Epilepsy in Jerusalem, Israel

SUMMARY Epileptic disorders of unknown cause in Jerusalem, Israel, which were diagnosed during the period January, 1958, through December, 1961, were ascertained by reviewing hospital and clinic records, the data from the central EEG laboratory and interviews with physicians. A total of 689 cases was identified. The prevalence of epilepsy was 4.1 per 1000 population, a value which is close to that reported in the few other populations where comparable survey techniques were used. In Jerusalem, the rate per 1000 Afro-Asians, Europeans, and native-born Israelis was also similar suggesting that “idiopathic” epilepsy does not differ appreciably in frequency in diverse populations. Of the various types of seizures, grand mal was the most frequently diagnosed, petit mal and focal seizures together accounting for less than half the cases reported. The age specific distribution of patients with various forms of epilepsy showed a fairly stable rate up to age 44 and a decrease in prevalence thereafter. Analysis by sex revealed a preponderance of males with grand mal and psychomotor seizures but not with petit mal or other focal attacks. In 44% of the patients with epilepsy, seizures began during the first 5 years of life, 78% of the patients had their first attack before age 20, 16% between age 20 and 40, and only 6% after age 40. The electroencephalogram was abnormal or borderline in about two-thirds of the patients with petit mal and focal seizures (including psychomotor attacks) but in only about half of the patients with grand mal attacks. Analysis of anticonvulsant treatment revealed that the drugs most frequently used were diphenylhydantoin sodium (Dilantin®), and phenobarbital (Phenobarbitone®). Other drugs (trimethadione (Tridione ®), primidone (Mysoline ®)) were given to a relatively small number of patients, especially those with petit mal or focal seizures. Information was also gathered on patients with febrile convulsions and non-convulsive attacks and comparisons between these groups and epileptics were carried out. The literature on the frequency of epilepsy was reviewed. The difficulties in definition of epilepsy for epidemiologic studies were discussed and the necessity of applying standard diagnostic criteria and survey methods were stressed. RESUME Des troubles epileptiques d'origine inconnue, diagnostiques a Jerusalem, Israel, pendant la periode allant de janvier 1958 a decembre 1961 ont ete precises au moyen des fiches des hopitaux et cliniques, des donnees du laboratoire central d'EEG et des interviews obtenues des praticiens. On a identifie en tout 689 cas. L'incidence de l‘epilepsie a ete de 4.1 p. 1000 individus, chiffre tres proche de ceux qui ont ete publies en ce qui concerne d'autres populations ou des techniques de controle comparables ont ete utilisees. A Jerusalem, la proportion p. 1000 Afro-Asiatiques, Europeens et natifs dTsrael a ete similaire, ce qui permet de penser que l’epilepsie “idiopathique” ne differe pas sensiblement en frequence d'un peuple a l'autre. Parmi les divers types de crises, le grand mal aete le plus frequemment observe, le petit mal et les crises focales n'atteignaient pas ensemble la moitie des cas rapportes. La repartition par âges des malades atteints de formes variees d'epilepsie a montre une proportion assez stable jusqu'a 44 ans puis une decroissance. L'analyse relative au sexe a revele une preponderance des sujets mâles pour les crises de grand mal et les crises psychomotrices, mais non pour le petit mal et les autres crises focales. Chez 44% des epileptiques, les acces ont commence pendant les 5 premieres annees de la vie, 78% ont eu leur premiere crise avant 20 ans, 16% entre 20 et 40 ans, et seulement 6% apres 40 ans. L'electroencephalogramme etait anormal ou a la limite du normal chez les deuxtiers environ des malades atteints de petit mal et d'attaques focales (y compris les crises psycho-motrices), mais chez la moitie seulement des malades sujets aux crises de grand mal. L'analyse du traitement anticonvulsivant a revele que les medicaments le plus frequemment utilises etaient la diphenylhydantoine sodee (Dilantin®), etlepheno-barbital. D'autres medicaments–trimethadione (Tridione®), primidone (Mysoline®) –ont ete administres a un nombre relativement faible de malades, en particulier a ceux qui souffraient de petit mal ou de crises focales. On a egalement recueilli des donnees sur les malades atteints de convulsions febriles et de crises non-convulsives, et on a fait des comparaisons entre ces groupes et celui des malades epileptiques. La litterature concernant la frequence de l'epilepsie a ete revue. Les difficultes de definition de l'epilepsie en vue des etudes epidemiologiques ont ete discutees, et la necessite d'applique des criteres standard de diagnostic et des methodes standard de controle a ete soulignee.