Mental illness related to premature death in epilepsy patients

People with the neurological disorder epilepsy are ten times more likely to die at a younger age than the general population. Undertreated psychiatric disorder may influence this relation, according to a study from Karolinska Institutet and University of Oxford.

The new findings, published in The Lancet, reveal a striking correlation between early death and mental illness in epilepsy patients, with 40% of people with epilepsy having received a lifetime psychiatric diagnosis compared with only 10% in the general population. The difference is considerably larger than previously thought and may have important implications for epilepsy management.

Researchers at Karolinska Institutet and the University of Oxford studied 69,995 individuals with epilepsy born in Sweden between 1954 and 2009. They followed these patients longitudinally over 41 years, between 1969 and 2009, and compared mortality and causes of death with those among 660,869 age- and sex-matched control individuals from the general population. Throughout follow-up, 8.8 per cent of epilepsy patients died compared with 0.7 per cent of matched people from the general population.

Following causes directly related to the underlying brain disease, death by accidents or suicide were the most common causes of death among people with epilepsy. Together, these causes accounted for 16 per cent of all deaths and three quarters were among epilepsy patients who also had a psychiatric diagnosis. The odds of a person with epilepsy committing suicide were four times higher than in the general population.

To address the influence of background factors such as genetic risk and upbringing, researchers also looked at outcome of unaffected siblings of epilepsy patients. Unaffected siblings did not have higher risks of premature death compared with general population controls. This provides further evidence that epilepsy as a brain disease is an independent risk factor for death by any cause.

"Reducing premature mortality from external causes of death including suicide remains an important issue in epilepsy management", comments study co-author Professor Niklas Långström of Karolinska Institutet. "Our results suggest that preventive efforts should focus on patients with psychiatric comorbidities, particularly depression and substance abuse."

The study was funded by the Wellcome Trust and the Swedish Research Council.

Publication

Premature mortality in epilepsy and the role of psychiatric comorbidity: a total population study over 41 years
Seena Fazel, Achim Wolf, Niklas Långström, Charles R Newton, Paul Lichtenstein
The Lancet, online 22 July 2013