Johnson EL, et al. - In this cohort study involving 10,420 adults, researchers investigated the midlife vascular and lifestyle risk factors for late-onset epilepsy. Outcomes suggested an association of hypertension, diabetes, smoking, APOE ε4 allele number, activity level, and alcohol use with late-onset epilepsy. They found that stroke and dementia were associated with late-onset epilepsy; however, vascular and lifestyle risk factors remained significant, even in the absence of stroke or dementia.

Methods

• The Atherosclerosis Risk in Communities (ARIC) study was a multicenter prospective cohort study involving 15,792 participants.
• Participants were followed up 1987-1989 with in-person visits, telephone calls, and surveillance of hospitalizations (10,974 invited without completing enrollment).
• For ARIC, participants were selected from four US communities.
• For this study, researchers included 10,420 black or white participants with ≥ 2 years of Medicare fee-for-service coverage and without missing baseline data.
• Data analysis was performed from April 2017 and May 2018.
• In multivariable survival models including demographics, vascular risk factors, and lifestyle risk factors, they evaluated demographic, vascular, lifestyle, and other possible epilepsy risk factors measured at baseline (age 45-64 years).
• They assessed time to development of late-onset epilepsy (≥ 2 International Classification of Diseases, Ninth Revision codes for epilepsy or seizures starting at age ≥ 60 years in any claim [hospitalization or outpatient Medicare through 2013]), with first code for seizures after ≥ 2 years without code for seizures as main outcomes and measures.

Results

• Of the 10,420 participants, 596 participants developed late-onset epilepsy.
• Researchers noted higher incidence in black vs white participants.
• In multivariable analysis, an increased risk of late-onset epilepsy was evident in correlation with baseline hypertension, diabetes, smoking, apolipoprotein E ε4 genotype, and incident stroke and dementia, while lower risk was evident in correlation with higher levels of physical activity and moderate alcohol intake.
• After censoring individuals with stroke or dementia, similar results were noted.