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02 22, 2022;98 (8): e808-e817.

Association of Head Injury With Late-Onset Epilepsy: Results From the Atherosclerosis Risk in Communities Cohort.

Andrea L C Schneider, Rebecca F Gottesman, Gregory L Krauss, James Gugger, Ramon Diaz-Arrastia, Anna Kucharska-Newton, Juebin Huang, Emily L Johnson
Author Information
  1. Andrea L C Schneider: From the Department of Neurology (A.L.C.S., J.G., R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Stroke Branch (R.F.G.), National Institutes of Neurological Disorders and Stroke Intramural Research Program, Bethesda; Department of Neurology (G.L.K., E.L.J.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; and Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson. andrea.schneider@pennmedicine.upenn.edu. ORCID
  2. Rebecca F Gottesman: From the Department of Neurology (A.L.C.S., J.G., R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Stroke Branch (R.F.G.), National Institutes of Neurological Disorders and Stroke Intramural Research Program, Bethesda; Department of Neurology (G.L.K., E.L.J.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; and Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson.
  3. Gregory L Krauss: From the Department of Neurology (A.L.C.S., J.G., R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Stroke Branch (R.F.G.), National Institutes of Neurological Disorders and Stroke Intramural Research Program, Bethesda; Department of Neurology (G.L.K., E.L.J.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; and Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson.
  4. James Gugger: From the Department of Neurology (A.L.C.S., J.G., R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Stroke Branch (R.F.G.), National Institutes of Neurological Disorders and Stroke Intramural Research Program, Bethesda; Department of Neurology (G.L.K., E.L.J.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; and Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson. ORCID
  5. Ramon Diaz-Arrastia: From the Department of Neurology (A.L.C.S., J.G., R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Stroke Branch (R.F.G.), National Institutes of Neurological Disorders and Stroke Intramural Research Program, Bethesda; Department of Neurology (G.L.K., E.L.J.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; and Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson.
  6. Anna Kucharska-Newton: From the Department of Neurology (A.L.C.S., J.G., R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Stroke Branch (R.F.G.), National Institutes of Neurological Disorders and Stroke Intramural Research Program, Bethesda; Department of Neurology (G.L.K., E.L.J.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; and Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson.
  7. Juebin Huang: From the Department of Neurology (A.L.C.S., J.G., R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Stroke Branch (R.F.G.), National Institutes of Neurological Disorders and Stroke Intramural Research Program, Bethesda; Department of Neurology (G.L.K., E.L.J.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; and Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson.
  8. Emily L Johnson: From the Department of Neurology (A.L.C.S., J.G., R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Stroke Branch (R.F.G.), National Institutes of Neurological Disorders and Stroke Intramural Research Program, Bethesda; Department of Neurology (G.L.K., E.L.J.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; and Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson.
PMID: 34921108 DOI: 10.1212/WNL.0000000000013214

Abstract

BACKGROUND AND OBJECTIVES: Late-onset epilepsy (LOE; i.e., epilepsy starting in later adulthood) affects a significant number of individuals. Head injury is also a risk factor for acquired epilepsy, but the degree to which prior head injury may contribute to LOE is less well understood. Our objective was to determine the association between head injury and subsequent development of LOE.
METHODS: Included were 8,872 participants enrolled in the Atherosclerosis Risk in Communities (ARIC) study with continuous Centers for Medicare Services fee-for-service (FFS) coverage (55.1% women, 21.6% Black). We identified head injuries through 2018 from linked Medicare fee for service claims for inpatient/emergency department care, active surveillance of hospitalizations, and participant self-report. LOE cases through 2018 were identified from linked Medicare FFS claims. We used Cox proportional hazards models to evaluate associations of head injury with LOE, adjusting for demographic, cardiovascular, and lifestyle factors.
RESULTS: The adjusted hazard ratio (HR) for developing LOE after a history of head injury was 1.88 (95% confidence interval [CI] 1.44-2.43). There was evidence for dose-response associations with greater risk for LOE with increasing number of prior head injuries (HR 1.37, 95% CI 1.01-1.88 for 1 prior head injury and HR 3.55, 95% CI 2.51-5.02 for 2+ prior head injuries, compared to no head injuries) and with more severe head injury (HR 2.53, 95% CI 1.83-3.49 for mild injury and HR 4.90, 95% CI 3.15-7.64 for moderate/severe injury, compared to no head injuries). Associations with LOE were significant for head injuries sustained at older age (age ≥67 years: HR 4.01, 95% CI 2.91-5.54), but not for head injuries sustained at younger age (age < 67 years: HR 0.98, 95% CI 0.68-1.41).
DISCUSSION: Head injury was associated with increased risk of developing LOE, particularly when head injuries were sustained at an older age, and there was evidence for higher risk for LOE after a greater number of prior head injuries and after more severe head injuries.
CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that an increased risk of late-onset epilepsy is associated with head injury and that this risk increases further with multiple and more severe head injuries.

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Grants

  1. U01 HL096812/NHLBI NIH HHS
  2. K24 AG052573/NIA NIH HHS
  3. HHSN268201700001I/NHLBI NIH HHS
  4. HHSN268201700004I/NHLBI NIH HHS
  5. U01 HL096902/NHLBI NIH HHS
  6. HHSN268201700002I/NHLBI NIH HHS
  7. U01 HL096899/NHLBI NIH HHS
  8. HHSN268201700003I/NHLBI NIH HHS
  9. U01 HL096814/NHLBI NIH HHS
  10. U01 HL096917/NHLBI NIH HHS
  11. K23 AG063899/NIA NIH HHS
  12. HHSN268201700005I/NHLBI NIH HHS

MeSH Term

Adult
Aged
Atherosclerosis
Cohort Studies
Craniocerebral Trauma
Epilepsy
Female
Humans
Male
Medicare
Risk Factors
United States
Journal Article Research Support, N.I.H., Extramural Research Support, U.S. Gov't, Non-P.H.S.
Article has an altmetric score of 143

Word Cloud

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