Life Expectancy In People With Epilepsy

Epilepsy is one of the most common neurological disorders, affecting more than 50 million people globally. In the United States, in 2015, 1.2%¹ of the population had active epilepsy.

In other words, in 2015, approximately three million adults and 470,000 children were experiencing or being treated for epilepsy-related seizures nationwide. If you fall into this group or care for someone who does, you might wonder how this condition affects life expectancy.

What is epilepsy?

Epilepsy is a term used to describe a group of neurological conditions that share the common characteristic of brain seizures. While the onset of epilepsy can occur at any age, it is most frequently diagnosed in early childhood or late adulthood.

It is possible to outgrow epilepsy (most likely in children who develop the condition before the age of 12) or for seizures to stop following the use of antiseizure medications.

What do seizures look like?

Your neurons (particular brain cells) communicate through rapid electrical impulses that control your thoughts, feelings, perceptions, and actions. A seizure is like an electrical storm in your brain: a sudden burst of abnormal, uncontrolled electrical activity that sends confusing messages to the rest of your body.

Seizures can be either generalized (affecting both sides of the brain) or focal (located or beginning in one small part of the brain). Because seizures can affect the brain differently, not all seizures look the same.

Some may last a few seconds, and others a couple of minutes. In some cases, the person experiencing the seizure may be aware of what is happening, but in others, they may lose consciousness. Sometimes it may just seem like the individual spaces out for a few seconds. In the case of tonic-clonic seizures, you may cry out, fall to the ground, or experience muscle jerks or spasms.

What causes epilepsy?

Epilepsy can be categorized into three broad groups:

• Idiopathic

• Cryptogenic

• Symptomatic

Idiopathic epilepsy

Common among children, idiopathic epilepsy is an inherited type of epilepsy with a strong genetic component and no structural brain abnormalities. Provoked seizures (for example, from flashing lights) are often seen in idiopathic epilepsy.

Cryptogenic epilepsy

Cryptogenic epilepsy has no known cause and often involves unprovoked seizures. This accounts for approximately 20% of seizure cases.

Symptomatic epilepsy

Symptomatic epilepsy is caused by an injury to the brain. Common causes include:

• Head injuries

• Central nervous system infections

• Loss of oxygen to the brain

• Strokes

• Brain tumor

• Surgery

How can epilepsy result in premature death?

Premature deaths in people living with epilepsy can be attributed to:

• The seizures themselves

• Collateral damage related to a seizure

• Reduced quality of life that comes with living with epilepsy

In addition to the causes listed below, epilepsy can also result in premature death through fatal unintentional injuries (for example, falls and burns), or through aspiration pneumonia.

Serious transport accidents

Seizures — which can result in impaired awareness and uncontrolled motor activity — put people living with epilepsy at increased risk of serious transport accidents. A study² in Sweden found that people living with epilepsy had a 37% increased risk of serious transport accidents than those who did not have epilepsy.

This increased risk doesn’t just apply to car accidents. Epilepsy was linked to a 2.2-fold increased risk of pedestrian accidents and a 1.7-fold increased risk of bicycle accidents.

Drowning

Because seizures can lead to a loss of consciousness or uncontrolled motor activity, people living with epilepsy are also at increased risk of drowning. A meta-analysis³ published in 2008found that the risk of drowning is 15- to 19-fold higher in people with epilepsy than in the general population.

While cases of drowning often occur in the bathtub, at least one case of seizure-related drowning in the shower has been recorded in Japan.

Status epilepticus

Status epilepticus is a condition in which a person experiences abnormally prolonged seizures (longer than five minutes in the case of generalized tonic-clonic seizures) that can lead to long-term consequences, including brain damage and death.

Psychiatric illness

Up to 30% of people with epilepsy have depression, which increases the risk of suicide. Research⁴ has shown that the high incidence and prevalence of psychiatric illness (including impulsivity, psychosis, and substance abuse) correlates with the duration and severity of epilepsy.

Suicide rates increase three- to four-fold among people living with epilepsy. Depression is also associated with poorer medication adherence (people not taking their medications as recommended), which can increase mortality.

What is a sudden unexpected death in epilepsy (SUDEP)?

In addition to the causes of death listed above, premature mortality in people with epilepsy can also be attributed to a sudden unexpected death in epilepsy (SUDEP). In the US, there are at least 2,750 cases of SUDEP per year.

SUDEP refers to deaths among people with epilepsy that cannot be attributed to other known causes. Studies suggest that for every 100,000 people with epilepsy, there will be approximately 116 cases of SUDEP.

While the causes of SUDEP are not yet fully understood, most cases occur during or immediately after a seizure and generally during sleep. Possible seizure-related factors contributing to SUDEP include breathing and/or heart rhythm disruptions.

Does epilepsy shorten your life expectancy?

Some research⁵ suggests that people with epilepsy are two to three times more likely to die early than those without the condition. This research suggests that epilepsy can shorten life expectancy by ten years for those living with symptomatic epilepsy and by two years for those with idiopathic/cryptogenic epilepsy.

However, one recent study⁶ found that while life expectancy is reduced in cases of symptomatic epilepsy (by approximately seven years), people with cryptogenic epilepsy had an almost normal life expectancy.

The lowdown

While epilepsy can increase your risk of premature death, it is possible — in most cases — to manage these risks with anti-epileptic drugs, appropriate mental healthcare, and lifestyle changes.

Making family, friends, and colleagues aware of the risks and how they might be able to help you reduce these risks can go a long way to keeping you safe.