy diagnoses in the 6 months after COVID-19 was low overall, but higher than in matched patients with influenza. This difference was more marked in people who were not hospitalized, highlighting the risk of epilepsy and seizures even in those with less severe infection. Children appear at particular risk of seizures and epilepsy after COVID-19 providing another motivation to prevent COVID-19 infection in pediatric populations. That the varying time of peak risk related to hospitalization and age may provide clues as to the underlying mechanisms of COVID-associated seizures and epilepsy.
Open access
2022-11-01T00:00:00ZNeurological and psychiatric risk trajectories after SARS-CoV-2 infection: an analysis of 2-year retrospective cohort studies including 1 284 437 patients
https://oxfordhealth-nhs.archive.knowledgearc.net/handle/123456789/1131
Neurological and psychiatric risk trajectories after SARS-CoV-2 infection: an analysis of 2-year retrospective cohort studies including 1 284 437 patients
Taquet, Maxime; Harrison, Paul J
COVID-19 is associated with increased risks of neurological and psychiatric sequelae in the weeks and months thereafter. How long these risks remain, whether they affect children and adults similarly, and whether SARS-CoV-2 variants differ in their risk profiles remains unclear.
Methods
In this analysis of 2-year retrospective cohort studies, we extracted data from the TriNetX electronic health records network, an international network of de-identified data from health-care records of approximately 89 million patients collected from hospital, primary care, and specialist providers (mostly from the USA, but also from Australia, the UK, Spain, Bulgaria, India, Malaysia, and Taiwan). A cohort of patients of any age with COVID-19 diagnosed between Jan 20, 2020, and April 13, 2022, was identified and propensity-score matched (1:1) to a contemporaneous cohort of patients with any other respiratory infection. Matching was done on the basis of demographic factors, risk factors for COVID-19 and severe COVID-19 illness, and vaccination status. Analyses were stratified by age group (age <18 years [children], 18–64 years [adults], and ≥65 years [older adults]) and date of diagnosis. We assessed the risks of 14 neurological and psychiatric diagnoses after SARS-CoV-2 infection and compared these risks with the matched comparator cohort. The 2-year risk trajectories were represented by time-varying hazard ratios (HRs) and summarised using the 6-month constant HRs (representing the risks in the earlier phase of follow-up, which have not yet been well characterised in children), the risk horizon for each outcome (ie, the time at which the HR returns to 1), and the time to equal incidence in the two cohorts. We also estimated how many people died after a neurological or psychiatric diagnosis during follow-up in each age group. Finally, we compared matched cohorts of patients diagnosed with COVID-19 directly before and after the emergence of the alpha (B.1.1.7), delta (B.1.617.2), and omicron (B.1.1.529) variants.
Findings
We identified 1 487 712 patients with a recorded diagnosis of COVID-19 during the study period, of whom 1 284 437 (185 748 children, 856 588 adults, and 242 101 older adults; overall mean age 42·5 years [SD 21·9]; 741 806 [57·8%] were female and 542 192 [42·2%] were male) were adequately matched with an equal number of patients with another respiratory infection. The risk trajectories of outcomes after SARS-CoV-2 infection in the whole cohort differed substantially. While most outcomes had HRs significantly greater than 1 after 6 months (with the exception of encephalitis; Guillain-Barré syndrome; nerve, nerve root, and plexus disorder; and parkinsonism), their risk horizons and time to equal incidence varied greatly. Risks of the common psychiatric disorders returned to baseline after 1–2 months (mood disorders at 43 days, anxiety disorders at 58 days) and subsequently reached an equal overall incidence to the matched comparison group (mood disorders at 457 days, anxiety disorders at 417 days). By contrast, risks of cognitive deficit (known as brain fog), dementia, psychotic disorders, and epilepsy or seizures were still increased at the end of the 2-year follow-up period. Post-COVID-19 risk trajectories differed in children compared with adults: in the 6 months after SARS-CoV-2 infection, children were not at an increased risk of mood (HR 1·02 [95% CI 0·94–1·10) or anxiety (1·00 [0·94–1·06]) disorders, but did have an increased risk of cognitive deficit, insomnia, intracranial haemorrhage, ischaemic stroke, nerve, nerve root, and plexus disorders, psychotic disorders, and epilepsy or seizures (HRs ranging from 1·20 [1·09–1·33] to 2·16 [1·46–3·19]). Unlike adults, cognitive deficit in children had a finite risk horizon (75 days) and a finite time to equal incidence (491 days). A sizeable proportion of older adults who received a neurological or psychiatric diagnosis, in either cohort, subsequently died, especially those diagnosed with dementia or epilepsy or seizures. Risk profiles were similar just before versus just after the emergence of the alpha variant (n=47 675 in each cohort). Just after (vs just before) the emergence of the delta variant (n=44 835 in each cohort), increased risks of ischaemic stroke, epilepsy or seizures, cognitive deficit, insomnia, and anxiety disorders were observed, compounded by an increased death rate. With omicron (n=39 845 in each cohort), there was a lower death rate than just before emergence of the variant, but the risks of neurological and psychiatric outcomes remained similar.
Interpretation
This analysis of 2-year retrospective cohort studies of individuals diagnosed with COVID-19 showed that the increased incidence of mood and anxiety disorders was transient, with no overall excess of these diagnoses compared with other respiratory infections. In contrast, the increased risk of psychotic disorder, cognitive deficit, dementia, and epilepsy or seizures persisted throughout. The differing trajectories suggest a different pathogenesis for these outcomes. Children have a more benign overall profile of psychiatric risk than do adults and older adults, but their sustained higher risk of some diagnoses is of concern. The fact that neurological and psychiatric outcomes were similar during the delta and omicron waves indicates that the burden on the health-care system might continue even with variants that are less severe in other respects. Our findings are relevant to understanding individual-level and population-level risks of neurological and psychiatric disorders after SARS-CoV-2 infection and can help inform our responses to them.
Open Access
2022-08-01T00:00:00ZA feasibility study to determine whether the daily consumption of flavonoid-rich pure cocoa has the potential to reduce fatigue and fatigability in people with Parkinson's (pwP)
https://oxfordhealth-nhs.archive.knowledgearc.net/handle/123456789/1042
A feasibility study to determine whether the daily consumption of flavonoid-rich pure cocoa has the potential to reduce fatigue and fatigability in people with Parkinson's (pwP)
Dawes, Helen
Summary
Flavonoids, plant compounds found in certain foods, may have the ability to improve fatigue and fatigability. However, to date, no well-designed intervention studies assessing the role of flavonoid consumption for fatigue management in people with Parkinson's (pwP) have been performed.
Objectives
To determine the feasibility and estimate potential effect of flavonoid-rich cocoa on fatigue and fatigability in pwP.
Methods
This was a randomised (1:1) double-blind placebo controlled feasibility study in which 30 pwP were recruited from the European Parkinson Therapy Centre, Italy (trial registration: NCT03288155). During a six day intervention participants consumed a high (10.79 mg/g) or low flavonoid cocoa (1.02 mg/g) beverage (18 g Cocoa with 200 ml Rice milk) once daily. Potential effect on fatigue and fatigability was measured (baseline to day 6). Feasibility and fidelity were assessed through recruitment and retention, adherence and a process evaluation.
Results
From July 2017 to May 2018, 30 pwP were recruited and randomised and allocated to high (n = 15) or low (n = 15) flavonoid groups and included in analysis. Missing data was less than 5% and adherence to intervention of all allocated individuals was 97%. There was a small effect on fatigability (6 min walk test: ES 0.11 (95%CI = −0.11-0.26); Z = 0.81). There were two adverse events (one in the control and one in the intervention group).
Conclusion
The consumption of cocoa is feasible and well received in pwP, and further investigation on the effect on fatigability is warranted.
Contact the library for a copy of this article
2022-01-01T00:00:00ZOutcomes of importance to children and young adults with cerebral palsy, their parents and health professionals following lower limb orthopaedic surgery: A qualitative study to inform a Core Outcome Set
https://oxfordhealth-nhs.archive.knowledgearc.net/handle/123456789/1034
Outcomes of importance to children and young adults with cerebral palsy, their parents and health professionals following lower limb orthopaedic surgery: A qualitative study to inform a Core Outcome Set
Dawes, Helen
Introduction: Although several outcomes are commonly measured to assess the
effect of surgery for young people with cerebral palsy (CP), these are selected mainly
by health professionals and researchers. Including the perspectives of a broader
range of stakeholders is an essential step towards determining important outcomes
for assessment. This qualitative study involves the development of a core outcome
set (COS) for lower limb orthopaedic surgery for ambulant children with CP.
Objective: This study aimed to identify outcomes that matter to children and young
people with CP, their parents and healthcare professionals following lower limb
orthopaedic surgery.
Methods: Semi‐structured interviews were conducted with 10 healthcare
professionals, 10 children and young people with CP and 8 parents. Interview data
were analysed by content analysis supported by the International Classification of
Functioning, Disability and Health (ICF‐CY) supplemented by thematic analysis.
Findings: Thirty‐one outcomes were identified in total, which were linked to eleven
second‐level ICF‐CY categories. There were differences between stakeholder
groups in preferences and expectations from surgical outcomes. Healthcare
professionals and children with their parents identified 31 and 25 outcomes,
respectively. Health outcomes valued by participants were lower limb alignment and
symmetry, flexibility and muscle strength, mental health, fatigue, pain, function in
life, mobility, participation, being independent, quality of life and adverse events.
Compared to previous published trials, 10 new outcomes were revealed by this
study.
Conclusion: The researchers identified outcomes that are important to all
stakeholders following lower limb orthopaedic surgery for ambulant CP. Including these outcomes in future studies would promote patient‐centred care for children
and young adults with CP. Findings will be used to inform an international Delphi
survey and develop a COS in this field.
Patient and Public Contribution: This study was informed by an advisory group
including a young adult with CP and a parent of a child with CP. This group engaged
in the design of the study and the information material to support the interview
(information sheet and interview topic guide).
Open Access
2022-02-01T00:00:00Z