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September 17, 2013; 81 (12) Article

Cardiovascular fitness and later risk of epilepsy

A Swedish population-based cohort study

Jenny Nyberg, Maria A.I. Åberg, Kjell Torén, Michael Nilsson, Elinor Ben-Menachem, H. Georg Kuhn
First published September 4, 2013, DOI: https://doi.org/10.1212/WNL.0b013e3182a4a4c0
Jenny Nyberg
From the Center for Brain Repair and Rehabilitation (J.N., M.A.I.Å., M.N., E.B.-M., H.G.K.), Institute for Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg; Occupational and Environmental Medicine (K.T.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Hunter Medical Research Institute (M.N.), University of Newcastle, Australia.
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Maria A.I. Åberg
From the Center for Brain Repair and Rehabilitation (J.N., M.A.I.Å., M.N., E.B.-M., H.G.K.), Institute for Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg; Occupational and Environmental Medicine (K.T.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Hunter Medical Research Institute (M.N.), University of Newcastle, Australia.
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Kjell Torén
From the Center for Brain Repair and Rehabilitation (J.N., M.A.I.Å., M.N., E.B.-M., H.G.K.), Institute for Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg; Occupational and Environmental Medicine (K.T.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Hunter Medical Research Institute (M.N.), University of Newcastle, Australia.
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Michael Nilsson
From the Center for Brain Repair and Rehabilitation (J.N., M.A.I.Å., M.N., E.B.-M., H.G.K.), Institute for Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg; Occupational and Environmental Medicine (K.T.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Hunter Medical Research Institute (M.N.), University of Newcastle, Australia.
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Elinor Ben-Menachem
From the Center for Brain Repair and Rehabilitation (J.N., M.A.I.Å., M.N., E.B.-M., H.G.K.), Institute for Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg; Occupational and Environmental Medicine (K.T.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Hunter Medical Research Institute (M.N.), University of Newcastle, Australia.
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H. Georg Kuhn
From the Center for Brain Repair and Rehabilitation (J.N., M.A.I.Å., M.N., E.B.-M., H.G.K.), Institute for Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg; Occupational and Environmental Medicine (K.T.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Hunter Medical Research Institute (M.N.), University of Newcastle, Australia.
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Citation
Cardiovascular fitness and later risk of epilepsy
A Swedish population-based cohort study
Jenny Nyberg, Maria A.I. Åberg, Kjell Torén, Michael Nilsson, Elinor Ben-Menachem, H. Georg Kuhn
Neurology Sep 2013, 81 (12) 1051-1057; DOI: 10.1212/WNL.0b013e3182a4a4c0

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Abstract

Objective: To analyze the associations between cardiovascular fitness at age 18 years and future risk of epilepsy.

Methods: Population-based cohort study of Swedish male conscripts (n = 1,173,079) born in 1950–1987, who were followed for up to 40 years. Data on cardiovascular fitness were collected during conscription exams and linked with hospital registers to calculate later risk of epilepsy using Cox proportional hazard models controlling for several confounders, including familial factors.

Results: Epilepsy was recorded in 6,796 individuals during the follow-up time. In fully adjusted models, low and medium cardiovascular fitness (compared with high) at age 18 years was associated with increased risk of future epilepsy (hazard ratio 1.79, 95% confidence interval 1.57–2.03; and hazard ratio 1.36, 95% confidence interval 1.27–1.45, respectively). The associations changed only marginally after adjustment for familial influences and prior severe traumatic brain injury, cerebrovascular disease, or diabetes.

Conclusions: Low cardiovascular fitness early in life is associated with an increased risk of epilepsy later in adulthood. These results agree with previous results from animal models. We propose that behaviors that increase cardiovascular fitness may act as positive disease-modifiers for the development of epilepsy.

GLOSSARY

BMI=
body mass index;
ICD=
International Classification of Diseases;
LISA=
Longitudinal Integration Database for Health Insurance and Labor Market Studies;
TBI=
traumatic brain injury;
Wmax=
maximum work rate at volitional exhaustion

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Supplemental data at www.neurology.org

  • Received February 13, 2013.
  • Accepted in final form June 13, 2013.
  • © 2013 American Academy of Neurology
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