title: Risk of Epilepsy in Individuals With Posttraumatic Stress Disorder: A Nationwide Longitudinal Study.
abstract: OBJECTIVE
  Several cross-sectional studies have reported a relationship between posttraumatic stress disorder (PTSD) and epilepsy. However, the temporal association between PTSD and epilepsy has rarely been investigated. We hypothesized that the risk of developing epilepsy later in life would be higher in patients with PTSD than in those without PTSD.
  
  
  METHODS
  Using the Taiwan National Health Insurance Research Database, 6425 individuals with PTSD and 24,980 age-/sex-matched controls were enrolled between 2002 and 2009 in our study and followed up to the end of 2011. Those who developed epilepsy during the follow-up period were identified.
  
  
  RESULTS
  Individuals with PTSD had a higher incidence of developing epilepsy (2.65 versus 0.33 per 1000 person-years, p < .001), with an earlier onset of epilepsy (37.53 years [15.80 years] versus 48.11 years [23.97 years], p = .002) than did the controls. Individuals with PTSD had an elevated risk of developing epilepsy (hazard ratio [HR] = 3.72, 95% confidence interval [CI] = 2.27-6.11) during the follow-up after adjustment for demographic data and medical and psychiatric comorbidities. Sensitivity analyses after excluding the observation in the first year (HR = 2.53, 95% CI = 1.44-4.47) and the first 3 years (HR = 2.14, 95% CI = 1.15-4.01) revealed consistent results.
  
  
  CONCLUSIONS
  These results supported a temporal association between PTSD and the development of epilepsy. Further studies are warranted to investigate the underlying pathophysiological pathways that explain the longitudinal association of PTSD with subsequent epilepsy.
authors.affiliation: From the Department of Psychiatry (Y.-H. Chen, Wei, Bai, Hsu, Huang, Su, Li, Lin, Tsai, M.-H. Chen), Taipei Veterans General Hospital; Division of Psychiatry (Bai, Hsu, Huang, Su, Li, Lin, Tsai, M.-H. Chen), School of Medicine, National Yang-Ming University; Department of Family Medicine (T.-J. Chen), Taipei Veterans General Hospital; Institute of Hospital and Health Care Administration (T.-J. Chen), National Yang-Ming University; Department of Neurology (Wu), and Center for Geriatrics and Gerontology (Wu), Taipei Veterans General Hospital, Taipei; School of Traditional Chinese Medicine (Pan), Chang Gung University; Research Center for Chinese Herbal Medicine and Research Center for Food and Cosmetic Safety (Pan), College of Human Ecology, Chang Gung University of Science and Technology; Liver Research Center (Pan), Chang Gung Memorial Hospital, Taoyuan; and Division of Psychiatry (Wei), Kunming Branch, Taipei City Hospital, Taipei, Taiwan.
authors.forename: Yu-Hsiung
authors.initials: YH
authors.lastname: Chen
authors.forename: Han-Ting
authors.initials: HT
authors.lastname: Wei
authors.forename: Ya-Mei
authors.initials: YM
authors.lastname: Bai
authors.forename: Ju-Wei
authors.initials: JW
authors.lastname: Hsu
authors.forename: Kai-Lin
authors.initials: KL
authors.lastname: Huang
authors.forename: Tung-Ping
authors.initials: TP
authors.lastname: Su
authors.forename: Cheng-Ta
authors.initials: CT
authors.lastname: Li
authors.forename: Wei-Chen
authors.initials: WC
authors.lastname: Lin
authors.forename: Yi-Hui
authors.initials: YH
authors.lastname: Wu
authors.forename: Tai-Long
authors.initials: TL
authors.lastname: Pan
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.forename: Shih-Jen
authors.initials: SJ
authors.lastname: Tsai
authors.forename: Mu-Hong
authors.initials: MH
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D016208:Databases, Factual; D004827:Epilepsy / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D013624:Taiwan; D055815:Young Adult