New-Onset Epilepsy Risk Factors in Older Veterans

Authors

  • Mary Jo V. Pugh PhD, RN,

    1. From the *Department of Veterans Affairs, South Texas Veterans Health Care System, Veterans Evidence-Based Research Dissemination Implementation Research Center, Health Services Research and Development Service, San Antonio, TexasDivision of Internal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TexasNew Mexico Veteran Health Care System, Albuquerque, New Mexico§Center for Health Quality, Outcomes and Economic Research, Bedford Veterans Affairs Hospital, Bedford, MassachusettsSchool of Public Health, Boston University, Boston, Massachusetts#Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania**Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania.
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  • Janice E. Knoefel MD,

    1. From the *Department of Veterans Affairs, South Texas Veterans Health Care System, Veterans Evidence-Based Research Dissemination Implementation Research Center, Health Services Research and Development Service, San Antonio, TexasDivision of Internal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TexasNew Mexico Veteran Health Care System, Albuquerque, New Mexico§Center for Health Quality, Outcomes and Economic Research, Bedford Veterans Affairs Hospital, Bedford, MassachusettsSchool of Public Health, Boston University, Boston, Massachusetts#Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania**Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania.
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  • Eric M. Mortensen MD, MSc,

    1. From the *Department of Veterans Affairs, South Texas Veterans Health Care System, Veterans Evidence-Based Research Dissemination Implementation Research Center, Health Services Research and Development Service, San Antonio, TexasDivision of Internal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TexasNew Mexico Veteran Health Care System, Albuquerque, New Mexico§Center for Health Quality, Outcomes and Economic Research, Bedford Veterans Affairs Hospital, Bedford, MassachusettsSchool of Public Health, Boston University, Boston, Massachusetts#Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania**Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania.
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  • Megan E. Amuan MPH,

    1. From the *Department of Veterans Affairs, South Texas Veterans Health Care System, Veterans Evidence-Based Research Dissemination Implementation Research Center, Health Services Research and Development Service, San Antonio, TexasDivision of Internal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TexasNew Mexico Veteran Health Care System, Albuquerque, New Mexico§Center for Health Quality, Outcomes and Economic Research, Bedford Veterans Affairs Hospital, Bedford, MassachusettsSchool of Public Health, Boston University, Boston, Massachusetts#Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania**Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania.
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  • Dan R. Berlowitz MD, MPH,

    1. From the *Department of Veterans Affairs, South Texas Veterans Health Care System, Veterans Evidence-Based Research Dissemination Implementation Research Center, Health Services Research and Development Service, San Antonio, TexasDivision of Internal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TexasNew Mexico Veteran Health Care System, Albuquerque, New Mexico§Center for Health Quality, Outcomes and Economic Research, Bedford Veterans Affairs Hospital, Bedford, MassachusettsSchool of Public Health, Boston University, Boston, Massachusetts#Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania**Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania.
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  • Anne C. Van Cott MD

    1. From the *Department of Veterans Affairs, South Texas Veterans Health Care System, Veterans Evidence-Based Research Dissemination Implementation Research Center, Health Services Research and Development Service, San Antonio, TexasDivision of Internal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TexasNew Mexico Veteran Health Care System, Albuquerque, New Mexico§Center for Health Quality, Outcomes and Economic Research, Bedford Veterans Affairs Hospital, Bedford, MassachusettsSchool of Public Health, Boston University, Boston, Massachusetts#Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania**Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania.
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Address correspondence to Mary Jo Pugh, South Texas Veterans Health Care System (VERDICT), Audie L. Murphy Division (11C6), 7400 Merton Minter Boulevard, San Antonio, TX 78229. E-mail: PughM@uthscsa.edu

Abstract

OBJECTIVES: To identify risk factors for new-onset geriatric epilepsy that may trigger clinicians to consider a differential diagnosis of epilepsy at symptom onset.

DESIGN: Retrospective cohort study.

SETTING: National Veterans Affairs (VA) databases.

PARTICIPANTS: Veterans aged 66 and older in fiscal year 2000 (FY00) who received VA care in FY99 and FY00. Individuals with new-onset epilepsy based on a validated algorithm constituted the epilepsy cohort (n=1,843), and individuals without epilepsy constituted the geriatric cohort (n=1,023,376).

MEASUREMENTS: Age, sex, and race were derived from VA databases. Clinical conditions associated with new-onset geriatric epilepsy (e.g., cerebrovascular disease, dementia, brain tumor) and stroke risk-factors (e.g., hypertension, diabetes mellitus, cardiovascular disease) were identified using validated International Classification of Diseases, Ninth Revision, Clinical Modification, codes before epilepsy onset (epilepsy cohort) and in FY00 (geriatric cohort).

RESULTS: Multivariable logistic regression analysis indicated that patients with cerebrovascular disease (odds ratio (OR)=3.50, 95% confidence interval (CI)=3.13–3.91), cerebrovascular disease and dementia (OR=4.14, 95% CI=3.46–4.96), brain tumor (OR=2.14, 95% CI=1.46–3.13), head injury (OR=2.11, 95% CI=1.41–3.14), and other central nervous system (CNS) conditions (OR=1.57, 95% CI=1.32–1.88) were more likely to experience new-onset epilepsy. Statin prescription (OR=0.64, 95% CI=0.56–0.73), older age (≥85 vs 66–74, OR=0.66, 95% CI=0.50–0.87), obesity (OR=0.74, 95% CI=0.62–0.87), and hypercholesterolemia (OR=0.87, 95% CI=0.76–0.98) were associated with a lower likelihood of epilepsy.

CONCLUSION: These data suggest greater epilepsy risk for older individuals with CNS insult and an additive effect of cerebrovascular disease and dementia. The statin finding requires further exploration but points to a possible target for prevention of geriatric epilepsy.

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