Objective: To assess frequency, types, and mechanisms of comorbidities in people with epilepsy and verify their association with disease features and outcome. Methods: This cohort study was performed in 13 Italian epilepsy centers with nationwide distribution and accurate records. Eligible patients were children and adults diagnosed before December 31, 2005, and followed for a minimum of 10 years. Two pairs of raters independently reviewed patients’ records and classified each comorbidity. In case of disagreement, a third reviewer made the final decision. Comorbidities were classified according to type (organ/system) and underlying mechanism (causal, shared risk factors, chance association). Comorbidity types and mechanisms were described in the entire sample and according to epilepsy prognostic patterns (sustained remission, relapsing-remitting course, no remission). Results: Of 1006 included patients, 266 (26.4%) had at least one comorbidity. The most common were developmental/perinatal (7.5% of cases), psychiatric (6.2%), cardiovascular (5.3%), and endocrine/metabolic (3.8%). Among 408 reported comorbidities, the underlying mechanisms were, in decreasing order, chance association (42.2%), shared risk factors (31.1%), and causal (26.7%). Psychiatric diseases were present in 13.3% of patients with no remission, 5.9% of patients with relapsing-remitting course, and 4.8% of patients with sustained remission (p =.016). The corresponding numbers for endocrine/metabolic diseases were respectively, 9.6%, 3.4%, and 2.9% (p =.013); for respiratory diseases were 3.6%,.3%, and.3% (p =.001), and for urogenital diseases were 3.6%,.7%, and 1.6% (p =.048). The association of endocrine/metabolic, psychiatric, and respiratory comorbidities with epilepsy prognosis was confirmed by multivariable analysis adjusted for the main demographic and clinical variables, with patients with these comorbidities showing a lower probability of achieving remission. Significance: Comorbidities in epilepsy are not uncommon and reflect differing underlying mechanisms. Psychiatric, endocrine/metabolic, and respiratory disorders are associated with a worse long-term epileptological outcome.
Giussani, G., Bianchi, E., Beretta, S., Carone, D., DiFrancesco, J., Stabile, A., et al. (2021). Comorbidities in patients with epilepsy: Frequency, mechanisms and effects on long-term outcome. EPILEPSIA, 62(10), 2395-2404 [10.1111/epi.17022].
|Citazione:||Giussani, G., Bianchi, E., Beretta, S., Carone, D., DiFrancesco, J., Stabile, A., et al. (2021). Comorbidities in patients with epilepsy: Frequency, mechanisms and effects on long-term outcome. EPILEPSIA, 62(10), 2395-2404 [10.1111/epi.17022].|
|Tipo:||Articolo in rivista - Articolo scientifico|
|Carattere della pubblicazione:||Scientifica|
|Presenza di un coautore afferente ad Istituzioni straniere:||No|
|Titolo:||Comorbidities in patients with epilepsy: Frequency, mechanisms and effects on long-term outcome|
|Autori:||Giussani, G; Bianchi, E; Beretta, S; Carone, D; DiFrancesco, J; Stabile, A; Zanchi, C; Pirovano, M; Trentini, C; Padovano, G; Colombo, M; Cereda, D; Tinti, L; Scanziani, S; Gasparini, S; Bogliun, G; Ferrarese, C; Beghi, E; Romeo, A; Viri, M; Specchio, L; Trivisano, M; Mecarelli, O; Zarabla, A; Capovilla, G; Beccaria, F; Sasanelli, F; Galimberti, C; Tartara, E; Zamponi, N; Cappanera, S; Aguglia, U; Ferlazzo, E; La Neve, A; Luisi, C; Pontrelli, G; Cantisani, A; De Maria, G; Albanese, Y|
|Data di pubblicazione:||2021|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1111/epi.17022|
|Appare nelle tipologie:||01 - Articolo su rivista|