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Bariatric surgery increases the risk of epilepsy

Bariatric surgery increased the risk of epilepsy, a retrospective Canadian study showed.

During a minimum 3-year follow-up, bariatric surgery patients had a 45% increased risk of developing epilepsy compared with people who did not undergo bariatric surgery (HR 1.45, 95% CI: 1.35-1 ,56), reported Jorge Burneo, MD, MSPH, of Western University in London, Ontario, Canada, and colleagues.

Stroke during the follow-up period increased the risk of epilepsy for bariatric surgery patients (HR 14.03, 95% CI 4.26-46.25), they wrote in Neurology.

The findings echoed earlier research that showed elevated risks of epilepsy and seizures after gastric bypass surgery in Sweden. The Swedish study suggested that “bariatric surgery may be an unrecognized risk factor for epilepsy; however, this potential association has not been fully explored,” Burneo and his colleagues noted.

Late neurological complications of bariatric procedures, defined as those occurring 3 to 20 months after surgery, occur in 5% to 16% of patients, they noted.

“Our findings suggest that epilepsy may be among these long-term neurological complications; however, the mechanism remains unclear,” they wrote.

Malabsorption could be a factor, the researchers suggested. “Although limited, there is some research investigating the role of micronutrient deficiencies in epilepsy,” they noted.

A study observed significantly lower levels of vitamin C, zinc, and copper among patients with epilepsy and no history of antiepileptic drug treatment relative to healthy controls,” they continued.another study of a small number of patients with epilepsy found that normalization of serum 25-hydroxyvitamin D levels significantly reduced mean seizure frequency by 40%.”

Burneo and colleagues used administrative health databases in Ontario, Canada, to identify 16,958 adults who underwent bariatric surgery for obesity from July 2010 to December 2016 (exposed participants) and 622,514 adults who were hospitalized with obesity. a diagnosis of obesity but who did not undergo bariatric surgery during the same period (unexposed participants).

The study excluded people with a history of seizures, epilepsy, risk factors for seizures or epilepsy, psychiatric disorders, or substance abuse or dependence.

The median age was about 47 years, and about two-thirds of the participants were women. The study followed the patients until December 2019.

Total and median follow-up was 3,691,411 and 5.8 person-years in the exposed cohort and 3,818,669 and 5.9 person-years in the unexposed cohort.

For the primary analysis, the investigators used the inverse probability of treatment weighting to control for confounding. In the weighted cohorts, the estimated rates of epilepsy were 50.1 per 100,000 person-years in the exposed group and 34.1 per 100,000 person-years in the unexposed group.

“We did not find that patients had a differential risk of epilepsy based on the type of procedure received,” the researchers said. “However, we were likely underpowered to detect differences in risk between types of procedures.”

Stroke was a significant risk factor for new-onset epilepsy in the exposed group. “However, the very wide confidence interval around this estimate (95% CI 4.26 to 46.25) indicates that we observed a small number of strokes,” Burneo and his colleagues wrote. “Future research should try to provide a more precise estimate of the effect of stroke occurring after bariatric surgery on epilepsy risk.”

A limitation of the analysis was that the investigators were unable to assess obesity status or BMI throughout the study. Some obesity-related conditions may affect epilepsy risk, Burneo’s group noted.

  • Judy George covers neurology and neuroscience news for MedPage Today and writes about brain aging, Alzheimer’s, dementia, multiple sclerosis, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s , ALS, concussion, CTE, sleep, pain and more. To follow

Disclosures

The study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and the Ministry of Long-Term Care.

Burneo disclosed that he held the Jack Cowin Endowed Chair in Epilepsy Research at Western University.


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