Patients with epilepsy have a greater risk for unnatural mortality (such as accidental poisoning and suicide) than people without the disorder, according to a study published in JAMA Neurology.

Hayley C. Gorton, PhD, of the Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, at the School of Health Sciences, Faculty of Biology, Medicine, and Health at the University of Manchester in the UK, and associates conducted a population-based group analysis to determine cause-related unnatural deaths in patients with epilepsy and the potential medications associated with poisoning mortality.

The investigators used 2 primary care data sets affiliated with reported hospitalizations and mortalities: the Clinical Practice Research Datalink (CPRD) and the Secure Anonymised Information Linkage (SAIL). CPRD data included 44,678 participants with epilepsy and 891,429 control participants, while SAIL data included 14,051 individuals with epilepsy and 279,365 matches.

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In both the CPRD and SAIL data sets, 51% of epilepsy and control participants were men (median age of 40 years in CPRD, 43 years in SAIL).

The researchers reported a statistically significant risk associated with patients with epilepsy to die of unnatural causes more frequently than people without epilepsy (hazard ratio [HR], 2.77). This likelihood increased in unintentional injury or poisoning (HR, 2.97). Suicide was another measured factor that was more common in participants with epilepsy than those without (HR, 2.15).

Greater risks for accidental medication poisoning and deliberate self-poisoning using medication were reported among patients with epilepsy (HR, 4.99; 3.55, respectively). Both opioids (56.5%) and psychotropic medication (32.3%) were more likely to be used as poisoning drugs than antiepileptic drugs (9.7%).

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“Compared with people without epilepsy, people with epilepsy are at increased risk of unnatural death and thus should be adequately advised about unintentional injury prevention and monitored for suicidal ideation, thoughts, and behaviors,” wrote the authors. “The suitability and toxicity of concomitant medication should be considered when prescribing for comorbid conditions.”


Gorton HC, Webb RT, Carr MJ, DelPozo-Banos M, John A, Ashcroft DM. Risk of unnatural mortality in people with epilepsy. [Published online April 09, 2018]. JAMA Neurol. doi:10.1001/jamaneurol.2018.0333