Vascular risk factors linked to epilepsy in older adults
Across six US cohorts, current smoking was linked to late-onset epilepsy with a hazard ratio—a comparison of new-case rates—of 1.39.
Limit: Medicare claims can misclassify epilepsy cases
An observational analysis pooled six US cohorts involving 42,257 adults whose average age was 71.4 years; 56.0% were women. Researchers followed participants for an average of 9.3 years to identify epilepsy beginning at age 65 or older.
During follow-up, 1,500 participants (3.5%) developed late-onset epilepsy. Current smoking, high blood pressure, diabetes, chronic kidney disease and a history of stroke were associated with higher risk after adjustment for other factors. Hazard ratios were 1.39 for current smoking, 1.17 for high blood pressure, 1.42 for diabetes, 1.29 for chronic kidney disease and 1.99 for prior stroke. The associations were similar across age, sex, and racial and ethnic groups.
Why it matters
The authors suggested that epilepsy beginning in older age may reflect the underlying burden of disease in the brain’s blood vessels.
Caveats
This observational analysis cannot show that these factors caused epilepsy or that treating them would prevent it. The analysis excluded people who already had epilepsy, and five cohorts used Medicare claims to identify cases.
The paper
Vascular Risk Factors and Late-Onset Epilepsy
Vagelos College of Physicians and Surgeons; Brigham Young University
JAMA Neurology, Oct 19, 2026
