People with epilepsy are 11 times more likely to die prematurely than the general population, and the risk appears to be much higher for individuals with common co-existing psychiatric illnesses*, especially depression and alcohol and drug use disorders, new research published in The Lancet suggests.
In the 41-year study of almost 70 000 patients with epilepsy, researchers found that three-quarters of those who died from accidents or suicide had also been diagnosed with a psychiatric condition during their lifetime.
Led by Seena Fazel from the University of Oxford, the study looked at 69 995 people with epilepsy born in Sweden between 1954 and 2009 who were tracked for up to 41 years. The causes of death were assessed and compared with 660 869 age-matched and sex-matched individuals from the general population, and 81 396 unaffected siblings of people with epilepsy to account for the influence of genetic or early environmental risk factors.
Roughly 9% (6155) of people with epilepsy died during follow up compared with 0.7% (4892) of people from the general population.
Deaths from external causes (suicides, vehicle and non-vehicle accidents, and assaults) accounted for almost 16% of all deaths in people with epilepsy and were the most common causes of death not linked to the underlying disease process. Of these, 75% of patients also had a diagnosis of mental disorder, with substance misuse (56%) and depression (23%) the largest contributors.
For example, findings showed that people with both epilepsy and substance misuse were 22 times more likely to die from external causes than those with neither condition.
The majority of early deaths from external causes were from suicides, with the odds of death four times higher for those with epilepsy than controls.
Importantly, the researchers also found that the risk of early death in people with epilepsy compared with their unaffected siblings, and the risk of early death in people with epilepsy compared with general population, did not differ significantly. This suggests that epilepsy is an independent risk factor for all-cause and external causes of death.
According to Fazel, “Our results have significant public health implications as around 70 million people worldwide have epilepsy, and emphasise that carefully assessing and treating psychiatric disorders as part as part of standard checks in persons with epilepsy could help reduce the risk of premature death in these patients. Our study also highlights the importance of suicide and non-vehicle accidents as major preventable causes of death in people with epilepsy.”**
Commenting on the study, Ley Sander from University College London Institute of Neurology, London, UK, says, “For a condition with such high comorbidity, management of such comorbidities should be part of a holistic approach…The presence of comorbid disorders is associated with increased health-care needs, poorer health-related quality of life, and is a major driver for premature mortality. Prevention, identification, and adequate treatment of comorbid disorders should be an important part of epilepsy management at all levels of care.”