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Stroke, diabetes, and hypertension raise epilepsy risk in seniors. A large pooled analysis of over 42,000 US adults found that common vascular risk factors — including stroke, diabetes, smoking, chronic kidney disease, and hypertension — significantly increase the likelihood of developing late-onset epilepsy (LOE). The findings suggest that epilepsy in older adults may often reflect an underlying vascular disease burden.
A major new study published in JAMA Neurology is drawing a clearer line between cardiovascular health and epilepsy risk in older adults. Researchers pooled data from six prospective US cohort studies involving 42,257 adults (average age 71.4 years) and tracked them for nearly a decade. Of those, 1,500 — about 3.5% — developed late-onset epilepsy (LOE), at a rate of 3.8 cases per 1,000 person-years.
The strongest risk factor was a history of stroke, which nearly doubled the odds of developing LOE. Diabetes, current smoking, chronic kidney disease, and hypertension also independently raised the risk. Even a genetic factor — carrying two copies of the APOE ε4 allele — was linked to an 84% higher risk of LOE.
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Why it matters: These findings suggest that late-onset epilepsy in older adults may be a downstream consequence of vascular disease — meaning clinicians should routinely assess vascular risk factors when evaluating new-onset seizures in this population. While the study doesn't establish causation, it raises important questions about whether better vascular risk management could one day help prevent epilepsy.
