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Research: seizures in old age suggest high risk of subsequent stroke

14 April, 2004

New research has
highlighted how an unexplained epileptic seizure among people aged 60
years or over may indicate a high risk of subsequent stroke.

Raymond Tallis from the Hope Hospital in Salford and colleagues obtained data from the UK General Practice Research Database
for around 4,700 individuals who had experienced seizures beginning at
or after the age of 60. 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 to have a
subsequent stroke than people who had no history of seizures.

The authors of the study, published in The Lancet,
wrote that the identification of patients at increased stroke risk has
implications for preventative treatment and that 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.

Professor Tallis commented:

'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, writes:

'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'.