AsI have written in earlier monthly blogs, most people are surprised to learnthat the commonest onset of epilepsy is in the older age-group and not in the pediatricpopulation Why? We are living longer.

Theepilepsy population is one percent of all people. In only half of these peoplecan a cause for their epilepsy be identified. In the other half no cause can befound, in other words, these people have idiopathic epilepsy. In those for whoma cause can be identified, they have what is called symptomatic epilepsy. Usually,the cause is a structural abnormality in the brain associated with scars fromtrauma, scars from strokes, brain tumors, brain infections, abnormal bloodvessels etc.

Thisblog highlights a summary edited by Susan Kreimer in the Neurology TodayApril 4, 2024, issue. It addresses the higher incidence of dementia in thosewith post-traumatic epilepsy1. Post-traumatic epilepsy (PTE) isassociated over a 25-year follow-up of developing dementia compared withepilepsy without a history of head trauma. A combination of epilepsy and headinjury places the person at an increased risk of developing dementia.

Althoughsome patients experiencing significant head injury are placed on anticonvulsantmedications even before a seizure occurs, usually for short periods, as seizureprophylaxis, this has not been found to alter the risk of eventually developingPTE. Even mild traumatic brain injury can result in PTE up to a year after thehead injury.

Researcherscollected 12,558 individuals aged 45-64. The average age at baseline was 54years. Nearly 58% were female and 28% were Black. Of this group 14.4 reportedpast head injury, 5.1% had seizure/epilepsy and 1.2 % had PTE. After follow-upspanning a median of 25 years, 19.9 of the participants developed dementia.Dementia risk factors may vary among population subgroups. The researchersadjusted for vascular and genetic risk factors.

Approximately5-8% of the American population over 65 has dementia. Neurologists areencouraged to have a lower threshold to suspect cognitive impairment anddementia in their patients with PTE. Screen the patients themselves rather thanrely on reports of caregivers to identify such patients for greater diagnosticaccuracy. Have them undergo neuropsychological testing to confirm dementia ifit appears.

Weconclude that being aware of this group of PTE patients and of assessing them periodicallyfor their higher risk of developing dementia can lead to better healthoutcomes.

1)    SchneiderKCA, Law CA, Gottesman RF et. al.  Post-traumaticEpilepsy and dementia risk. JAMA Neurol 2024; Epub 2024 Feb 26

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