Advertisement
Research Article| Volume 138, 108960, January 2023

Download started.

Ok

Comorbidities in newly diagnosed epilepsy: Pre-existing health conditions are common and complex across age groups

  • Anne M. McIntosh
    Correspondence
    Corresponding author at: 245 Burgundy St, Heidelberg, VIC 3084, Australia.
    Affiliations
    Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Australia

    The Melbourne Brain Centre, The Department of Medicine, The University of Melbourne, Melbourne, Australia

    The Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia

    Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Australia
    Search for articles by this author
  • Patrick W. Carney
    Affiliations
    Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Australia

    Florey Institute of Neuroscience and Mental Health, Australia

    Department of Medicine, Monash University, Australia

    Eastern Health, Australia
    Search for articles by this author
  • K. Meng Tan
    Affiliations
    The Melbourne Brain Centre, The Department of Medicine, The University of Melbourne, Melbourne, Australia

    The Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia

    Gold Coast University Medical Centre, QLD, Australia
    Search for articles by this author
  • Tahir M. Hakami
    Affiliations
    The Melbourne Brain Centre, The Department of Medicine, The University of Melbourne, Melbourne, Australia

    The Faculty of Medicine, Jazan University, Saudi Arabia
    Search for articles by this author
  • Piero Perucca
    Affiliations
    Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Australia

    The Melbourne Brain Centre, The Department of Medicine, The University of Melbourne, Melbourne, Australia

    The Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia

    Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Australia

    Department of Neurology, Alfred Health, Melbourne Australia

    Department of Neuroscience, Central Clinical School, Monash University, Australia
    Search for articles by this author
  • Author Footnotes
    1 These senior authors contributed equally.
    Patrick Kwan
    Footnotes
    1 These senior authors contributed equally.
    Affiliations
    The Melbourne Brain Centre, The Department of Medicine, The University of Melbourne, Melbourne, Australia

    The Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia

    Department of Neurology, Alfred Health, Melbourne Australia

    Department of Neuroscience, Central Clinical School, Monash University, Australia
    Search for articles by this author
  • Author Footnotes
    1 These senior authors contributed equally.
    Terence J. O'Brien
    Footnotes
    1 These senior authors contributed equally.
    Affiliations
    The Melbourne Brain Centre, The Department of Medicine, The University of Melbourne, Melbourne, Australia

    The Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia

    Department of Neurology, Alfred Health, Melbourne Australia

    Department of Neuroscience, Central Clinical School, Monash University, Australia
    Search for articles by this author
  • Author Footnotes
    1 These senior authors contributed equally.
    Samuel F. Berkovic
    Footnotes
    1 These senior authors contributed equally.
    Affiliations
    Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Australia

    Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Australia
    Search for articles by this author
  • Author Footnotes
    1 These senior authors contributed equally.
Published:November 22, 2022DOI:https://doi.org/10.1016/j.yebeh.2022.108960

      Highlights

      • We studied existing disorders in adults with a new diagnosis of epilepsy/seizures.
      • Forty percent of patients had a positive history, and 8 % reported >1 disorder.
      • Psychiatric (18%) and substance use (16%) disorders were most common.
      • Psychiatric and substance use disorders were most reported in those ≤65 years old.
      • Pre-existing health conditions were common and affected all age groups.

      Abstract

      Objectives

      People with epilepsy have a higher prevalence of medical and psychiatric comorbidities compared to the general population. Comorbidities are associated with poor epilepsy outcomes, and there have been recommendations for screening and early identification to improve clinical management. Data from ‘First Seizure Clinics’ (FSCs) with expert epileptological review can inform about disorders already present at the point of diagnosis of epilepsy or unprovoked seizures. Here, we aimed to describe pre-existing conditions with a focus on psychiatric, substance use, cardiac, neurological, and cancer health domains.

      Methods

      We included 1383 adults who received a new diagnosis of epilepsy or unprovoked seizures at Austin Hospital (AH) or Royal Melbourne Hospital (RMH) (Australia) FSCs from 2000 to 2010. Data were audited from FSC records, primarily detailed interviews undertaken by epileptologists. Logistic regression examined age distribution and other risk factors.

      Results

      The median age at FSC presentation was 37 years (IQR 26–53, range 18–94). Pre-existing conditions were reported by 40 %; from 32 % in the youngest group (18–30 years) to 53 % in the oldest (65+ years). Psychiatric (18 %) and substance use (16 %) disorders were most common, with higher prevalence among patients 18 to 65 years of age compared to those older than 65 years (p < 0.001). Cardiac, neurological, or cancer conditions were reported by 3–6 %, most often amongst those older than 65 years (p < 0.01). Eight percent (n = 112) reported disorders in >1 health domain. The commonest combination was a psychiatric condition with substance use disorder. Of the sixty-two patients reporting this combination, 61 were ≤65 years of age.

      Conclusions

      Pre-existing health conditions are present in a substantial proportion of patients diagnosed with epilepsy or unprovoked seizures. Disorders are highest amongst elders, but one-third of younger adults also reported positive histories. These are predominantly psychiatric and/or substance use disorders, conditions strongly associated with poor outcomes in the general population. These findings inform post-diagnosis planning and management, as well as research examining post-diagnostic outcomes and associations between comorbidities and epilepsy.

      Abbreviations:

      FSC (First Seizure Clinics (FSCs)), RMH (The Royal Melbourne Hospital (Australia)), AH (Austin Health (Australia)), IRSAD (The Index of Relative Socioeconomic Advantage and Disadvantage), ABS (Australian Bureau of Statistics)

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Epilepsy & Behavior
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Tellez-Zenteno J.F.
        • Matijevic S.
        • Wiebe S.
        Somatic comorbidity of epilepsy in the general population in Canada.
        Epilepsia. 2005; 46: 1955-1962
        • Gaitatzis A.
        • Carroll K.
        • Majeed A.
        • J ws.
        The epidemiology of the comorbidity of epilepsy in the general population.
        Epilepsia. 2004; 45: 1613-1622
        • Keezer M.R.
        • Sisodiya S.M.
        • Sander J.W.
        Comorbidities of epilepsy: current concepts and future perspectives.
        Lancet Neurol. 2016; 15: 106-115
        • Blank L.J.
        • Acton E.K.
        • Willis A.W.
        Predictors of mortality in older adults with epilepsy: implications for learning health systems.
        Neurology. 2021; 96: e93-e101
        • Cramer J.A.
        • Blum D.
        • Fanning K.
        • Reed M.
        The impact of comorbid depression on health resource utilization in a community sample of people with epilepsy.
        Epilepsy Behav. 2004; 5: 337-342
        • Fazel S.
        • Wolf A.
        • Langstrom N.
        • Newton C.R.
        • Lichtenstein P.
        Premature mortality in epilepsy and the role of psychiatric comorbidity: a total population study.
        Lancet. 2013; 382: 1646-1654
        • Gaitatzis A.
        • Sisodiya S.M.
        • Sander J.W.
        The somatic comorbidity of epilepsy: a weighty but often unrecognized burden.
        Epilepsia. 2012; 53: 1282-1293
        • Taylor R.S.
        • Sander J.W.
        • Taylor R.J.
        • Baker G.A.
        Predictors of health-related quality of life and costs in adults with epilepsy: a systematic review.
        Epilepsia. 2011; 52: 2168-2180
        • England M.J.
        • Liverman C.T.
        • Schultz A.M.
        • Strawbridge L.M.
        Epilepsy across the spectrum: promoting health and understanding: a summary of the Institute of Medicine report.
        Epilepsy Behav. 2012; 25: 266-276
        • Helmstaedter C.
        • Aldenkamp A.P.
        • Baker G.A.
        • Mazarati A.
        • Ryvlin P.
        • Sankar R.
        Disentangling the relationship between epilepsy and its behavioral comorbidities – the need for prospective studies in new-onset epilepsies.
        Epilepsy Behav. 2014; 31: 43-47
        • McIntosh A.M.
        • Tan K.M.
        • Hakami T.M.
        • Newton M.R.
        • Carney P.W.
        • Yang M.
        • et al.
        Newly diagnosed seizures assessed at two established first seizure clinics: Clinic characteristics, investigations, and findings over 11 years.
        Epilepsia Open. 2021; 6: 171-180
        • Medel-Matus J.S.
        • Orozco-Suarez S.
        • Escalante R.G.
        Factors not considered in the study of drug-resistant epilepsy: Psychiatric comorbidities, age, and gender.
        Epilepsia Open. 2021;
      1. Australian Institute of Health and Welfare. Australia's Health 2012. Australia’s health series no 13 AUS 156. Canberra: AIHW; 2012. https://www.aihw.gov.au/reports/australias-health/australias-health-2012/contents/table-of-contents [Date of access Jan 20th 2020].

        • Szaflarski M.
        Social determinants of health in epilepsy.
        Epilepsy Behav. 2014; 41: 283-289
        • Firkin A.L.
        • Marco D.J.
        • Saya S.
        • Newton M.R.
        • O'Brien T.J.
        • Berkovic S.F.
        • et al.
        Mind the gap: multiple events and lengthy delays before presentation with a “first seizure”.
        Epilepsia. 2015; 56: 1534-1541
        • Beghi E.
        • Carpio A.
        • Forsgren L.
        • Hesdorffer D.C.
        • Malmgren K.
        • Sander J.W.
        • et al.
        Recommendation for a definition of acute symptomatic seizure.
        Epilepsia. 2010; 51: 671-675
      2. World Health Organization (WHO). International Classification of Diseases and Related Health Problems 10th Revision. Chapter V Mental and behavioral disorders due to psychoactive substance use. 2019. https://icd.who.int/browse10/2016/en#/F10-F19 – ICD-10 Version:2016. [Access date Jan 1st 2021].

        • Hakami T.
        • McIntosh A.
        • Todaro M.
        • Lui E.
        • Yerra R.
        • Tan K.M.
        • et al.
        MRI-identified pathology in adults with new-onset seizures.
        Neurology. 2013; 81: 920-927
      3. Australian Institute of Health and Welfare. Australian Cancer Database (ACD) Australia: AIHW; 2021 [updated 04/13/2021. v43:[Available from: https://www.aihw.gov.au/about-our-data/our-data-collections/australian-cancer-database. [Access date: April 13th 2021].

      4. Australian Bureau of Statistics. 3415.0 - Migrant Data Matrices, June 2011. https://www.abs.gov.au/AUSSTATS/[email protected]/Lookup/3415.0Glossary1June+2011 [Access date 8/1/2018].

      5. Australian Bureau of Statistics. 2033.0.55.001- Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia - Data only, 2006. https://www.abs.gov.au/AUSSTATS/[email protected]/DetailsPage/2033.0.55.0012006?OpenDocument [Access date 03/02/2021].

      6. Australian Bureau of Statistics. 3303.0 - Causes of Death, Australia, 2017. Deaths due to harmful alcohol consumption in Australia. https://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/3303.0∼2017∼Main%20Features∼Deaths%20due%20to%20harmful%20alcohol%20consumption%20in%20Australia∼4 [Access July 21, 2021].

        • Rehm J.
        • Mathers C.
        • Popova S.
        • Thavorncharoensap M.
        • Teerawattananon Y.
        • Patra J.
        Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders.
        Lancet. 2009; 373: 2223-2233
      7. Australian Bureau of Statistics. 4362.0 - National Health Survey: Summary of Results; Victoria State Tables, 2004-05. https://www.abs.gov.au/AUSSTATS/[email protected]/DetailsPage/4362.02004-05?OpenDocument [Accessed 11 December 2020].

        • Kanner A.M.
        Depression in epilepsy: prevalence, clinical semiology, pathogenic mechanisms, and treatment.
        Biol Psychiatry. 2003; 54: 388-398
        • Hancock L.
        • Walsh R.
        • Henry D.A.
        • Redman S.
        • Sanson-Fisher R.
        Drug use in Australia: a community prevalence study.
        Med J Aust. 1992; 156: 759-764
      8. Begg S, Vos T, Barker B, Stevenson C, Stanley L, Lopez AD. The burden of disease and injury in Australia 2003. In: Welfare AIoHa, editor. Canberra, ACT 2007.

        • Roche A.
        • Kostadinov V.
        • Fischer J.
        • Nicholas R.
        Evidence Review: The social determinents of inequities in alcohol consumption and alcohol-related health outcomes.
        VicHealth, Victoria, Australia2015
      9. National Expert Advisory Committee on Alcohol. Alcohol in Australia: Issues and strategies. Australia: Commonwealth Department of Health and Aged Care; 2001. https://www.yumpu.com/en/document/read/44119075/alcohol-in-australia-issues-and-strategies-department-of-health-. [Access date October 10th 2021].

        • Grant B.F.
        • Goldstein R.B.
        • Saha T.D.
        • Chou S.P.
        • Jung J.
        • Zhang H.
        • et al.
        Epidemiology of DSM-5 alcohol use disorder: results from the national epidemiologic survey on alcohol and related conditions III.
        JAMA Psychiatry. 2015; 72: 757-766
        • Schmidt L.A.
        • Makela P.
        • Rehm J.
        • Room R.
        Alcohol: equity and social determinants.
        in: Blass E. Kurup A.S. Equity, social determinants and public health programs. World Health Organization, Geneva, Switzerland2010
        • Collins S.E.
        Associations between socioeconomic factors and alcohol outcomes.
        Alcohol Res. 2016; 38: 83-94
        • Savola O.
        • Niemelä O.
        • Hillbom M.
        Alcohol intake and the pattern of trauma in young adults and working aged people admitted after trauma.
        Alcohol and Acoholism. 2005; 40: 269-273
        • Sveinsson O.
        • Andersson T.
        • Mattsson P.
        • Carlsson S.
        • Tomson T.
        Clinical risk factors in SUDEP: a nationwide population-based case-control study.
        Neurology. 2020; 94: e419-e429
        • Scorzai C.A.
        • Cysneiros R.M.
        • Arida R.M.
        • Terra V.C.
        • Machado H.R.
        • de Almeida A.C.
        • et al.
        Alcohol consumption and sudden unexpected death in epilepsy: experimental approach.
        Arq Neuropsiquiatr. 2009; 67: 1003-1006
        • Bensken W.P.
        • Navale S.M.
        • Andrew A.S.
        • Jobst B.C.
        • Sajatovic M.
        • Koroukian S.M.
        Markers of quality care for newly diagnosed people with epilepsy on Medicaid.
        Med Care. 2021; 59: 588-596
        • Hitiris N.
        • Mohanraj R.
        • Norrie J.
        • Sills G.J.
        • Brodie M.J.
        Predictors of pharmacoresistant epilepsy.
        Epilepsy Res. 2007; 75: 192-196
      10. Australian Bureau of Statistics. 4362.0 - National Health Survey: Summary of Results; Victoria State Tables, 2007-08. https://www.abs.gov.au/ausstats/[email protected]/second+level+view?ReadForm&prodno=4362.0&viewtitle=National%20Health%20Survey:%20Summary%20of%20Results;%20State%20Tables∼2007-2008%20(Reissue)∼Latest∼02/09/2009&&tabname=Related%20Products&prodno=4362.0&issue=2007-2008%20(Reissue)&num=&view=& [Access date 5/9/2021].

        • Martin R.C.
        • Faught E.
        • Richman J.
        • Funkhouser E.
        • Kim Y.
        • Clements K.
        • et al.
        Psychiatric and neurologic risk factors for incident cases of new-onset epilepsy in older adults: data from U.S. Medicare beneficiaries.
        Epilepsia. 2014; 55: 1120-1127
        • Adelöw C.
        • Andersson T.
        • Ahlbom A.
        • Tomson T.
        Hospitalization for psychiatric disorders before and after onset of unprovoked seizures/epilepsy.
        Neurology. 2012; 78: 396-401
        • Hesdorffer D.C.
        • Hauser W.A.
        • Olafsson E.
        • Ludvigsson P.
        • Kjartansson O.
        Depression and suicide attempt as risk factors for incident unprovoked seizures.
        Ann Neurol. 2006; 59: 35-41
        • Hesdorffer D.C.
        • Hauser W.A.
        • Annegers J.F.
        • Cascino G.
        Major depression is a risk factor for seizures in older adults.
        Ann Neurol. 2000; 47: 246-249
        • Hesdorffer D.C.
        • Ishihara L.
        • Mynepalli L.
        • Webb D.J.
        • Weil J.
        • Hauser W.A.
        Epilepsy, suicidality, and psychiatric disorders: a bidirectional association.
        Ann Neurol. 2012; 72: 184-191
        • Seidenberg M.
        • Pulsipher D.T.
        • Hermann B.
        Association of epilepsy and comorbid conditions.
        Future Neurol. 2009; 4: 663-668
        • Alessi N.
        • Perucca P.
        • McIntosh A.M.
        Missed, mistaken, stalled: Identifying components of delay to diagnosis in epilepsy.
        Epilepsia. 2021; 62: 1494-1504
        • Giussani G.
        • Bianchi E.
        • Beretta S.
        • Carone D.
        • DiFrancesco J.C.
        • Stabile A.
        • et al.
        Comorbidities in patients with epilepsy: frequency, mechanisms and effects on long-term outcome.
        Epilepsia. 2021; 62: 2395-2404
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Elixhauser A.
        • Steiner C.
        • Harris D.R.
        • Coffey R.M.
        Comorbidity measures for use with administrative data.
        Med Care. 1998; 36: 8-27
        • St Germaine-Smith C.
        • Liu M.
        • Quan H.
        • Wiebe S.
        • Jette N.
        Development of an epilepsy-specific risk adjustment comorbidity index.
        Epilepsia. 2011; 52: 2161-2167
        • Keezer M.R.
        • Sander J.W.
        Comorbidity as an epidemiological construct.
        Lancet Neurol. 2016; 15: 32
        • Hesdorffer D.C.
        • Hauser W.A.
        • Annegers J.F.
        • Rocca W.A.
        Severe, uncontrolled hypertension and adult-onset seizures: a case-control study in Rochester.
        Minnesota Epilepsia. 1996; 37: 736-741
        • Ong M.S.
        • Kohane I.S.
        • Cai T.
        • Gorman M.P.
        • Mandl K.D.
        Population-level evidence for an autoimmune etiology of epilepsy.
        JAMA Neurol. 2014; 71: 569-574