Epilepsy Risk Following Bariatric Surgery for Weight Loss

Tresah C Antaya; Amna Qureshi; Lucie Richard; Salimah Z Shariff; Ahmad Elnahas; Jorge G Burneo

doi:10.1212/WNL.0000000000201100

Epilepsy Risk Following Bariatric Surgery for Weight Loss

Neurology. 2022 Nov 22;99(21):e2359-e2367. doi: 10.1212/WNL.0000000000201100. Epub 2022 Sep 28.

Authors

Tresah C Antaya¹, Amna Qureshi¹, Lucie Richard¹, Salimah Z Shariff¹, Ahmad Elnahas¹, Jorge G Burneo²

Affiliations

¹ From the Department of Clinical Neurological Sciences (T.C.A., A.Q., J.G.B.), Western University, London, Ontario, Canada; ICES Western (L.R., S.Z.S., A.E., J.G.B.), London, Ontario, Canada; and Department of Surgery (A.E.), Western University, London, Ontario, Canada.
² From the Department of Clinical Neurological Sciences (T.C.A., A.Q., J.G.B.), Western University, London, Ontario, Canada; ICES Western (L.R., S.Z.S., A.E., J.G.B.), London, Ontario, Canada; and Department of Surgery (A.E.), Western University, London, Ontario, Canada. jburneo2@uwo.ca.

PMID: 36171141
DOI: 10.1212/WNL.0000000000201100

Abstract

Background and objectives: A previous study reported finding that epilepsy risk is elevated after bariatric surgery for weight loss; however, this association has not been adequately explored. Our objectives were to (1) estimate the risk of epilepsy after bariatric surgery for weight loss relative to a nonsurgical cohort of patients with an obesity diagnosis and (2) identify epilepsy risk factors among bariatric surgery recipients.

Methods: We conducted a population-based retrospective cohort study using linked health administrative databases in Ontario, Canada. Participants were accrued between July 1, 2010, and December 31, 2016, and followed until December 31, 2019. All Ontario residents aged 18 years and older who had bariatric surgery during the accrual period were eligible for inclusion in our exposed cohort. Patients hospitalized with a diagnosis of obesity and who did not have bariatric surgery during the accrual period were eligible for inclusion in our unexposed cohort. We excluded patients with a history of seizures, epilepsy, various seizure or epilepsy risk factors, psychiatric disorders, or drug or alcohol abuse/dependence. In our primary analysis, we used inverse probability of treatment weighting to control for confounding. A marginal Cox proportional hazards model was then used to estimate the risk of epilepsy associated with bariatric surgery. A Cox model was also used to identify epilepsy risk factors among exposed participants.

Results: The final sample included 16,958 exposed participants and 622,514 unexposed participants. After inverse probability of treatment weighting, the estimated rates of epilepsy were 50.1 and 34.1 per 100,000 person-years among those who did and did not have bariatric surgery, respectively. The hazard ratio for developing epilepsy after bariatric surgery was 1.45 (95% CI = 1.35, 1.56). Among participants who received bariatric surgery, stroke during follow-up increased epilepsy risk (HR = 14.03, 95% CI = 4.26, 46.25).

Discussion: In this study, we found that patients with a history of bariatric surgery were at increased risk of developing epilepsy. These findings suggest that epilepsy is a long-term risk associated with bariatric surgery for weight loss.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Bariatric Surgery* / adverse effects
Epilepsy* / epidemiology
Epilepsy* / etiology
Epilepsy* / surgery
Humans
Obesity / epidemiology
Obesity / surgery
Ontario / epidemiology
Retrospective Studies
Weight Loss