Epilepsy is a condition in which a person suffers from unprovoked seizures. It is a common condition affecting 1 out of every 100 people in the United Kingdom (UK). However, epilepsy is not as common as other diseases, such as heart disease or diabetes, making it a challenge to study using traditional methods with small numbers of patients. This is problematic since the disease is estimated to cost over £2 billion annually in the UK. Epilepsy is also associated with a greater risk of certain other illnesses and death.
The risk of epilepsy in the elderly has almost tripled over the past 40 years yet this population remains understudied compared to other age groups. Previous studies have suggested a link between epilepsy, heart disease, osteoporosis, mental health issues, and death. The risk of these conditions may be even higher for the elderly with epilepsy. However, the overall number of people with elderly with epilepsy makes it difficult recruit sufficient patients to draw precise conclusions. We propose comprehensively examining the risk of other physical and mental disorders, and death, in the elderly with epilepsy using large, linked electronic health records to improve care for this vulnerable and disadvantaged population.
The incidence of epilepsy has almost quintupled over the past 40 years likely due to longer lifespans and the consequent accumulation of medical conditions that predispose to recurrent seizures. Despite this, epilepsy in the elderly remains a remarkably underexplored condition. Epilepsy itself is associated with increased risks for heart disease, osteoporosis, mental health disorders, and death. These risks are reasonably expected to be even higher for the elderly. Hence, we propose using age 65, a data-driven empirical definition of elderly with epilepsy, to study this issue. Multiple analyses will be performed on independent cohorts. First, we will isolate all those over the age 65 and perform multivariate Cox regression analyses, using epilepsy diagnosis as the exposure and treating it as a time-varying covariate, to determine the hazard of a variety of somatic and psychiatric conditions in relation to incident epilepsy. We will then replicate this analysis using all-cause and cardiac-specific death as outcomes controlling for known confounders and the potential effect of enzyme-inducing antiepileptic drugs. We will then perform similar analyses, using age 65 as the index date, to determine the influence of prevalent epilepsy (accumulated risk) on the same outcomes and mortality.
Colin Josephson - Chief Investigator - O'Brien Institute for Public Health & Hotchkiss Brain Institute
Colin Josephson - Corresponding Applicant - O'Brien Institute for Public Health & Hotchkiss Brain Institute
Ana Subota - Collaborator - University of Calgary
Arturo Gonzalez-Izquierdo - Collaborator - University College London ( UCL )
Jordan Engbers - Collaborator - Desid Labs, Inc.
Maria Pikoula - Collaborator - University College London ( UCL )
Mark Keezer - Collaborator - Centre Hospitalier de l'Universite de Montreal
Marta Berglund - Collaborator - University College London ( UCL )
Nathalie Jette - Collaborator - University of Calgary
Samuel Wiebe - Collaborator - University of Calgary
Spiros Denaxas - Collaborator - University College London ( UCL )
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation