Dec 3, 2021

Childhood-Onset Epilepsy Speeds Up Brain Aging Study Shows Adverse Changes More Common in Those with Active Epilepsy

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CHICAGO – Childhood-onset epilepsy accelerates brain aging by about 10 years, suggests a first-of-its-kind study being presented at the American Epilepsy Society Annual Meeting.

The study compared the course of cognitive and brain aging in people in Finland with childhood-onset epilepsy and those without epilepsy who have been followed for approximately 55 years since the initiation of the study. Participants with epilepsy were about 5 years old on average when the study began and are now in their 60s. Researchers conducted in-person clinical, neurological, cognitive, and neuroimaging evaluations of both groups over a recent five-year interval (2012-2017).

“None of the patients have exhibited dementia so far, but it does appear childhood-onset epilepsy may speed up aging processes, especially among those who continue to have active epilepsy from childhood into their 60s,” said Matti Sillanpää, MD, PhD, senior author of the study and senior research scientist at the University of Turku, Finland. “Compared to those without epilepsy, people with childhood-onset epilepsy had greater rates of cognitive changes and their brain scans showed more amyloid plaques, which may increase the risk of Alzheimer’s disease.

The signs of brain aging were more advanced in people with focal (affecting one side of the brain) vs. generalized (affecting both sides of the brain) epilepsy, in those who had active epilepsy, meaning their epilepsy wasn’t well-controlled, and in those with a genetic risk marker (APOE 4).

The researchers compared 41 people with childhood-onset epilepsy to a control group of 46 people who did not have epilepsy, based on evaluations performed beginning in 2012 and then repeated in 2017. They used PET scans to assess amyloid plaques in the brain, MRI exams to assess gray and white matter, and conducted in-person neurological and cognitive evaluations. Because MRI and PET scans are performed in confined spaces, patients with claustrophobia did not have those tests. Of the childhood-onset epilepsy group, 32 had their epilepsy under control for 10 years or more (in remission) and nine had active epilepsy that has persisted for decades.

In 2012, brain PET scans showed 22% of people with childhood-onset epilepsy had amyloid plaques vs. 7% of the control group. In 2017, 33% of people with childhood-onset epilepsy had amyloid plaques vs. 11% of the control group. There was no difference in the presence of amyloid plaques among those with active epilepsy compared to those whose epilepsy was in remission. However, while those whose epilepsy was in remission exhibited modest but detectable abnormalities, the majority of adverse changes were associated with those who have active epilepsy. Researchers also found:

  • People with childhood-onset epilepsy had a higher rate of cognitive change during the five-year period compared to the control group, specifically in immediate verbal memory, verbal reasoning, and mental flexibility. Those with active epilepsy also had abnormal delayed memory and object naming.
  • Immediate memory declines were observed in 28.6% of those whose epilepsy was in remission, 37.5% of those with active epilepsy, and 10% of controls.
  • Delayed memory declines were observed in 17.9% of those whose epilepsy was in remission, 62.5% of those with active epilepsy, and 17.5% of controls.
  • Declines in executive functioning (such as working memory and planning) were observed in 25% of all people with epilepsy compared to 5% of controls.
  • Neurological signs were significantly more common in those with active epilepsy, with cerebellar signs (such as balance and coordination) the most frequent abnormality. Balance disturbances were five times more common in those with active epilepsy than those whose epilepsy was in remission.
  • Neurological signs in general and cerebellar signs, in particular, were significantly more common in those with focal epilepsy compared to those with generalized epilepsy.
  • MRIs showed greater atrophy, or shrinkage, of the hippocampus (the area of the brain associated with memory) in those with epilepsy who also had high blood pressure.


“Our results suggest it is important for those with childhood-onset epilepsy to work to achieve seizure control but it’s also vital that they pay attention to risk and resilience factors for healthy brain and cognitive aging, including a healthy diet, exercise, and social activity, as well as treating high blood pressure, high cholesterol and high blood glucose levels,” said Bruce Hermann, PhD, co-author of the study and emeritus professor of the University of Wisconsin Medical School, Madison. “We do not know yet if people with childhood-onset epilepsy who have amyloid plaques are more likely to develop Alzheimer’s disease, a critical question we will be studying in the future.”


Davis Renzelmann
Public Communications Inc.

About the American Epilepsy Society

Founded in 1936, the American Epilepsy Society (AES) is a medical and scientific society whose members are dedicated to advancing research and education for preventing, treating and curing epilepsy. AES is an inclusive global forum where professionals from academia, private practice, not-for-profit, government and industry can learn, share and grow to eradicate epilepsy and its consequences.