Suicide and Epilepsy

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Summary and Comment

Suicide and Epilepsy

The risk for suicide is greatest during the first 6 months after epilepsy diagnosis and in those with coexisting psychiatric illness.

Numerous studies have shown an increased rate of suicide among patients with epilepsy, yet the design and power limitations of those studies have led to uncertainty as to the magnitude and nature of this risk. Christensen and colleagues used the Danish Cause of Death Registry and several other databases to determine the relative risk for suicide among people with epilepsy. They examined approximately 21,000 suicide cases and more than 400,000 age- and sex-matched controls in the general population.

The relative risk for suicide was three times higher among people with epilepsy than among controls, and it remained significantly (two times) higher even after controlling for demographic and socioeconomic factors and history of psychiatric disease. Notably, the risk for suicide was greatest during the first 6 months after epilepsy was diagnosed and among those with epilepsy and comorbid psychiatric illness (affective disorder, schizophrenia, anxiety disorder, chronic alcohol use, and others). The risk for suicide among those with epilepsy and either affective disorder or schizophrenia was more than 20 times the risk among controls; after controlling for demographic and socioeconomic factors, the risk among those with epilepsy and schizophrenia was 13 times higher than the risk in controls. Compared with controls, the increase in suicide risk after age 60 was less pronounced in people with epilepsy.

Comment: This large and well-powered study confirms the findings of many smaller and less well-controlled series: Epilepsy is an important risk factor for suicide. In addition to the expected and previously reported risk for comorbid psychiatric illness with epilepsy — and the accompanying increased risk for suicide — these researchers have identified newly diagnosed epilepsy as a particularly important risk factor for suicide.

— Orrin Devinsky, MD

Dr. Devinsky is Professor of Neurology, Neurosurgery, and Psychiatry, New York University School of Medicine, New York City.

Published in Journal Watch Neurology August 21, 2007