Reducing mortality: an important aim of epilepsy management
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1, UK
- Correspondence to: Professor Josemir Sander Box 29, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK;
- Received 26 September 2003
- Accepted 29 November 2003
Reduction of mortality needs to be paramount in the management of epilepsy
Epilepsy is often regarded as a benign condition, but there is little doubt that people with epilepsy are two to three times more likely to die prematurely than those without it.1 The risk is not uniform over the lifetime of a person with epilepsy, nor across different populations.
Epilepsy is a symptom of a variety of conditions, and the mortality may be different for each condition. In the early years after the diagnosis of epilepsy most deaths are likely to be caused by the background aetiology of the epilepsy—for example, tumours, trauma, degenerative conditions, or cerebrovascular diseases. In this group it is unlikely that treatment of epilepsy will of its own improve the prognosis for life.
People with epilepsy are subject to the same causes of death as the population without epilepsy, but there are some specific ways in which mortality differs. Those with epilepsy may be more likely to die as a result of suicide than the general population, and are more likely to die accidentally. Status epilepticus can occur de novo in people without existing epilepsy, but around half of all cases occur in those already known to have epilepsy. It carries a significant risk of mortality. The population with epilepsy is also at risk from sudden unexpected death in epilepsy (SUDEP). There is controversy about the risk of dying from ischaemic heart disease in people with epilepsy,2–4 but mortality is increased for various forms of malignancy.2,3
In an estimation of death in a cohort of people with epilepsy, 30% of those dying over an eight year period died of accidents, 23% died suddenly, 16% died in status epilepticus, and 14% committed suicide.5 Some of these deaths are potentially preventable. …