ABSTRACT
A diagnostic system for ICD-11 is proposed which commences with broad reorganization and simplification of the current categories and the use of clinically relevant specifiers. Such changes have implications for the positioning of diagnostic groups and lead to a range of possibilities for improving terminology and the juxtaposition of individual conditions. The development of ICD-11 provides the fi rst opportunity in almost two decades to improve the validity and reliability of the international classification system. Widespread change in broad categories and criteria cannot be justified by research that has emerged since the last revision. It would also be disruptive to clinical practice and might devalue past research work. However, the case for reorganization of the categories is stronger and has recently been made by an eminent international group of researchers (Andrews et al., 2009). A simpler, interlinked diagnostic system is proposed here which is likely to have fewer categories than its predecessor. There are major advantages of such a system for clinical practice and research and it could also produce much needed simplification for primary care (Gask et al., 2008) and the developing world (Wig, 1990; Kohn et al., 2004).
Subject(s)
International Classification of Diseases/trends , Mental Disorders/classification , Mental Disorders/diagnosis , Adult , Biomedical Research/trends , Child , Forecasting , Humans , Internationality , Referral and Consultation , Reproducibility of Results , United KingdomABSTRACT
Post-stroke seizure and post-stroke epilepsy are common causes of hospital admissions, either as a presenting feature or as a complication after a stroke. They require appropriate management and support in long term. With an increasingly ageing population, and age itself being an independent risk factor for stroke, the incidence and prevalence of post-stroke seizure and post-stroke epilepsy is likely to increase. This article examines aetiology, clinical presentation, and presents a management outline of these conditions with particular focus on adults. The aim of this review article is to provide the clinicians with background information and recommendations.
Subject(s)
Epilepsy/etiology , Stroke/complications , Diagnosis, Differential , Electrocardiography , Epilepsy/diagnosis , Epilepsy/therapy , Humans , Incidence , Magnetic Resonance Imaging , Patient Care Team , Prevalence , Seizures/diagnosis , Seizures/etiology , Seizures/therapy , Tomography, X-Ray ComputedABSTRACT
Individuals with learning difficulties commonly suffer from concomitant conditions; epilepsies constitute up to 35%. The prevalence of epileptic syndromes in learning disabled people is less well documented. Non-convulsive status epilepticus (NCSE) occurs with many epileptic syndromes. It can present with insidious or paroxysmal change of neurovegetative, behavioural, cognitive or affective symptoms which can mistakenly be attributed to other causes. NCSE of generalized epilepsy syndromes can show localizing features and NCSE of localization-related epilepsy can show generalized epileptiform discharge patterns. We reviewed 14 residents' (< 20 years, all learning disabled) EEG recordings in inter-ictal stages and in NCSE and conclude that the current nosological grouping of NCSE does not ensure appropriate categorization in a significant number of cases. We developed a revised NCSE classification: (I) Generalized epileptic syndromes: (a) with no evidence of lateralization inter-ictally or in NCSE; (b) with evidence of lateralization in NCSE only. (II) Localization-related epileptic syndromes: (a) with evidence of lateralization/focal activity in NCSE; (b) with evidence of generalized EEG patterns when in NCSE only; (c) with transient forms: same individual shows generalized and lateralized/focal NCSE activity in different EEGs. We suggest our system be tested in larger studies for its sensitivity, reliability and validity.
