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New-onset epilepsy risk factors in older veterans
Pugh MJ, Knoefel JE, Mortensen EM, Amuan ME, Berlowitz DR, Van Cott AC.. Journal of the American Geriatrics Society, 2009-02-01
Topic: Risk, prevention and care in population studies
Plain-language summary
Objectives To identify risk factors for new-onset geriatric epilepsy that may trigger clinicians to consider a differential diagnosis of epilepsy at symptom onset. Design Retrospective cohort study. Setting National Veterans Affairs (VA) databases. Participants Veterans aged 66 and older in fiscal year 2000 (FY00) who received VA care in FY99 and FY00. Individuals with new-onset epilepsy based on a validated algorithm constituted the epilepsy cohort (n=1,843), and individuals without epilepsy constituted the geriatric cohort (n=1,023,376). Measurements Age, sex, and race were derived from VA databases. Clinical conditions associated with new-onset geriatric epilepsy (e.g., cerebrovascular disease, dementia, brain tumor) and stroke risk-factors (e.g., hypertension, diabetes mellitus, cardiovascular disease) were identified using validated International Classification of Diseases, Ninth Revision, Clinical Modification, codes before epilepsy onset (epilepsy cohort) and in FY00 (geriatric cohort). Results Multivariable logistic regression analysis indicated that patients with cerebrovascular disease (odds ratio (OR)=3.50, 95% confidence interval (CI)=3.13-3.91), cerebrovascular disease and dementia (OR=4.14, 95% CI=3.46-4.96), brain tumor (OR=2.14, 95% CI=1.46-3.13), head injury (OR=2.11, 95% CI=1.41-3.14), and other central nervous system (CNS) conditions (OR=1.57, 95% CI=1.32-1.88) were more likely to experience new-onset epilepsy. Statin prescription (OR=0.64, 95% CI=0.56-0.73), older age (> or =85 vs 66-74, OR=0.66, 95% CI=0.50-0.87), obesity (OR=0.74, 95% CI=0.62-0.87), and hypercholesterolemia (OR=0.87, 95% CI=0.76-0.98) were associated with a lower likelihood of epilepsy. Conclusion These data suggest greater epilepsy risk for older individuals with CNS insult and an additive effect of cerebrovascular disease and dementia. The statin finding requires further exploration but points to a possible target for prevention of geriatric epilepsy.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Pugh, M. J., Knoefel, J. E., Mortensen, E. M., Amuan, M. E., Berlowitz, D. R., & Van Cott, A. C. (2009). New-onset epilepsy risk factors in older veterans. Journal of the American Geriatrics Society. https://doi.org/10.1111/j.1532-5415.2008.02124.x
Vancouver
Pugh MJ, Knoefel JE, Mortensen EM, Amuan ME, Berlowitz DR, Van Cott AC. New-onset epilepsy risk factors in older veterans. Journal of the American Geriatrics Society. 2009. doi:10.1111/j.1532-5415.2008.02124.x. PMID: 19207140.
BibTeX
@article{pugh2009-19207140,
author = {Pugh, M. J. and Knoefel, J. E. and Mortensen, E. M. and Amuan, M. E. and Berlowitz, D. R. and Van Cott, A. C.},
title = {{New-onset epilepsy risk factors in older veterans}},
journal = {Journal of the American Geriatrics Society},
year = {2009},
doi = {10.1111/j.1532-5415.2008.02124.x},
pmid = {19207140},
url = {https://doi.org/10.1111/j.1532-5415.2008.02124.x}
}
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Key findings
- Clinical conditions associated with new-onset geriatric epilepsy (e.g., cerebrovascular disease, dementia, brain tumor) and stroke risk-factors (e.g., hypertension, diabetes mellitus, cardiovascular disease) were identified using validated International Classification of Diseases, Ninth Revision, Clinical Modification, codes before epilepsy onset (epilepsy cohort) and in FY00 (geriatric cohort).
- Results Multivariable logistic regression analysis indicated that patients with cerebrovascular disease (odds ratio (OR)=3.50, 95% confidence interval (CI)=3.13-3.91), cerebrovascular disease and dementia (OR=4.14, 95% CI=3.46-4.96), brain tumor (OR=2.14, 95% CI=1.46-3.13), head injury (OR=2.11, 95% CI=1.41-3.14), and other central nervous system (CNS) conditions (OR=1.57, 95% CI=1.32-1.88) were more likely to experience new-onset epilepsy.
- Statin prescription (OR=0.64, 95% CI=0.56-0.73), older age (> or =85 vs 66-74, OR=0.66, 95% CI=0.50-0.87), obesity (OR=0.74, 95% CI=0.62-0.87), and hypercholesterolemia (OR=0.87, 95% CI=0.76-0.98) were associated with a lower likelihood of epilepsy.
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Study details
- Study designcohort study
- Participants1,843
- Effect sizeOR=4.14; OR=2.14; OR=2.11
- Evidence strengthModerate
How this study scored 67/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for randomized / blinded because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multicenter collaboration, so those were left out: it earned 39 of the 58 points we could judge it on, which is 67 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of the American Geriatrics Society) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2009 — within 20 year(s) of the newest study here |
| Sample size | 3 / 4 | 1,843 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multicenter collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 19207140) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 39 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 39 of the 58 points we could judge it on is 67 out of 100. |
| Total | 67 / 100 | — |
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