Sexual and Gender Minorities Twice as Likely to Report Epilepsy

Individuals who identified with a sexual or gender minority were more than twice as likely to report having epilepsy compared with the general population, survey data showed.

Active epilepsy was reported by 2.4% of the population who identified with a sexual orientation other than heterosexual or did not identify with their gender assigned at birth, compared with 1.1% among others, researchers led by Emily Johnson, MD, MPH, of Johns Hopkins University School of Medicine in Baltimore, said in a JAMA Neurology brief report. Overall, 3.5% of transgender individuals reported having epilepsy, followed by gender-diverse individuals (1.5%), and LGBQ+ individuals (2.4%).

After adjusting for age, race, ethnicity, income, and education, individuals of a sexual or gender minority were twice as likely to report active epilepsy (adjusted OR 2.14, 95% CI 1.35-3.37), the researchers noted.

“I think it’s important for providers to be aware of all aspects of a person’s life which may affect the ability to access care and have social supports,” Johnson told MedPage Today, noting the importance of creating a welcoming atmosphere for people who may have had negative healthcare experiences.

That’s certainly the case for epilepsy, said Gwen Zeigler, DO, of Albany Medical College in New York, who was not involved in the study.

“This finding emphasizes an increased need for access to medical care for [this] serious, yet highly treatable medical condition of epilepsy,” Zeigler told MedPage Today.

However, it’s not clear what kind of mechanism might be linking epilepsy to sexual and gender identity, Zeigler cautioned.

“Minority stress theory has been posited to explain disparities in the sexual and gender minority communities, which may explain part of what we are seeing,” Johnson wrote in an email. “But, we need more research to understand other factors.”

The minority stress theory posits detrimental physical and mental health effects of chronic stress, which could be brought on by tangible threats of violence or harassment, internalized stigma, or diminished access to gender-affirming care.

The risk of physical assault or substance abuse also may be higher in this population, which could contribute to brain injury and epilepsy incidence, Johnson and co-authors noted. Functional neurologic symptoms, including nonepileptic seizures, may be elevated in sexual and gender minority populations and could lead to self-reported epilepsy diagnosis, they added.

Hormone therapy might theoretically be another factor, the researchers suggested. While the epilepsy link hasn’t been well studied, hormone therapy used by transgender women has been tied to other disorders like multiple sclerosis and stroke. Another study found chronic mental health and neurologic conditions, including epilepsy, were elevated in transgender people on Medicare without looking specifically at hormone use.

Johnson’s group studied data from the nationally representative 2022 National Health Interview Survey (NHIS), which randomly selects adults from all U.S. states. The in-person survey included questions about demographics, medical conditions, and social factors. Of the 27,624 survey respondents, 54% were women, 12% were Black persons, and the mean age was 48.2 years.

The 2022 survey asked participants about their current gender identity and sex assigned at birth. The sexual and gender minority category included 6.6% of participants who reported LGBQ+ sexual orientation. People who reported sexual or gender minority status were younger than the overall population.

The NHIS also asked participants whether they had epilepsy or seizure disorder, whether they use medication to treat it, and how many seizures they had in the past year. Active epilepsy was defined as a diagnosis of epilepsy and the use of an antiseizure medicine or at least one seizure in the past year.

Those with epilepsy were more likely to report white or other or multiracial race, non-Hispanic identity, lower educational attainment, and lower household income. Transgender people represented 0.67% of the population; they had a high prevalence of depression (67% vs 18% in cisgender individuals, P<0.001), as did those who reported epilepsy overall (44% vs 18% in people without epilepsy, P<0.001).

An important limitation of the study is that epilepsy was self-reported. Participants may have been reluctant to report their sexual or gender minority status to an interviewer, even if their answers were anonymous. The cross-sectional design of the study prevented analysis of associations over time between epilepsy and sexual and gender minority identity. Neurologic comorbidities were not included, and there were no subgroup analyses.

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