Thursday, July 26, 2018

Blog #96: Neurologists May Be Missing the Higher Risk of Suicide/Drug Overdose in Epilepsy Patients

            A troubling picture is emerging: the deadly side of epilepsy. Epilepsy patients have a higher risk of unnatural death compared with the non-epilepsy population. SUDEP (Sudden Unexplained Death in Epilepsy) is not common, but suicide and drug overdose and other unnatural causes are.

            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.