Abstract Details

Comorbidities common in epilepsy are burdensome to patients and may also be associated with mortality. However, little is known about how phenotypic patterns of comorbidity before and after emergence of epilepsy, and their associations with mortality/cause of death. 

Identify phenotypic patterns of comorbidity in epilepsy.

We identified epilepsy and seizure index date in a cohort of Post-9/11 Era Veterans in VA care (2002-2018). We included those with data available for a 5 year ‘trajectory’ period centered on the index date (-2, index [0], +2 years). For each year we identified diagnoses for 26 conditions associated with traumatic brain injury (TBI), post-concussion symptoms, chronic disease, and mental health conditions. Latent class analysis (LCA) grouped Veterans based on similarity of comorbidity trajectories (phenotypes) over the 5-year period, and examined mortality and cause of death associated with phenotypes adjusted for demographic characteristics. 

15,716 Veterans met inclusion criteria (mean age 33.5; SD 9.9). LCA identified 6 phenotypes. 

Healthy: few comorbidities except brain tumor (highest in this group). 

Deterioration: moderate probabilities of mental health conditions that increased over time. 

Bipolar/Substance Use Disorder (SUD)

 Chronic Disease: hypertension, cerebrovascular disease (CVD), cardiac disease

Post-traumatic Stress Disorder (PTSD): PTSD, TBI, headache 

Polytrauma: TBI, PTSD, pain. headache, lung disease 

Treating the seizure is not the sum total of treating the patient with epilepsy. We identified six epilepsy comorbidity phenotypes, which were associated with mortality and cause of death. Future work will identify optimal treatment approaches and develop risk scores to identify early, individuals that are likely to have adverse outcomes.