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First Epileptic Seizures in Old Age Suggest High Risk of Subsequent Stroke

(pp 1175, 1184)

Lancet 2004; 363: 1174-75, 1184-86

UK research in this week's issue of THE LANCET highlights how an unexplained epileptic seizure among people aged 60 years or over probably indicates a high risk of subsequent stroke. Authors of the study comment 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.

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 (p 1175), 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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