People with epilepsy (PWE) have excess mortality, even those without comorbidities and receiving monotherapy, according to a study published online March 22 in Neurology.

Hye-Jin Moon, M.D., Ph.D., from Soonchunhyang University Bucheon Hospital in South Korea, and colleagues estimated the risk and causes of death in PWE according to age, disease severity, disease course, comorbidities, and socioeconomic status in a population-based retrospective cohort study using the National Health Insurance database linked with the national death register for Korea.

The researchers identified 20,095 deaths among 138,998 PWE during a mean follow-up of 4.79 years. In the overall group of PWE, the standardized mortality ratio (SMR) was 2.25, with a higher value seen in the younger age group at diagnosis and a shorter interval after diagnosis. The SMR was 1.56 and 4.93 among patients receiving monotherapy and those receiving four or more antiseizure medications, respectively. The SMR was 1.61 for PWE without any comorbidities. SMR was higher for PWE who were rural versus urban residents (2.47 versus 2.03). Among PWE, the causes of death were cerebrovascular disease, malignant neoplasms outside the central nervous system (CNS), malignant neoplasms of the CNS, pneumonia, and external causes, including suicide (SMRs, 4.50, 1.37, 46.95, 2.08, 2.17, and 2.07, respectively). Overall, 1.9 percent of deaths were accounted for by epilepsy itself and status epilepticus.

“Active control of seizures, education about injury prevention, monitoring for suicidal thoughts, and efforts to improve accessibility to epilepsy care all contribute to reducing mortality,” a coauthor said in a statement.