Neurological

Psychiatric comorbidities related to higher mortality in epilepsy

According to study results published in Neurology: Clinical Practice, mortality rates are higher among adults with epilepsy with comorbid psychiatric illness than among the general population.

Preliminary studies have shown that patients with epilepsy and psychiatric illnesses may have a higher risk of death. Other research has shown that increased neuropsychiatric symptoms are associated with increased resistance to anti-epileptic drugs. The aim of the current study was to assess mortality in patients with coexisting epilepsy and psychiatric illness.

Researchers retrospectively reviewed admission records of patients with uncontrolled seizure disorders or difficult-to-control epilepsy who underwent video electroencephalography (VEM) 1.5T / 3.0T magnetic resonance imaging (MRI) in 3 hospitals in Melbourne, Australia from 1995 to 2015 . The patients were examined for psychiatric and epileptic diagnoses. The researchers included adult patients (n = 1805) who received a formal diagnosis of epilepsy in the study.

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In the study, the mortality of patients with epilepsy exceeded the mortality of the general population, regardless of the concurrent occurrence of a psychiatric illness in their life history (comorbid psychiatric disorder SMR 3.6 95% CI 2.9-4.4, no psychiatric disorder SMR 2, 5 95% CI 1.9-3.2).

After adjusting for age and sex disorder factors, mortality was higher in patients with epilepsy and comorbid psychiatric disorders (52% of the cohort) than in patients with epilepsy only (HR 1.41 95% CI 1.02-1.97).

In an analysis of patients with known epilepsy type and syndrome, after adjusting for epilepsy type and lesionality, the researchers found that mortality was higher in people with epilepsy who had comorbid psychiatric disorders than in those who did not (HR 1, 54 95% CI 1.05-2.24).

Patients with a comorbid psychiatric disorder did not have a higher risk of mortality than patients without psychiatric comorbidities. No specific comorbid psychiatric disorder showed a significantly different mortality than patients without psychiatric comorbidities.

Nervous system disorders, neoplasms, and external causes of death were the leading causes of death in the 147 patients in the cohort (87 with lifelong psychiatric illness) who died during follow-up. 36 patients experienced definitive (n = 29) or likely (n = 7) sudden unexplained death in suspected epilepsy (SUDEP), the researchers reported.

There were 5 confirmed suicide cases and 1 potential suicide case in people with epilepsy and psychiatric disorders, compared with 2 confirmed suicide cases in people with epilepsy alone.

The limitations of the study related to generalizability, the exclusion of patients with incomplete neuropsychiatric data and the potential disruptive effects of polypharmacy.

The researchers concluded that “this study found that the presence of comorbid psychiatric disorders in adults” [patients with epilepsy] PWE is associated with increased all-cause mortality, with a quarter of patients dying from SUDEP. “

This underscores the importance of identifying and treating psychiatric disorders in this patient population, they explained.

Disclosure: Some study authors stated links with biotech, pharmaceutical, and / or device companies. For a full list of the author’s disclosures, see the original reference.

reference

Tao G, Auvrez C, Nightscales R, et al. Relationship between psychiatric comorbidities and mortality in epilepsy. Neurol: Clin Pract. Published online July 12, 2021. doi: 10.1212 / CPJ.0000000000001114

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