Comorbidities to Consider in Epilepsy

Andrew N. Wilner, MD


December 26, 2012

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Welcome. I am Dr. Andrew Wilner, reporting for Medscape from the 66th American Epilepsy Society Annual Meeting in sunny San Diego, California. I would like to review just a few of the more interesting posters that were presented yesterday on comorbidities with epilepsy.

I had an opportunity to chat with my old friend, Dr. Alan Ettinger, an epileptologist at the Albert Einstein College of Medicine in New York, about his poster entitled "Attention Deficit Disorder Symptoms, Rates and Impact in Adults With Self-Reported Epilepsy: Results From the National Epidemiologic Survey of Epilepsy."[1] Attention-deficit/hyperactivity disorder (ADHD) symptoms have been associated with epilepsy in children, but this is the first study to demonstrate an association with ADHD symptoms in adults with epilepsy. In a large survey of 340,000 households, data were available for 1361 people with epilepsy who completed a self-report scale for ADHD; 18.4% of people with epilepsy had symptoms consistent with ADHD, much higher than would be expected in a normal population.

Those who reported symptoms consistent with ADHD had statistically significant differences in several measures: decreased quality of life; increased depression, as measured on the Patient Health Questionnaire (PHQ-9); and increased anxiety, as measured on the Generalized Anxiety Disorder Assessment (GAD-7). The group was also more likely to be rural, disabled, without full-time employment, making less than $30,000 per year, and younger than 30 years of age. All of these features were statistically significant. Interestingly, no gender differences were found. Although ADHD is more common in boys and children, this was not found in adults in this study. Dr. Ettinger emphasized that these participants did not have a formal diagnosis of ADHD but had symptoms consistent with that diagnosis. This study is important because ADHD symptoms can be treated and may be one way to improve the quality of life for some people with epilepsy.

The next poster was presented by Dr. Eva Andell Jason, a pediatrician from the Department of Women's and Children's Health at Karolinska University, Sweden. The study was entitled "Prevalence of Comorbidities at Onset of Unprovoked Seizures in Children -- a Report From Stockholm Incidence Register of Epilepsy."[2] The study population included 766 children with new-onset seizures. Of these, 247 children, or 32%, had 1 or more neurodevelopmental comorbidity at presentation or were diagnosed within 6 months. The most common neurodevelopmental comorbidities were mental retardation (16%), cerebral palsy (9%), and ADHD (6%), and some children had multiple comorbidities. This observation is important because it emphasizes that seizures are often not the only problem in children with epilepsy.

The next study has to do with weight change after seizure surgery. This poster, entitled "Does the Amygdala Play a Role in Weight Gain After Epilepsy Surgery? -- A Tertiary Care Center Experience", was presented by Dr. Rajasekaran, a neurology resident from West Virginia University.[3] Fifty-seven patients who had amygdalohippocampectomy for intractable epilepsy were evaluated. Of these, 35 patients had left-sided surgery and 22 had right-sided surgery. Those who had left-sided surgery tended to gain weight (an average of 11 lb), while those who had right-sided surgery tended to lose weight (an average of 15 lb). Over time, these differences did decrease. The difference in weight change between left- and right-sided surgery was not due to antiepileptic drugs, seizure freedom, or age. The amygdala's role in appetite is unclear. Lateralization regarding weight gain or weight loss is an interesting possibility to pursue.

The last study was entitled "Common Comorbidities in Women and Men With Epilepsy and the Relationship Between Number of Comorbidities and Health Plan Paid Costs in 2010."[4] I would like to present the results of my own research with my colleagues at Accordant Health Services in Greensboro, North Carolina. We reviewed claims data from 6621 commercially insured patients. About 50% of patients had at least 1 of 29 prespecified comorbidities. The top 4 comorbidities for men and women were psychiatric, hypertension, asthma, and hyperlipidemia. For those with no comorbidities, the claims per member per month were $439 for women and $403 for men. If there was just 1 comorbidity, the cost of care of tripled to $1245 for women and $1264 for men. This study emphasizes that comorbidities affect about half of the people with epilepsy and contribute significantly to the cost of care.

I think that is all we have time for today. Thank you for listening to this brief review of posters on comorbidities from the American Epilepsy Society Annual Meeting in San Diego, California.