Epilepsy in Elderly Could Signal Increased Stroke Risk

March 17, 2017

HOUSTON, Texas — Elderly patients with seizures have an increased risk for future stroke, a new study has found.

 "We found elderly patients with epilepsy had a much greater burden of comorbid vascular disease and risk factors, such as hypertension, atrial fibrillation, peripheral vascular disease, and coronary artery disease, than the general population," said Matthew Mercuri, MD, Weill Cornell Medicine, New York City, New York. They also had an increased risk for ischemic stroke.

"Our conservative conclusion is that epilepsy in elderly patients signifies hidden cerebrovascular disease," Dr Mercuri said. "We suggest that cerebrovascular disease may cause seizures, and even if a patient hasn't had an overt cerebrovascular event they may have silent vascular disease, which may cause a seizure. I think we should regard seizures as a warning of future stroke risk."

He added: "If an older patient presents with seizures, I think we should consider their stroke risk and use this as an opportunity to control risk factors such as blood pressure, cholesterol, atrial fibrillation, and smoking. This is probably something most doctors wouldn't think of at present."

The study was presented here at the recent International Stroke Conference (ISC) 2017.

Seizures and Stroke

Dr Mercuri explained that vascular brain injury can result in epilepsy, so he and his colleagues wondered whether there was a link between seizures and stroke.

To look for such a link, they examined inpatient and outpatient claims data from 2008 to 2014 on a 5% sample of Medicare beneficiaries 66 years of age or over.  

They used epilepsy, defined as two or more inpatient or outpatient claims with a diagnosis of seizure, as the predictor variable and stroke or acute myocardial infarction (MI) as the primary outcome.

Survival statistics and Cox proportional hazards models were used to assess the relationship between epilepsy and incident ischemic stroke or MI while adjusting for demographic characteristics and vascular risk factors.

Results showed that among 1,548,556 beneficiaries with a mean follow-up of 4.4 years, 15,055 (1.0%) developed epilepsy and 121,866 (7.9%) experienced an ischemic stroke or acute MI.

Patients with seizures were older (76.1 vs 73.7 years) and had a significantly higher burden of vascular comorbidities than the remainder of the cohort.

The annual incidence of stroke or acute MI was 3.28% (95% confidence interval [CI], 3.10% - 3.47%) in those with seizures vs 1.79% (95% CI, 1.78% - 1.80%) in those without (unadjusted hazard ratio [HR], 1.89; 95% CI, 1.78 - 2.00).

After adjustment for demographics and risk factors, epilepsy had a weak association with the composite outcome (adjusted HR, 1.36; 95% CI, 1.29 - 1.44), a stronger association with ischemic stroke (adjusted HR, 1.77; 95% CI, 1.65 - 1.90), and no association with acute MI (adjusted HR, 0.95; 95% CI, 0.86 - 1.04).

International Stroke Conference (ISC) 2017. Abstract 140. Presented February 23, 2017.

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