Prevalence of various risk factors associated with new‐onset epilepsy after the age of 50: a retrospective population‐based study

Abstract

Objective. Population‐based studies of epilepsy risk factors are rare. We aimed to evaluate the prevalence of various risk factors associated with new‐onset epilepsy after the age of 50 years. We included all incident cases in North Macedonia between 2015 and 2018. Methods. Study participants were ascertained from the national healthcare platform. We performed a retrospective analysis of Electronic Health Records of 2,367 patients (1,017 females and 1,350 males) whose epileptic seizures started after the age of 50 years. Patients were stratified into 10‐year age groups. Results. The most common risk factor for new‐onset epilepsy in our cohort was stroke, which was associated with new‐onset epilepsy in 20% of patients aged 50‐59 years and almost 50% of patients aged 70‐79 years. The second most frequent risk factor was neoplasm in patients aged 50‐69 years and dementia in patients older than 70 years. The other pre‐existing conditions included: metabolic disorders, traumatic brain injury, and postencephalitic and inflammatory diseases. Chronic alcoholism was the most common metabolic risk factor associated with new‐onset epilepsy and accounted for 84% of cases in this subgroup. Only metabolic disorders were significantly more frequent in males than in females (p<0.00001). We did not identify any epilepsy risk factor in 967 patients (41%). Systemic vascular risk factors were frequent in our cohort: 1,574 patients had hypertension (66%) and 449 patients had diabetes (19%), and 339 had both conditions (14%). Significance. We found that structural lesions were the most prevalent risk factor associated with new‐onset epilepsy in middle‐aged and elderly patients. Recognition of possibly modifiable factors associated with late‐onset epilepsy could have a positive impact on reducing the risk of developing epilepsy.

Seizure remissions and cycles in pediatric focal epilepsy

“…Also, to date, seizure cycles have not been systematically related to a specific epileptogenic pathology, although relapsing-remitting courses have been previously reported in association with focal cortical dysplasia (FCD). 2,3 Saito et al address some of these issues in a retrospective cohort study with 291 children who underwent resective surgery for focal epilepsy. 4 Based on longitudinal seizure diaries completed by caregivers, a 'periodic seizure cycle' corresponded to ≥2 occurrences of clustering (≥5 seizures/day for ≥1 week), followed by the absence of seizures for ≥1 week.…”

“…How many seizure chronotypes exist in adult and pediatric focal and generalized epilepsy has not yet been fully elucidated, mainly due to the historical lack of long data from large and well‐characterized cohorts. Also, to date, seizure cycles have not been systematically related to a specific epileptogenic pathology, although relapsing–remitting courses have been previously reported in association with focal cortical dysplasia (FCD) 2, 3 …”

“…All types of Mendelian inheritance have been described, and numerous de novo genetic variants have been reported as well. 2 HSPs have historically been under-and misdiagnosed for many years, a situation exacerbated by the high cost and limited availability of genetic testing in the past. However, since the advent of whole exome and whole genome sequencing, more causative genes have been identified and genetic testing has become more affordable and accessible, substantially improving diagnostic accuracy.…”

Fractures in people with epilepsy: A nationwide population‐based cohort study

“…[6][7][8][9][10] A significant portion of PWE have various comorbidities, which may additionally increase the risk of falling and injury. [11][12][13][14] Therefore, PWE are more likely to suffer a serious fracture than the general population. However, despite possible debilitating consequences, little is known regarding the frequency, age and gender predominance, and locations of bone fractures in PWE.…”

“…Furthermore, chronic antiseizure medication (ASM) treatment impedes bone metabolism, which increases bone fragility and elevates fragility fracture risk 6–10 . A significant portion of PWE have various comorbidities, which may additionally increase the risk of falling and injury 11–14 . Therefore, PWE are more likely to suffer a serious fracture than the general population.…”