Journal Club: Estimating risk for developing epilepsy

Abstract

This initial Journal Club article looks at a study from Hesdorffer and colleagues1 who have calculated the lifetime risk of developing epilepsy. The study provides an elegant example of proper epidemiologic methods and results in data that have important implications for public health. When addressing public health aspects of epilepsy, it is essential to obtain an unbiased estimate of the lifetime risk of epilepsy. With this assessment, the economic burden of epilepsy, including health care expenditures, productivity loss, intangible costs such as those associated with stigma, and additional costs from medical comorbidities of epilepsy can be extrapolated.2,3 Similarly, the patient-perceived burden of epilepsy, including associations between epilepsy and poor health, unemployment, lower annual incomes, lower health-related quality of life, smoking, and obesity, can be better evaluated.4 Given this information and the proportion of the aging population that is at risk for epilepsy, the limited number of specialists able to care for epilepsy patients is a growing concern. Nearly 35% of adults with self-reported active epilepsy reported not having seen a neurologist or epileptologist in the previous year4 and the Workforce Task Force of the American Academy of Neurology predicts a shortfall of neurologists in the years to come.5 With these broad consequences of epilepsy, the questions that Hesdorffer and colleagues pose in their study are relevant to neurologic practice. What is the risk of developing epilepsy over the course of a lifetime? How much does this risk increase with age? How does the incidence of epilepsy differ among age groups? To answer these critical epidemiologic questions, Hesdorffer and colleagues performed a population-based retrospective cohort study using medical records from Southeastern Minnesota. The study population was limited to those who developed epilepsy between January 1, 1960, and December 31, 1979, as documented through the …