Phenotypes of Comorbidity in Epilepsy: Variation by TBI Severity and Deployment Status
Abstract
Scientific Rationale: Epilepsy affects 1 in 26 Americans and is a potential result of traumatic brain injury (TBI). This is a significant concern for the Department of Defense (DoD) and Department of Veterans Affairs (VA) given the high number of Service members who have suffered a TBI while deployed in support of the wars in Iraq and Afghanistan (Post-9/11) and the number of Active Duty Service Members (ADSM) who experience TBI in non-deployed settings. Because the majority of TBI are mild, even a slightly elevated risk of post-traumatic epilepsy following mild TBI (mTBI) could substantially increase the burden of epilepsy on patients and families and increase the care burden for epilepsy in the DoD and VA healthcare systems. What are those burdens? An important burden identified by the Institute of Medicine Report, Epilepsy Across the Spectrum, Promoting Health and Understanding, is co-occurring neurological, psychological, and chronic disease conditions, or comorbidities. Concern about comorbidities in patients with epilepsy has been evident since Hippocrates described the co-occurrence of depression and epilepsy in 400 BC. Despite this concern, research examining comorbidity has examined the problem primarily with snapshots of data that do not allow longitudinal evaluation. Why do we need to identify longitudinal comorbidity patterns, or phenotypes? Existing work that used longitudinal data has revealed that some conditions have a bidirectional relationship with epilepsy, meaning that people with a condition are more likely to develop epilepsy and people with epilepsy are also more likely to develop that condition. Examples include depression, bipolar disorder, schizophrenia, and others. Moreover, existing studies have not examined comorbidity patterns longitudinally in a way that provides a description of comorbidity phenotypes that may help health care providers identify the best treatment approaches for the patient and identify patients who are at risk for bad outcomes, such as death, early enough to intervene in ways that may be helpful to the patient and family. Scientific Objective: The proposed study will leverage data from an existing DoD-funded post-traumatic epilepsy study (W81XWH-16-2-0046) that is examining the relationship between mTBI and epilepsy in deployed Post-9/11 Veterans. We will add to that study by identifying patterns of comorbidity in Post-9/11 deployed Veterans with epilepsy using latent class analysis, and by adding a cohort of non-deployed Post-9/11 Veterans who are also in VA care for the same analysis. As a result, with a small investment we will be able to identify specific phenotypes of comorbidity in Veterans with epilepsy and be able to determine if those patterns are different for individuals who: (1) were deployed, where the likelihood of blast exposure is higher, and (2) have TBI exposure compared to those who do not. Finally, we will examine the extent to which these comorbidity phenotypes help explain premature death and the specific cause of death in these individuals with epilepsy. Not only will we describe the extent to which death is self-inflicted, accidental, related to Sudden Unexplained Death in Epilepsy (SUDEP) or due to chronic disease, but we will also use statistical models to identify comorbidity phenotypes at greatest risk of death overall and specific types of death. These findings will have enormous implications for healthcare delivery for Veterans and ADSM with epilepsy. For instance, the data may suggest that chronic disease is an important cause of death. This finding would suggest the importance of care coordination between primary care providers and neurologists/epileptologists providing subspecialty care for patients with epilepsy. This study addresses the Epilepsy Research Program Idea Development Award focus area of epilepsy epidemiology by examining variation in comorbidity phenotypes before and after epilepsy among deployed and no
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1810247
Entities
People
- Mary Jo V Pugh
Organizations
- United States Army
- Western Institute For Biomedical Research