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Review highlights need for interventions to reduce preventable deaths in people with epilepsy

A review of research on epilepsy deaths has highlighted the need for interventions to reduce avoidable deaths in people with epilepsy. The review found that important interventions could help reduce deaths amenable to medical care, such as suicide and accidents.  It focuses on behavioural and psychological risks and the interventions that could help reduce deaths in people with epilepsy.

The review by third year clinical medical student, Alexander Olster was supervised by Professor Leone Ridsdale, Chair of Neurology & Psychiatry Teaching and Dr Sian Cousins at King’s College London. The study was presented as a poster at the Royal College of General Practitioners National Conference last autumn. 

The review examines mortality, suicide and accident rates together with risk factors for mortality including; substance-related disorders, psychiatric disorders, accidents and non-adherence to anti- epileptic drugs (AED).   

The review found that being seizure free (no seizures within the previous 12 months) was associated with a lower mortality rate. It also found that not taking epilepsy medications increased risk by 50% while people with a psychiatric disorder and people misusing alcohol were high risk groups. The incidences of depressive symptoms are significantly higher in people with epilepsy compared with the general population and patients with other long-term conditions.

Jane Hanna from SUDEP Action said:  “It is hoped that this review will stimulate GP research which may address risks for death in epilepsy in primary care. Proven interventions are still lacking but psychiatric disorders and substance abuse are treatable. Seizures are treatable, and non-collection of prescriptions is detectable and potentially worth addressing in primary care.  We were pleased to sponsor a student at King’s this year as part of our ongoing collaboration with King’s College, London.”

Professor Ridsdale from King’s College, London said: “Community interventions including patient education and support addressing socio-economic and educational disadvantage, inequality of access to secondary care through lack of agreed pathways, depression, stigma and the reasons why patients are not taking medications need to be developed and supported”.   

Professor Ridsdale has previously led work on epilepsy mortality trends and risk using a very large general practice population. This pilot study was commissioned by SUDEP Action in 2011 and identified risks that could be flagged up in general practice and potential for intervention (Ridsdale et al. Epilepsy mortality and risk factors for death in epilepsy: a population-based study. British Journal of General Practice 2011; 61(586):e271-e8)

The review also found that people with epilepsy were over three times more likely to commit suicide. The risk of suicide was increased for patients who were not seizure free and that being diagnosed with a psychiatric disorder was a strong risk factor. 

The study found that accidents were the third cause of greatest excess mortality in people with chronic epilepsy. Not taking anti-epileptic medication increased the risk of accidents by 50%. People with a psychiatric disorder or misusing alcohol were at increased risk of death from injury.

The full report is available in the Research and Education section of the SUDEP Action website