Health related information and news from around the world.

The incidence of a disease means the number of new cases in a defined population (usually

100 000) in a defined period of time (usually one year).

Good figures for the incidence of new cases of epilepsy come from the population of Olmstead County in Minnesota. People in this rural part of the USA do not move around very much, and have the good fortune to be cared for by doctors at the famous Mayo Clinic. Research workers there have long had an interest in identifying all patients with epilepsy.

The incidence of new cases is highest in infancy and in old age, but new cases can occur at any age. Throughout middle life the incidence is about 40 cases per 100 000 per year. As the years go by, the risk of having had epilepsy at some time in one’s life increases in a cumulative fashion. The cumulative incidence in a population of children studied in the UK was 410 per 100 000 by the age of eleven, 600 by the age of 16, and 1000 per 100 000 by the age of 23. From the United States study cited above, the cumulative risk by age 75 was 3400 per 100 000 (3.4 per cent) for males and 2800 per 100 000 (2.8 per cent) for females. Epilepsy is thus not a rare or unusual disorder; seizures may impinge upon the lives of any one of us.

Another word used in counting cases of disease is prevalence. Here it is best to consider first another common illness which has a prolonged and steady course such as Parkinson’s disease. It is quite easy (though expensive) to do a door to door survey and count the people found to have Parkinson’s disease, as the signs of it will always be apparent. Prevalence is usually expressed per 1000. The prevalence of cases per 1000 population means that this number of people have the disease on the day of the survey. This technique is more difficult for epilepsy because of its episodic nature. Clearly, common sense dictates that if someone had a seizure during a day on which a survey day was done, they should be included, but what about someone who had many seizures in the past, but none for three years? One has to judge where to draw the line. In practice, most surveys of prevalence include people who have had more than one non-febrile seizure in the past, and are on continuing anti-epileptic drugs and/or who have had at least one seizure in the last two years. After early childhood, the prevalence is more or less constant throughout life at about seven per 1000 in developed countries, and considerably higher in developing countries.

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An itching rash covered in tiny blisters may occur at points of contact with watch bands, ear rings, and costume jewelry, and then spread widely over the surrounding skin in people who have become sensitive to nickel. This is much more likely to occur when there is excessive perspiration, so that the skin is moist at the point of contact with the metal. In some cases, furthermore, the dermatitis becomes so widespread that it is mistaken for scabies.

The latest news about nickel, Cutis (35#5:424) reports, is the mysterious appearance of dermatitis on the abdomen just below the umbilicus. Eventually, its cause was found to be contact with nickel buttons on blue jeans. In many cases, the dermatitis had also spread to other parts of the body. More often than not, treatment of this condition involves nothing more than replacing the button, watch band, etc., with an item made of another material. If the rash is severe and widespread, however, a visit to the dermatologist for special medication is required.

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Symptoms: pain in hip or knee; limp; limited movement of hip joint; slight fever (in case of acute synovitis).

Home care

Keep the child off his or her feet for three or four days.

Consult the doctor if the condition does not improve.

Precautions

-    Pain in the knee may be a sign of a hip problem.

-    A severe form of arthritis may be signaled by hip pain and a limp accompanied by high fever. If the child appears to have a hip problem and also has a high fever, call the doctor.

-    Some hip problems can cause permanent deformity if left untreated.

Children are susceptible to joint pains, most of which come and go and are not serious – for example, sprains and growing pains. Occasionally children get arthritis, which may affect the hips. Dislocated hips sometimes occur in infants and toddlers. There are also three specific causes of hip pain that occur commonly in children.

Acute synovitis of the hip can be described as a bruise of the inside of the hip joint. It is usually associated with a viral illness and is nearly always a harmless condition that disappears by itself. It can occur at any age, but most frequently happens between ages two and six.

Legg-Calve-Perthes disease is a serious condition in which the upper end of the thigh bone (femoral head) softens and becomes deformed. No one knows why it happens, but it usually begins between ages four and ten years and affects boys more often than girls. If it is not treated, Legg-Calve-Perthes disease results in a severe and permanent deformity of the hip.

Slipped femoral epiphysis is another condition of unknown origin, but it is possible that it happens as a delayed result of an injury. It occurs most often in the teen years, usually in overweight (obese or muscular) children. It results in severe deformity if it is not treated.

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