Overall,
life expectancy is comparable to the general population.1 But in
certain types of epilepsy, the
risk of premature death is higher than that of the general population. Most of
the increased risk is directly related to what causes your epilepsy.
Only a small number of deaths in the epilepsy patient
population are epilepsy related. These are deaths caused by a seizure or
accidents during or immediately after the seizure, as well as sudden unexpected
death for which no cause of the death can be identified. SUDEP (see below) is
one example of this. Sudden unexpected deaths are more common in patients with
poorly controlled, intractable epilepsy. Improved seizure control, medical advice
and avoiding the hazards that occur during a seizure are key. Regular medical follow-up
care and supervision may help reduce the risks of epilepsy-related death
occurring.
What causes epilepsy?
Epilepsy
can be categorized into three broad groups:
Idiopathic epilepsy
Common
among children, idiopathic epilepsy is an inherited type of epilepsy with a
strong genetic component and no structural brain abnormalities. Provoked
seizures (for example, from flashing lights) are often seen in idiopathic
epilepsy.
Cryptogenic epilepsy
Cryptogenic
epilepsy is the type with no known cause and often involves unprovoked
seizures. This accounts for approximately 20% of seizure cases.
Symptomatic epilepsy
Symptomatic
epilepsy is caused by an injured brain. Common causes: head injuries, central
nervous system infections, loss of oxygen to the brain, strokes, brain tumors
and brain surgery.
How can your epilepsy result in premature death?
Premature
deaths in people living with epilepsy: failure to take antiseizure medications
as prescribed; the seizures themselves; collateral damage related to a seizure;
reduced quality of life that comes with living with epilepsy; fatal
unintentional injuries (for example, falls and burns), or through aspiration
pneumonia during a seizure.
Additionally:
Serious transportation accidents: Seizures
— which can result in impaired awareness and uncontrolled motor activity — put
people living with epilepsy at increased risk of serious transportation
accidents. This increased risk doesn’t apply to just car accidents but to the
increased risk of pedestrian accidents and increased risk of bicycle accidents.
Drowning: because seizures can lead to a loss of
consciousness or uncontrolled motor activity, people living with epilepsy are
at increased risk of drowning. The risk of drowning is much higher in people
with epilepsy. Despite my warnings, one of my young surfer patients ignored
this warning and continued surfing. I don’t know his current condition While
cases of drowning often occur in the bathtub (Mark Twain’s adult daughter had epilepsy;
she drowned in her bath, for example), less frequently patients die in the
shower; the body, face-down, blocks the drain resulting in drowning in just
inches of water.
Status epilepticus: status epilepticus is a condition in
which a person experiences abnormally prolonged seizures (longer than five
minutes in the case of generalized tonic-clonic seizures; they usually last
under 2 minutes) that can lead to long-term consequences, including brain
damage and death.
Psychiatric illness: people with epilepsy commonly have
depression, which increases the risk of suicide. The high incidence and
prevalence of psychiatric illness (including impulsivity, psychosis, and
substance abuse) correlates with the duration and severity of epilepsy. Depression
is also associated with not taking medications as recommended, which can
increase mortality.
What is a sudden unexpected death in epilepsy (SUDEP)? Premature mortality in people with epilepsy can also be attributed to a
sudden unexpected death in epilepsy (SUDEP): Blog
#108: SUDEP—Sudden Death in Epilepsy—Occurs in All Types of Epilepsies; Blog
#74: New Studies Reveal High SUDEP Risk of Death in Poorly Controlled Epilepsy.
In the US, there are at least 2,750 cases of SUDEP per
year. SUDEP refers to deaths among people with epilepsy that cannot be
attributed to other known causes. Studies suggest that for every 100,000 people
with epilepsy, there will be approximately 116 cases of SUDEP. While the causes
of SUDEP are not yet fully understood, most cases occur during or immediately
after a seizure and generally during sleep. Possible seizure-related factors
contributing to SUDEP include breathing and/or heart rhythm disruptions.
Does epilepsy shorten your life expectancy? People with epilepsy are two to three times more likely to die early
than those without the condition. This suggests that epilepsy can shorten life
expectancy by ten years for those living with symptomatic epilepsy and by two
years for those with idiopathic/cryptogenic epilepsy where no serious brain
pathology can be identified. While
life expectancy is reduced in cases of symptomatic epilepsy (by approximately
seven years), people with cryptogenic epilepsy had an almost normal life
expectancy.
SUMMARY: While epilepsy can increase your risk of premature death, it is possible,
in most cases, to manage these risks with anti-epileptic drugs, appropriate
mental healthcare, and lifestyle changes. Mortality in patients
with newly diagnosed epilepsy is higher than in patients with chronic epilepsy due
mainly to the underlying epilepsy cause.
MY
ADVICE: making family, friends, and colleagues aware of the
risks and how they might be able to help you reduce these risks can go a long
way to keeping you safe. Be certain that you have follow-up care and
observation by your physician for your best chance of thriving with epilepsy.
1.
Granbichler CA, Zimmerman G,
Oberaigner W, et. al. Potential years lost and life expectancy in adults with
newly diagnosed epilepsy. Epilepsia. 2017;58(11): 1939-1945.
Lance
Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of
Medicine at UCLA. His
hard-hitting emotional family medical
drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first
novel. Aside from acclamation on internet bookstore sites, U.S. Report
of Books, and the Hollywood Book Review, DINGS has been advertised in recent
New York Times Book Reviews, the Los Angeles Times Calendar section and
Publishers Weekly. DINGS teaches epilepsy and is now available
in eBook, audiobook, soft and hard cover editions.
