015-23 – Cardiovascular and Cerebrovascular Health in Patients with Late Onset Unprovoked Seizures and Epilepsy

Introduction

The number of patients developing seizures and epilepsy in adult life is increasing with the ageing population. Patients developing late onset unprovoked seizures and epilepsy (LOUE) after the age of 60 have a three times increased risk of stroke compared to healthy controls. At present, routine clinical care does not address the increased vascular risk for adult patients presenting with a first, unprovoked seizure, but this could be an important timepoint in the patient journey to improve overall vascular health and mitigate future vascular events.

The aims for this project are to assess vascular health measures in patients with LOUE and determine:

• How their risk profile compares with healthy controls and patients with newly diagnosed hypertension.
• If LOUE patients have vascular risk factors and/or impaired cerebrovascular physiology that could be modified to reduce their future risk of vascular events
• If it is possible to predict future vascular events in LOUE patients.

Methods

The study consists of three parts. The first part will be a cross-sectional comparison of vascular health measures in patients with LOUE to age and sex matched hypertensive and healthy controls. Vascular health will be assessed using transcranial doppler studies; arterial stiffness and QRisk3 score.

In part 2 of the study, these measures will be repeated at 6 and 12 months in patients with LOUE and hypertension.

Part 3 of the study will involve establishing a prospective clinical cohort of patients with LOUE to correlate vascular risk profile and clinical MRI brain at presentation with incident cardiovascular events at 12 months.

Analysis

The primary outcomes are the results of the physiology studies and QRisk3 score. Secondary outcomes are adverse cardiovascular events at 12 months. Cross sectional and longitudinal differences will be tested between LOUE, disease-control hypertension and healthy controls using one-way and repeated measures ANOVA respectively.