Hostname: page-component-848d4c4894-tn8tq Total loading time: 0 Render date: 2024-06-21T22:41:15.144Z Has data issue: false hasContentIssue false
  • English
  • Français

The Consequences of Uncontrolled Epilepsy

Published online by Cambridge University Press:  07 November 2014

Michael R. Sperling
Get access Rights & Permissions [Opens in a new window]

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.

Type
Review Article
Information
CNS Spectrums , Volume 9 , Issue 2 , February 2004 , pp. 98 - 109
Copyright
Copyright © Cambridge University Press 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Sutula, TP, Hagen, J, Pitkänen, A. Do epileptic seizures damage the brain? Curr Opin Neural. 2003;16:189–195.CrossRefGoogle ScholarPubMed
2.Buck, D, Baker, GA, Jacoby, A, Smith, DF, Chadwick, DW. Patients' experiences of injury as a result of epilepsy. Epilepsia. 1997;38:439–444.CrossRefGoogle ScholarPubMed
3.Neufeld, MY, Vishne, T, Chistik, V, Korczyn, AD. Life-long history of injuries related to seizures. Epilepsy Res. 1999;34:123–127.CrossRefGoogle ScholarPubMed
4.Beghi, E, Cornaggia, C. Morbidity and accidents in patients with epilepsy: results of a European cohort study. Epilepsia. 2002;43:1076–1083.CrossRefGoogle ScholarPubMed
5.Morgan, CL, Kerr, MP. Epilepsy and mortality: a record linkage study in a U.K. population. Epilepsia. 2002;43:1251–1255.CrossRefGoogle Scholar
6.Sperling, MR, Feldman, H, Kinman, J, Liporace, J, O'Connor MJ. Seizure control and mortality in epilepsy. Ann Neurol. 1999;46:45–50.3.0.CO;2-I>CrossRefGoogle ScholarPubMed
7.Tomson, T. Mortality in epilepsy. J Neurol. 2000;247:15–21.CrossRefGoogle ScholarPubMed
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;344:918–921.CrossRefGoogle ScholarPubMed
9.Harvey, AS, Nolan, T, Carlin, JB. Community-based study of mortality in children with epilepsy. Epilepsia. 1993;34:597–603.CrossRefGoogle ScholarPubMed
10.Strauss, DJ, Day, SM, Shavelle, RM, Wu, YW. Remote symptomatic epilepsy. Does seizure severity increase mortality? Neurology. 2003;60:395–399.CrossRefGoogle ScholarPubMed
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;56:149–152.CrossRefGoogle ScholarPubMed
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;36:1187–1194.CrossRefGoogle Scholar
13.Sillanapaa, M, Jalava, M, Kaleva, O, Shinnar, S. Long-term prognosis of seizures with onset in childhood. N Engl J Med. 1998;338:1715–1722.CrossRefGoogle Scholar
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;353:888–893.CrossRefGoogle ScholarPubMed
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;58:462–464.CrossRefGoogle Scholar
16.Langan, Y, Nashef, L, Sander, JW. Certification of deaths attributable to epilepsy. J Neural Neurosurg Psychiatry. 2002;73:751–752.CrossRefGoogle ScholarPubMed
17.Olafsson, E, Hauser, WA, Gudmundsson, G. Long-term survival of people with unprovoked seizures: a population-based study. Epilepsia. 1998;39:89–92.CrossRefGoogle ScholarPubMed
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;43:445–450.CrossRefGoogle ScholarPubMed
19.Salanova, V, Markand, O, Worth, R. Temporal lobe epilepsy surgery: outcome, complications, and late mortality rate in 215 patients. Epilepsia. 2002;43:170–174.CrossRefGoogle ScholarPubMed
20.Sutula, T, Pitkänen, A. Do seizures damage the brain? Prog Brain Res. 2002;135:133–138.CrossRefGoogle Scholar
21.Kotloski, R, Lynch, M, Lauersdorf, S, et al.Repeated brief seizures induce progressive hippocampal neuron loss and memory deficits. Prog Brain Res. 2002;135:95–110.CrossRefGoogle ScholarPubMed
22.Bengzon, J, Mohapel, P, Ekdahl, C, et al.Neuronal apoptosis after brief and prolonged seizures. Prog Brain Res 2002;135:111–119.CrossRefGoogle ScholarPubMed
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;46:69–82.CrossRefGoogle ScholarPubMed
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;51:641–644.CrossRefGoogle Scholar
25.Austin, J, Dunn, D. Progressive behavioral changes in children with epilepsy. Prog Brain Res. 2002;135:419–427.CrossRefGoogle ScholarPubMed
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;10:250–259.CrossRefGoogle ScholarPubMed
27.Helmstaedter, C. Effects of chronic epilepsy on declarative memory systems. Prog Brain Res. 2002;135:439–453.CrossRefGoogle ScholarPubMed
28.Hauser, WA, Lee, JR. Do seizures beget seizures? Prog Brain Res. 2002;135:215–219.CrossRefGoogle ScholarPubMed
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; 1998:2227–2231.Google Scholar
30.McGlone, J. Memory complaints before and after temporal lobectomy: do they predict memory performance or lesion laterally? Epilepsia. 1994;35:529–539.CrossRefGoogle ScholarPubMed
31.Perrine, K, Hermann, BP, Meador, KJ, et al.The relationship of neuropsychological functioning to quality of life in epilepsy. Arch Neurol. 1995;52:997–1003.CrossRefGoogle ScholarPubMed
32.Johnson, V, Cho, R, Tracy, J, Glosser, D, Sperling, M. Determinants of quality of life in epilepsy. Neurology. 2002;58 (suppl 3):213.Google Scholar
33.Baker, G. Assessment of quality of life in people with epilepsy: some practical implications. Epilepsia. 2001;42:66–69.CrossRefGoogle ScholarPubMed
34.Bishop, M, Allen, C. The impact of epilepsy on quality of life: a qualitative analysis. Epilepsy Behavr. 2003;4:226–233.CrossRefGoogle ScholarPubMed
35.Berto, P. Quality of life in patients with epilepsy and impact of treatments. Pharmacoeconomics. 2002;20:1039–1059.CrossRefGoogle ScholarPubMed
36.Birbeck, G, Hays, R, Cui, X, Vickrey, B. Seizure reduction and quality of life improvements in people with epilepsy. Epilepsia. 2002;43:535–538.CrossRefGoogle ScholarPubMed
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.Google Scholar
38.Collings, J. Life fulfilment in an epilepsy sample from the United States. Soc Sci Med. 1995;40:1579–1584.CrossRefGoogle Scholar
39.Kellett, M, Smith, D, Backer, G, Chadwick, D. Quality of life after epilepsy surgery. J Neurol Neurosurg Psychiatry. 1997;63:52–58.CrossRefGoogle ScholarPubMed
40.Suurmeijer, TP, Reuvekamp, MF, Aldenkamp, BP. Social functioning, psychological functioning, and quality of life in epilepsy. Epilepsia. 2001;42:1160–1168.CrossRefGoogle ScholarPubMed
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;37:158–166.CrossRefGoogle ScholarPubMed
42.Weibe, S, Matijevic, S, Eliasziw, M, Derry, PA. Clinically important change in quality of life in epilepsy. J Neurol Neurosurg Psychiatry. 2002;73:116–120.CrossRefGoogle Scholar
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;43:1062–1070.CrossRefGoogle ScholarPubMed
44.Jokeit, H, Ebner, A. Effects of chronic epilepsy on intellectual functions. Prog Brain Res. 2002;135:455–463.CrossRefGoogle ScholarPubMed
45.Neyens, L, Aldenkamp, A, Meinardi, H. Prospective follow-up of intellectual development in children with a recent onset of epilepsy. Epilepsy Res. 1999;34:85–90.CrossRefGoogle ScholarPubMed
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;43:567–573.CrossRefGoogle ScholarPubMed
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;107:71–84.CrossRefGoogle Scholar
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;30:1–9.CrossRefGoogle ScholarPubMed
49.Nowack, W. Psychiatric disorders associated with epilepsy [eMedicine Web site]. Available at: www.emedicine.com/neuro/topic604.htm. Accessed January 5, 2004.Google Scholar
50.Hauser, W, Hesdorffer, D. Intellectual and psychological factors. In: Epilepsy: Frequency, Causes and Consequences. New York, NY: Demos Publications; 1990:245–271.Google Scholar
51.Taylor, D. Overview: psychiatric issues. In: Engel, J JrPedley, T, eds. Epilepsy: A Comprehensive Textbook. E. Washington Square, Penn: Lippincott-Raven Publishers; 1997:2039–2043.Google Scholar
52.Blumer, D, Altschuler, LL. Affective disorders. In: Engel, J JrPedley, T, eds. Epilepsy: A Comprehensive Textbook. E. Washington Square, Penn: Lippincott-Raven Publishers; 1997:2083–2124.Google Scholar
53.Tucker, GJ. Seizure disorders presenting with psychiatric symptomatology. Psychiatr Clin North Am. 1998;21:625–635.CrossRefGoogle ScholarPubMed
54.Sperling, MR, O'Connor, MJ, Saykin, AJ, Plummer, C. Temporal lobectomy for refractory epilepsy. JAMA. 1996;276:470–475.CrossRefGoogle ScholarPubMed
55.Batzel, L. Neuropsychological and emotional correlates of marriage and the ability to live independently in individuals with epilepsy. Epilepsia. 1984;25:594–598.CrossRefGoogle ScholarPubMed
56.Callaghan, N, Crowley, M, Goggin, T. Epilepsy and employment, marital, education and social status. Ir Med J. 1992;85:17–19.Google ScholarPubMed
57.Carran, M, Kohler, C, O'Connor, MJ, Cloud, B, Sperling, MR. Marital status after epilepsy surgery. Epilepsia. 1999;40:1755–60.CrossRefGoogle ScholarPubMed
58.Demerdash, A, Shaalan, M, Midani, A, Kamel, F, Bahri, M. Sexual behavior of a sample of females with epilepsy. Epilepsia. 1991;32:82–85.CrossRefGoogle ScholarPubMed
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;37:148–161.CrossRefGoogle Scholar
60.Seidenberg, M, Beck, N, Geisser, M, et al.Academic achievement of children with epilepsy. Epilepsia. 1986;27:753–759.CrossRefGoogle ScholarPubMed
61.Suurmeijer, T. Treatment, seizure-free periods, and educational achievements: a follow-up study among children with epilepsy and healthy children. Fam Pract. 1991;8:320–328.CrossRefGoogle ScholarPubMed
62.Zelnik, N, Sa'ado, L, Silman-Stolar, Z, Goikhman, I. Seizure control and educational outcome in childhood-onset epilepsy. J Child Neurol. 2001;16:820–824.Google ScholarPubMed
63.Kokkonen, J, Kokkonen, E, Saukkonen, A, Pennanen, P. Psychosocial outcome of young adults with epilepsy in childhood. J Neuro Neurosurg Psychiatry. 1997;62:265–268.CrossRefGoogle ScholarPubMed
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;61:64–70.CrossRefGoogle ScholarPubMed
65.The RESt-1 Group. Social aspects of epilepsy in the adult in seven European countries. Epilepsia. 2000;41:998–1004.CrossRefGoogle Scholar
66.Sperling, MR, Saykin, A, Roberts, R, French, JA, O'Connor, MJ. Occupational outcome following temporal lobe surgery. J Epilepsy. 1994;7:144–151.Google Scholar
67.Jones, J, Berven, N, Ramirez, L, Woodard, A, Hermann, BP. Long-term psychosocial outcomes of anterior temporal lobectomy. Epilepsia. 2002;43:896–903.CrossRefGoogle ScholarPubMed
68.Reeves, AL, So, E, Evans, RW, et al.Factors associated with work outcome after anterior temporal lobectomy for intractable epilepsy. Epilepsia. 1997;38:689–695.CrossRefGoogle ScholarPubMed
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;38:233–236.CrossRefGoogle ScholarPubMed