Risk Factors for Suicide in Epilepsy: A Case Control Study

Abstract

Summary:Purpose: Suicide is considered to be one of the most important causes of death contributing to the increased mortality of persons with epilepsy. We investigated the association between the risk of suicide in persons with epilepsy and clinical factors that might increase or have been suggested to increase the risk of suicide.Methods: A case-control study was nested within a cohort of 6,880 patients registered in the Stockholm County In-Patient Register with a diagnosis of epilepsy. The study population was followed up through the National Cause of Death Register. Twenty-six cases of suicide, 23 cases of suspected but not proven suicide, and 171 controls, living epilepsy patients, were selected from the cohort. Clinical data were collected through medical record review.Results: There was a ninefold increase in risk of suicide with mental illness and a 10-fold increase in relative risk (RR) with the use of antipsychotic drugs. The estimated RR of suicide was 16.0 [95% confidence interval (CI), 4.4-58.3] for onset of epilepsy at younger than 18 years, compared with onset after 29 years. The risk of suicide seemed to increase with high seizure frequency and antiepileptic drug (AED) polytherapy, although the estimates were imprecise and the associations not statistically significant. Insufficient data on seizure frequency and changes in AED dosage due to incomplete case records were associated with high RRs. We found no association between risk of suicide and any particular AED, with type of epilepsy, or localization or lateralization of epileptogenic focus on EEG [RR ‫ס‬ 0.3 (95% CI, 0.1-1.7)].Conclusions: The profile of the epilepsy patient who commits suicide that emerges from our study is a patient with early onset (particularly onset during adolescence) but not necessarily severe epilepsy, psychiatric illness, and perhaps inadequate neurologic follow-up. Previous reports of an association with temporal lobe epilepsy could not be confirmed.

A Comprehensive Review on Comorbid Depression in Patients With Epilepsy

“…Psychiatric disorders mainly the affective disorders can increase the risk of the patient to attempt suicide [45,46]. Epilepsy also increases the risk of attempting suicide among patients who undergo psychiatric illness [47] and concomitantly epilepsy can also jeopardize the life of the patient and exposes the patient to develop psychiatric illness [48].…”

Epidemiology and Risk Factors for Suicide Among Adult Patients with Epilepsy

“…Apart from current or past co-morbidity with psychiatric disorders, other risk factors include the use of anti-psychotics and the irst instance of a seizure before 1 years of age [65]. In January 200 , the Food and Drug Administration FDA alerted that the use of anti-epileptic drugs AEDs is associated with an increased risk of suicide in patients who use them.…”

“…Furthermore, it was indicated that the use of anti-epileptic drugs in polytherapy is also a factor in the risk of suicide [65].…”

Moderate toxic effects following acute zonisamide overdose

“…The most commonly reported adverse effects associated with ZNS use were somnolence, anorexia, dizziness, headache, nausea, and agitationirritation in a retrospective case study [11]. Although epileptic patients have a high incidence of psychiatric comorbidities with depression being the most common diagnosis [12], and AEDs are common agents taken in intentional drug overdose [13], limited data exist on overdose of ZNS, and to our knowledge no case of ZNS monointoxication has been published to date. There are two cases of ZNS poisoning reported in the literature, but in both, other AEDs in overdose were coingested [14,15].…”