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      Diagnostic Yield and Accuracy of Different Metabolic Syndrome Criteria in Adult Patients with Epilepsy

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          Abstract

          Introduction

          Metabolic syndrome (MetS) is an emergent problem among patients with epilepsy. Here, we evaluate and compare the diagnostic yield and accuracy of different MetS criteria among adult patients with epilepsy to further explore the best strategy for diagnosis of MetS among patients with epilepsy.

          Materials and methods

          Ninety-five epileptic adults from a tertiary epilepsy reference center were prospectively recruited over 22 weeks in a cross-sectional study. MetS was defined according to five international criteria used for the diagnosis of the condition [ATP3, American Association of Clinical Endocrinologists (AACE), International Diabetes Federation (IDF), AHA/NHLBI, and harmonized criteria]. Sensitivity, specificity, positive and negative predictive values (NPVs), and area under the receiver operating characteristic curve (ROC) curve were estimated for each criterion.

          Results

          In our sample, adult patients with epilepsy showed a high prevalence of obesity, hypertension, and diabetes. However, the prevalence of MetS was significantly different according to each criterion used, ranging from 33.7%, as defined by AACE, to 49.4%, as defined by the harmonized criteria ( p < 0.005). IDF criteria showed the highest sensitivity [ S = 95.5% (95% CI 84.5–99.4), p < 0.05] and AACE criteria showed the lowest sensitivity and NPV [ S = 68.2% (95% CI 52.4–81.4), p < 0.05; NPV = 75.8% (95% CI 62.3–86.1), p < 0.05]. ROC curve for all criteria studied showed that area under curve (AUC) for IDF criterion was 0.966, and it was not different from AUC of harmonized criterion ( p = 0.092) that was used as reference. On the other hand, the use of the other three criteria for MetS resulted in significantly lower performance, with AUC for AHA/NHLBI = 0.920 ( p = 0.0147), NCEP/ATP3 = 0.898 ( p = 0.0067), AACE = 0.830 ( p = 0.00059).

          Conclusion

          Our findings suggest that MetS might be highly prevalent among adult patients with epilepsy. Despite significant variations in the yield of different criteria, the harmonized definition produced the highest prevalence rates and perhaps should be preferred. Correct evaluation of these patients might improve the rates of detection of MetS and foster primary prevention of cardiovascular events in this population.

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          Most cited references21

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          Applied multivariate statistics for the social sciences

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            American College of Endocrinology position statement on the insulin resistance syndrome.

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              The epidemiology of the comorbidity of epilepsy in the general population.

              To describe the epidemiology of somatic and psychiatric conditions in adults with epilepsy in the community and compare it to that of people without epilepsy. A cross-sectional population-based study extracting data from the UK General Practice Research Database for the period 1995-1998. Age- and sex-standardized prevalence rates were estimated for selected conditions and groups of conditions (categorized by ICD-9 chapters) in adults with epilepsy registered with primary care physicians. Results were compared with those in adults without epilepsy in the cohort, and prevalence ratios were calculated according to two broad age groups (16-64 and older than 64 years). Conditions common in the general population also were common in adults with epilepsy. Psychiatric disorders occurred twice as often, and the risk of somatic disorders was increased in people with epilepsy, with the exception of musculoskeletal and connective tissue disorders in older adults. The prevalence ratio of neoplasia, excluding intracranial tumors, was not increased in epilepsy. The prevalence ratio of brain tumors was particularly increased in young adults [prevalence ratio (PR), 70.7] and of meningiomas in older adults (PR, 91.9). Neurodegenerative conditions, particularly dementias and Alzheimer' disease (PR, 6.3 and 8, respectively) and Parkinson' disease (PR, 3.2), appeared more frequently in people with epilepsy. Upper gastrointestinal bleed occurred more frequently in epilepsy (PR, 4.3), as did cardio- and cerebrovascular disorders, fractures, pneumonia and chronic lung diseases, and diabetes. Eczema, osteoarthritis, and rheumatoid arthritis did not occur more frequently in epilepsy. The prevalence ratio of many common psychiatric and somatic conditions is increased in adults with epilepsy who consult a primary care physician in the U.K. These findings may have implications in the diagnosis and management of epilepsy and coexisting conditions, as well as in health care provision.
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                Author and article information

                Contributors
                URI : http://frontiersin.org/people/u/15249
                Journal
                Front Neurol
                Front Neurol
                Front. Neurol.
                Frontiers in Neurology
                Frontiers Media S.A.
                1664-2295
                01 September 2017
                2017
                : 8
                : 460
                Affiliations
                [1] 1Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul , Porto Alegre, Brazil
                [2] 2Basic Research and Advanced Investigations in Neurology (BRAIN), Experimental Research Centre, Hospital de Clínicas de Porto Alegre , Porto Alegre, Brazil
                [3] 3Neurology Division, Hospital de Clínicas de Porto Alegre , Porto Alegre, Brazil
                [4] 4Centro de Tratamento de Epilepsia Refratária (CETER), Department of Neurology, Hospital de Clínicas de Porto Alegre , Porto Alegre, Brazil
                Author notes

                Edited by: Fernando Cendes, Universidade Estadual de Campinas, Brazil

                Reviewed by: Luiz Eduardo Betting, Universidade Estadual Paulista Júlio Mesquita Filho, Brazil; Marco Mula, St George’s, University of London, United Kingdom

                *Correspondence: Marino Muxfeldt Bianchin, mbianchin@ 123456hcpa.edu.br

                Specialty section: This article was submitted to Epilepsy, a section of the journal Frontiers in Neurology

                Article
                10.3389/fneur.2017.00460
                5595158
                e3bcd724-44eb-4b69-b8ba-5cce7aa95409
                Copyright © 2017 Cabral, Cherubini, de Oliveira, Bianchini, Torres and Bianchin.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 17 March 2017
                : 18 August 2017
                Page count
                Figures: 3, Tables: 9, Equations: 0, References: 36, Pages: 11, Words: 6803
                Funding
                Funded by: Conselho Nacional de Desenvolvimento Científico e Tecnológico 10.13039/501100003593
                Award ID: #485423/2012-0, #307084/2014-0, #11/2043.0
                Categories
                Neuroscience
                Original Research

                Neurology
                metabolic syndrome,comorbidities in epilepsy,general medical conditions,risk factors,cardiovascular risk

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