Mortality and Comorbidities in Epilepsy

Epilepsy carries a markedly elevated risk of premature death, driven by a combination of seizure‐related events, associated systemic disease and modifiable health factors. Standardised mortality ratios typically exceed those of the general population by two to threefold, encompassing both direct consequences of seizures, such as status epilepticus and sudden unexpected death in epilepsy, and indirect contributors including cardiovascular disease, respiratory infections, malignancies and mental health conditions. Comorbid disorders are common and span psychiatric illnesses—particularly depression and anxiety—cardiometabolic risk factors such as hypertension and diabetes, and substance misuse including alcohol dependence. The interplay of polypharmacy, lifestyle factors and socioeconomic determinants often exacerbates both mortality risk and quality of life. Holistic management strategies now emphasise not only seizure control but also early identification and treatment of comorbidities, optimisation of cardiovascular health, mental wellbeing and substance misuse support.

Research from Nature Portfolio

A cohort study using national insurance records in Taiwan examined the incidence and outcomes of diabetes in individuals with epilepsy compared to matched controls. Findings revealed that people with epilepsy experienced a 31% increased hazard of developing diabetes and faced significantly higher odds of adverse post-diabetes complications, including pneumonia and urinary tract infection. These results highlight the need for targeted metabolic monitoring and tailored prevention strategies in this population.

Mortality and Comorbidities in Epilepsy publication trend

The graph below shows the total number of articles in mortality and comorbidities in epilepsy across all publications each year (not limited to Nature Index journals).

Technical terms

Standardised Mortality Ratio (SMR): the ratio of observed to expected deaths in a study population, adjusted for demographic factors.

Comorbidity: the presence of additional diseases or disorders co-occurring with a primary condition.

Retrospective Cohort Study: research design analysing historical data to compare outcomes across predefined groups based on exposure.

Atherosclerotic Cardiovascular Disease (ASCVD) Risk: an estimate of the likelihood of heart attack or stroke within a ten-year period, calculated from clinical and laboratory measures.

References

1. Cardiovascular disease risk, awareness, and treatment in people with epilepsy. Epilepsy & Behavior (2021).
2. Mortality among People with Epilepsy: A Retrospective Nationwide Analysis from 2016 to 2019. International Journal of Environmental Research and Public Health (2021).
3. Risk and outcomes of diabetes in patients with epilepsy. Scientific Reports (2021).
4. Alcohol-Specific Mortality in People With Epilepsy: Cohort Studies in Two Independent Population-Based Datasets. Frontiers in Neurology (2021).