Suicide rates are higher in people with epilepsy compared to the general population, according to results published in the journal Epilepsy and Behaviour. Suicide prevention measures should therefore be put in place to prevent such deaths.
Rosemarie Kobau, one of the authors of the study, commented: “Caregivers of people with epilepsy and other members of the public can participate in programs such as Mental Health First Aid, an evidence-based program available in many U.S. communities that teaches people about mental illness symptoms, and how to recognize and intervene during a mental health crisis.”
The programme also exists in England, and more information about it can be found on the Mental Health First Aid England webpage.
During the study, scientists from the US Centers for Disease Controls and Prevention (CDC) used data collected over eight years, between 2003 and 2011, to determine how often and in what circumstances suicide occurs in people with epilepsy.
They found that an average of 17 out of 100,000 people with epilepsy, aged 10 years and older, died from suicide each year during the study period, compared to 14 out of 100,000 in the general population.
The team then focused on people aged 40-49 years, and discovered that the suicide rates were 29% amongst those with epilepsy and 22% in the general population.
Looking at the relationships between suicide rate and a) race/ethnicity, b) education and c) marital status, there were no significant differences between the epilepsy and general population ‘groups’. In both, approximately one-third of suicides were committed by people with the lowest level of education.
When the researchers examined the locations in which the suicides occurred most, they found that 81% of people with epilepsy committed suicide in residential settings, compared to 76% of people without epilepsy.
This result suggests that it may be beneficial that caregivers, relatives, and others living with people with epilepsy to assess the availability of potentially harmful materials in the home to reduce the risk of suicide.
According to Samaritans, there were more than 6.500 suicides in the UK and Republic of Ireland in 2014. It is thought that there might be a link between epilepsy, psychiatric disorders and suicide.
If you feel that you, or someone you know is at risk of suicide, you can contact Samaritans any time, from any phone, on 116 123.
Author: Dr Özge Özkaya
Click here to read more stories about living with epilepsy.
Seizure-onset patterns in focal cortical dysplasia and neurodevelopmental tumors: Relationship with surgical prognosis and neuropathologic subtypes
The study of intracerebral electroencephalography (EEG) seizure-onset patterns is crucial to accurately define the epileptogenic zone and guide successful surgical resection. It also raises important pathophysiologic issues concerning mechanisms of seizure generation. Until now, several seizure-onset patterns have been described using distinct recording methods (subdural, depth electrode), mostly in temporal lobe epilepsies or with heterogeneous neocortical lesions.Methods
We analyzed data from a cohort of 53 consecutive patients explored by stereoelectroencephalography (SEEG) and with pathologically confirmed malformation of cortical development (MCD; including focal cortical dysplasia [FCD] and neurodevelopmental tumors [NDTs]).Results
We identified six seizure-onset patterns using visual and time-frequency analysis: low-voltage fast activity (LVFA); preictal spiking followed by LVFA; burst of polyspikes followed by LVFA; slow wave/DC shift followed by LVFA; theta/alpha sharp waves; and rhythmic spikes/spike-waves. We found a high prevalence of patterns that included LVFA (83%), indicating nevertheless that LVFA is not a constant characteristic of seizure onset. An association between seizure-onset patterns and histologic types was found (p = 001). The more prevalent patterns were as follows: (1) in FCD type I LVFA (23.1%) and slow wave/baseline shift followed by LVFA (15.4%); (2) in FCD type II burst of polyspikes followed by LVFA (31%), LVFA (27.6%), and preictal spiking followed by LVFA (27.6%); (3) in NDT, LVFA (54.5%). We found that a seizure-onset pattern that included LVFA was associated with favorable postsurgical outcome, but the completeness of the EZ resection was the sole independent predictive variable.Significance
Six different seizure-onset patterns can be described in FCD and NDT. Better postsurgical outcome is associated with patterns that incorporate LVFA.
Outcomes after changing antiepileptic drugs (AEDs) have largely been studied in single cohort series. We recently reported the first study to examine this question in a controlled manner. Here we expand on these results by using a matched, prospective methodology applied to both uncontrolled and well-controlled patients taking any AED.Methods
We reviewed all outpatient notes over a 9-month period and identified patients with focal epilepsy who were on monotherapy. We classified those who switched AEDs as case patients, with those remaining on the same drug serving as controls. We matched cases with controls for seizure status (seizure-free in the preceding 6 months or not), current AED, and number of failed AEDs. We subsequently assessed outcome 6 months later.Results
Seizure-free patients who switched drug (n = 12) had a 16.7% rate of seizure recurrence at 6 months, compared to 2.8% among controls remaining on the same drug (n = 36, p = 0.11). There was a 37% remission rate among uncontrolled patients who switched drug compared to 55.6% among controls (n = 27 per group, p = 0.18). Uncontrolled patients who had previously tried more than one AED were somewhat less likely to enter remission (p = 0.057). Neither AED mechanism of action nor change in dosage impacted outcome.Significance
Herein we provide further estimation of the modest risk (~14%) associated with switching AEDs in patients in remission compared to being maintained on the same regimen. Uncontrolled patients were no more likely to enter remission after a drug switch than they were after remaining on the same drug, suggesting that spontaneous changes in disease state, and not drug response, underlie remission in this population.
Circadian and ultradian patterns of epileptiform discharges differ by seizure-onset location during long-term ambulatory intracranial monitoring
Previous studies reporting circadian patterns of epileptiform activity and seizures are limited by (1) short-term recording in an epilepsy monitoring unit (EMU) with altered antiepileptic drugs (AEDs) and sleep, or (2) subjective seizure diary reports. We studied circadian patterns using long-term ambulatory intracranial recordings captured by the NeuroPace RNS System.Methods
Retrospective study of RNS System trial participants with stable detection parameters over a continuous 84-day period. We analyzed all detections and long device–detected epileptiform events (long episodes) and defined a subset of subjects in whom long episodes represented electrographic seizures (LE-SZ). Spectrum resampling determined the dominant frequency periodicity and cosinor analysis identified significant circadian peaks in detected activity. Chi-square analysis was used to compare subjects grouped by region of seizure onset.Results
In the 134 subjects, detections showed a strongly circadian and uniform pattern irrespective of region of onset that peaked during normal sleep hours. In contrast, long episodes and LE-SZ patterns varied by region. Neocortical regions had a monophasic, nocturnally dominant rhythm, whereas limbic regions showed a more complex pattern and diurnal peak. Rhythms in some individual limbic subjects were best fit by a dual oscillator (circadian + ultradian) model.Significance
Epileptiform activity has a strong 24 h periodicity with peak nocturnal occurrence. Limbic and neocortical epilepsy show divergent circadian influences. These findings confirm that circadian patterns of epileptiform activity vary by seizure-onset zone, with implications for treatment and safety, including SUDEP.