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Sudden Death Risk Higher for Patients with Chronic Epilepsy

Physicians should weigh various factors when deciding whether to broach the topic with patients

WEDNESDAY, May 3 (HealthDay News) -- Patients with newly diagnosed epilepsy or those who have inadequate seizure control have a higher risk of sudden death than non-epileptics, according to a report published online May 3 in The Lancet Neurology.

Rajiv Mohanraj, M.B.B.S., of the Royal Preston Hospital in Lancashire, U.K., and colleagues compared death rates over 20 years among 2,689 patients with chronic, inadequately controlled epilepsy and in 890 patients with newly diagnosed epilepsy.

Newly diagnosed patients had a 42 percent higher standardized mortality ratio than controls, but the risk was elevated only in those patients who did not respond to treatment (42 deaths vs. 16.5 expected deaths). Patients who were seizure-free were not at higher risk. Those patients with chronic epilepsy had more than twice the number of expected deaths as controls. The risk of sudden unexpected death in epilepsy (SUDEP) was 1.08 per 1,000 patient-years in newly diagnosed epilepsy patients and 2.46 per 1,000 patient-years in chronic epilepsy patients, with the highest excess risk in those under 30 years old.

"Mortality risks and preventive strategies should be discussed with patients with epilepsy when treatment fails or is refused despite recurrent seizures," the authors write.

In an accompanying editorial, Roy G. Beran of Liverpool Hospital in New South Wales, Australia, writes that discussing sudden unexpected death in epilepsy "should be considered on a case-by-case basis that respects a patient's autonomy and a right to receive as much information as he or she requests."

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