Photo Credit: Bestdesigns
Siran Koroukian, PhD, and colleagues discuss their findings that medical and psychiatric comorbidities in new-onset or incident epilepsy are common in adults.
“Most prior studies that have examined comprehensive sets of comorbid chronic conditions in older adults with epilepsy have focused on those with prevalent epilepsy, but fewer have examined more than a few comorbidities among those with new onset or incident epilepsy,” researchers wrote in Epilepsia. “The overwhelming focus on prevalent epilepsy makes it difficult to understand which chronic conditions may be risk factors for epilepsy onset.”
Current literature indicates that older adults with epilepsy experience a higher prevalence of chronic conditions than their counterparts with no epilepsy, according to the study results.
Siran M. Koroukian, PhD, and colleagues conducted a retrospective cohort study of epilepsy incidence in a random sample of 4.9 million fee-for-service Medicare beneficiaries older than 65. Results demonstrated an excess prevalence of most pre-existing chronic conditions among beneficiaries with incident epilepsy (n=20,545; weighted n=19,631). Stroke, developmental, neurologic, and substance use disorders and congenital and psychiatric conditions were the most common.
Physician’s Weekly (PW) spoke with Dr. Koroukian and two of her coauthors— Martha Sajatovic, MD, and Gena R. Ghearing, MD—to learn more about the implications of the study’s results.
PW: Why was it important to do this study?
Dr. Sajatovic: Many people think that epilepsy starts in childhood, and they do not realize that its highest incidence is in older adults. Health complications in later life, such as a stroke or a serious fall, can predispose to later-life epilepsy onset.
We need to better understand how disease burden and disparities contribute to epilepsy so we can identify older adults at risk for health complications that might lead to seizures and effectively educate and treat them. Providers caring for older adults need to recognize and manage seizures, and we should consider educating older adults who are at risk for seizures, such as those who have suffered a stroke, about seizure symptoms and first aid.
For clinicians, what are the most important takeaways?
Dr. Ghearing: Our findings suggest that older adults who have chronic comorbidities require a comprehensive evaluation of medical, neurological, and psychiatric disorders that may impact their brain health. This evaluation needs to consider the disparities and specific needs faced by our patients in Hispanic, Black, and other at-risk populations, including those with higher levels of medical disability.
Did the results surprise you?
Dr. Ghearing: I was not surprised that seizures were more common in those with medical and psychiatric diseases and that this differed based on race and ethnicity. I was, though, surprised by the marked increase in the Hispanic population and by the robustness of the increased prevalence of pre-existing chronic conditions across populations.
Those who care for people with epilepsy recognize how common their medical and psychiatric comorbidities are and how critical treatment is. Limited language proficiency, stigma, lack of transportation, and housing or food insecurity may exacerbate barriers to treatment. A person with significant musculoskeletal disability may have interrupted sleep, decreased exercise, and other lifestyle changes that impact brain health and increase their risk for seizure. We need to think of brain health in the context of each patient’s situation and tailor our approach to their needs.
PW: How can managing these conditions impact epilepsy outcomes?
Dr. Koroukian: Pre-existing chronic conditions make managing epilepsy more complex due to disease-disease, disease-drug, or drug-drug interactions. Neurologists must adopt a multidisciplinary and comprehensive approach to manage each patient’s chronic conditions adequately.
PW: What questions remain unanswered for you?
Dr. Koroukian: We analyzed pre-existing chronic conditions in broad categories in this study. We next plan to identify the specific conditions for which we observe excess prevalence in older adults with incident epilepsy, such as atrial fibrillation within the broader category of cardiovascular conditions or depression within the broader category of psychiatric conditions.
We will work to identify combinations of conditions within and across these broad diagnostic categories that are in excess in people with incident epilepsy, such as hypertension + atrial fibrillation + depression. We will also identify polypharmacy and specific combinations of medications that are common in individuals who develop epilepsy.
Rather than looking at one risk factor at a time, it’s important to analyze epilepsy incidence comprehensively, considering each individual’s demographic characteristics, social determinants of health, chronic disease burden, and polypharmacy. The key is to characterize the combinations of risk factors as specifically as possible to develop effective strategies for health promotion, prevention, and disease surveillance.
To read more about the specific study findings from Dr. Koroukian and colleagues, click here!
