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Unexplained Epileptic
Seizure at 60+ May Indicate Future Strokes
April 9, 2004 - People 60 and over who
experience an unexplained epileptic seizure may be at high risk of
subsequent strokes, according to new research. This high risk
identification could lead to preventative treatment.
These seizures should be viewed as a
risk factor for stroke in the same way as other conventional risk
factors such as smoking or lack of exercise, say the UK researchers,
whos study appears in this weeks issue of THE LANCET.
Raymond Tallis from the Hope Hospital,
Salford, UK, and colleagues obtained data from the UK General Practice
Research Database for around 4700 individuals who had experienced
seizures beginning at or after the age of 60 years. They also identified
the same number of people who had not had seizures and whom did not have
any history of cerebrovascular disease (or any other risk factors for
stroke) and compared the two groups for subsequent occurrence of stroke.
Those individuals with seizures were
around three times more likely (relative risk value 2*89) to have a
subsequent stroke than people who had no history of seizures.
Professor Tallis comments: "Our findings
have potentially important clinical implications. They suggest that a
patient who presents with seizures for the first time in late life, when
there is no apparent predisposing cause, should be deemed to be at
increased risk of stroke. The relative hazard of 2*89 found in this
study can be compared, for instance, with the relative risk of 1*4
associated with low HDL-cholesterol concentrations, the doubling of risk
associated with smoking, and the doubling to tripling of risk associated
with lack of exercise. Such patients should be screened for vascular
risk factors and treated appropriately. Further research is warranted to
assess the benefit of specific interventions against stroke in elderly
patients with epilepsy. We believe that these findings are an important
contribution to current stroke-prevention strategies."
In an accompanying Commentary, Cathy
Sudlow from the University of Edinburgh, UK, concludes: "In view of the
likely increased stroke risk, it seems reasonable for general
practitioners, general physicians, geriatricians, neurologists, and
others managing these patients to assess their vascular risk factors,
and to consider treatment to prevent stroke (and other vascular
disease). However, whether or not preventive treatments, such as
cholesterol-lowering, antihypertensive, or antiplatelet drugs, are
appropriate for individual patients will depend on their absolute risk
of stroke and of other vascular events rather than on the existence or
extent of any particular risk factor."
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