Mortality Risk in Epilepsy

SSEP is a scholarly textbook on epilepsy treatment based heavily on worldwide empirical researchs. I have read the two related chapters (2 and 3) on epilepsy mortality. There are two key practical insights from those chapters:

1. Epilepsy is related with higher mortality risk. The risk arises mostly from the underlying causes of epilepsy, and also from the seizures. (L. Forsgren in "Epidemiology and Prognosis of Epilepsy and its Treatment" (Chapter 2 in SSEP p. 37): "Overall it is reasonable to conclude that epilepsy doubles or triples mortality in people with epilepsy mainly due to the underlying causes of epilepsy and less often as a direct result of seizures. Thus, the potential to reduce mortality in epilepsy through reduction or elimination of seizures may be limited in the general epilepsy population but substantial in adolescents and younger adults with intractable epilepsy where SUDEP most often occurs [141,150]." and also L. Nashef and Y. Langan in "Sudden Death in Epilepsy" (Chapter 3 in SSEP p. 43): "Mortality is increased in epilepsy. Overall standardized mortality ratios (SMRs)1 in population-based cohorts are 2-3 times that of the general population [1—4]. Much of the excess mortality is due to associated or underlying disease, but there is also a small excess due to epilepsy itself.")

Nashef and Langan further wrote that (p. 43) "Causes of death in epilepsy are listed in Table 3.1; those that are epilepsy related are to some extent preventable. Sudden unexpected death in epilepsy (SUDEP), where an otherwise well person with epilepsy dies unexpectedly with no cause found at autopsy, is the single most important category of epilepsy related deaths [5-9]......As discussed below, the evidence suggests that most, but probably not all, SUDEP deaths are related to epileptic convulsions."

The causes of deaths listed in table 3.1 are "Death from underlying/associated disease; status epilepticus; trauma, burns or drowning consequent to a seizure; deaths in a seizure with severe aspiration/airway obstruction by food, etc.; deaths provoked by habitual seizures due to coexisting cardiorespiratory disease; Deaths due to medical or surgical treatment of epilepsy; Suicide".

2. To a certain extent, the mortality risk can be managed and minimised. For the mortality risk associated with epilepsy, especially for SUDEP, Nashef and Langan recommended the following prevention strategies: Prevention of convulsions, Avoiding abrupt medication changes/non-compliance, Ensuring prompt response to seizures, and Reversing treatment interventions that worsen epilepsy control.

Those prevention strategies are currently the best we can do for the patients. This is because the causes of epilepsy remain unidentified for most patients (see Forgren in SSEP p. 26: "The cause of epilepsy is unknown in the majority of patients"), so there is almost nothing we can do for the mortality risk associated with the causes of epilepsy.