From the Journals

Epilepsy upped risk of unnatural death

 

Key clinical point: Epilepsy increases the risk of mortality from unnatural causes.

Major finding: Epilepsy was associated with a significantly increased risk of death from any unnatural cause (HR, 2.8), from accidental medication poisoning (HR, 5.0), and from suicide (HR, 2.2).

Study details: A population-based cohort study of more than 1 million people.

Disclosures: Funders included the National Institute for Health Research and Health and Care Research Wales. The researchers reported having no conflicts of interest.

Source: Gorton HC et al. JAMA Neurol. 2019 Apr 9. doi: 10.1001/jamaneurol.2018.0333.

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‘See’ patients, disease biology

The study elucidates “an enormous problem hiding in plain sight” – persistently high rates of unnatural and medication-induced death among people with epilepsy, wrote Orrin Devinsky, MD, Anuradha Singh, MD, and Daniel Friedman, MD, in an accompanying editorial in JAMA Neurology.

“We need a new paradigm to ‘see’ patients and ‘understand’ their disorders and experiences,” the editorialists explained. Mood disorders, poor judgment, impulsive behavior, and cognitive impairment “are part of the disease biology as much as brain stem cardiopulmonary dysfunction is thought to contribute to sudden unexpected death in epilepsy.”

They called on the National Institute of Mental Health and the National Institute of Neurological Disorders and Stroke to encourage studies of “the tangled thicket where neurology and psychiatry meet.”

All three physicians are at NYU Langone Medical Center, New York. Dr. Devinsky disclosed ties to GW Pharmaceuticals and several other companies. No other disclosures were reported (JAMA Neurol. 2018 Apr 9. doi: 10.1001/jamaneurol.2018.0002).


 

FROM JAMA NEUROLOGY

People with epilepsy were about three times more likely to die from unnatural causes and five times more likely to die from unintentional medication poisoning than controls in a large study.

Opioid and psychotropic drugs were the main sources of poisoning deaths, said Hayley C. Gorton, PhD, of the University of Manchester, England, and her associates. Epilepsy also was associated with a twofold increase in risk of suicide. Providers should counsel patients with epilepsy about unintentional injuries, exercise caution when prescribing opioids, and monitor patients closely for suicidal thoughts, ideation, and behavior, the researchers wrote online April 9 in JAMA Neurology.

The study included 58,729 individuals with epilepsy and nearly 1.2 million controls matched by age, sex, and location. Data sources included the Clinical Practice Research Datalink in England and the Secure Anonymised Information Linkage Databank in Wales. The researchers identified unnatural deaths by querying relevant codes from the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. The study spanned 1998-2014, with typically 4-8 years of follow-up.

Epilepsy was associated with a significantly increased risk of death from any unnatural cause (hazard ratio, 2.8; 95% confidence interval, 2.4-3.3), from accidental medication poisoning (HR, 5.0; 95% CI, 3.2-7.7), and from suicide (HR, 2.2; 95% CI, 1.5-3.1). Opioids were the most common cause of death from medication poisoning (56%), followed by psychotropic drugs (32%). Antiepileptic drugs were responsible for only about 10% of iatrogenic deaths.

As in prior studies, epilepsy was tied to numerous psychiatric comorbidities, including substance abuse disorders, anxiety, mood and eating disorders, personality disorders, and schizophrenia. Mental illness increases the risk of unintentional injury, poisoning, and suicide, the investigators noted. Mental illness and associated stigma also explain why epilepsy patients were three times more likely to die from homicide (HR, 3.5; 95% CI, 1.2-10.6), they wrote.

Funders included the National Institute for Health Research and Health and Care Research Wales. The researchers reported having no conflicts of interest.

SOURCE: Gorton HC et al. JAMA Neurol. 2019 Apr 9. doi: 10.1001/jamaneurol.2018.0333.

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