Brief CommunicationInfodemiology of status epilepticus: A systematic validation of the Google Trends-based search queries
Introduction
Status epilepticus (SE), an abnormally prolonged or recurrent epileptic seizure, represents a serious, life-threatening medical emergency requiring a prompt, aggressive treatment. Overall, it has an incidence ranging from 10 to 41 patients per 100,000 [1] and is characterized by high mortality (range: 1.9–40%) [2].
Causes include cerebrovascular diseases (stroke or hemorrhage), infections (meningitis, sepsis), history of epilepsy, low antiepileptic drug levels, alcoholism, drug intoxication or abrupt withdrawal, encephalitis and encephalopathies, neurodegenerative diseases, sleep deprivation, tumors and paraneoplastic syndromes, autoimmune disorders, and metabolic impairments [3]. However, a certain fraction of SE cases remains unknown [3].
The treatment of SE follows a staged approach [1], [4]. Benzodiazepines (such as diazepam, lorazepam, midazolam, and clonazepam) represent first-line therapies. After failure of benzodiazepines, the following antiepileptic drugs can be used: phenytoin/fosphenytoin, valproic acid, levetiracetam, and lacosamide [4]. In the presence of continuing SE despite these drugs, therapeutic options usually include anesthetics (propofol, continuous midazolam administration, isoflurane, lidocaine, and ketamine) or barbiturates (phenobarbital, thiopental sodium, and pentobarbital) [5], [6]. Nonpharmacological management options (such as surgery, electroconvulsive therapy, transcranial magnetic stimulation, and vagus nerve stimulation or VNS) might be taken into consideration for super-refractory cases of SE, where seizure control cannot be achieved with anesthetics or barbiturates [5], [6]. These therapeutic options are rarely used, besides being poorly supported by scientific evidence [5], [6].
People increasingly use the search engines looking for health-related information. We previously demonstrated that in English-speaking countries most people use the Internet in order to obtain information on SE definition, types/subtypes, and treatment [7].
In this study, we aimed at providing a quantitative analysis of SE-related web queries. This analysis represents an advancement, with respect to what was previously discussed, in that the Google Trends (GT) algorithm has been further refined and correlational analyses have been carried out in order to validate the GT-based query volumes. Furthermore, recommendations provided by Nuti et al. in their systematic review on the use of GT in the field of health care have been taken into account, in order to increase the rigor and the reproducibility of the current research [8].
Section snippets
Material and methods
Google Trends is an online tracking system of Internet hit-search volumes that recently merged with its sister project Google Insights for Search (Google Inc.). Google Trends is freely available and accessible at www.google.com/trends. Google Trends enables searching and monitoring of Internet-related activities concerning a particular topic over time. This interest can be visualized in terms of relative search volumes (RSVs) from the plot displayed automatically by GT.
Google Trends global data
Results
The search using “status epilepticus” as keyword and the “search topic” option yielded the highest RSV, while some SE subtypes such as epilepsia partialis continua and aura continua were little searched (Fig. 1).
Google Trends-based SE-related query volumes were well correlated with information concerning causes (Table 1) and pharmacological (Table 2) and nonpharmacological treatments (Table 3).
In particular, as far as etiology is concerned, positive correlation coefficients were obtained with
Discussion
Classical epidemiological studies are time-consuming. Furthermore, most available population-based studies reflect the epidemiology of selected Western countries, particularly the United States. For some countries such as New Zealand, data are still unavailable, and the EpiNet project is expected to soon release the incidence rate of SE in the greater Auckland area [10]. For Thailand and other developing countries, national databases present some challenges and are usually limited in
Conclusion
We quantitatively analyzed GT-generated SE-related query volumes and have shown that a good correlation between GT-based SE-related RSVs and information concerning SE causes and management exists. To our knowledge, this is the first quantitative analysis of epilepsy-related web activities.
Google Trends can provide both researchers and clinicians with data on realities and contexts that are generally overlooked and underexplored by classic epidemiology. In this way, GT can foster new
Conflict of interests
Nicola Luigi Bragazzi received a travel grant from Merck Serono.
Eugen Trinka has acted as a paid consultant to Eisai, Ever Neuropharma, Biogen Idec, Medtronics, Bial, Shire, and UCB and has received speakers' honoraria from Bial, Eisai, GL Lannacher, GlaxoSmithKline, Boehringer, Viropharma, Actavis, Teva, Newbridge, and UCB Pharma.
Eugen Trinka has received research funding from UCB Pharma, Biogen-Idec, Red Bull, Merck, the European Union, FWF Österreichischer Fond zur Wissenschaftsförderung,
References (21)
- et al.
Status epilepticus in adults
Lancet Neurol
(2015) - et al.
Google search behavior for status epilepticus
Epilepsy Behav
(2015) - et al.
Use of the EpiNet database for observational study of status epilepticus in Auckland, New Zealand
Epilepsy Behav
(2015) - et al.
Incidences and outcomes of status epilepticus: a 9-year longitudinal national study
Epilepsy Behav
(2015) Infodemiology and infoveillance tracking online health information and cyberbehavior for public health
Am J Prev Med
(2011)- et al.
Why do people Google epilepsy? An infodemiological study of online behavior for epilepsy-related search terms
Epilepsy Behav
(2014) - et al.
Web search behavior for multiple sclerosis: an infodemiological study
Mult Scler Relat Disord
(2014) - et al.
Wikipedia and neurological disorders
J Clin Neurosci
(2015) - et al.
The epidemiology of convulsive and nonconvulsive status epilepticus
Epilepsia
(2007) - et al.
A definition and classification of status epilepticus — report of the ILAE Task Force on Classification of Status Epilepticus
Epilepsia
(2015)
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