The somatic comorbidity of epilepsy: A weighty but often unrecognized burden

Abstract

SUMMARYA range of medical and neurologic disorders occurs more frequently in people with epilepsy than in the general population and constitutes its somatic comorbidity. Common examples include cardiac, gastrointestinal, and respiratory disorders; stroke; dementia; and migraine. Alzheimer's disease and migraine are not only more common in epilepsy but are also risk factors for the development of seizures, suggesting a bidirectional association and shared disease mechanisms. Less well-appreciated associations with epilepsy include Parkinson's disease and obstructive sleep apnea. The association between epilepsy and other conditions can be due to a variety of interacting genetic, biologic, and environmental factors. We propose an etiologic classification of comorbidity into uncertain (coincidence or unknown), causal (cause), shared risk factors (common disease mechanisms or shared predisposing risk factors), and resultant (consequence). Co-occurrence of other conditions in a person with epilepsy can complicate diagnosis or have adverse prognostic implications. Management of these conditions may facilitate the treatment of epilepsy, as in the case of obstructive sleep apnea. The presence of somatic disorders in epilepsy is associated with increased health care needs, poorer health-related quality of life, and premature mortality. Prevention, identification, and adequate treatment of comorbid disorders in epilepsy should be an important part of epilepsy management at all levels of care.

Prevalence of cardiovascular risk factors in people with epilepsy

“…In our analysis, the lowest prevalence of CRF was associated with genetic etiology. A recent review (Gaitatzis et al., 2012) reported high prevalence of CRFs in PWE and suggested that this is more likely a cause than a result of epilepsy, as they increase the risk of stroke, which is a cause of epilepsy. In our initial analysis, structural and unknown etiology were associated with higher prevalence of all three risk factors, compared to genetic etiology.…”

“…A recent review of comorbidity in epilepsy (Gaitatzis, Sisodiya, & Sander, 2012) suggested a causal association with hypertension and diabetes, both of which are risk factors for stroke. As cerebrovascular disease accounts for approximately 30% of newly diagnosed epilepsy in adults (Hauser, Annegers, & Kurland, 1993), that could reflect the causal association between these risk factors and epilepsy.…”

Comorbidities of epilepsy: current concepts and future perspectives

“…20,21 A classifi cation scheme for the diff erent mechanisms of association between epilepsy and comorbid conditions has been presented previously. 3 Here, we build on this initial scheme and incorporate additional aspects, dividing the mechanisms of association into fi ve categories: chance and artifactual comorbidities, causative mechanisms, resultant mechanisms, shared risk factors, and bidirectional eff ects (fi gure 1).…”

“…1,2 Several large population-based studies report various conditions that are up to eight times more prevalent in people with epilepsy relative to the general population. 3,4 Appreciation of the relevance of these comorbidities is increasing because they aff ect epilepsy prognosis and quality of life. For example, migraine and psychiatric comorbidities are associated with poor seizure outcome, whereas depression has been linked with reduced quality of life.…”

Comorbidity and Childhood Epilepsy: A Nationwide Registry Study

“…2 -4 Consequently, these other conditions may precede, cooccur with, or follow the diagnosis of epilepsy. 2 Comorbid disorders contribute to the disease burden experienced by patients and their families and influence their quality of life and long-term outcome. 2 -11 Most studies of comorbidity in childhood epilepsy have focused on neurocognitive, behavioral, social, and psychiatric disorders or difficulties.…”