Mortality Risk in Epilepsy: New Data

Kelli Whitlock Burton

March 23, 2023

People with epilepsy have a twofold increased risk for death compared with their counterparts without the condition, irrespective of comorbidities or disease severity, new research shows.

"To our knowledge, this is the only study that has assessed the cause-specific mortality risk among people with epilepsy according to age and disease course," investigators led by Seo-Young Lee, MD, PhD, of Kangwon National University in Chuncheon, Republic of Korea, write. "Understanding cause-specific mortality risk, particularly the risk of external causes, is important because they are mostly preventable."

The findings were published online March 22 in Neurology.

Higher Mortality Risk

For the study, researchers analyzed data from the National Health Insurance Service database in Korea from 2006 to 2017 and vital statistics from Statistics Korea from 2008 to 2017.

The study population included 138,998 patients with newly treated epilepsy, with an average at diagnosis of 48.6 years.

Over 665,928 person years of follow-up (mean follow-up, 4.79 years), 20.095 patients died.

People with epilepsy had more than twice the risk for death compared with the overall population (standardized mortality ratio [SMR], 2.25; 95% CI, 2.22-2.28). Mortality was highest in children aged 4 years or younger and was higher in the first year after diagnosis and in women at all age points.

People with epilepsy had a higher mortality risk compared with the general public regardless of how many anti-seizure medications they were taking. Those taking only one medication had a 156% higher risk for death (SMR, 1.56; 95% CI, 1.53-1.60) compared with 493% higher risk in those taking four or more medications (SMR, 4.93; 95% CI, 4.76-5.10).

Where patients lived also played a role in mortality risk. Living in a rural area was associated with a 247% higher risk for death compared with people without epilepsy who lived in the same area (SMR, 2.47; 95% CI, 2.41-2.53), and the risk was 203% higher risk among those living in urban centers (SMR, 2.03; 95% CI, 1.98-2.09).

Although people with comorbidities had higher mortality rates, even those without any other health conditions had a 161% higher risk for death compared with people without epilepsy (SMR, 1.61; 95% CI, 1.50-1.72).

Causes of Death

The most frequent causes of death were malignant neoplasm and cerebrovascular disease, which researchers noted are thought to be underlying causes of epilepsy.

Among external causes of death, suicide was the most common cause (2.6%). The suicide rate was highest among younger patients and gradually decreased with age.

Deaths tied directly to epilepsy, transport accidents, or falls were lower in this study than had been previously reported, which may be due to adequate seizure control or because the number of older people with epilepsy and comorbidities is higher in Korea than that reported in other countries.

"To reduce mortality in people with epilepsy, comprehensive efforts including a national policy against stigma of epilepsy and clinicians' total management, such as risk stratification, education about injury prevention, and monitoring for suicidal ideation with psychological intervention, as well as active control of seizures, are needed," the authors write.

Generalizable Findings

Commenting on the findings for Medscape Medical News, Joseph Sirven, MD, professor of neurology at Mayo Clinic Florida in Jacksonville, Florida, said that although the study included only Korean patients, the findings are applicable to other counties.

That researchers found patients with epilepsy were more than twice as likely to die prematurely compared with the general population wasn't particularly surprising, Sirven said.

"What struck me the most was the fact that even patients who were on a single drug and seemingly well controlled also had excess mortality reported," Sirven said. "That these risks occur should be part of what we tell all patients with epilepsy so that they can better arm themselves with information and help to address some of the risks that this study showed."

Another important finding is the risk for suicide in patients with epilepsy, especially those who are newly diagnosed, he said.

"When we treat a patient with epilepsy it should not just be about seizures, but we need to inquire about the psychiatric comorbidities and more importantly manage them in a comprehensive manner," Sirven said.

The study was funded by Soonchunhyang University Research Fund and the Korea Health Technology R&D Project. Study authors and Sirven report no relevant financial conflicts.

Neurology. Published online March 22, 2023. Abstract

Kelli Whitlock Burton is a reporter for Medscape Medical News covering neurology and psychiatry.

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