Mortality in patients with epilepsy

Prospective and retrospective incidence cohort studies have been consistent in identifying an increased mortality in patients with epilepsy, although risk ratios vary considerably. Standardized mortality ratios in these populations range from 1.6 to 5.3, but they tend to be higher in studies in selected populations. A few studies have addressed the mortality rate in patients after epilepsy surgery. Mortality seemed to be lower for surgery than for non-surgery patients. The main factors contributing to the late mortality rate in this population are the persistence of seizures after surgery, the long duration of epilepsy before surgery, and the side of the resection. Despite recent improvements in diagnosis and therapeutic management, status epilepticus is still associated with significant mortality, with a case fatality reaching 39%. Early patient management could influence the outcome of status epilepticus. Reports on suicide in epilepsy are based on small samples from different populations, highly selected groups of patients, using different methods of analysis. The rates vary from zero to 25%, and seem to be related more to a psychiatric co-morbidity than the severity of epilepsy. Sudden unexplained death is considered to be the most frequent epilepsy-related death. Clinical and experimental evidence supports the theory that sudden unexplained death is a recent seizure-mediated event with ictal stimulation of the autonomic system. In some situations, the increased risk of death could be prevented by a better definition of populations at increased risk, better therapeutic management, and adequate neurological follow-up.