Friday, March 25, 2016

Blog #68: Epilepsy, Risks to a Long Life and Mortality

          A study exploring the risks for premature death in the epilepsy community appeared in a recent issue of Neurology.1 Five hundred fifty-eight people with epilepsy were followed for 25 years. The authors wished to identify predictors of longevity. They found that conditions unrelated to epilepsy caused death in 59 percent (111/189) of the sample: most commonly cancers not related to the nervous system followed by cardiovascular diseases (heart attack, heart failure, etc.) and then cerebrovascular conditions (stroke, etc.). Only 3 percent (6/189) died of their epilepsy, e.g. SUDEP (sudden death in epilepsy), drowning or trauma. 
          The death rate was found to be higher in the first two years after the initial seizure, specifically associated with cancers.  Pneumonia was the most common cause of death occurring in 31.2 percent. Males and people who received early epilepsy-control seemed protected against death. This gender difference was surprising since being male is typically associated with having a shorter life-expectancy. More studies need to explore this correlation. Conditions that strongly predicted mortality included brain and non-brain cancers, dementia, Parkinson’s disease, stroke, brain trauma and drug abuse.

          Counseling of the epilepsy population appears to be of primary importance. Physicians’ evaluations can detect malignancies and vascular disease followed by treatment. Medical guidance can prevent many disease-related complications. These non-epilepsy conditions must be addressed just as much as counseling individuals regarding SUDEP (see Blog #13 and Blog #30) or status epilepticus (see Blog # 37).

11    Keezer MR, Bell GS, Neligan A, et. al. Cause of Death and Predictors of Mortality in a Community-Based Cohort of People with Epilepsy. Neurology 2016; 86: 704-12.

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.