The Epidemiology of the Comorbidity of Epilepsy in the General Population

Athanasios Gaitatzis

Institute of Neurology, University College London and Neuroepidemiology Unit, National Hospital for Neurology and Neurosurgery

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Kevin Carroll,

Kevin Carroll

Office for National Statistics

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Azeem Majeed,

Azeem Majeed

Department of Primary Care & Social Medicine, Imperial College Faculty of Medicine, London, United Kingdom

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Josemir W. Sander,

Josemir W. Sander

Institute of Neurology, University College London and Neuroepidemiology Unit, National Hospital for Neurology and Neurosurgery

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Athanasios Gaitatzis,

Athanasios Gaitatzis

Institute of Neurology, University College London and Neuroepidemiology Unit, National Hospital for Neurology and Neurosurgery

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Kevin Carroll,

Kevin Carroll

Office for National Statistics

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Azeem Majeed,

Azeem Majeed

Department of Primary Care & Social Medicine, Imperial College Faculty of Medicine, London, United Kingdom

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Josemir W. Sander,

Josemir W. Sander

Institute of Neurology, University College London and Neuroepidemiology Unit, National Hospital for Neurology and Neurosurgery

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First published: 29 November 2004

https://doi.org/10.1111/j.0013-9580.2004.17504.x

Citations: 470

Address correspondence and reprint requests to Dr. J.W. Sander at Institute of Neurology [Box 29], University College London, Queen Square, London WC1N 3BG, U.K. E-mail: [email protected]

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Abstract

Summary: Purpose: To describe the epidemiology of somatic and psychiatric conditions in adults with epilepsy in the community and compare it to that of people without epilepsy.

Methods: A cross-sectional population-based study extracting data from the UK General Practice Research Database for the period 1995–1998. Age- and sex-standardized prevalence rates were estimated for selected conditions and groups of conditions (categorized by ICD-9 chapters) in adults with epilepsy registered with primary care physicians. Results were compared with those in adults without epilepsy in the cohort, and prevalence ratios were calculated according to two broad age groups (16–64 and older than 64 years).

Results: Conditions common in the general population also were common in adults with epilepsy. Psychiatric disorders occurred twice as often, and the risk of somatic disorders was increased in people with epilepsy, with the exception of musculoskeletal and connective tissue disorders in older adults. The prevalence ratio of neoplasia, excluding intracranial tumors, was not increased in epilepsy. The prevalence ratio of brain tumors was particularly increased in young adults [prevalence ratio (PR), 70.7] and of meningiomas in older adults (PR, 91.9). Neurodegenerative conditions, particularly dementias and Alzheimer' disease (PR, 6.3 and 8, respectively) and Parkinson' disease (PR, 3.2), appeared more frequently in people with epilepsy. Upper gastrointestinal bleed occurred more frequently in epilepsy (PR, 4.3), as did cardio- and cerebrovascular disorders, fractures, pneumonia and chronic lung diseases, and diabetes. Eczema, osteoarthritis, and rheumatoid arthritis did not occur more frequently in epilepsy.

Conclusions: The prevalence ratio of many common psychiatric and somatic conditions is increased in adults with epilepsy who consult a primary care physician in the U.K. These findings may have implications in the diagnosis and management of epilepsy and coexisting conditions, as well as in health care provision.

REFERENCES

1 Feinstein AR. The pre-therapeutic classification of comorbidity in chronic disease. J Chronic Dis 1973; 23: 455–69.DOI: 10.1016/0021-9681(70)90054-8
10.1016/0021-9681(70)90054-8
Web of Science® Google Scholar
2 Ottman R, Lipton RB. Comorbidity of migraine and epilepsy. Neurology 1994; 44: 2105–10.
10.1212/WNL.44.11.2105
CAS PubMed Web of Science® Google Scholar
3 Forsgren L. Prevalence of epilepsy in adults in northern Sweden. Epilepsia 1992; 33: 450–8.
10.1111/j.1528-1157.1992.tb01690.x
CAS PubMed Web of Science® Google Scholar
4 Gudmundsson G. Epilepsy in Iceland: a clinical and epidemiological investigation. Acta Neurol Scand 1966; 43(suppl 25): 1–124.
PubMed Google Scholar
5 Havlova M. Prognosis in childhood epilepsy. Acta Univ Carol Med Monogr 1990; 135: 1–105.
PubMed Google Scholar
6 Jacoby A, Baker GA, Steen N, et al. The clinical course of epilepsy and its psychosocial correlates: findings from a U.K. community study. Epilepsia 1996; 37: 148–61.
10.1111/j.1528-1157.1996.tb00006.x
CAS PubMed Web of Science® Google Scholar
7 Jalava M, Sillanpää M. Concurrent illnesses in adults with childhood-onset epilepsy: a population-based 35-year follow-up study. Epilepsia 1996; 37: 1155–63.
10.1111/j.1528-1157.1996.tb00547.x
CAS PubMed Web of Science® Google Scholar
8 Krohn W. A study of epilepsy in northern Norway, its frequency and character. Acta Psychiatr Neurol Scand 1961; 150(suppl): 215–25.
10.1111/j.1600-0447.1961.tb08388.x
Google Scholar
9 Annegers JF, Melton LJ III, Sun CA, et al. Risk of age-related fractures in patients with unprovoked seizures. Epilepsia 1989; 30: 348–55.
10.1111/j.1528-1157.1989.tb05308.x
PubMed Web of Science® Google Scholar
10 Gurney JG, Mueller BA, Preston-Martin S, et al. A study of pediatric brain tumors and their association with epilepsy and anticonvulsant use. Neuroepidemiology 1997; 16: 248–55.
10.1159/000109694
CAS PubMed Web of Science® Google Scholar
11 Hesdorffer DC, Hauser WA, Annegers JF, et al. Severe, uncontrolled hypertension and adult-onset seizures: a case control study in Rochester, Minnesota. Epilepsia 1996; 37: 736–41.
10.1111/j.1528-1157.1996.tb00644.x
PubMed Web of Science® Google Scholar
12 Hesdorffer DC, Hauser WA, Annegers JF, et al. Dementia and adult-onset unprovoked seizures. Neurology 1996; 46: 727–30.
10.1212/WNL.46.3.727
CAS PubMed Web of Science® Google Scholar
13 Li X, Breteler MM, De Bruyne MC, et al. Vascular determinants of epilepsy: the Rotterdam Study. Epilepsia 1997; 38: 1216–20.
10.1111/j.1528-1157.1997.tb01219.x
CAS PubMed Web of Science® Google Scholar
14 Ng SK, Hauser WA, Brust JC, et al. Hypertension and the risk of new-onset unprovoked seizures. Neurology 1993; 43: 425–8.
10.1212/WNL.43.2.425
CAS PubMed Web of Science® Google Scholar
15 Hermann BP, Seidenberg M, Bell B. Psychiatric comorbidity in chronic epilepsy: identification, consequences, and treatment of major depression. Epilepsia 2000; 41(suppl 2): S31–41.
10.1111/j.1528-1157.2000.tb01522.x
PubMed Web of Science® Google Scholar
16 Torta R, Keller R. Behavioral, psychotic, and anxiety disorders in epilepsy: etiology, clinical features, and therapeutic implications. Epilepsia 1999; 40(suppl 10): S2–20.
10.1111/j.1528-1157.1999.tb00883.x
PubMed Web of Science® Google Scholar
17 Majeed A. Sources, uses, strengths and limitations of data collected in primary care in England. Health Stat Q 2004; 21: 5–14.
PubMed Google Scholar
18 Gaitatzis A, Purcell B, Carroll K, et al. Differences in the use of health services among people with and without epilepsy in the United Kingdom: socio-economic and disease-specific determinants. Epilepsy Res 2002; 50: 233.DOI: 10.1016/S0920-1211(02)00031-1
10.1016/S0920-1211(02)00031-1
CAS PubMed Web of Science® Google Scholar
19 Donaldson L. Annual report of the Chief Medical Officer 2001. London Department of Health , 2001.
Google Scholar
20 Hollowell J. The General Practice Research Database: quality of morbidity data. Popul Trends 1997; 87: 36–40.
PubMed Google Scholar
21 Jick H, Jick SS, Derby LE. Validation of information recorded on general practitioner based computerised data resource in the United Kingdom. BMJ 1991; 302: 766–8.
10.1136/bmj.302.6779.766
CAS PubMed Web of Science® Google Scholar
22 Office for National Statistics. Key health statistics from general practice 1998. (Series MB6 No.2). London : Office for National Statistics , 2000.
Google Scholar
23 Forrest CB, Majeed A, Weiner JP, et al. Comparison of specialty referral rates in the United Kingdom and the United States: retrospective cohort analysis. BMJ 2002; 325: 370–1.
10.1136/bmj.325.7360.370
PubMed Web of Science® Google Scholar
24 Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 1959; 22: 719–48.
CAS PubMed Web of Science® Google Scholar
25 The Editor. Netting an important database. Lancet 2001; 357: 649.DOI: 10.1016/S0140-6736(00)04144-1
10.1016/S0140-6736(00)04144-1
PubMed Web of Science® Google Scholar
26 Mant D. R&D in primary care: National Working Group Report. London Department of Health , 1997.
Google Scholar
27 Bell GS, Sander JW. The epidemiology of epilepsy: the size of the problem. Seizure 2001; 10: 306–16.
10.1053/seiz.2001.0584
CAS PubMed Web of Science® Google Scholar
28 Sander JW, O'Donoghue MF. Epilepsy: getting the diagnosis right. BMJ 1997; 314: 158–9.
10.1136/bmj.314.7075.158
PubMed Web of Science® Google Scholar
29 Moran N, Poole K, Bell G, et al. NHS services for epilepsy from the patient's perspective: a survey of primary, secondary and tertiary care access throughout the UK. Seizure 2000; 9: 559–65.DOI: 10.1053/seiz.2000.0451
10.1053/seiz.2000.0451
CAS PubMed Web of Science® Google Scholar
30 Purcell B, Gaitatzis A, Majeed A, et al. Epilepsy prevalence and prescribing patterns in England and Wales. Health Stat Q 2002; 15: 23–30.
Google Scholar
31 Forsgren L, Nystrom L. An incident case-referent study of epileptic seizures in adults. Epilepsy Res 1990; 6: 66–81.DOI: 10.1016/0920-1211(90)90010-S
10.1016/0920-1211(90)90010-S
PubMed Web of Science® Google Scholar
32 Dallal HJ, Palmer KR. ABC of the upper gastrointestinal tract: upper gastrointestinal haemorrhage. BMJ 2001; 323: 1115–7.
10.1136/bmj.323.7321.1115
CAS PubMed Web of Science® Google Scholar
33 Lipton RB, Silberstein SD. Why study the comorbidity of migraine? Neurology 1994; 44(suppl 7): S4–5.
CAS PubMed Web of Science® Google Scholar
34 Kanner AM, Balabanov A. Depression and epilepsy: how closely related are they? Neurology 2002; 58(suppl 5): S27–39.DOI: 10.1159/000066479
10.1159/000066479
PubMed Web of Science® Google Scholar
35 Toone BK. The psychoses of epilepsy [Editorial]. J Neurol Neurosurg Psychiatry 2000; 69: 1–4.DOI: 10.1136/jnnp.69.1.1
10.1136/jnnp.69.1.1
CAS PubMed Web of Science® Google Scholar
36 Barnes PJ. Chronic obstructive pulmonary disease. N Engl J Med 2000; 343: 269–80.
10.1056/NEJM200007273430407
CAS PubMed Web of Science® Google Scholar
37 Barendregt JJ, Bonneux L, Van Der Maas PJ. The health care costs of smoking. N Engl J Med 1997; 337: 1052–7.
10.1056/NEJM199710093371506
CAS PubMed Web of Science® Google Scholar
38 Sears MR, Greene JM, Willan AR, et al. A longitudinal, population-based, cohort study of childhood asthma followed to adulthood. N Engl J Med 2003; 349: 1414–22.DOI: 10.1056/NEJMoa022363
10.1056/NEJMoa022363
CAS PubMed Web of Science® Google Scholar
39 Heaney DC, MacDonald BK, Everitt A, et al. Socioeconomic variation in incidence of epilepsy: prospective community based study in south east England. BMJ 2002; 325: 1013–6.
10.1136/bmj.325.7371.1013
PubMed Web of Science® Google Scholar
40 Mendez MF, Catanzaro P, Doss RC, et al. Seizures in Alzheimer's disease: clinicopathologic study. J Geriatr Psychiatry Neurol 1994; 7: 230–3.
10.1177/089198879400700407
CAS PubMed Google Scholar
41 Nussbaum RL, Ellis CE. Alzheimer's disease and Parkinson's disease. N Engl J Med 2003; 348: 1356–64.DOI: 10.1056/NEJM2003ra020003
10.1056/NEJM2003ra020003
CAS PubMed Web of Science® Google Scholar
42 Gaitatzis A, Sander JW. The mortality of epilepsy revisited. Epileptic Disord 2004; 6: 3–13.
10.1684/j.1950-6945.2004.tb00043.x
PubMed Web of Science® Google Scholar
43 Ottman R, Hong S, Lipton RB. Validity of family history data on severe headache and migraine. Neurology 1993; 43: 1954–60.
10.1212/WNL.43.10.1954
CAS PubMed Web of Science® Google Scholar
44 Goodridge DM, Shorvon S. Epileptic seizures in a population of 6000, II: treatment and prognosis. Br Med J 1983; 287: 645–7.
10.1136/bmj.287.6393.645
PubMed Web of Science® Google Scholar
45 Hart YM, Shorvon S. The nature of epilepsy in the general population, I: characteristics of patients receiving medication for epilepsy. Epilepsy Res 1995; 21: 43–9.DOI: 10.1016/0920-1211(95)00007-W
10.1016/0920-1211(95)00007-W
PubMed Web of Science® Google Scholar

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Volume45, Issue12

December 2004

Pages 1613-1622

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