Psychiatric assessment needed in epilepsy
By Eleanor McDermid, Senior medwireNews Reporter
25 July 2013
Lancet 2013; Advance online publication

medwireNews: Research shows that psychiatric comorbidity is a major contributor to the excess mortality from external causes seen in patients with epilepsy.

“Our results have significant public health implications as around 70 million people worldwide have epilepsy, and emphasise that carefully assessing and treating psychiatric disorders as part of standard checks in persons with epilepsy could help reduce the risk of premature death in these patients,” said lead researcher Seena Fazel (University of Oxford, UK) in a press statement.

Using linked nationwide Swedish registers, Fazel and team identified 69,995 epilepsy patients, 8.8% of whom died during an average of 9 years of follow up. Most deaths were caused by the same processes that underlay the epilepsy, with neoplasms and nervous system diseases the two most common causes, and conditions that began in the perinatal period associated with the highest relative risk.

The third most common category was external causes, which accounted for 15.8% of deaths and were 3.6-fold more likely to cause death in epilepsy patients than in 660,869 age- and gender-matched controls, of whom just 0.7% died.

Psychiatric disorders were more prevalent in epilepsy patients than controls, at 18.0% versus 3.5%, and were particularly common among those who died of external causes, with 75% having any psychiatric disorder, 56% having a history of substance misuse, and 23% a history of depression.

Relative to controls, the likelihood for epilepsy patients dying of external causes was elevated 10.6-fold if they had any psychiatric disorder, 13.0-fold if they had depression, and 22.4-fold if they had a history of substance misuse. Patients in these groups also had increased risks for death from suicide and from accidents not involving vehicles.

In a comment accompanying the study in The Lancet, Josemir Sander (UCL Institute of Neurology, London, UK) highlights the issue of substance misuse, suggesting that physicians should be screening epilepsy patients “more robustly for substance misuse,” particularly if this might reduce premature mortality.

“ ‘Is it really epilepsy?’ has long been a mantra in the management of epilepsy, since misdiagnosis is common,” observes Sander. He suggests that another mantra is needed: “epilepsy and what else?”

He says: “Indeed, for a condition with such high comorbidity, management of such comorbidities should be part of a holistic approach.”

medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

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