Skip to main content
×
×
Home

The Consequences of Uncontrolled Epilepsy

  • Michael R. Sperling
Abstract

The consequences of epilepsy can be quite severe and include shortened lifespan, excessive bodily injury, neuropsychological and psychiatric impairment, and social disability. There is evidence that seizures cause brain injury, including neuronal death and physiological dysfunction. Mortality rates are 4—7 times higher in people with medically refractory seizures, and injury rates are substantial, ranging from one per 20 person-years to as much as one per 3 person-years. Quality of life is impaired in epilepsy, and relates to seizure control. Psychosocial disabilities, including lower social interaction with reduced marriage rates and reduced employment levels, are more common in people with refractory seizures. Complete seizure control is desirable, since seizures potentially constitute a serious threat to health and well-being. Therefore, satisfactory seizure control should be defined as having no seizures. Treatment should be directed to preventing seizures whenever possible and achieving control early in the course of illness. The risks of uncontrolled seizures outweigh the risks of aggressive medical or surgical therapy.

Copyright
Corresponding author
Please direct all correspondence to: Michael R. Sperling, MD, Thomas Jefferson University Hospital, 111 S. 11th Street, Philadelphia, PA 19107; Tel: 215-955-1222, Fax:, 215-955-3745; E-mail: michael.sperling@jefferson.edu.
References
Hide All
1.Sutula, TP, Hagen, J, Pitkänen, A. Do epileptic seizures damage the brain? Curr Opin Neural. 2003;16:189195.
2.Buck, D, Baker, GA, Jacoby, A, Smith, DF, Chadwick, DW. Patients' experiences of injury as a result of epilepsy. Epilepsia. 1997;38:439444.
3.Neufeld, MY, Vishne, T, Chistik, V, Korczyn, AD. Life-long history of injuries related to seizures. Epilepsy Res. 1999;34:123127.
4.Beghi, E, Cornaggia, C. Morbidity and accidents in patients with epilepsy: results of a European cohort study. Epilepsia. 2002;43:10761083.
5.Morgan, CL, Kerr, MP. Epilepsy and mortality: a record linkage study in a U.K. population. Epilepsia. 2002;43:12511255.
6.Sperling, MR, Feldman, H, Kinman, J, Liporace, J, O'Connor MJ. Seizure control and mortality in epilepsy. Ann Neurol. 1999;46:4550.
7.Tomson, T. Mortality in epilepsy. J Neurol. 2000;247:1521.
8.Cockerell, OC, Johnson, AL, Sander, JW, Hart, YM, Goodridge, DMG, Shorvon, SD. Mortality from epilepsy: results from a prospective population-based study. Lancet. 1994;344:918921.
9.Harvey, AS, Nolan, T, Carlin, JB. Community-based study of mortality in children with epilepsy. Epilepsia. 1993;34:597603.
10.Strauss, DJ, Day, SM, Shavelle, RM, Wu, YW. Remote symptomatic epilepsy. Does seizure severity increase mortality? Neurology. 2003;60:395399.
11.Klenerman, P, Sander, JW, Shorvon, SD. Mortality in patients with epilepsy: a study of patients in long-term residential care. J Neurol Neurosurg Psychiatry. 1993;56:149152.
12.Nashef, L, Fish, DR, Garner, S, Sander, JW, Shorvon, SD. Sudden death in epilepsy: a study of incidence in a young cohort with epilepsy and learning difficulty. Epilepsia. 1995;36:11871194.
13.Sillanapaa, M, Jalava, M, Kaleva, O, Shinnar, S. Long-term prognosis of seizures with onset in childhood. N Engl J Med. 1998;338:17151722.
14.Nilsson, L, Farahmand, B, Persson, PG, Thiblin, I, Tomson, T. Risk factors for sudden, unexpected death in epilepsy—a case control study. Lancet. 1999;353:888893.
15.Nashef, L, Fish, DR, Sander, JW, Shorvon, SD. Incidence of sudden unexpected death in an adult outpatient cohort with epilepsy at a tertiary referral centre. J Neurol Neurosurg Psychiatry. 1995;58:462464.
16.Langan, Y, Nashef, L, Sander, JW. Certification of deaths attributable to epilepsy. J Neural Neurosurg Psychiatry. 2002;73:751752.
17.Olafsson, E, Hauser, WA, Gudmundsson, G. Long-term survival of people with unprovoked seizures: a population-based study. Epilepsia. 1998;39:8992.
18.Shackleton, DP, Westendorp, RG, Kasteleijn-Nolst Trenite, DG, de Craen, AJ, Vandenbroucke, JP. Survival of patients with epilepsy: an estimate of the mortality risk. Epilepsia. 2002;43:445450.
19.Salanova, V, Markand, O, Worth, R. Temporal lobe epilepsy surgery: outcome, complications, and late mortality rate in 215 patients. Epilepsia. 2002;43:170174.
20.Sutula, T, Pitkänen, A. Do seizures damage the brain? Prog Brain Res. 2002;135:133138.
21.Kotloski, R, Lynch, M, Lauersdorf, S, et al.Repeated brief seizures induce progressive hippocampal neuron loss and memory deficits. Prog Brain Res. 2002;135:95110.
22.Bengzon, J, Mohapel, P, Ekdahl, C, et al.Neuronal apoptosis after brief and prolonged seizures. Prog Brain Res 2002;135:111119.
23.Salmenperä, T, Kälviäinen, R, Partanen, K, et al.Hippocampal and amygdaloid damage in partial epilepsy: a cross-sectional MRI study of 241 patients. Epilepsy Res. 2001;46:6982.
24.Briellmann, R, Berkovic, S, Syngeniotis, A, et al.Seizure-associated hippocampal volume loss: a longitudinal magnetic resonance study of temporal lobe epilepsy. Ann Neurol. 2002;51:641644.
25.Austin, J, Dunn, D. Progressive behavioral changes in children with epilepsy. Prog Brain Res. 2002;135:419427.
26.Bjørnaes, H, Stabell, K, Henriksen, O, et al.The effects of refractory epilepsy on intellectual functioning in children and adults: a longitudinal study. Seizure. 2001;10:250259.
27.Helmstaedter, C. Effects of chronic epilepsy on declarative memory systems. Prog Brain Res. 2002;135:439453.
28.Hauser, WA, Lee, JR. Do seizures beget seizures? Prog Brain Res. 2002;135:215219.
29.Dodrill, C, Batzel, L. Issues in quality of life assessment. In: Engel, J JrPedley, T, eds. Epilepsy: A Comprehensive Textbook. E. Washington Square, Penn: Lippincott-Raven Publishers; 1998:22272231.
30.McGlone, J. Memory complaints before and after temporal lobectomy: do they predict memory performance or lesion laterally? Epilepsia. 1994;35:529539.
31.Perrine, K, Hermann, BP, Meador, KJ, et al.The relationship of neuropsychological functioning to quality of life in epilepsy. Arch Neurol. 1995;52:9971003.
32.Johnson, V, Cho, R, Tracy, J, Glosser, D, Sperling, M. Determinants of quality of life in epilepsy. Neurology. 2002;58 (suppl 3):213.
33.Baker, G. Assessment of quality of life in people with epilepsy: some practical implications. Epilepsia. 2001;42:6669.
34.Bishop, M, Allen, C. The impact of epilepsy on quality of life: a qualitative analysis. Epilepsy Behavr. 2003;4:226233.
35.Berto, P. Quality of life in patients with epilepsy and impact of treatments. Pharmacoeconomics. 2002;20:10391059.
36.Birbeck, G, Hays, R, Cui, X, Vickrey, B. Seizure reduction and quality of life improvements in people with epilepsy. Epilepsia. 2002;43:535538.
37.Devinsky, O. Psychosocial and behavioral function in epilepsy. In: Porter, R, Chadwick, D, eds. The Epilepsies. 2nd ed. Newton, Mass: Butterworth-Heinemann; 1997:347–363.
38.Collings, J. Life fulfilment in an epilepsy sample from the United States. Soc Sci Med. 1995;40:15791584.
39.Kellett, M, Smith, D, Backer, G, Chadwick, D. Quality of life after epilepsy surgery. J Neurol Neurosurg Psychiatry. 1997;63:5258.
40.Suurmeijer, TP, Reuvekamp, MF, Aldenkamp, BP. Social functioning, psychological functioning, and quality of life in epilepsy. Epilepsia. 2001;42:11601168.
41.Vickrey, BG, Hays, RD, Engel, J Jret al.Outcome assessment for epilepsy surgery: the impact of measuring health related quality of life. Ann Neurol. 1995;37:158166.
42.Weibe, S, Matijevic, S, Eliasziw, M, Derry, PA. Clinically important change in quality of life in epilepsy. J Neurol Neurosurg Psychiatry. 2002;73:116120.
43.Hermann, B, Seidenberg, M, Bell, B, et al.The neurodevelopmental impact of childhood onset temporal lobe epilepsy on brain structure and function. Epilepsia. 2002;43:10621070.
44.Jokeit, H, Ebner, A. Effects of chronic epilepsy on intellectual functions. Prog Brain Res. 2002;135:455463.
45.Neyens, L, Aldenkamp, A, Meinardi, H. Prospective follow-up of intellectual development in children with a recent onset of epilepsy. Epilepsy Res. 1999;34:8590.
46.Huang, L, Yang, S, Liou, C, et al.Pentylenetetrazol-induced recurrent seizures in rat pups: time course on spatial learning and long-term effects. Epilepsia. 2002;43:567573.
47.Lee, C, Hannay, J, Hrachovy, R, et al.Spatial learning deficits without hippocampal neuronal loss in a model of early-onset epilepsy. Neuroscience. 2001;107:7184.
48.Prevey, M, Delaney, RJ, Cramer, R, Mattson, VA. Epilepsy Cooperative Study 264 Group. Complex partial and secondarily generalized seizure patients: cognitive functioning prior to treatment with antiepileptic medication. Epilepsy Res. 1998;30:19.
49.Nowack, W. Psychiatric disorders associated with epilepsy [eMedicine Web site]. Available at: www.emedicine.com/neuro/topic604.htm. Accessed January 5, 2004.
50.Hauser, W, Hesdorffer, D. Intellectual and psychological factors. In: Epilepsy: Frequency, Causes and Consequences. New York, NY: Demos Publications; 1990:245271.
51.Taylor, D. Overview: psychiatric issues. In: Engel, J JrPedley, T, eds. Epilepsy: A Comprehensive Textbook. E. Washington Square, Penn: Lippincott-Raven Publishers; 1997:20392043.
52.Blumer, D, Altschuler, LL. Affective disorders. In: Engel, J JrPedley, T, eds. Epilepsy: A Comprehensive Textbook. E. Washington Square, Penn: Lippincott-Raven Publishers; 1997:20832124.
53.Tucker, GJ. Seizure disorders presenting with psychiatric symptomatology. Psychiatr Clin North Am. 1998;21:625635.
54.Sperling, MR, O'Connor, MJ, Saykin, AJ, Plummer, C. Temporal lobectomy for refractory epilepsy. JAMA. 1996;276:470475.
55.Batzel, L. Neuropsychological and emotional correlates of marriage and the ability to live independently in individuals with epilepsy. Epilepsia. 1984;25:594598.
56.Callaghan, N, Crowley, M, Goggin, T. Epilepsy and employment, marital, education and social status. Ir Med J. 1992;85:1719.
57.Carran, M, Kohler, C, O'Connor, MJ, Cloud, B, Sperling, MR. Marital status after epilepsy surgery. Epilepsia. 1999;40:1755–60.
58.Demerdash, A, Shaalan, M, Midani, A, Kamel, F, Bahri, M. Sexual behavior of a sample of females with epilepsy. Epilepsia. 1991;32:8285.
59.Jacoby, A, Baker, BA, Steen, N, Potts, P, Chadwick, DW. The clinical course of epilepsy and its psychosocial correlates: findings from a UK community study. Epilepsia. 1996;37:148161.
60.Seidenberg, M, Beck, N, Geisser, M, et al.Academic achievement of children with epilepsy. Epilepsia. 1986;27:753759.
61.Suurmeijer, T. Treatment, seizure-free periods, and educational achievements: a follow-up study among children with epilepsy and healthy children. Fam Pract. 1991;8:320328.
62.Zelnik, N, Sa'ado, L, Silman-Stolar, Z, Goikhman, I. Seizure control and educational outcome in childhood-onset epilepsy. J Child Neurol. 2001;16:820824.
63.Kokkonen, J, Kokkonen, E, Saukkonen, A, Pennanen, P. Psychosocial outcome of young adults with epilepsy in childhood. J Neuro Neurosurg Psychiatry. 1997;62:265268.
64.Shackleton, DP, Kasteleijn-Nolst Trenite, DG, De Craen, AJ, Vandenbroucke, JP, Westendorp, RG. Living with epilepsy: Long-term prognosis and psychosocial outcomes. Neurology. 2003;61:6470.
65.The RESt-1 Group. Social aspects of epilepsy in the adult in seven European countries. Epilepsia. 2000;41:9981004.
66.Sperling, MR, Saykin, A, Roberts, R, French, JA, O'Connor, MJ. Occupational outcome following temporal lobe surgery. J Epilepsy. 1994;7:144151.
67.Jones, J, Berven, N, Ramirez, L, Woodard, A, Hermann, BP. Long-term psychosocial outcomes of anterior temporal lobectomy. Epilepsia. 2002;43:896903.
68.Reeves, AL, So, E, Evans, RW, et al.Factors associated with work outcome after anterior temporal lobectomy for intractable epilepsy. Epilepsia. 1997;38:689695.
69.Gilliam, F, Kuzniecky, R, Faught, E, Black, L, Carpenter, G, Schrodt, R. Patient-validated content of epilepsy-specific quality-of-life measurement. Epilepsia. 1997;38:233236.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

CNS Spectrums
  • ISSN: 1092-8529
  • EISSN: 2165-6509
  • URL: /core/journals/cns-spectrums
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed