Somatic Comorbidities in Older People Ageing with Epilepsy

Background: Older adults ageing with epilepsy carry accumulated consequences of chronic seizures and decades of antiseizure medication (ASM) exposure, with ageing-related physiological vulnerabilities. Systematic, multidomain data from South Asia remain scarce. Methods: This case–control study enrolled 30 persons with epilepsy aged ≥ 60 years on ASM for ≥ 10 years and 30 age- and gender-matched controls. Both groups underwent dual-energy X-ray absorptiometry, FRAX (Fracture Risk Assessment Tool), serum lipid, and vitamin D profiling, 12-lead electrocardiogram, Addenbrooke’s Cognitive Examination-III (ACE-III), Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Generalized Anxiety Disorder-7, Falls Risk Assessment Tool (FRAT), and QRISK3. Post hoc analysis examined dose and duration relationships for phenytoin and phenobarbitone with bone, lipid, and cognitive outcomes. Results: Mean epilepsy duration was 39.2 ± 14.5 years; 96.7% were on enzyme-inducing ASMs. Osteoporosis or osteopenia was found in 76.7% of cases versus 50.0% of controls ( p = 0.032). Ten-year major fracture probability was nearly double in cases (14.3% vs. 7.9%, p = 0.004). Alkaline phosphatase was 101.7 versus 76.3 IU/L in controls ( p = 0.001). Vitamin D deficiency affected 50.0% of cases versus 23.3% of controls ( p = 0.032). Total cholesterol (206.6 vs. 178.9 mg/dL, p = 0.013) and triglycerides (181.4 vs. 121.4 mg/dL, p = 0.015) were higher in cases. ST-T abnormalities were present in 63.3% of cases versus 23.3% of controls ( p = 0.004). Mean ACE-III score was 65.3 versus 84.8 ( p < 0.001); using the Indian-validated cutoff (≤ 71), 53.3% of cases had cognitive impairment, versus none of the controls. Depression (NDDI-E > 11) was identified in 40.0% of cases versus 16.7% of controls ( p = 0.045). FRAT scores were higher in cases (7.7 vs. 6.1, p = 0.046). Post hoc analysis found no graded dose–response or duration–response for bone, lipid, or cognitive outcomes, likely reflecting limited power. Conclusion: Older persons ageing with epilepsy carry a substantial, multidomain comorbidity burden disproportionate to age-related changes alone. Bone disease, dyslipidemia, subclinical cardiac pathology, cognitive impairment, and depression are prevalent and underrecognized. Systematic comorbidity surveillance should be standard in epilepsy care for this population. Publication History Article published online: 15 July 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Thieme Medical and Scientific Publishers Private Limited A-13A, Graphix Tower 1, 6th floor, Sector 62, Noida 201309, Uttar Pradesh, India