Saha Romi

University Hospitals Sussex NHS Foundation Trust

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Alessandro Nobili

Mario Negri Institute for Pharmacological Research

Eva Bunting

University Hospitals Sussex NHS Foundation Trust

Luca Merlino

Regione Lombardia

Bryant Jayne

University Hospitals Sussex NHS Foundation Trust

Giorgia Giussani

Mario Negri Institute for Pharmacological Research

Angela Bortolotti

Ministero della Salute

Ida Fortino

Regione Lombardia

M Montesano

Azienda Ospedaliera Sant'Andrea

Ettore Beghi

Mario Negri Institute for Pharmacological Research

Paolo Messina

Commissariat à l'Énergie Atomique et aux Énergies Alternatives

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Mario Negri Institute for Pharmacological Research

Istituti di Ricovero e Cura a Carattere Scientifico

Regione Lombardia

Lombardia Informatica (Italy)

Italian Medicines Agency

Ministero della Salute

Regional Health

Istituto Superiore di Sanità

University Hospitals Sussex NHS Foundation Trust

University of Milano-Bicocca

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Validation of healthcare administrative data for the diagnosis of epilepsy

Journal of Epidemiology & Community Health (2013)

Carlotta Franchi Giorgia Giussani Paolo Messina M Montesano Saha Romi

Administrative databases have become an important tool to monitor diseases. Patients with epilepsy could be traced using disease-specific codes and prescriptions, but formal validation is required to obtain an accurate case definition. The aim of the study was to correlate administrative data on epilepsy with an independent source of patients with epilepsy in a district of Lombardy, Northern Italy, from 2000 to 2008.Data of nearly 320 600 inhabitants in the district of Lecco collected from the Drug Administrative Database of the Lombardy Region were analysed. Among them were included patients who fulfilled the International Classification of Diseases 9 (ICD-9) codes and/or the disease-specific exemption code for epilepsy and those who had at least one EEG record and took antiepileptic drugs (AEDs) as monotherapy or in variable combinations. To ascertain epilepsy cases, 11 general practitioners (GPs) with 15 728 affiliates were contacted. Multiple versions of the diagnostic algorithm were developed using different logistic regression models and all combinations of the four independent variables.Among the GP affiliates, 71 (4.5/1000) had a gold standard diagnosis of epilepsy. The best and most conservative algorithm included EEG and selected treatment schedules and identified 61/71 patients with epilepsy (sensitivity 85.9%, CI 76.0% to 92.2%) and 15 623/15 657 patients without epilepsy (specificity 99.8%,CI 99.7% to 99.8%). The positive and negative predictive values were 64.2% and 99.9%. Sensitivity (86.7%) and the positive predictive value (68.4%) increased only slightly when patients with single seizures were included.A diagnostic algorithm including EEG and selected treatment schedules is only moderately sensitive for the detection of epilepsy and seizures. These findings apply only to the Northern Italian scenario.

Diagnosis code

Gold standard (test)

Positive predicative value

Antiepileptic drug

10.1136/jech-2013-202528

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Addressing the gender divide: managing idiopathic Parkinson’s disease in the menopausal and peri-menopausal population

Eva Bunting Bryant Jayne Saha Romi

Idiopathic Parkinson's disease (IPD) is more common in men than women, with a relative risk 1.5 times greater in males[1]. Additionally, IPD tends to present later in women [2, 3] and progress more slowly, as females are more likely to present with the tremor-dominant PD phenotype[2]. Attempts have been made to establish if female gonadal hormones explain these observed differences, exerting a neuro-protective effect on dopaminergic transmission and neuronal degeneration, however the results have been inconsistent [4]. There is a shared symptomatology between menopausal and IPD individuals, further one may serve to exacerbate the other. We will present a survey of menopausal and perimenopausal patients with IPD, summarising the rates of Hormone Replacement Therapy (HRT) use, its perceived effects on wellbeing, including IPD symptoms and any barriers to accessing treatment. In Sussex, we have collaborated with local GP's and menopause specialists to develop guidance which aims to improve access to HRT for menopausal patients with IPD. We suggest that the threshold at which HRT therapy is offered to patients with IPD should be lower than in the general population. We hope that sharing our experience will help patients and neurologists navigate this evolving field.

Peri

10.1136/jnnp-2023-abn.111

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