As
I have written in earlier monthly blogs, most people are surprised to learn
that the commonest onset of epilepsy is in the older age-group and not in the pediatric
population Why? We are living longer.
The
epilepsy population is one percent of all people. In only half of these people
can a cause for their epilepsy be identified. In the other half no cause can be
found, in other words, these people have idiopathic epilepsy. In those for whom
a cause can be identified, they have what is called symptomatic epilepsy. Usually,
the cause is a structural abnormality in the brain associated with scars from
trauma, scars from strokes, brain tumors, brain infections, abnormal blood
vessels etc.
This
blog highlights a summary edited by Susan Kreimer in the Neurology Today
April 4, 2024, issue. It addresses the higher incidence of dementia in those
with post-traumatic epilepsy1. Post-traumatic epilepsy (PTE) is
associated over a 25-year follow-up of developing dementia compared with
epilepsy without a history of head trauma. A combination of epilepsy and head
injury places the person at an increased risk of developing dementia.
Although
some patients experiencing significant head injury are placed on anticonvulsant
medications even before a seizure occurs, usually for short periods, as seizure
prophylaxis, this has not been found to alter the risk of eventually developing
PTE. Even mild traumatic brain injury can result in PTE up to a year after the
head injury.
Researchers
collected 12,558 individuals aged 45-64. The average age at baseline was 54
years. Nearly 58% were female and 28% were Black. Of this group 14.4 reported
past head injury, 5.1% had seizure/epilepsy and 1.2 % had PTE. After follow-up
spanning a median of 25 years, 19.9 of the participants developed dementia.
Dementia risk factors may vary among population subgroups. The researchers
adjusted for vascular and genetic risk factors.
Approximately
5-8% of the American population over 65 has dementia. Neurologists are
encouraged to have a lower threshold to suspect cognitive impairment and
dementia in their patients with PTE. Screen the patients themselves rather than
rely on reports of caregivers to identify such patients for greater diagnostic
accuracy. Have them undergo neuropsychological testing to confirm dementia if
it appears.
We
conclude that being aware of this group of PTE patients and of assessing them periodically
for their higher risk of developing dementia can lead to better health
outcomes.
1)
Schneider
KCA, Law CA, Gottesman RF et. al. Post-traumatic
Epilepsy and dementia risk. JAMA Neurol 2024; Epub 2024 Feb 26
of
Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is
told
from a mother’s point of view. “DINGS” is his first novel. Aside from
acclamation
on
internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review,
DINGS
has been advertised in recent New York Times Book Reviews, the Los Angeles
Times
Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now
available
in eBook, audiobook, soft and hard cover editions.
