title: Prevalence of epilepsy/seizures as a comorbidity of neurologic disorders in nursing homes.
abstract: OBJECTIVE
  To determine the prevalence of epilepsy/seizure (epi/sz) comorbid with other neurologic disorders in elderly nursing home residents and to examine demographic and regional variability and associations with clinical characteristics.
  
  
  METHODS
  We studied 5 cross-sectional cohorts of all residents in any Medicare/Medicaid-certified nursing home in the United States on July 15 of each year from 2003 to 2007. Epi/sz was identified by ICD-9 codes (345.xx or 780.39) or check box (Minimum Data Set). Epi/sz prevalence was stable across all years, so only 2007 data were examined further. Logistic regression with generalized estimating equations was used to model cross-sectional prevalence of epi/sz as a function of demographics and neurologic comorbidities of interest, with adjustment for clinical characteristics, including cognitive status, comorbidity burden, medication burden, and activities of daily living.
  
  
  RESULTS
  Point prevalence of epi/sz in 2007 was 7.7% (n = 91,372 of N = 1,186,579) differing by geographical region, race/ethnicity, age group, and sex. Neurologic conditions having the highest association with epi/sz were brain tumor (epi/sz prevalence 23.4%-35.2%), head injury (17.9%), hemiplegia (17.7%), and stroke (13.7%). Epi/sz comorbid with stroke or dementia had a strong decreasing association with age (65-74 years had ≈3.8-times higher odds of epi/sz than 85+ years). Activities of daily living, comorbidity burden, and cognition scores were worse in persons with than without epi/sz.
  
  
  CONCLUSIONS
  The prevalence of epi/sz in the elderly nursing home population is >7-fold higher compared to community-dwelling elderly and is 7 to 30 times higher among those with certain comorbid neurologic conditions. Demographics and clinical characteristics had weaker associations with epi/sz prevalence.
authors.affiliation: From Experimental and Clinical Pharmacology (A.K.B., I.E.L.), College of Pharmacy, Department of Neurology (I.E.L.), and Division of Biostatistics (K.S., L.E.E.), School of Public Health, University of Minnesota, Minneapolis. birnb002@umn.edu.
authors.forename: Angela K
authors.initials: AK
authors.lastname: Birnbaum
authors.affiliation: From Experimental and Clinical Pharmacology (A.K.B., I.E.L.), College of Pharmacy, Department of Neurology (I.E.L.), and Division of Biostatistics (K.S., L.E.E.), School of Public Health, University of Minnesota, Minneapolis.
authors.forename: Ilo E
authors.initials: IE
authors.lastname: Leppik
authors.affiliation: From Experimental and Clinical Pharmacology (A.K.B., I.E.L.), College of Pharmacy, Department of Neurology (I.E.L.), and Division of Biostatistics (K.S., L.E.E.), School of Public Health, University of Minnesota, Minneapolis.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Svensden
authors.affiliation: From Experimental and Clinical Pharmacology (A.K.B., I.E.L.), College of Pharmacy, Department of Neurology (I.E.L.), and Division of Biostatistics (K.S., L.E.E.), School of Public Health, University of Minnesota, Minneapolis.
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Eberly
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003704:Dementia / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D004827:Epilepsy / Q000150:complications* / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid; D006278:Medicare; D009735:Nursing Homes / Q000706:statistics & numerical data; D015995:Prevalence; D012306:Risk; D020521:Stroke / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D014481:United States / Q000453:epidemiology