Researchers identify ‘epilepsy belt’ where seniors are at higher risk

A first-of-its-kind nationwide study has pinpointed where epilepsy affects older Americans the most and uncovered surprising social and environmental factors that may increase risk. 

The research,  published in JAMA Neurology and led by teams at the Houston Methodist Research Institute and Case Western Reserve University, offers the clearest national picture yet of how and where epilepsy impacts adults age 65 and older.

By analyzing data from 4.8 million Medicare beneficiaries between 2016 and 2019, researchers uncovered a clear geographic trend: older adults living in parts of Louisiana, Mississippi, East Texas and central Oklahoma had significantly higher rates of epilepsy than those in other regions.

Lead investigator Weichuan Dong, Ph.D., said the findings offer critical insights long missing from national data.

“Until now, we didn’t have a national picture of where epilepsy affects older adults the most,” Dong explained. “We revealed striking clusters of high epilepsy rates across parts of the South — what we call the ‘epilepsy belt.’ Understanding where the burden lies is the first step toward uncovering why.”

Factors that raise risk

While epilepsy can affect anyone, the study found that several conditions strongly predicted a higher incidence in older adults. These include:

• Insufficient sleep—fewer than seven hours per night
• Extreme heat—a growing concern as many regions experience more days above a heat index of 95°F
• Low levels of physical activity
• Limited access to a household vehicle, which affects access to care
• Lack of health insurance among younger adults, suggesting that some people may go undiagnosed until they reach Medicare age

Many of these risk factors reflect local environments and socioeconomic conditions, meaning that community-level solutions could make a real difference. One finding stood out: the powerful link between extreme heat and new epilepsy cases.

“This is the first study documenting such a strong association between extreme heat and incident epilepsy in older adults,” said Siran Koroukian, Ph.D., of Case Western Reserve University. “It highlights the importance of climate change in emergency preparedness, especially as our population grows older.”

Why these findings matter

Epilepsy affects an estimated 3.3 million Americans, and care for epilepsy and seizures totaled $24.5 billion in health care spending in 2019, according to the CDC. But until now, little was known about how the condition varies geographically for older adults.

By using advanced machine learning and geospatial mapping, researchers were able to uncover patterns that traditional approaches could not. Obesity levels and access to primary care were also strong predictors of where epilepsy rates ran highest.

For older adults and their families, the study shows the importance of managing sleep, staying cool in high heat, staying physically active, and ensuring reliable access to health care, especially in regions identified as high-risk.

For community leaders and health systems, the findings could guide decisions about where to invest in preventive care, cooling centers, transportation assistance, or public health outreach.

Researchers from multiple institutions contributed to the project, including experts from Houston Methodist, Case Western Reserve University, the University of Alabama at Birmingham, Bowling Green State University, and Mount Sinai Health System.