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Abstract Details

Sex Differences in Epilepsy Risk Factors and Outcomes in U.S. Veterans
Epilepsy/Clinical Neurophysiology (EEG)
P9 - Poster Session 9 (5:00 PM-6:00 PM)
10-008

To compare the prevalence of epilepsy-related characteristics among male and female veterans in the VA’s Million Veteran Program (MVP) genetic research biobank.
Civilian studies describe sexual dimorphism in certain epilepsy-related outcomes (e.g. lower incidence of status epilepticus and higher incidence of genetic generalized epilepsy in women), which suggest genetic factors may modify epilepsy risk. This preliminary epidemiological analysis of epilepsy-related sex differences in MVP lays the foundation for future genetic epidemiology studies.

This retrospective cohort study included all Veterans enrolled in MVP by 10/1/2024. Epilepsy-related risk factors and outcomes by sex at birth were determined using diagnostic coding and prescription data extracted from the VA EMR. Logistic regression was performed in R to calculate age-adjusted odds ratios (OR).
 Of the 1,016,584 Veterans enrolled in MVP, 10.49% (n=106,642) were female and 4.14% (n=42,073) developed epilepsy. Median age at enrollment was 58 years in females and 71 in males. Compared to males, female Veterans were more likely to have epilepsy (OR=1.14, 95%CI=1.11-1.18) and benign brain tumors (OR=1.88, 95%CI=1.78-1.98), but less likely to have strokes (OR=0.86, 95%CI=0.84-0.88) and traumatic brain injury (TBI, OR=0.74, 95%CI=0.72-0.75). Females with epilepsy were more likely prescribed three or more anti-seizure medications (ASMs, OR=1.45, 95%CI=1.37-1.55) and undergo neurostimulator placement (OR=1.72, 95%CI=1.37-2.14), but less likely to develop status epilepticus (OR=0.78, 95%CI=0.70-0.86) than males.

Among Veterans in MVP, females were more likely to develop epilepsy and benign brain tumors than men, but less likely to develop stroke or TBI. Among Veterans with epilepsy, females were more likely to undergo multiple ASM trials and neurostimulation and less likely to develop status epilepticus, which suggests female Veterans may have more refractory epilepsy or are more willing to try different treatments than male Veterans. Future studies will analyze the influence of various risk factors, additional covariates, and genotypes on epilepsy outcomes.
Authors/Disclosures
Madeline Evans, MD (Oregon Health and Science University)
PRESENTER 		Dr. Evans has nothing to disclose.
Andrea Hildebrand (VA Portland Health Care System) The institution of Ms. Hildebrand has received research support from National MS Society.
Julie Lynch (Salt Lake City VA) No disclosure on file
Tia DiNatale, MPH Ms. DiNatale has nothing to disclose.
Mary Jo Pugh, PhD, RN, FAAN The institution of Dr. Pugh has received research support from Department of Defense, Epilepsy Research Program. The institution of Dr. Pugh has received research support from VA Health Services Research and Development Service. The institution of Dr. Pugh has received research support from VA Rehabilitation Research and Development Service. The institution of Dr. Pugh has received research support from Congressionally Directed Research Programs.
Zulfi Haneef, MD, MBBS, MRCP, FAAN Dr. Haneef has received publishing royalties from a publication relating to health care.
Andrea L. Schneider, MD, PhD (University of Pennsylvania) Dr. Schneider has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN - Neurology.
Nishant K. Mishra, MD, MBBS, PhD, FESO (Yale University) Dr. Mishra has nothing to disclose.
Jessica Minnier, PhD Dr. Minnier has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association.
Anh Huan H. Vo, MD (OHSU) Dr. Vo has nothing to disclose.
Marissa Kellogg, MD, MPH, FAAN (VA Portland Healthcare System, Dept of Neurology) The institution of Dr. Kellogg has received research support from VA & DoD.