Epilepsy

The study was carried out in London, where everyone has access to universal health care and where investigators were able to delineate which manifestations and ...

Other findings revealed that patients going to a physician within 2 years of their PD diagnosis with complaints of depression, anxiety, fatigue, and insomnia had about 2- to 4-fold higher odds of the disease. Epilepsy was linked with later PD across all time periods. Black, South Asian, and Chinese; other; and mixed ethnic groups make up about 45% of residents in East London compared with 14% in the rest of the United Kingdom. In addition, East London has one of the highest unemployment rates (6.7%), and most patients (80%) rank in the lowest 2 quintiles of national wealth. The nested case-control study was conducted with extracted clinical information from electronic medical records on more than 1 million patients from primary care practices in East London, with visits recorded between 1990 and February 6, 2018. The majority of PD studies are conducted with data on patients who are White and from higher socioeconomic levels. The matched analysis of 1055 individuals with PD and 10,550 controls found that less than 2 years before the diagnosis, patients with PD were more likely to visit their physician for complaints of tremor (odds ratio [OR], 145.96; 95% CI, 90.55-235.28) and memory problems (OR, 8.60; 95% CI, 5.91-12.49). Memory problems were also seen up to 5 years before a PD diagnosis but not beyond that. Hearing loss was linked with subsequent PD when found less than 2 years or 2 to 5 years prior to a PD diagnosis. Pain factored in as well, with visits for shoulder pain linked with a doubling of the odds of PD diagnosis up to 5 years before diagnosis. The investigators examined what patients went to primary care clinics in the years before a PD diagnosis, stratified into 3 time periods: less than 2, 2 to less than 5, and 5 to 10 years before diagnosis; the time periods were analyzed separately and together. The study was carried out in London, where everyone has access to universal health care and where investigators were able to delineate which manifestations and issues led patients to visit primary care in the decade before receiving a PD diagnosis. Moreover, one of the main strengths of the study, published in JAMA Neurology, is that it was carried out in East London, a very diverse area with a high rate of poverty and socioeconomic deprivation compared with the rest of the United Kingdom.1 The researchers replicated their findings from primary care databases with data from the UK Biobank. Researchers said 2 additional warning signs of Parkinson disease (PD) may be the onset of hearing loss and epilepsy years before the hallmark features of the disease appear, adding new weight to the idea that the neurological condition has a long prodromal phase.