Vascular Risk Factors Associated With Increased Risk of Late-Onset Epilepsy in Older Adults
KEY TAKEAWAYS
- A pooled analysis of 42,257 US adults found that 1500 participants (3.5%) developed late-onset epilepsy (LOE) during a mean follow-up of 9.3 years.
- History of stroke, diabetes, current smoking, chronic kidney disease, and hypertension were associated with increased LOE incidence.
- The findings highlight the potential importance of evaluating vascular risk factors in older adults presenting with new-onset epilepsy.
A pooled individual participant data meta-analysis of 6 prospective US cohort studies identified significant associations between vascular risk factors and incident late-onset epilepsy (LOE), suggesting that underlying cerebrovascular disease may contribute to epilepsy development in older adults. Findings were published October 19, 2026, in JAMA Neurology.¹
The analysis included 42,257 adults (mean age, 71.4 years; 56.0% female). During a mean follow-up of 9.3 years, 1500 participants developed LOE, corresponding to an incidence rate of 3.8 cases per 1000 person-years.¹
In fully adjusted analyses, a history of stroke demonstrated the strongest association with LOE (hazard ratio [HR], 1.99; 95% CI, 1.63–2.43), followed by diabetes (HR, 1.42; 95% CI, 1.25–1.62), current smoking (HR, 1.39; 95% CI, 1.18–1.64), chronic kidney disease (HR, 1.29; 95% CI, 1.13–1.48), and hypertension (HR, 1.17; 95% CI, 1.04–1.31). Carrying 2 apolipoprotein E (APOE) ε4 alleles was also associated with increased LOE incidence (HR, 1.84; 95% CI, 1.36–2.50).¹
These findings align with previous Practical Neurology coverage, including Diagnostic Considerations for New-Onset Epilepsy in Older Adults, which identifies cerebrovascular disease as a major cause of epilepsy in this population.² The relationship between stroke and subsequent seizures is further explored in Management of Poststroke Epilepsy: An Update.³
The investigators concluded that LOE may reflect underlying vascular disease burden, supporting vascular risk assessment in older adults with new-onset epilepsy. However, the observational findings do not establish causality or demonstrate that vascular risk reduction prevents epilepsy.
References
- Choi H, Gutierrez J, Wang T, et al. Vascular risk factors and late-onset epilepsy. JAMA Neurol. Published online October 19, 2026. doi:10.1001/jamaneurol.2026.3708.
- Mocker H, Elder C. Diagnostic considerations for new-onset epilepsy in older adults. Practical Neurology. Published October 30, 2024. Read article.
- Kawamura Y, Beriwal N, Misra S, Mishra NK. Management of poststroke epilepsy: an update. Practical Neurology. Published December 4, 2024. Read article.