Counseling and Management of the Risks of Living With Epilepsy

Katherine Noe, MD, PhD, FAAN Epilepsy p. 477-491 April 2019, Vol.25, No.2 doi: 10.1212/CON.0000000000000708
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PURPOSE OF REVIEW: For patients living with epilepsy, quality of life is determined not only by seizure control but by mood, antiepileptic drug adverse effects, relationships, and access to education, employment, and transportation. This article reviews some of the most commonly encountered concerns associated with epilepsy, including mood disorders, driving, injuries, mortality, bone health, genetic burden, and impact on relationships.

RECENT FINDINGS: People with epilepsy are at increased risk for anxiety, depression, and suicide. Depression is underrecognized in patients with epilepsy, but effective validated screening tools are available for use. Mortality rates for people with epilepsy are 2 times higher than those of the general population, but much of this is attributable to underlying conditions rather than seizures. Sudden unexpected death in epilepsy (SUDEP) occurs in an estimated 1:1000 adults with epilepsy per year, and the risk can be reduced by improved observation and seizure control. An increased risk of injury, including fractures, is also present in patients with epilepsy. Reduced bone health leading to increased fracture risk is an important negative consequence of long-term use of antiepileptic medication. Seizures while driving can also cause accidents and injury. Despite the importance of driving for people with epilepsy, physicians are underperforming in providing counsel about driving.

SUMMARY: Optimal care of the patient with epilepsy includes addressing risks to emotional health, physical health including fractures and SUDEP, social health, and an independent lifestyle. Identification of and treatments to reduce these risks can do more to improve quality of life than a narrow clinical focus on seizure control alone.

Address correspondence to Dr Katherine Noe, Department of Neurology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054, noe.katherine@mayo.edu.

RELATIONSHIP DISCLOSURE: Dr Noe has received research/grant support from NeuroPace, Inc.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Noe reports no disclosure.

© 2019 American Academy of Neurology