Analysis Of Etiology Of Epilepsy Patients In Western Yunnan

Objective To investigate the etiology of epilepsy patients in western Yunnan(western Yunnan)in recent 5 years,to provide evidence for evaluating the level of epilepsy diagnosis and treatment in the region and improving local epilepsy diagnosis and treatment norms.Methods 1.Through the electronic medical record system,using "epilepsy","status epilepticus" and "seizure" as keywords,searched for epilepsy patients who were treated in the First Affiliated Hospital of Dali University from January 2017 to January 2022,The clinical data and relevant auxiliary examination information of all patients were collected.Grouped by gender,age,ethnicity,type of seizures,etc.2.Retrospectively analyze the overall etiological composition of epilepsy in this region,and the etiology classification is based on the 2017 International League Against Epilepsy(ILAE)epilepsy etiology classification criteria.The Chi-square test was used to compare the etiology of different genders,different age groups,different ethnic groups,and different types of epileptic seizures.P<0.05 was considered statistically significant.Results 1.A total of 10,866 patients were retrieved,excluding 5,676 repeated visits and extremely incomplete medical history data,and 5,190 eligible patients were included,including 3,130 males(60.3%)and 2,060 females(39.7%).The ratio of male to female is 1.52:1.The age range was from January to 87 years old,including 1570 cases from 0 to 18 years old,1635 cases from 19 to 45 years old,1440 cases from 46 to 64 years old,and 545 cases ≥65 years old.2.The overall etiology composition is as follows: 2355 cases of unknown etiology(45.4%),1960 cases of structural(37.8%),615 cases of infectious(11.8%),180 cases of metabolic(3.5%),80 cases of immune(1.5%)).3.The seizure types of the 5190 patients included in the study were divided into focal,generalized,and unknown origin according to the latest ILAE epilepsy classification criteria in 2017.Among them,2,235 cases were focal,accounting for 43.1% of the total number of cases,followed by 2,105 cases of comprehensive disease,accounting for 40.6% of the total number of cases,and 850 cases of unknown etiology,accounting for 16.4% of the total number of cases.There was a statistically significant difference in the etiological composition of different seizure types(P<0.05);895 cases(42.5%)of structural etiology were the most common origin,followed by 705 cases(33.5%)of unknown etiology,and 340 cases(16.2%)of infectious origin),metabolic in 115 cases(5.5%),and immune in 50 cases(2.4%).The etiology distribution of focal origin was mainly structural in 995 cases(44.5%),unknown etiology in 915 cases(40.9%),infectious in 245 cases(11.0%),metabolic in 55 cases(2.5%),and immune in 25 cases(1.1%).%).There were 735 cases(86.5%)of unknown etiology,70 cases(8.2%)of structural etiology,30 cases(3.5%)of infectious,10 cases(1.2%)of metabolic,and 5 cases(0.6%)of immune.4.There was no statistically significant difference in the etiology composition of different genders and ethnic groups(P>0.05).In the etiology distribution of male epilepsy patients,1405 cases(44.9%)of unknown etiology occupied the first place,followed by 1202 cases(38.4%)of structural,355 cases(11.3%)of infectious,123 cases(3.9%)of metabolic,123 cases(3.9%)of immunological 45 cases(1.4%).Among female epilepsy patients,950 cases(46.1%)of unknown etiology also occupied the first place,followed by structural 758 cases(36.8%),infectious 260 cases(12.6%),metabolic 57 cases(2.8%),and immune 35 cases(1.7%).The proportion of women with infectious and immune epilepsy was more than that of men,and there was no statistically significant difference in the overall etiology of men and women.The proportions of unknown etiology in each ethnic group were(45.4%,45.6%,44.7%,43.7%,47.2%).Followed by structural etiology(38.9%,37.2%,38.2%,36.9%,32.8%).Infectious causes accounted for(11.3%,12.8%,10.5%,12.3%,13.4%)respectively.The remaining cases of immune and metabolic etiologies were relatively small,and there was no statistically significant difference in etiology composition among different ethnic groups.5.There is a statistically significant difference in the etiology composition of different age groups(P<0.05).In each age group,the unknown etiology occupies the first place in the 0-18 and 19-45 age groups,followed by structural,infectious,metabolic and immune etiologies.In the 46-64 and ≥65-year-old age group,the structural etiology took the first place,followed by unknown etiology,infection,metabolism,and immune etiology.6.The spectrum distribution of diseases with different etiologies is different in each age group.The common diseases with structural etiology in the age group of 0-18 are ischemic-hypoxic encephalopathy,abnormal brain development,and craniocerebral trauma.Among the age groups of 19-45 years,46-64 years and ≥65 years old,the common diseases of structural etiology were cerebrovascular accident,craniocerebral trauma,and space-occupying lesions.Viral encephalitis and encephalocysticercosis were common diseases among infectious causes in the age group of 0-18 years old.Cerebral cysticercosis and viral encephalitis were the common infectious causes in the 19-45,46-64,and ≥65-year-old age groups.Alcoholic encephalopathy is a common disease of metabolic etiology in the age groups of 19-45 years,46-64 years and ≥65 years old.7.Among all epilepsy patients,2429 cases(23.4%)had refractory epilepsy.Among patients with intractable epilepsy,533 cases(43.9%)of unknown etiology,130 cases(10.7%)of cerebrovascular accident,73 cases(6.0%)of craniocerebral spaceoccupying lesions,75 cases(6.2%)of craniocerebral trauma,brain development Abnormal 51 cases(4.2%),hippocampal abnormalities in 34 cases(2.8%),other structural diseases in 47 cases(3.9%),central nervous system infection in 224 cases(18.5%),metabolic diseases in 32 cases(2.6%),immune Sexual etiology occurred in 15 cases(1.2%).Conclusions: 1.There are more male epilepsy patients than women in this region;2.The most unknown etiology is the most unknown among all epilepsy patients,followed by structural,infectious,metabolic and immune causes.The etiological composition of epilepsy has nothing to do with gender or ethnicity;3.The seizure type was mainly focal origin,followed by comprehensive origin and unknown origin.The etiological composition of different seizure types is different;4.Different age groups have different etiological compositions,and unknown etiologies in the 0~18-year-old and 19~45-year-old age groups occupy the first place,followed by structural,infectious,metabolic and immune causes.The 46~64 years old and ≥65 years old age group occupied the first place with structural causes,followed by unexplained,infectious,metabolic,and immune causes.Different disease profiles of different ages and etiologies are different; 5.The most unknown etiology is among patients with refractory epilepsy,followed by structural,infectious,metabolic and immune etiology.