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New-Onset Epilepsy Rates Are Higher in Nursing Home Residents


 

A significant number of elderly residents in nursing homes have new-onset epilepsy and seizures.

TORONTO—The rate of new-onset epilepsy or seizures was twelve-fold higher among elderly nursing home residents compared with community-dwelling elderly, according to research presented at the 62nd Annual Meeting of the American Academy of Neurology.

Lynn E. Eberly, PhD, Associate Professor of Biostatistics, University of Minnesota in Minneapolis, and colleagues reviewed baseline Minimum Data Set assessments for more than 4.5 million elderly nursing home residents (ages 65 and older) for indications of epilepsy and seizures from 2003 to 2005. More than 3.6 million residents without epilepsy were then followed until 2007 or until the end of their nursing home stay. Incidence rates of epilepsy and seizures per 10,000 person-years were computed overall and by predisposing conditions, which included hypertension, hemiplegia, diabetes mellitus, Parkinson’s disease, Alzheimer’s disease, dementia, stroke, multiple sclerosis (MS), cancer, and others. Rates were also calculated for each predisposing condition in every US state and per length of follow-up.

The prevalence of epilepsy and seizures at baseline was 5.2% in persons with any predisposing condition and 3.4% in those with no predisposing condition. About 70% of participants were women, and 87% were white. Overall, the researchers observed 164.2 new-onset epilepsy/seizure cases per 10,000 person years, which was 12 times higher than the rate among elderly persons not living in a nursing home, per a previous report.

“Very high incidence rates were seen among those with baseline brain tumor, head injury, hemiplegia, and stroke, significantly higher than in persons without each of those conditions,” reported Dr. Eberly and colleagues. “Lower incidence rates were seen among those with baseline primary and secondary nonbrain cancers, diabetes mellitus, Parkinson’s disease, hypertension, dementia, and MS, but still significantly higher than in persons without each of those conditions.”

Among 407,801 residents who had no predisposing condition, the epilepsy/seizure rate was “significantly lower”—124.5 per 10,000 person years, but nine times higher than in community-dwelling elderly, according to the investigators. “The incidence rates during year 1 of follow-up were the highest, followed by incidence rates between year 1 and year 2 of follow-up, followed by incidence rates after year 2,” reported the study authors.

Incidence rates also varied geographically and for particular predisposing conditions at baseline. For example, among persons with Alzheimer’s disease, Washington, Oregon, Florida, Illinois, Mississippi, New Jersey, Virginia, Kentucky, West Virginia, and Maryland were among the states with the highest epilepsy/seizure rates. States with the lowest epilepsy/seizure rates among persons with Alzheimer’s disease included New Mexico, Utah, Colorado, Wyoming, Montana, South Dakota, Iowa, and Wisconsin.

Among persons with stroke at baseline, the highest epilepsy/seizure rates were observed in Texas, Nevada, Florida, Illinois, New York, and others. Low epilepsy/seizure rates for persons with stroke were found in Alaska, Montana, Idaho, Utah, Arkansas, and others.

“Incidence varies widely by baseline conditions that are potential precursors to seizures, and generally decreases across longer follow-up,” Dr. Eberly’s group commented. “These results have health care system implications for planning, care, and cost.”

—ColbyStong


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