Risk of injuries, accidents and mortality in epilepsy

Epilepsy is a serious condition associated with a variety of risks. These include increased incidence of injuries and accidents and also of premature mortality. Several factors can contribute to the risks including the etiology underlying the patients’ epilepsy, occurrence of comorbidities, the prescribed treatment and not least the seizures. This is important to consider in order to better identify the patient at high risk and to be able to take preventive measures. For obvious reasons, the incidence of seizure related injuries varies depending on the type of epilepsy population. Population-based studies of people with epilepsy have indicated one seizure related injury per 50-60 patient-years, but the risk may be significantly higher in patients with severe epilepsy. Compared with the general population, the hazard ratio for injuries was 1.7 in people with newly diagnosed epilepsy, but only 1.3 if patients with comorbidities were excluded. In the same cohort, fractures were the most common injuries leading to hospitalisation, most often caused by falls. The largest increase in risk was for drowning. The types of injuries will, however, vary with the setting. Mortality is increased 2-3 fold among people with epilepsy. Some of this excess mortality, in particular early after epilepsy onset, is related to the cause of epilepsy rather than a consequence of the seizures.The causes of death vary considerably between high-income and low-middle-income countries, with fatal injuries being more common in the latter.Sudden Unexpected Death in Epilepsy (SUDEP) is, however, the leading epilepsy-related cause of death with an estimated incidence of 1 per 1000 patient-years.Frequency of generalized tonic-clonic seizures is the most important risk factor for SUDEP and improved seizure control the best method to reduce the risk of SUDEP as well as of injuries.