Bidirectional relation between schizophrenia and epilepsy: A population-based retrospective cohort study

Authors

  • Yu-Tzu Chang,

    1. Division of Pediatric Neurology, Department of Pediatrics, China Medical University and Hospital, Taichung, Taiwan
    2. China Medical University, Taichung, Taiwan
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  • Pei-Chun Chen,

    1. Management Office for Health Data, China Medical University and Hospital, Taichung, Taiwan
    2. Department of Public Health, China Medical University and Hospital, Taichung, Taiwan
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  • I-Ju Tsai,

    1. Management Office for Health Data, China Medical University and Hospital, Taichung, Taiwan
    2. Department of Public Health, China Medical University and Hospital, Taichung, Taiwan
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  • Fung-Chang Sung,

    1. Management Office for Health Data, China Medical University and Hospital, Taichung, Taiwan
    2. Department of Public Health, China Medical University and Hospital, Taichung, Taiwan
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  • Zheng-Nan Chin,

    1. Division of Pediatric Neurology, Department of Pediatrics, China Medical University and Hospital, Taichung, Taiwan
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  • Huang-Tsung Kuo,

    1. Division of Pediatric Neurology, Department of Pediatrics, China Medical University and Hospital, Taichung, Taiwan
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  • Chang-Hai Tsai,

    1. Division of Pediatric Neurology, Department of Pediatrics, China Medical University and Hospital, Taichung, Taiwan
    2. Department of Healthcare Administration, Asia University, Taichung, Taiwan
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  • I-Ching Chou

    1. Division of Pediatric Neurology, Department of Pediatrics, China Medical University and Hospital, Taichung, Taiwan
    2. Department of Healthcare Administration, Asia University, Taichung, Taiwan
    3. Graduate Institute of Integrated Medicine, China Medical University College of Chinese Medicine, Taichung, Taiwan
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  • Drs. Chen and Chou contributed equally to this work.

Address correspondence to I-Ching Chou, Division of Pediatric Neurology, Department of Pediatrics, Children’s Medical Center, China Medical University Hospital, No. 2, Yuh-Der Road, North District, Taichung 40402, Taiwan. E-mail: iching@mail.cmuh.org.tw. Pei-Chun Chen, Ph.D. MSPH, Department of Public Health, China Medical University and Hospital, No. 091, Hsueh-Shih Road, Taichung 40442, Taiwan. E-mail: tw.mohd@gmail.com

Summary

Purpose:  Schizophrenia and epilepsy may share a mutual susceptibility. This study examined the bidirectional relation between the two disorders.

Methods:  We used claims data obtained from the Taiwan National Health Insurance database to conduct retrospective cohort analyses. Analysis 1 compared 5,195 patients with incident schizophrenia diagnosed in 1999–2008 with 20,776 controls without the disease randomly selected during the same period, frequency matched with sex and age. Analysis 2 comprised a similar method to compare 11,527 patients with newly diagnosed epilepsy with 46,032 randomly selected sex- and age-matched controls. At the end of 2008, analysis 1 measured the incidence and risk of developing epilepsy and analysis 2 measured the incidence and risk of developing schizophrenia.

Key Findings:  In analysis 1, the incidence of epilepsy was higher in the schizophrenia cohort than in the nonschizophrenia cohort (6.99 vs. 1.19 per 1,000 person-years) with an adjusted hazard ratio (aHR) of 5.88 [95% confidence interval (CI) 4.71–7.36] for schizophrenia patients. In analysis 2, the incidence of schizophrenia was higher in the epilepsy cohort than in the nonepilepsy comparison cohort (3.53 vs. 0.46 per 1,000 person-years) with an aHR of 7.65 (95% CI 6.04–9.69) for epilepsy patients. The effect of schizophrenia on subsequent epilepsy was greater for women, but the association between epilepsy and elevated incidence of schizophrenia was more pronounced in men.

Significance:  We found a strong bidirectional relation between schizophrenia and epilepsy. These two conditions may share common causes. Further studies on the mechanism are required.

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