Introduction

According to eight reports, death by suicide occurs in 5% of patients with epilepsy, compared with 1.4% in the general population (Matthews and Barabas, 1981). Based on four reports, the four – to fivefold increase in suicides among patients with epilepsy over the rate in the general population is magnified to approximately 25–fold among patients with temporal lobe epilepsy (Barraclough, 1987). In a Danish study covering 14 years (Henriksen et al., 1970), 164 of 2763 patients with epilepsy died (an excess mortality rate of 273% compared to the number of deaths expected in the general population). While epilepsy was the cause of death in 26%, suicide was the cause of death in 20% (an excess mortality rate of 300%) at an average age at death of 32 years. For studies of an association between epilepsy and suicide to be statistically valid, the cohort must be standardized by age and sex, according to Stenager and Stenager (1992); most studies have not met these standards. The same authors pointed out that the variety of forms of epilepsy necessitates an examination of each syndrome singly for risk of suicide. Their second point is very significant, because the data available indicate that suicide is associated particularly with temporal lobe epilepsy.

Suicide and attempted suicide

Murphy (1994) points out that it is important to distinguish between suicide and attempted suicide. Differences between epileptic patients who attempt suicide and those who complete the act are not established.