J Novy1,2,3, G S Bell1,2, J L Peacock4,5, S M Sisodiya1,2, J W Sander1,2,6. 1. Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, Queen Square, London. 2. Chalfont Centre for Epilepsy, Chalfont St Peter, UK. 3. Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland. 4. National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK. 5. Division of Health and Social Care Research, King's College London, London, UK. 6. Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.
Abstract
BACKGROUND: People with epilepsy have more concomitant medical conditions than the general population; these comorbidities play an important role in premature mortality. We sought to generate explanatory hypotheses about the co-occurrence of somatic comorbidities and epilepsy, avoiding causal and treatment-resultant biases. METHODS: We collected clinical, demographic and somatic comorbidity data for 2016 consecutive adults with epilepsy undergoing assessment at a tertiary centre and in 1278 people with epilepsy in the community. Underlying causes of epilepsy were not classed as comorbidities. RESULTS: Somatic comorbidities were more frequent in the referral centre (49%) where people more frequently had active epilepsy than in the community (36%). Consistent risk factors for comorbidities were found in both cohorts. Using multivariable ordinal regression adjusted for age, longer epilepsy duration and an underlying brain lesion were independently associated with a smaller burden of somatic conditions. The treatment burden, measured by the number of drugs to which people were exposed, was not an independent predictor. Shorter epilepsy duration was a predictor for conditions that conceivably harbour significant mortality risks. CONCLUSIONS: Somatic comorbidities do not occur randomly in relation to epilepsy; having more severe epilepsy seems to be a risk factor. Independently from age, the early period after epilepsy onset appears to be at particular risk, although it is not clear whether this relates to an early mortality or to a later decrease in the burden of comorbidities. These results suggest that, for some people, epilepsy should be considered a systemic condition not limited to the CNS.
BACKGROUND:People with epilepsy have more concomitant medical conditions than the general population; these comorbidities play an important role in premature mortality. We sought to generate explanatory hypotheses about the co-occurrence of somatic comorbidities and epilepsy, avoiding causal and treatment-resultant biases. METHODS: We collected clinical, demographic and somatic comorbidity data for 2016 consecutive adults with epilepsy undergoing assessment at a tertiary centre and in 1278 people with epilepsy in the community. Underlying causes of epilepsy were not classed as comorbidities. RESULTS: Somatic comorbidities were more frequent in the referral centre (49%) where people more frequently had active epilepsy than in the community (36%). Consistent risk factors for comorbidities were found in both cohorts. Using multivariable ordinal regression adjusted for age, longer epilepsy duration and an underlying brain lesion were independently associated with a smaller burden of somatic conditions. The treatment burden, measured by the number of drugs to which people were exposed, was not an independent predictor. Shorter epilepsy duration was a predictor for conditions that conceivably harbour significant mortality risks. CONCLUSIONS: Somatic comorbidities do not occur randomly in relation to epilepsy; having more severe epilepsy seems to be a risk factor. Independently from age, the early period after epilepsy onset appears to be at particular risk, although it is not clear whether this relates to an early mortality or to a later decrease in the burden of comorbidities. These results suggest that, for some people, epilepsy should be considered a systemic condition not limited to the CNS.
Authors: Anny Reyes; Sanam J Lalani; Erik Kaestner; Kiera Hooper; Austin Chen; Anna Christina Macari; Brianna M Paul; Bruce P Hermann; Carrie R McDonald Journal: Epilepsy Behav Date: 2019-11-13 Impact factor: 2.937
Authors: Andre Altmann; Mina Ryten; Martina Di Nunzio; Teresa Ravizza; Daniele Tolomeo; Regina H Reynolds; Alyma Somani; Marco Bacigaluppi; Valentina Iori; Edoardo Micotti; Rossella Di Sapia; Milica Cerovic; Eleonora Palma; Gabriele Ruffolo; Juan A Botía; Julie Absil; Saud Alhusaini; Marina K M Alvim; Pia Auvinen; Nuria Bargallo; Emanuele Bartolini; Benjamin Bender; Felipe P G Bergo; Tauana Bernardes; Andrea Bernasconi; Neda Bernasconi; Boris C Bernhardt; Karen Blackmon; Barbara Braga; Maria Eugenia Caligiuri; Anna Calvo; Chad Carlson; Sarah J A Carr; Gianpiero L Cavalleri; Fernando Cendes; Jian Chen; Shuai Chen; Andrea Cherubini; Luis Concha; Philippe David; Norman Delanty; Chantal Depondt; Orrin Devinsky; Colin P Doherty; Martin Domin; Niels K Focke; Sonya Foley; Wendy Franca; Antonio Gambardella; Renzo Guerrini; Khalid Hamandi; Derrek P Hibar; Dmitry Isaev; Graeme D Jackson; Neda Jahanshad; Reetta Kälviäinen; Simon S Keller; Peter Kochunov; Raviteja Kotikalapudi; Magdalena A Kowalczyk; Ruben Kuzniecky; Patrick Kwan; Angelo Labate; Soenke Langner; Matteo Lenge; Min Liu; Pascal Martin; Mario Mascalchi; Stefano Meletti; Marcia E Morita-Sherman; Terence J O'Brien; Jose C Pariente; Mark P Richardson; Raul Rodriguez-Cruces; Christian Rummel; Taavi Saavalainen; Mira K Semmelroch; Mariasavina Severino; Pasquale Striano; Thomas Thesen; Rhys H Thomas; Manuela Tondelli; Domenico Tortora; Anna Elisabetta Vaudano; Lucy Vivash; Felix von Podewils; Jan Wagner; Bernd Weber; Roland Wiest; Clarissa L Yasuda; Guohao Zhang; Junsong Zhang; Costin Leu; Andreja Avbersek; Maria Thom; Christopher D Whelan; Paul Thompson; Carrie R McDonald; Annamaria Vezzani; Sanjay M Sisodiya Journal: Neuropathol Appl Neurobiol Date: 2021-09-05 Impact factor: 8.090
Authors: Jana E Jones; Miya R Asato; Mesha-Gay Brown; Julia L Doss; Elizabeth A Felton; Jennifer A Kearney; Delia Talos; Penny A Dacks; Vicky Whittemore; Annapurna Poduri Journal: Epilepsy Curr Date: 2020-01-23 Impact factor: 7.500