Epilepsy Among Iraq and Afghanistan War Veterans — United States, 2002–2015

Pugh, Mary Jo; Cott, Anne C. Van; Amuan, Megan E.; Baca, Christine B.; Rutecki, Paul; Zack, Matthew M.; Kobau, Rosemarie

doi:10.15585/mmwr.mm6544a5

Cited by 11 publications

(13 citation statements)

References 9 publications

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“…A complete description of the algorithm is detailed elsewhere. [16][17][18][19] Briefly, the algorithm requires ICD-9-CM diagnosis code(s) indicative of epilepsy (345) or convulsion (780.39) and subsequent/concomitant use of ASM. We included individuals whose only ASM was gabapentin/pregabalin only if they had a 345 (epilepsy specific) diagnosis.…”

Section: Cohort Developmentmentioning

confidence: 99%

Multimodal Quality of Life Assessment in Post-9/11 Veterans With Epilepsy

et al. 2022

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Background and Objectives:Epilepsy is defined by the occurrence of multiple unprovoked seizures, but quality of life (QOL) in people with epilepsy is determined by multiple factors, in which psychiatric comorbidities play a pivotal role. Therefore, understanding the interplay between comorbidities and QOL across epilepsy phenotypes is an important step towards improved outcomes. Here, we report the impact of QOL across distinct epilepsy phenotypes in a cohort of post-9/11 veterans with high rates of traumatic brain injury (TBI).Methods:This observational cohort study from the Veterans Health Administration included post-9/11 Veterans with epilepsy. A process integrating an epilepsy identification algorithm, chart abstraction, and self-reported measures was used to classify patients into one of four groups: 1. Epilepsy controlled with medications, 2. Drug resistant epilepsy (DRE), 3. Post-traumatic epilepsy (PTE), or 4. Drug resistant post-traumatic epilepsy (PT-DRE). Summary scores for six QOL measures were compared across the groups, adjusting for age, sex, and number of comorbidities.Results:A total of 529 survey respondents with epilepsy were included in the analysis: 249 controls (i.e., epilepsy without DRE or PTE), 124 with DRE, 86 with PTE, and 70 with PT-DRE. Drug resistant epilepsy was more common in those with PTE compared with non-traumatic epilepsy (45% vs. 33%, odds ratio 1.6 (95% CI: [1.1-2.4], p=0.01)). Patients with PTE and PT-DRE had significantly more comorbid conditions in health records than those with nontraumatic epilepsy. Those with both PTE and DRE reported the lowest QOL across all six measures, and this persisted after adjustment for comorbidities, and in further linear analyses.Discussion:Among those with PTE, DRE prevalence was significantly higher than for non-traumatic epilepsies. PTE was also associated with higher burden of comorbidity, and worse overall QOL compared to those with non-traumatic epilepsies. People with PTE are distinctly vulnerable to the comorbidities associated with TBI and epilepsy. This at-risk group should be the focus of future studies aimed at elucidating the factors associated with adverse health outcomes and developing anti-epileptogenic therapies.

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Section: Cohort Developmentmentioning

confidence: 99%

Multimodal Quality of Life Assessment in Post-9/11 Veterans With Epilepsy

et al. 2022

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“…This is an important finding, as VWEs who served in the Iraq and Afghanistan wars have been found to be more likely to have sustained TBI 30 and to have additional medical and psychiatric comorbidities; studies indicate that VWEs were also twice as likely to die compared to veterans without epilepsy. 4 Psychiatric comorbidities and non-epilepsy-related neurologic comorbidities such as migraines, are known to be more prevalent in the epilepsy community, 31,32 and this may interact with other factors such as veteran identity and race/ethnicity. Apart from levetiracetam and phenytoin, four of the six most commonly prescribed ASMs among HL-VWEs, including gabapentin, valproate, lamotrigine, and topiramate, have other established uses.…”

Section: Discussionmentioning

confidence: 99%

“…3 Epilepsy is a common and disabling neurologic illness besetting U.S. veterans, including veterans from underrepresented minority groups, secondary to unique exposures such as traumatic brain injury (TBI). 4 Among these veterans with epilepsy (VWEs), the profile of Hispanic/Latino VWEs (HL-VWEs or "Hispanic veterans") and their access to epilepsy care are poorly understood. Despite a growing need to study health care utilization in veterans with epilepsy and non-epileptic seizures, only a few studies have been published, and these did not stratify by race or ethnicity.…”

Section: Introductionmentioning

confidence: 99%

Health care utilization of Hispanic/Latino veterans with epilepsy: A national population‐based study

Tantillo,

Sullivan‐Baca,

Rehman

et al. 2024

Epilepsia

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ObjectiveHispanic/Latino people with epilepsy are a growing population that has been understudied in clinical epilepsy research. U.S. veterans are at a higher risk of epilepsy due to greater exposures including traumatic brain injury. Hispanic/Latino Veterans with Epilepsy (HL‐VWEs) represent a growing population; however the treatment utilization patterns of this population have been vastly understudied.MethodsHL‐VWE were identified from administrative databases during fiscal year 2019. Variables compared between Hispanic and non‐Hispanic VWEs included demographics, rurality, service era, utilization of clinical services/investigations, and service‐connected injury. Chi‐square and Student's t tests were used for comparisons.ResultsAmong 56 556 VWEs, 3247 (5.7%) were HL. HL‐VWEs were younger (59.2 vs 63.2 years; p < .01) and more commonly urban‐dwelling (81.6% vs 63.2%, p < .01) compared to non–HL‐VWEs. They were also more likely to have served in recent missions such as the Persian Gulf War and post‐ 9/11 wars (p < .01). HL‐VWEs had a higher utilization of all neurology services examined including neurology clinic visits, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, electroencephalography (EEG), epilepsy monitoring, and comprehensive epilepsy care (p < .01 for all). HL‐VWEs were more likely to visit an emergency room or have seizure‐related hospitalizations (p < .01). HL‐VWEs were more likely to have a service‐connected disability greater or equal to 50% (p < .01).SignificanceThis study is one of the largest cohorts examining HL‐VWEs. We found higher utilization of services in neurology, epilepsy, and neuroimaging by HL‐VWEs. HL‐VWE are younger, more commonly urban‐dwelling, and more likely to have served during recent combat periods and have higher amounts of service‐connected disability. Given that the proportion of Hispanic veterans is projected to rise over time, more research is needed to provide the best interventions and mitigate the long‐term impact of epilepsy on this diverse patient group.

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“…AED users were further grouped as those with epilepsy (who met the criteria for epilepsy using our previously validated epilepsy identification algorithm 7,8 ) and without epilepsy. Individuals who were classified as having epilepsy by the algorithm eventually during follow-up period after the index date (n = 119) were excluded from the analysis.…”

Section: Study Measuresmentioning

confidence: 99%