Study links heart attacks and late-onset epilepsy in older adults

Older adults who have a heart attack may be more likely to develop epilepsy later in life, according to a study published November 5, 2025 in Neurology®, the medical journal of the American Academy of Neurology. While the study shows a link between these conditions, it does not prove cause and effect.

“In middle-aged and older adults, vascular disease can block, weaken or narrow blood vessels, and it often affects multiple parts of the body at once,” said study author Evan L. Thacker, PhD, of Brigham Young University in Provo, Utah. “Our study found a first heart attack may flag cerebrovascular disease, a condition that affects blood vessels in the brain, which may raise the risk of epilepsy.”

The study included 3,174 adults who were stroke-free and had no history of heart attack or epilepsy at the start of the study. They had an average age of 69 and were followed for up to 30 years.

During the study, 296 people had a heart attack, 120 developed late-onset epilepsy, which is epilepsy after age 60, and 794 died of vascular causes other than stroke. Vascular causes included heart attack as well as heart failure, irregular heartbeat, pulmonary embolism—a blood clot in the lungs—and aortic aneurysm, a bulge in the main artery of the heart.

For people who had a heart attack, seven people per 1,000 person-years later developed epilepsy compared to two people per 1,000 person-years who did not have a heart attack. Person-years represent both the number of people in the study and the amount of time each person spends in the study.

After adjusting for factors such as age, smoking and weight, researchers found after a heart attack, people were about twice as likely to develop late-onset epilepsy.

Researchers also looked at whether people with late-onset epilepsy had an increased risk of then having a heart attack, but found no significant association.

Researchers found that deaths from a vascular cause other than stroke occurred at a rate of 99 deaths per 1,000 person-years after a person developed late-onset epilepsy compared to 16 per 1,000 person years for people who never developed epilepsy. After adjustments, people who developed late-life epilepsy were nearly three times more likely to die from a vascular cause.

“These findings highlight the interconnectedness that heart and vascular health may have with brain health in later life,” Thacker said. “When an older adult has a heart attack, clinicians may want to stay alert for possible seizures later.”

A limitation of the study was that the number of people who developed both conditions was small, which makes the estimates less certain.

Reference: Evan L. Thacker, Hyunmi Choi, Kevin Strobino, Minghua Liu, Sylwia Misiewicz, John D. Beard, Marco R. Di Tullio, Tatjana Rundek, Mitchell S.V. Elkind , Jose Gutierrez, Study links heart attacks and late-onset epilepsy in older adults, American Academy of Neurology, Journal Neurology, https://doi.org/10.1212/WNL.0000000000214292