Comorbidities in patients with epilepsy: Frequency, mechanisms and effects on long-term outcome.
cohort study
comorbidities
epilepsy
mechanism
prognosis
Journal
Epilepsia
ISSN: 1528-1167
Titre abrégé: Epilepsia
Pays: United States
ID NLM: 2983306R
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
revised:
22
06
2021
received:
23
04
2021
accepted:
15
07
2021
pubmed:
27
7
2021
medline:
19
4
2022
entrez:
26
7
2021
Statut:
ppublish
Résumé
To assess frequency, types, and mechanisms of comorbidities in people with epilepsy and verify their association with disease features and outcome. This cohort study was performed in 13 Italian epilepsy centers with nationwide distribution and accurate records. Eligible patients were children and adults diagnosed before December 31, 2005, and followed for a minimum of 10 years. Two pairs of raters independently reviewed patients' records and classified each comorbidity. In case of disagreement, a third reviewer made the final decision. Comorbidities were classified according to type (organ/system) and underlying mechanism (causal, shared risk factors, chance association). Comorbidity types and mechanisms were described in the entire sample and according to epilepsy prognostic patterns (sustained remission, relapsing-remitting course, no remission). Of 1006 included patients, 266 (26.4%) had at least one comorbidity. The most common were developmental/perinatal (7.5% of cases), psychiatric (6.2%), cardiovascular (5.3%), and endocrine/metabolic (3.8%). Among 408 reported comorbidities, the underlying mechanisms were, in decreasing order, chance association (42.2%), shared risk factors (31.1%), and causal (26.7%). Psychiatric diseases were present in 13.3% of patients with no remission, 5.9% of patients with relapsing-remitting course, and 4.8% of patients with sustained remission (p = .016). The corresponding numbers for endocrine/metabolic diseases were respectively, 9.6%, 3.4%, and 2.9% (p = .013); for respiratory diseases were 3.6%, .3%, and .3% (p = .001), and for urogenital diseases were 3.6%, .7%, and 1.6% (p = .048). The association of endocrine/metabolic, psychiatric, and respiratory comorbidities with epilepsy prognosis was confirmed by multivariable analysis adjusted for the main demographic and clinical variables, with patients with these comorbidities showing a lower probability of achieving remission. Comorbidities in epilepsy are not uncommon and reflect differing underlying mechanisms. Psychiatric, endocrine/metabolic, and respiratory disorders are associated with a worse long-term epileptological outcome.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2395-2404Investigateurs
A Romeo
(A)
M Viri
(M)
L Specchio
(L)
M Trivisano
(M)
O Mecarelli
(O)
A Zarabla
(A)
G Capovilla
(G)
F Beccaria
(F)
F Sasanelli
(F)
C A Galimberti
(CA)
E Tartara
(E)
N Zamponi
(N)
S Cappanera
(S)
U Aguglia
(U)
E Ferlazzo
(E)
A La Neve
(A)
C Luisi
(C)
G Pontrelli
(G)
A T Cantisani
(AT)
G De Maria
(G)
Y Albanese
(Y)
Informations de copyright
© 2021 International League Against Epilepsy.
Références
Feinstein A. The Pre-therapeutic classification of co-morbidity in chronic disease. J Chronic Dis. 1970;23:455-68.
Gaitatzis A, Trimble MR, Sander JW. The psychiatric comorbidity of epilepsy. Acta Neurol Scand. 2004;110:207-20.
Gaitatzis A, Sisodiya SM, Sander JW. The somatic comorbidity of epilepsy: a weighty but often unrecognized burden. Epilepsia. 2012;53:1282-93.
Licence: CC BY-NC-SA 3.0 IGO. World Health Organization. Epilepsy: a public health imperative. Geneva: WHO; 2019.
Keezer MR, Sisodiya SM, Sander JW. Comorbidities of epilepsy: current concepts and future perspectives. Lancet Neurol. 2016;15:106-15.
Velioğlu SK, Boz C, Ozmenoğlu M. The impact of migraine on epilepsy: a prospective prognosis study. Cephalalgia. 2005;25:528-35.
Taylor RS, Sander JW, Taylor RJ, Baker GA. Predictors of health-related quality of life and costs in adults with epilepsy: a systematic review. Epilepsia. 2011;52:2168-80.
Neale MC, Kendler KS. Models of comorbidity for multifactorial disorders. Am J Hum Genet. 1995;57:935-53.
Rutter M. Comorbidity: concepts, claims and choices. Crim Behav Ment Health. 1997;7:265-85.
Rhee SH, Hewitt JK, Lessem JM, Stallings MC, Corley RP, Neale MC. The validity of the Neale and Kendler model-fi tting approach in examining the etiology of comorbidity. Behav Genet. 2004;34:251-65.
Beghi E, Beretta S, Carone D, Zanchi C, Bianchi E, Pirovano M, et al. Prognostic patterns and predictors in epilepsy: a multicentre study (PRO-LONG). J Neurol Neurosurg Psychiatry. 2019;90:1276-85.
Beretta S, Carone D, Zanchi C, Bianchi E, Pirovano M, Trentini C, et al. Long-term applicability of the new ILAE definition of epi epilepsy. Results from the PRO-LONG study. Epilepsia. 2017;58:1518-23.
Fisher RS, Acevedo C, Arzimanoglou A, Cross H, Elger CE, Engel J Jr, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014;55:475-82.
Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia. 1981;22:489-501.
Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia. 1989;30:389-99.
Scheffer IE, Berkovic S, Capovilla G, Connolly MB, French J, Guilhoto L, et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58:512-21.
Hill AB. The environment and disease: Association or causation? Proc Royal Soc Med. 1965;58:295-300.
Fujiwara T, Shigematsu H. Etiologic factors and clinical features of symptomatic epilepsy: focus on pediatric cases. Psychiatry Clin Neurosci. 2004;58:S9-12.
Beghi E, Beretta S, Colombo M, Bianchi E, Carone D, Zanchi C, et al. Discontinuation of antiseizure medications in seizure-free patients with long-term follow-up: Patients’ profile, seizure recurrence, and risk factors. Epilepsy Behav. 2021;6(117):107871. https://doi.org/10.1016/j.yebeh.2021.107871
Gasparini S, Beghi E, Ferlazzo E, Beghi M, Belcastro V, Biermann KP, et al. Management of psychogenic non-epileptic seizures: a multidisciplinary approach. Eur J Neurol. 2019;26(2):205-e15.
Gaitatzis A, Carroll K, Majeed A, Sander JW. The epidemiology of the comorbidity of epilepsy in the general population. Epilepsia. 2004;45:1613-22.
Galimberti CA, Magri F, Magnani B, Arbasino C, Cravello L, Marchioni E, et al. Antiepileptic drug use and epileptic seizures in elderly nursing home residents: a survey in the province of Pavia, Northern Italy. Epilepsy Res. 2006;68:1-8.
Fernandes MJS, Carletti CO, Sierra de Araújo LF, Santos RC, Reis J. Respiratory gases, air pollution and epilepsy. Rev Neurol (Paris). 2019;175:604-13.
Jaseja H, Goyal M, Mishra P. Drug-resistant epilepsy and obstructive sleep apnea: exploring a link between the two. World Neurosurg. 2020;146:210-4.
Uepping P, Hamer H, Scholten J, Kostev K. Physical and mental health comorbidities of patients with epilepsy in Germany - A retrospective cohort study. Epilepsy Behav. 2021;23(117):107857.
Bosak M, Kowalik M, Mołek P, Słowik A. Somatic comorbidity in Polish patients with epilepsy. Pol Arch Intern Med. 2019;129:303-7.
Roberts JI, Patten SB, Wiebe S, Hemmelgarn BR, Pringsheim T, Jetté N. Health-related behaviors and comorbidities in people with epilepsy: Changes in the past decade. Epilepsia. 2015;56:1973-81.
Téllez-Zenteno JF, Matijevic S, Wiebe S. Somatic comorbidity of epilepsy in the general population in Canada. Epilepsia. 2005;46:1955-62.
Tellez-Zenteno JF, Patten SB, Jetté N, Williams J, Wiebe S. Psychiatric comorbidity in epilepsy: a population-based analysis. Epilepsia. 2007;48:2336-44.
Strine TW, Kobau R, Chapman DP, Thurman DJ, Price P, Balluz LS, Psychological Distress, Comorbidities, and Health Behaviors among U.S. Adults with Seizures: Results from the 2002 National Health Interview Survey. Epilepsia. 2002;2005(46):1133-9.