Home Medizin Ist eine posttraumatische Epilepsie mit einem langfristigen Demenzrisiko verbunden?

Ist eine posttraumatische Epilepsie mit einem langfristigen Demenzrisiko verbunden?

von NFI Redaktion

The risk of long-term dementia is associated with both head injuries and epilepsy. However, research has mainly focused on the connections between post-traumatic epilepsy (PTE) and short-term cognitive outcomes.

A new study published in JAMA Neurology investigated the relationships between dementia risk and PTE.


Study: Posttraumatic Epilepsy and Dementia Risk. Image Source: LightField Studios/Shutterstock.com










Study: Posttraumatic Epilepsy and Dementia Risk. Image Source: LightField Studios/Shutterstock.com

Background

PTE, characterized by unprovoked seizures lasting more than a week after a traumatic brain injury, accounts for about 5 to 20% of acquired epilepsies.

Previous research has shown the connection between PTE and short-term cognitive, functional, and psychosocial outcomes. However, the understanding of the long-term consequences of a PTE diagnosis is incomplete.

Epilepsy and traumatic brain injury are independently associated with long-term dementia risk. Previous studies have highlighted the role of neurodegenerative mechanisms in the pathophysiology of PTE.

Given these findings, it is possible that individuals with PTE may achieve poorer long-term cognitive outcomes compared to those with epilepsy or a head injury alone.

About the Study

This study collected data from the Atherosclerosis Risk in Communities (ARIC) study, a community-based study compiled over a 30-year period.

The dementia risk associated with PTE was compared to dementia risk in three other groups: head injury only, no head injury or seizure/epilepsy, and seizure/epilepsy only.

The hypothesis was that there would be a stronger connection between PTE and dementia compared to head injuries or seizures/epilepsy alone.

Recognizing that dementia risk may vary depending on the population and type of head injury, the study examined the connections between PTE and dementia risk by race, gender, age, as well as severity and frequency of head injuries in subgroups.

Study Findings

This study found that individuals with PTE have about a 4.5-fold increased risk of dementia compared to those without epilepsy and head injury.

After controlling for competing risks of stroke and mortality, a three-fold increase in PTE-associated dementia risk was observed. The dementia risk associated with PTE was significantly higher than with seizures/epilepsy or head injuries alone. Therefore, prevention of head injuries and PTE after a head injury is essential.

This study adds to existing literature by demonstrating strong connections between PTE and long-term dementia risk.

Another important feature of this study is the consideration of a large sample of community-dwelling individuals observed for up to 30 years. The average age of participants was 54 years, which is informative given the highest incidence of epilepsy and head injuries in older individuals.

Among younger individuals, the relative risk of PTE-associated dementia was higher compared to older individuals.

One possible explanation for this observation is that older individuals with PTE are more likely to die before dementia is diagnosed. This pattern persisted after considering the competing risks of stroke and mortality.

There were no indications of ethnic or gender interactions in the analyses. Both PTE and head injuries occurred more frequently in men in younger population groups.

These differences were not present in older individuals in the study cohort. Women were more likely to experience a head injury in the study population.

Additionally, the dementia risk in PTE cases occurring after the first and second head injuries was similar. This was also true after light vs. moderate/severe injuries.

Study Limitations

The study sample included older individuals without a previous head injury at the beginning of the study. Therefore, the results documented here may not be generalizable to individuals who experience a head injury early in life.

Factors such as physical function and frailty were not considered, which could have impacted the observed connections.

The concept of head injuries accompanied by loss of consciousness or requiring medical treatment may not capture mild injuries accurately.

Data on key variables like clinical characteristics, injury mechanisms, or acute imaging findings were also not available. At the start of the study, a measure of self-reported seizures/epilepsy was not available, leading to the definition of seizures/epilepsy and PTE based on ICD-9/10 codes.

Conclusions

In conclusion, this study revealed a higher risk of dementia in individuals with PTE, which was significantly higher than the dementia risk in individuals with a history of seizures/epilepsy or head injuries alone.

These findings suggest that PTE is associated with long-term outcomes, emphasizing the importance of preventing head injuries through public health measures.

Further investigations are needed to uncover the risk factors and underlying mechanisms in PTE development. This will aid in focusing efforts on preventing PTE after a head injury.

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