People with epilepsy have excess mortality compared with the general population. This is the conclusion of a large population-based cohort study of more than 6 million people in Denmark that reveals the situation and the underlying causes of death among people with epilepsy. The researchers think that there should be more focus on excess mortality among people with epilepsy.
A new study shows that people with epilepsy have up to 16 years less life expectancy than the general population.
The study also shows that people with epilepsy not only die from the underlying cause of epilepsy – instead, their causes of death are the same as the causes of death for everyone else, such as cancer and cardiovascular disease, but just to a greater extent.
The results surprised the researchers behind the study.
“People with epilepsy generally die from the same causes as everyone else, they just die much earlier from these causes. The consequence of this excess mortality is a substantial reduction in life expectancy. No major study of the causes of death among people with epilepsy has estimated reduction in life expectancy, but the figures for excess mortality and reduced life expectancy are worse than I had expected,” explains Jakob Christensen, Associate Professor at the Department of Clinical Medicine, Aarhus University and doctor at Aarhus University Hospital.
The research has been published in Brain.
Up to 16 years lower life expectancy
Jakob Christensen and colleagues collected health data for 2000–2015 from the Danish National Patient Registry, the Danish Psychiatric Central Research Registry and the Danish Registry of Causes of Death.
In total, the researchers gathered data on 6,022,160 people, of whom 129,598 had been diagnosed with epilepsy with a mean age of onset of 36.5 years.
During the 16 years of follow-up, 851,087 people died, and 36,923 of these had been diagnosed with epilepsy.
The subgroups of people with epilepsy have considerably lower life expectancy than males and females of similar age in the general population.
- Men with epilepsy live 12 years less.
- Women with epilepsy live 11 years less.
- People with symptomatic epilepsy live 14 years less.
- People with epilepsy and a mental disorder live 13–16 years less.
- People with idiopathic epilepsy (no underlying brain disorder as the cause of epilepsy) live 8–10 years less.
“These numbers are substantial and higher than we expected. They indicate how severely having epilepsy affects life expectancy,” says Jakob Christensen.
Epilepsy cannot explain all the life-years lost
People with epilepsy may die earlier than people without epilepsy for several reasons related to their epilepsy.
· People with epilepsy risk having an accident in connection with an epileptic seizure.
· People with epilepsy have an increased risk of sudden unexpected death, in which no immediate explanation for the cause of death can be identified other than that it occurs in relation to an epileptic seizure.
These causes of death are especially important for young people with epilepsy; however, these causes of death alone do not explain the overall excess mortality the researchers found.
“Epilepsy is associated with shorter lifespan, but our data show that the direct effects of epilepsy itself cannot explain the full extent of the reduced life expectancy. The rest – and major part – results from other diseases,” explains Jakob Christensen.
Typically die earlier from numerous causes
The researchers found that people with epilepsy die from the same causes as everyone else but just much earlier.
People with epilepsy die earlier from causes such as cancer, cardiovascular disease, dementia, communicable diseases, metabolic disorders, pneumonia and liver disease.
“Epilepsy itself can only explain a small part of the 10–12 life-years lost compared with the general population. This indicates that people with epilepsy struggle with other health problems that may not be adequately addressed,” says Jakob Christensen.
Greater focus on health among people with epilepsy
Jakob Christensen thinks that the study indicates that there should be greater focus on the general state of health of people with epilepsy.
He wonders whether symptoms indicating risk of other diseases are overlooked because epilepsy and treatment for this are so strongly in focus among people with epilepsy and that this can result in a shorter life.
“Staying healthy and in good shape is just as important for people with epilepsy as for everyone else. These results show that a general effort is needed to take better care of people with epilepsy with a focus on all other possible risk factors. This requires good collaboration between hospitals and general practitioners, with a coordinated approach to medicines for epilepsy and other diseases – especially among the special risk group of people with epilepsy who also have a mental disorder."
"Finally, collaboration is also needed across hospital-based specialties, since people with epilepsy seem to die from diseases that are managed by many specialties,” concludes Jakob Christensen.