Association of Epilepsy and Comorbid Conditions

Abstract

Comorbid health conditions are common among people with epilepsy. Proposed explanations for this association include the possibility that first, epilepsy (including its treatment) causes the comorbid condition; second, the comorbid condition (including its treatment) causes epilepsy; or third, a common pathogenic mechanism mediates the co-occurrence of epilepsy and the comorbid condition. It is unlikely that a single explanation will suffice for all of the epilepsy comorbid conditions. Determining the basis of the association between epilepsy and its comorbid conditions has important implications for diagnosis and management. In this paper, we discuss this issue in the context of five common epilepsy comorbid conditions: bone health and fractures, stroke, depression, migraine and attention-deficit hyperactivity disorder. Current findings, research limitations and future directions of research efforts are discussed. KeywordsADHD; bone health; causal models; comorbidity; depression; epilepsy; migraine; risk factors; stroke Comorbidity refers to the co-occurrence of two conditions with a greater frequency than found in the general population [1,2]. Comorbid conditions are common in people with epilepsy, and their presence has important implications for diagnosis, treatment, medical costs and quality of life [3][4][5]. Comorbid conditions in epilepsy are found across the lifespan, and include medical, psychiatric and cognitive conditions alone or in combination. In 2003, Boro and Haut succinctly summarized the problem of comorbidity in epilepsy: "Nearly every patient with †Author for correspondence:

Health-care costs and utilization related to long- or short-acting antiepileptic monotherapy use

“…Epilepsy-related health-care costs in our study accounted for b 40% of total observed health-care costs, which suggests that comorbid conditions may be costly and/or that epilepsy-related health-care utilization was underidentified. Timely surveillance and treatment of comorbid conditions in adults with epilepsy are important because co-occurring conditions can be the cause of seizures (e.g., cerebrovascular disease) or can be exacerbated by epilepsy (e.g., neurodegenerative diseases), and poor control of comorbidities may further complicate the overall management of the disease, leading to an increased economic burden [1,[17][18][19][20].…”

Attention Deficit Hyperactivity Disorder: Comorbidities, Emphasis on Concurrence With Epilepsy

“…В целом у детей с эпилепсией распространенность сопутствующих заболеваний, в том числе различных нейропсихиатрических нарушений, значительно вы-ше, чем у здоровых детей [32,33,57,61,64]. По мне-нию авторов, СДВГ и другие психиатрические рас-стройства, такие как расстройства настроения, тревожные расстройства и психотические заболева-ния, -наиболее распространенные сопутствующие заболевания у пациентов с эпилепсией.…”

“…По мнению М. Seidenberg et al (2009), связь между эпилепсией и сопутствующим заболеванием можно рассматривать в трех плоскостях [64]. Эпилепсия (или ее лечение) может стать причиной сопутствую-щего заболевания, а сопутствующее заболевание (или его лечение) может стать причиной эпилепсии.…”

Epilepsy and Aging

“…Because it can be dif fi cult for physicians to differentiate seizures from various other conditions, neuropsychologists are likely to evaluate patients who have not yet received a de fi nitive diagnosis. It also is important to keep in mind that two different disorders may coexist in the same patient [ 65 ] .…”