Impact on priority setting

It is now acknowledged that an excess mortality is associated with epilepsy, over and above that of the underlying disease. This risk is even greater in uncontrolled epilepsy. Because sudden unexplained death in epilepsy (SUDEP) appears to be seizure-related, it is likely that this excess mortality would be reduced if seizures were better controlled or, ideally, stopped. Patients and physicians are in the fortunate position of being able to choose from more effective treatments for epilepsy than at any time in the past. Reductions in mortality, however, must go hand in hand with improved epilepsy care in general. In the past, this area has been overlooked and underfunded. There is some evidence that specialist epilepsy clinics are better at managing cases of epilepsy than general neurology clinics or general medical services. Investing in dedicated epilepsy services could arguably lead to a reduction in mortality. Such investment would also lead to improved provision of counseling and information services for people with epilepsy. It is not yet possible to determine the effects of these interventions or to set targets for a reduction in mortality in people with epilepsy, because there is a lack of accurate data on the prevalence of epilepsy and the rate of SUDEP. Obtaining these figures should perhaps be our first aim. The relevance of these issues to the management of SUDEP are discussed with regard to the United Kingdom Health Service.