Epilepsy Patients Have Higher Risk of Unnatural Death

Individuals with epilepsy have an increased risk of unnatural death from causes such as medication poisoning, unintentional injury, or suicide, according to new study findings.

As a result, the authors of the study are now calling for health care providers to ensure that epilepsy patients are “adequately advised about unintentional injury prevention and monitored for suicidal ideation, thoughts, and behaviors.”
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These findings emerged from a new study of individuals with epilepsy and up to 20 matched controls, using data from the Clinical Practice Research Datalink (CPRD) in England (n = 44,678 with epilepsy; n = 891,429 controls) and the Secure Anonymized Information Linkage (SAIL) Databank in Wales (n = 14,051 with epilepsy; n = 279,365 controls).

Causes of unnatural mortality were determined via the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes V01 through Y98 in the Office for National Statistics mortality records.

In addition, a stratified Cox proportional hazards model and DerSimonian and Laird random-effects models were used to estimate hazard ratios (HRs) and perform meta-analyses, respectively.

Results revealed that individuals with epilepsy had a significantly higher risk of mortality from any unnatural cause (HR 2.77), unintentional injury or poisoning (HR 2.97), or suicide (HR 2.15) compared with controls.

In particular, the largest risks were associated with unintentional medication poisoning (HR 4.99) and intentional medication self-poisoning (HR 3.55). Opioids (56.5%) and psychotropic medication (32.3%) were more frequently associated with poisoning deaths compared with antiepileptic drugs (9.7%).

With this in mind, the researchers reiterated the importance of monitoring the “suitability and toxicity of concomitant medication,” especially when prescribing for comorbid conditions.

—Christina Vogt

Reference:

Gorton HC, Webb RT, Carr MJ, et al. Risk of unnatural mortality in people with epilepsy [Published online April 9, 2018]. JAMA Neurol. doi:10.1001/jamaneurol.2018.0333.