Comorbidities in patients with epilepsy: Frequency, mechanisms and effects on long‐term outcome

Abstract

To assess frequency, types, and mechanisms of comorbidities in people with epilepsy and verify their association with disease features and outcome. Methods: This cohort study was performed in 13 Italian epilepsy centers with nationwide distribution and accurate records. Eligible patients were children and adults diagnosed before December 31, 2005, and followed for a minimum of 10 years. Two pairs of raters independently reviewed patients' records and classified each comorbidity. In case of disagreement, a third reviewer made the final decision. Comorbidities were classified according to type (organ/system) and underlying mechanism (causal, shared risk factors, chance association). Comorbidity types and mechanisms were described in the entire sample and according to epilepsy prognostic patterns (sustained remission, relapsing-remitting course, no remission). Results: Of 1006 included patients, 266 (26.4%) had at least one comorbidity. The most common were developmental/perinatal (7.5% of cases), psychiatric (6.2%), cardiovascular (5.3%), and endocrine/metabolic (3.8%). Among 408 reported comorbidities, the underlying mechanisms were, in decreasing order, chance association (42.2%), shared risk factors (31.1%), and causal (26.7%). Psychiatric diseases were present in 13.3% of patients with no remission, 5.9% of patients with relapsingremitting course, and 4.8% of patients with sustained remission (p = .016). The corresponding numbers for endocrine/metabolic diseases were respectively, 9.6%, 3.4%, and 2.9% (p = .013); for respiratory diseases were 3.6%, .3%, and .3% (p = .001), and for urogenital diseases were 3.6%, .7%, and 1.6% (p = .048). The association of endocrine/metabolic, psychiatric, and respiratory comorbidities with epilepsy prognosis was confirmed by multivariable analysis adjusted for the main demographic and

Prevalence of self‐reported emotional, physical, and sexual abuse and association with fear of childbirth in pregnant women with epilepsy: The Norwegian Mother, Father, and Child Cohort Study

“…The association between having experienced abuse or fear of childbirth and the consequences for pregnancy outcomes have not been examined previously in women with epilepsy. Several studies have found that women with epilepsy who experience abuse more often have depression and anxiety disorders, including postpartum depression 5,6,18 . Based on our findings, clinicians treating women with epilepsy should be aware of the increased risk of abuse associated with this disorder.…”

“…Several studies have found that women with epilepsy who experience abuse more often have depression and anxiety disorders, including postpartum depression. 5,6,18 Based on our findings, clinicians treating women with epilepsy should be aware of the increased risk of abuse associated with this disorder.…”

“…People with epilepsy have increased rates of anxiety and depressive disorders compared to the general population 1,5 . One study found that people with epilepsy report more sexual abuse and more discrimination than the general population 6 .…”

“…1,2 People with epilepsy have increased rates of anxiety and depressive disorders compared to the general population. 1,5 One study found that people with epilepsy report more sexual abuse and more discrimination than the general population. 6 Sexual abuse, domestic violence, and discrimination were associated with anxiety and depressive disorders in this group.…”

A complex systems view on the current hypotheses of epilepsy pharmacoresistance

“…A prospective study (5‐10‐year follow‐up) reported that comorbid migraine had a negative effect on the prognosis of epilepsy, in which patients that were diagnosed with both epilepsy and migraine had a higher incidence of intractable epilepsy and a significantly lower probability of being seizure‐free over 10 years when compared with the epilepsy without migraine group 116 . A cohort study performed in 13 Italian epilepsy centers reported an inverse association between the degree of seizure control and psychiatric comorbidities, as well as endocrine/metabolic, and respiratory disorders 117 . Taken together, these reports present a strong association between comorbidities and DRE (Figure 2B).…”