LAUSR

Commentary Epilepsy, whether in prevalent or incident form, is a steadily expanding national and global health concern. Recent US national surveillance data estimating prevalent epilepsy cases in child and adult groups found numbers increasing by a rate approaching 24% from 2010 to 2015 (2.3–3.0 million cases) with over 1% of the population identified as having epilepsy (1). When examining occurrence rates in older adults, numbers are likewise concerning. Estimated prevalence and incident rates from a large random sample of US Medicare beneficiaries found rates of 10.8/1000 and 2.4/1000, respectively (2). The numbers were especially notable for African-American males and for the oldest age group. Data from a large community-based surveillance sample found much higher incident rates in older adults (ages 60–74, 75–89) compared with younger adults (3). The rise as age increased doubled from the younger group to the age 60 to 74 group (from 10.6–25.8/100,000) and then dramatically increased in the oldest group (101.1/100,000). Similar to other studies, race was a factor with African-Americans having a higher incidence rate that Caucasians and that stroke history was a significantly predictive factor. Given the costly growth in terms of economic and healthcare costs, in addition the personal costs related to quality of life reduction in the older person with epilepsy, researchers continue with ongoing efforts to establish more precise incident and prevalent rates that in turn will contribute to developing improved predictor risk models. Of the many challenges when gathering epidemiologic information, one is the form by which it is determined. A number of well-known collection approaches have been described that include health surveys, direct health record reviews, insurance claims-based ascertainment methods, as well as various combination of these methods. Recently reported guidelines for epilepsy epidemiologic and surveillance studies outlined these issues (4). That comprehensive document also highlighted the need for epidemiologic studies of epilepsy to be mindful of study costliness, potential burden of time and privacy to those providing information, accuracy by which to improve the probability of raising the chance for a valid data collection (i.e., specificity and sensitivity values), and that the data be representative of the intended target population (4). Keeping these guideline recommendations in mind, recognition of accurate identification of epilepsy cases requires a comprehensive approach for gathering multiple data sources. These sources could include information from medical record chart reviews, insurance claims, and survey data. Studies that can access multiple pieces from these medical information sources hold improved prospects of establishing validated estimates of incident epilepsy. Some have been able to access Predictors of incident Epilepsy in older adults. The Cardiovascular Health Study.