Patients with epilepsy are at an increased risk of subsequent stroke: A population-based cohort study

Chang, Chen-Shu; Liao, Chien-Chang; Lin, Chun‐Pin; Lane, Hsien‐Yuan; Sung, Fung‐Chang; Kao, Chia-Huang

doi:10.1016/j.seizure.2014.02.007

Cited by 84 publications

(68 citation statements)

References 45 publications

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“…Among patients who did not have baseline psychiatric comorbidities, 14% subsequently developed a psychiatric condition, and 15% of patients without baseline physical comorbidities developed comorbidity during follow‐up (Table ). A threefold increased risk of stroke has been identified in Taiwanese patients with epilepsy, with a hazard ratio similar to that of a UK General Practice Research Database study . Stroke is also common among elderly Thai patients with epilepsy …”

Section: Burden Of Epilepsysupporting

confidence: 56%

“…Adult patients with drug‐resistant epilepsy in Hong Kong had worse verbal recall memory than those with drug‐responsive epilepsy, and there were correlations between psychological well‐being and cognitive performance . Data from the Taiwan National Health Insurance Research Database showed a bidirectional association between epilepsy and attention‐deficit/hyperactivity disorder (Table ) …”

Section: Burden Of Epilepsymentioning

confidence: 99%

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Epilepsy in Asia: Disease burden, management barriers, and challenges

et al. 2018

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This article reviews the burden of epilepsy in Asia, the challenges faced by people with epilepsy, and the management of epilepsy. Comparison is made with other parts of the world. For this narrative review, data were collected using specified search criteria. Articles investigating the epidemiology of epilepsy, diagnosis, comorbidities and associated mortality, stigmatization, and treatment were included. Epilepsy is a global health care issue affecting up to 70 million people worldwide. Nearly 80% of people with epilepsy live in low- and middle-income countries with limited resources. People with epilepsy are prone to physical and psychological comorbidities, including anxiety and depression, which can negatively impact their quality of life. Furthermore, people with epilepsy are at higher risk of premature death than people without epilepsy. Discrimination or stigmatization of people with epilepsy is common in Asia and can affect their education, work, and marriage opportunities. Access to epilepsy treatment varies throughout Asia. Although highly advanced treatment is available in some countries, up to 90% of people with epilepsy are not adequately treated or are not treated with conventional antiepileptic therapy in resource-limited countries. People in remote areas often do not receive any epilepsy care. First-generation antiepileptic drugs (AEDs) are available, but usually only in urban areas, and second-generation AEDs are not available in all countries. Newer AEDs tend to have more favorable safety profiles than first-generation AEDs and provide options to tailor therapy for individual patients, especially those with comorbidities. Active epilepsy surgery centers are present in some countries, although epilepsy surgery is often underutilized given the number of patients who could benefit. Further epidemiologic research is needed to provide accurate epilepsy data across the Asian region. Coordinated action is warranted to improve access to treatment and care.

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Section: Burden Of Epilepsysupporting

confidence: 56%

Section: Burden Of Epilepsymentioning

confidence: 99%

Epilepsy in Asia: Disease burden, management barriers, and challenges

et al. 2018

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“…Comorbidities including hypertension, mental disorder, diabetes, liver cirrhosis, hyperlipidemia, congestive heart failure, traumatic brain injury, anemia, atrial fibrillation, peripheral vascular disease, renal dialysis, epilepsy, and obesity were known factors associated with stroke [8,12,13,19–22]. These medical conditions also commonly coexisted in patients with COPD [1,23,24,25].…”

Section: Discussionmentioning

confidence: 99%

Risk of Stroke and Post-Stroke Adverse Events in Patients with Exacerbations of Chronic Obstructive Pulmonary Disease

et al. 2017

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BackgroundThe risk and outcomes of stroke in patients with chronic obstructive pulmonary disease exacerbations (COPDe) remain unclear. We examined whether patients with COPDe faced increased risk of stroke or post-stroke outcomes.MethodsUsing Taiwan’s National Health Insurance Research Database, we identified 1918 adults with COPDe and selected comparison cohorts of 3836 adults with COPD no exacerbations and 7672 adults without COPD who were frequency matched by age and sex in 2000–2008 (Study 1). Stroke event was identified during 2000–2013 follow-up period. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of stroke associated with COPDe were calculated. In a nested cohort study (Study 2) of 261686 new-diagnosed stroke patients in 2000–2009, we calculated adjusted odds ratios (ORs) and 95% CIs of adverse events after stroke in patients with COPDe.ResultsPatients with COPDe had increased stroke incidence, with an adjusted HR of 1.28 (95% CI, 1.03–1.59). In the Study 2, COPDe were associated with post-stroke mortality (OR, 1.34, 95% CI 1.20–1.52), epilepsy (OR, 1.43; 95% CI, (1.22–1.67), and pneumonia (OR, 1.50; 95% CI, 1.39–1.62). Previous intubation for COPD and inpatient admissions due to COPD were factors associated with post-stroke adverse events.ConclusionPatients who have had COPDe face increased risks of stroke and post-stroke adverse events.

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“…Subjects with a history of epilepsy had a 2.89 (95% CI 2.45–3.41) relative higher hazard of developing a stroke compared with the control group . Another population‐based study confirmed these findings . Likewise, in a prospective population‐based study conducted in Finland, 245 subjects with childhood‐onset epilepsy were followed at 45 years of age .…”

Section: Complex Relation Between Common Psychiatric Comorbidities Anmentioning

confidence: 73%

Bidirectional relations among common psychiatric and neurologic comorbidities and epilepsy: Do they have an impact on the course of the seizure disorder?

Kanner

Ribot

Mazarati³

2018

Epilepsia Open

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SummaryThe treatment of epilepsy is not limited to the achievement of a seizure‐free state. It must also incorporate the management of common psychiatric and neurologic comorbidities, affecting on average between 30 and 50% of patients with epilepsy, which have a significant impact on their lives at various levels, including quality of life and the prognosis of the seizure disorder. Mood and anxiety disorders are the most frequent psychiatric comorbidities, whereas stroke and migraine are among the more common neurologic comorbidities, migraine among the younger patients and stroke among the older patients. Not only do these psychiatric and neurologic comorbidities each have a bidirectional relation with epilepsy, but primary mood disorders have a bidirectional relation with these 2 neurologic disorders. Furthermore, depression and migraine have been each associated with a more severe epilepsy course, whereas depression has been associated with a more severe course of stroke and migraines. The purpose of this article is to review the clinical implications of the complex relations among epilepsy and these 3 comorbid disorders, and to identify any clinical and/or experimental evidence that may suggest that having more than one of these comorbid disorders may increase the risk of and course of epilepsy.

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Patients with epilepsy are at an increased risk of subsequent stroke: A population-based cohort study

Abstract: The patients with epilepsy exhibited a higher incidence of cerebral stroke than the general population did. In addition, younger patients with epilepsy and patients who took a high doses of antiepileptic drugs exhibited a high risk of stroke.

Cited by 84 publications

References 45 publications

Epilepsy in Asia: Disease burden, management barriers, and challenges

Epilepsy in Asia: Disease burden, management barriers, and challenges

Risk of Stroke and Post-Stroke Adverse Events in Patients with Exacerbations of Chronic Obstructive Pulmonary Disease

Bidirectional relations among common psychiatric and neurologic comorbidities and epilepsy: Do they have an impact on the course of the seizure disorder?

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