COMMENTARY

Comorbidities Common Even in Newly Diagnosed Epilepsy

Andrew N. Wilner, MD

Disclosures

November 29, 2016

Comorbidities in a Hong Kong Cohort

People with epilepsy have a higher prevalence of psychiatric and medical comorbid conditions than the general population.[1,2] Now a recent review of patients with newly diagnosed and treated epilepsy admitted to Hong Kong hospitals has revealed that even patients without a long history of epilepsy have increased morbidity and mortality.[3]

Chen and colleagues[3] took advantage of the fact that more than 90% of the Hong Kong population receives healthcare from a single public provider with an electronic database. They studied a population of 7461 patients (55% male) newly diagnosed with epilepsy who commenced antiepileptic drug treatment during hospitalization in a 5-year period (September 16, 2005 to September 15, 2010).

At baseline, more than half of the patients had 1 or more psychiatric (16.4%) or physical comorbidities (53%) or both (11%). The standardized hospital rate was 6.76 compared with the general population. Cerebrovascular disease was the most frequently recorded physical comorbidity, occurring in 78% of patients with a physical comorbidity. Epilepsy patients also had an increased risk of developing ischemic heart disease, expressed as a standardized incidence ratio (SIR) of 4.18. The SIR for cancer was elevated even after excluding central nervous system cancers (1.48). A striking 2166 (29%) patients died during the 5-year study. The standardized mortality ratio was highest in those with both psychiatric and physical comorbidities (6.47).

Discussion

This retrospective population study confirms the high frequency of psychiatric and/or physical comorbidities in people with epilepsy, which occurred in more than half of the population. These results are similar to our study of 6621 commercially insured patients, where 50% of women and 43% of men had one or more of 29 comorbidities.[4] The high frequency of cerebrovascular comorbidities and mortality reported by Chen and colleagues is likely related to the relatively older age of their patients (median age at onset, 60 years). In our study, the median age was 36 years, and the top medical comorbidities were hypertension, hyperlipidemia, and asthma.[4] Our population may not have had risk factors long enough to develop cerebrovascular disease.

The observations by Chen and colleagues emphasize the importance of comprehensive healthcare for people with epilepsy, even those who are newly diagnosed. In my practice, simple tools such as the Patient Health Questionnaire for depression and the Generalized Anxiety Disorder 7-item scale for anxiety help guide the need for psychiatric intervention. Routine blood pressure screening is part of every visit. Of course, neurologists must first target seizure control. However, addressing a patient's psychiatric and medical comorbidities may be at least as important for quality (and duration) of life!

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