RESUMEN
OBJECTIVE: Prior studies have examined chronic conditions in older adults with prevalent epilepsy, but rarely among those with incident epilepsy. Identifying the chronic conditions with which older adults present at epilepsy incidence assists with the evaluation of disease burden in this patient population and informs coordinated care development. The aim of this study was to identify preexisting chronic conditions with excess prevalence in older adults with incident epilepsy compared to those without. METHODS: Using a random sample of 4 999 999 fee-for-service Medicare beneficiaries aged >65 years, we conducted a retrospective cohort study of epilepsy incidence in 2019. Non-Hispanic Black and Hispanic beneficiaries were oversampled. We identified preexisting chronic conditions from the 2016-2018 Medicare Beneficiary Summary Files and compared chronic condition prevalence between Medicare beneficiaries with and without incident epilepsy in 2019. We characterized variations in preexisting excess chronic condition prevalence by age, sex, and race/ethnicity, adjusting for the racial/ethnic oversampling. RESULTS: We observed excess prevalence of most preexisting chronic conditions in beneficiaries with incident epilepsy (n = 20 545, weighted n = 19 631). For stroke, for example, the adjusted prevalence rate ratio (APRR) was 4.82 (99% CI:4.60, 5.04), meaning that, compared to those without epilepsy, beneficiaries with incident epilepsy in 2019 had 4.82 times the stroke prevalence. Similarly, beneficiaries with incident epilepsy had a higher prevalence rate for preexisting neurological conditions (APRR = 3.17, 99% CI = 3.08-3.27), substance use disorders (APRR = 3.00, 99% CI = 2.81-3.19), and psychiatric disorders (APRR = 1.98, 99% CI = 1.94-2.01). For most documented chronic conditions, excess prevalence among beneficiaries with incident epilepsy in 2019 was larger for younger age groups compared to older age groups, and for Hispanic beneficiaries compared to both non-Hispanic White and non-Hispanic Black beneficiaries. SIGNIFICANCE: Compared to epilepsy-free Medicare beneficiaries, those with incident epilepsy in 2019 had a higher prevalence of most preexisting chronic conditions. Our findings highlight the importance of health promotion and prevention, multidisciplinary care, and elucidating shared pathophysiology to identify opportunities for prevention.
Asunto(s)
Epilepsia , Medicare , Humanos , Anciano , Masculino , Femenino , Epilepsia/epidemiología , Prevalencia , Enfermedad Crónica/epidemiología , Estados Unidos/epidemiología , Anciano de 80 o más Años , Medicare/estadística & datos numéricos , Estudios Retrospectivos , Incidencia , Estudios de CohortesRESUMEN
PURPOSE OF THE RESEARCH: The geriatric population is the fastest-growing population in the United States and the impact of incident epilepsy on the cognitively intact geriatric population is not well-studied. Understanding how epilepsy affects the elderly is important to improve the quality of treatment and care for our aging population. This study sought to address the impact of incident epilepsy on the perceived Quality of Life (QOL) in cognitively intact elderly using the SF-36 questionnaire. METHODS: Nine hundred and twenty-seven participants were assessed from a community-based cohort. Based on a history of subsequent development of new-onset seizures, participants were divided into two groups, an incident seizure group that developed new-onset seizures after 65â¯years of age and the control group without incident seizures. Of this, six hundred eleven were analyzed with the SF-36 questionnaire after excluding for cognitive decline and inconsistent medical data. PRINCIPAL RESULTS: Statistically significant differences were found in 9 items on SF-36, involving perception of increased physical disability (pâ¯<â¯0.01; t-test), frailty (pâ¯<â¯0.04; t-test), emotional health limitations (pâ¯<â¯0.03; t-test), anxiety and sadness (pâ¯<â¯0.04; t-test), problems interfering with social activities (pâ¯<â¯0.0001; t-test). No between-group differences were found for demographic variables including age, education, gender, or minority status. Among the 611 subjects who remained cognitively normal across all longitudinal visits, 12 reported a history of new-onset seizures. Ten of these 12 subjects were seizure free as a result of treatment, with only 2 experiencing recent seizures. The incidence of seizures in our population was 300 per 100,000 person years. MAJOR CONCLUSIONS: This study identified the elderly population with incident epilepsy as a subgroup with an unmet health need, and healthcare professionals should address the potential impact of seizures with their geriatric patients to ensure comprehensive care.
Asunto(s)
Cognición , Epilepsia , Calidad de Vida , Convulsiones , Anciano , Estudios de Casos y Controles , Cognición/fisiología , Estudios de Cohortes , Epilepsia/epidemiología , Epilepsia/psicología , Humanos , Incidencia , Calidad de Vida/psicología , Convulsiones/epidemiología , Convulsiones/prevención & control , Encuestas y CuestionariosRESUMEN
The risk of seizure recurrence after a first unprovoked seizure is influenced by certain risk factors. To understand their effect in people with early diagnosed new epilepsy, we assessed the risk of recurrence of focal to bilateral tonic-clonic or generalized tonic-clonic seizures and the associated factors in a clinically well-characterized cohort of adults with a first unprovoked tonic-clonic seizure. We prospectively studied 150 consecutive adults with a first unprovoked tonic-clonic seizure and full clinical, EEG, and brain imaging assessment within the first four weeks. New epilepsy was diagnosed and classified according to the International League Against Epilepsy criteria. Time to second focal to bilateral tonic-clonic or generalized tonic-clonic seizure was analysed using the Kaplan-Meier method. Early diagnosis of new epilepsy, including type or syndrome and aetiology, was possible in 109 patients (72.7%). The diagnostic yield of sleep-deprived EEG was high in both genetic and non-genetic localized focal epilepsies. A second focal to bilateral tonic-clonic or generalized tonic-clonic seizure occurred in 100 patients (66.7%) during a three-year mean observation period. The risk was higher in non-genetic focal epilepsies and lower in genetic epilepsies. Concurrent absences or myoclonic seizures and a first occurrence after awakening were predictors of a second generalized tonic-clonic seizure in patients with genetic generalized epilepsy, while diagnosis of temporal or frontal lobe epilepsy, focal EEG discharges, and focal changes on brain imaging were related to an increased risk of focal to bilateral tonic-clonic seizure recurrence, showing additive effects. Identifiable modulators or triggers for the first tonic-clonic seizure, early treatment, and older age showed inverse association. The risk of a second generalized or focal to bilateral tonic-clonic seizure and the factors involved vary across epilepsy aetiologies and syndromes. Early diagnosis and classification of new epilepsy is possible in most patients and may enable important adjustments to their management and treatment.