The mortality of epilepsy revisited

Epilepsy carries a significant mortality that, on average, is 2-3 times higher than in the general population. Causes of death in epilepsy are presented. Mortality in epilepsy is assessed by means of particular parameters; the mortality rate, the standardised mortality ratio, and the proportional mortality rate. An overview of their use and significance is given here. A number of epidemiological studies have assessed mortality in people with epilepsy in the general population and in populations from hospitals, out-patient departments, and epilepsy centres. Methodological issues concerning the study of mortality in these populations are discussed. Epidemiological data are presented to describe the overall and cause-specific mortality, as well as determinants of mortality in epilepsy, such as epilepsy and seizure types, time from diagnosis, and age. It has become clear from population studies with long-term follow-up that epilepsy has a higher mortality in the first few years after diagnosis that tends to decrease over time. The pattern of mortality in epilepsy can reflect the underlying conditions causing epilepsy or be associated with the effect of seizures. Emphasis is given to preventable causes of death in epilepsy, such as sudden unexpected death in epilepsy and suicide, which are discussed more extensively. The size of the problem and measures to avoid more deaths in epilepsy are discussed in the light of recently published data.