Neurology Department, Hamad Medical Corporation, Doha, Qatar.
Neurology Epilepsy, Weill Cornell Medical College, Doha, Qatar.
Curr Med Res Opin. 2020 Sep;36(9):1473-1480. doi: 10.1080/03007995.2020.1776234. Epub 2020 Jul 15.
In this narrative review, we will discuss some of the significant risks and dramatic consequences that are associated with epilepsy: depression, suicide, seizure-related injuries, and mortality, both in adults and in children. Considering the high prevalence of depression among people with epilepsy (PWE), routine and periodic screening of all PWE for early detection and appropriate management of depression is recommended. PWE should be screened for suicidal ideation regularly and when needed, patients should be referred for a psychiatric evaluation and treatment. When starting an antiepileptic drug (AED) or switching from one to another AED, patients should be advised to report to their treating physician any change in their mood and existence of suicidal ideation. The risk of injuries for the general epilepsy population is increased only moderately. The risk is higher in selected populations attending epilepsy clinics and referral centers. This being said, there are PWE that may suffer frequent, severe, and sometimes even life-threatening seizure-related injuries. The most obvious way to reduce risk is to strive for improved seizure control. Finally, PWE have a 2-3 times higher mortality rate than the general population. Deaths in PWE may relate to the underlying cause of epilepsy, to seizures (including sudden unexpected death in epilepsy [SUDEP] and seizure related injuries) and to status epilepticus, as well as to other conditions that do not appear directly related to epilepsy. Improving seizure control and patient education may be the most important measures to reduce epilepsy related mortality in general and SUDEP in particular.
在这篇叙述性评论中，我们将讨论与癫痫相关的一些重大风险和戏剧性后果：包括成年人和儿童在内的癫痫患者的抑郁、自杀、与癫痫发作相关的伤害和死亡率。鉴于癫痫患者（PWE）中抑郁的高患病率，建议对所有 PWE 进行常规和定期筛查，以早期发现并对抑郁进行适当管理。应定期对 PWE 进行自杀意念筛查，如有需要，应将患者转介进行精神科评估和治疗。在开始使用抗癫痫药物（AED）或从一种 AED 转换为另一种 AED 时，应告知患者向主治医生报告任何情绪变化和自杀意念的存在。一般癫痫人群的伤害风险仅略有增加。在特定的癫痫诊所和转诊中心就诊的人群中，风险更高。也就是说，有些 PWE 可能会遭受频繁、严重甚至危及生命的与癫痫发作相关的伤害。降低风险的最明显方法是努力实现更好的癫痫控制。最后，癫痫患者的死亡率比一般人群高 2-3 倍。癫痫患者的死亡可能与癫痫的根本原因、癫痫发作（包括癫痫猝死[SUDEP]和与癫痫发作相关的伤害）和癫痫持续状态有关，也可能与其他似乎与癫痫无关的疾病有关。改善癫痫发作控制和患者教育可能是降低癫痫相关死亡率特别是 SUDEP 死亡率的最重要措施。
