Psychiatric and cognitive disorders in persons with epilepsy (PWE) are often overlooked or undertreated. Studies have shown that they occur in all types of epilepsy, but they are especially prominent when epilepsy is severe and multiple antiepileptic drugs are used. In particular, the clinician should be vigilant about the coexistence of depression with epilepsy. The depression must be properly treated to improve quality of life and also to prevent the mood disorder from interfering with epilepsy treatment.
Mortality in PWE is overall twice that in the general population, but most of the increased mortality is due to major conditions with which the epilepsy is associated. The clinician should be aware that some PWE have increased risk for suicide. The phenomenon of sudden unexplained death in epilepsy occurs at the highest rate in persons with uncontrolled seizures, especially generalized convulsive seizures. For now, optimizing seizure control appears to be the best way to reduce the risk for this still mysterious and catastrophic event.
Note: Text referenced in the Quintessentials Preferred Responses, which appear later in this issue, is indicated in yellow shading throughout this chapter.
Relationship Disclosure: Dr Hwang has received research support from GlaxoSmithKline for a research project on bipolar disorder in epilepsy. Dr Ettinger has received personal compensation for serving on scientific advisory boards for epidemiologic studies unrelated to any specific product from GlaxoSmithKline, Johnson & Johnson Services, Inc., and Ortho-McNeil-Janssen Pharmaceuticals, Inc. Dr Ettinger has received license fee payments or royalty payments from GlaxoSmithKline for research activities conducted at an institution with which he was formerly associated (Long Island Jewish Medical Center). Dr Ettinger has received research support from GlaxoSmithKline for a study of rates of bipolar disorder in epilepsy patients. Dr Ettinger's compensation and/or research work has been funded, entirely or in part, by a grant to his university from a pharmaceutical or device company. Dr So has nothing to disclose.
Unlabeled Use of Products/Investigational Use Disclosure: Drs Hwang, Ettinger, and So have nothing to disclose.