Blog #166: POST-TRAUMATIC EPILEPSY IS ASSOCIATED WITH HIGHER RISK FOR DEMENTIA

 

 

 

 

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

 

 Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School

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.