Comorbidities in newly diagnosed epilepsy: Pre-existing health conditions are common and complex across age groups

Objectives: People with epilepsy have a higher prevalence of medical and psychiatric comorbidities com-pared to the general population. Comorbidities are associated with poor epilepsy outcomes, and there have been recommendations for screening and early identification to improve clinical management. Data from 'First Seizure Clinics' (FSCs) with expert epileptological review can inform about disorders already present at the point of diagnosis of epilepsy or unprovoked seizures. Here, we aimed to describe pre-existing con-ditions with a focus on psychiatric, substance use, cardiac, neurological, and cancer health domains.Methods: We included 1383 adults who received a new diagnosis of epilepsy or unprovoked seizures at Austin Hospital (AH) or Royal Melbourne Hospital (RMH) (Australia) FSCs from 2000 to 2010. Data were audited from FSC records, primarily detailed interviews undertaken by epileptologists. Logistic regression examined age distribution and other risk factors.Results: The median age at FSC presentation was 37 years (IQR 26-53, range 18-94). Pre-existing condi-tions were reported by 40 %; from 32 % in the youngest group (18-30 years) to 53 % in the oldest (65+ years). Psychiatric (18 %) and substance use (16 %) disorders were most common, with higher prevalence among patients 18 to 65 years of age compared to those older than 65 years (p < 0.001). Cardiac, neurological, or cancer conditions were reported by 3-6 %, most often amongst those older than 65 years (p < 0.01). Eight percent (n = 112) reported disorders in >1 health domain. The commonest combination was a psychiatric condition with substance use disorder. Of the sixty-two patients reporting this combination, 61 were <= 65 years of age.Conclusions: Pre-existing health conditions are present in a substantial proportion of patients diagnosed with epilepsy or unprovoked seizures. Disorders are highest amongst elders, but one-third of younger adults also reported positive histories. These are predominantly psychiatric and/or substance use disorders, conditions strongly associated with poor outcomes in the general population. These findings inform post -diagnosis planning and management, as well as research examining post-diagnostic outcomes and associ-ations between comorbidities and epilepsy.(c) 2022 Elsevier Inc. All rights reserved.

Automated summary

Individuals with epilepsy often have comorbid medical and psychiatric conditions, which are associated with poor epilepsy outcomes. This study examined pre-existing conditions in patients with new diagnoses of epilepsy or unprovoked seizures and found high prevalence of psychiatric and substance use disorders. The findings highlight the importance of screening and managing comorbidities in individuals with epilepsy.