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Seizures in older adults could signal something deeper. A large pooled analysis of over 42,000 adults found that vascular risk factors — including stroke history, diabetes, smoking, chronic kidney disease, and hypertension — are each independently linked to higher rates of late-onset epilepsy (LOE). Experts say clinicians should look beyond seizure control and start assessing vascular health in these patients.
Seizures in older adults could signal something deeper. A major pooled analysis published in JAMA Neurology found that late-onset epilepsy (LOE) — epilepsy first diagnosed in adults 65 and older — is strongly tied to vascular risk factors, suggesting it may be a marker of underlying cerebrovascular disease rather than just a standalone neurological condition.
The study combined individual-level data from six US population-based cohorts, tracking 42,257 adults over a mean of 9.3 years. Of those, 1,500 developed LOE — an incidence rate 2–3 times higher than Parkinson's disease. Non-Hispanic Black participants had the highest incidence at 6.4 cases per 1,000 person-years, a disparity that vascular risk factors alone couldn't fully explain.
Key Takeaways:
Why it matters: Clinicians often focus solely on seizure control in older patients with epilepsy. This research suggests that LOE visits should also be an opportunity to screen for and manage vascular risk factors — potentially reshaping how neurologists and primary care providers approach this growing patient population.
