Neurofibromatosis Type 1 Patients With Epilepsy: A Comprehensive Analysis of Demographics, Comorbidities and Healthcare Outcomes

Abstract

Neurofibromatosis Type 1 (NF1) is the most common neurocutaneous disorder in the United States. Due to a nonfunctional mutation in the NF1 gene, the disorder may initially present with café-au-lait spots and later numerous neurofibromas across the body. Epilepsy is a rare comorbidity of NF1, with an incidence of just 4%–7%. While abnormal electroencephalograms have been seen in up to 25% of NF1 patients, very few studies have investigated the association between epilepsy and the NF1 patient profile. This study was aimed at evaluating the associations between epilepsy and demographics, comorbidities and healthcare outcomes in NF1 patients. The 2017 National Inpatient Sample (NIS) database was retrospectively queried for patients with NF1 using ICD-10 PCS codes. Chi-square tests were used in univariable analysis to compare patients within this cohort with and without epilepsy. Regression analysis was used in multivariable analysis to identify comorbidities that were predictors of epilepsy and the effect of comorbidities on outcomes. 4635 patients with NF1 were identified, of which 655 (14.1%) had epilepsy and 3980 (85.9%) did not. The NF1 patient population with epilepsy was largely comprised of White males of lower household income in larger urban/teaching hospitals and who used Medicare or Medicaid. Multivariable logistic regression revealed that malignant brain neoplasms, paralytic ileus, scoliosis, pregnancy complications, paralysis, other neurological disorders, metastatic cancer, coagulopathy, drug abuse and hypertension were predictors of developing epilepsy in NF1 patients. Additionally, epilepsy in NF1 patients was associated with a shorter length of stay, lower total charges and fewer total procedures.