In
the general population the actual risk of unnatural death is 0.3 to 0.5 percent
of total deaths. People with epilepsy are five times more likely to die because
of accidental poisoning from medication and three times more likely to die from
an intentional overdose of medication compared to people who don’t have
epilepsy. Although the researchers were already aware that people
with epilepsy are at a higher risk of death, “…we didn’t know much about the
risks of different types of death.”1
This
population-based cohort study
included more than 50 000 people with epilepsy and 1 million matched
individuals without epilepsy
who had identified in two data sets drawn from the general populations
of England and Wales. Researchers reported people with epilepsy had a 3-fold
increased risk of any unnatural mortality and a 5-fold increased risk of unintentional
medication poisoning. Psychotropic and opioid drugs were most commonly used in
poisoning, but not antiepileptic drugs.
Since
people with epilepsy are at increased risk of unnatural death, they and their
families should be advised about unintentional injury prevention and monitored
for suicidal ideation, thoughts, and behaviors. The suitability and toxicity of
concomitant medication should be considered when prescribing for comorbid
conditions.
Elizabeth
Donner, MD,2 director of the Comprehensive Epilepsy Program at the
Hospital for Sick Children in Toronto, said, “Having good seizure control
doesn’t mean the person with epilepsy is otherwise trouble-free or experiencing
a good quality of life.” She added that death certificates may not list
epilepsy as a contributing cause in suicide or drug overdose cases.
Psychological counseling should be recommended for our
patients who are at risk. A low threshold must be entertained for preventive
education and intervention. Clinicians should query patients and their families
about depression and addictive/and or dangerous behaviors to attempt to avoid
tragedy.
1.
Gorton
CH, PhD; Webb
RT, PhD; Carr MJ. PhD; et al. Risk of Unnatural
Mortality in People With Epilepsy. JAMA Neurol. Published online
April 9, 2018.
2.
Neurology Today. Volume 18/issue 10: May
17, 2018
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.
