Abstract
Background and ObjectivesLate-onset epilepsy (LOE; i.e., epilepsy starting in later adulthood) affects a significant number of individuals. Head injury is also a risk factor for acquired epilepsy, but the degree to which prior head injury may contribute to LOE is less well understood. Our objective was to determine the association between head injury and subsequent development of LOE.MethodsIncluded were 8,872 participants enrolled in the Atherosclerosis Risk in Communities (ARIC) study with continuous Centers for Medicare Services fee-for-service (FFS) coverage (55.1% women, 21.6% Black). We identified head injuries through 2018 from linked Medicare fee for service claims for inpatient/emergency department care, active surveillance of hospitalizations, and participant self-report. LOE cases through 2018 were identified from linked Medicare FFS claims. We used Cox proportional hazards models to evaluate associations of head injury with LOE, adjusting for demographic, cardiovascular, and lifestyle factors.ResultsThe adjusted hazard ratio (HR) for developing LOE after a history of head injury was 1.88 (95% confidence interval [CI] 1.44-2.43). There was evidence for dose-response associations with greater risk for LOE with increasing number of prior head injuries (HR 1.37, 95% CI 1.01-1.88 for 1 prior head injury and HR 3.55, 95% CI 2.51-5.02 for 2+ prior head injuries, compared to no head injuries) and with more severe head injury (HR 2.53, 95% CI 1.83-3.49 for mild injury and HR 4.90, 95% CI 3.15-7.64 for moderate/severe injury, compared to no head injuries). Associations with LOE were significant for head injuries sustained at older age (age ≥67 years: HR 4.01, 95% CI 2.91-5.54), but not for head injuries sustained at younger age (age < 67 years: HR 0.98, 95% CI 0.68-1.41).DiscussionHead injury was associated with increased risk of developing LOE, particularly when head injuries were sustained at an older age, and there was evidence for higher risk for LOE after a greater number of prior head injuries and after more severe head injuries.Classification of EvidenceThis study provides Class I evidence that an increased risk of late-onset epilepsy is associated with head injury and that this risk increases further with multiple and more severe head injuries.
| Original language | English |
|---|---|
| Pages (from-to) | E808-E817 |
| Journal | Neurology |
| Volume | 98 |
| Issue number | 8 |
| DOIs | |
| State | Published - Feb 22 2022 |
Bibliographical note
Publisher Copyright:© American Academy of Neurology.
Funding
The Atherosclerosis Risk in Communities study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, NIH, Department of Health and Human Services, under contracts HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, and HHSN268201700005I. Neurocognitive data were obtained by grants U01 HL096812, U01 HL096814, U01 HL096899, U01 HL096902, and U01 HL096917 from the National Heart, Lung, and Blood Institute, with funding also provided by the National Institute of Neurological Disorders and Stroke and National Institute on Aging. This study was also supported by contract K24 AG052573 (Dr. Gottesman) from the National Institute on Aging, K23 AG063899 (Dr. Johnson) from the National Institute on Aging, and W81XWH-21-1-0590 (Dr. Schneider) from the Department of Defense.
| Funders | Funder number |
|---|---|
| National Institutes of Health (NIH) | |
| U.S. Department of Defense | |
| U.S. Department of Health and Human Services | U01 HL096814, U01 HL096902, U01 HL096899, U01 HL096812, HHSN268201700003I, HHSN268201700004I, HHSN268201700005I, U01 HL096917, HHSN268201700001I, HHSN268201700002I |
| National Institute on Aging | K23 AG063899, W81XWH-21-1-0590, K24 AG052573 |
| National Heart, Lung, and Blood Institute (NHLBI) | U01HL096902 |
| National Institute of Neurological Disorders and Stroke |
ASJC Scopus subject areas
- Clinical Neurology