Association Between Psychiatric Comorbidities and Mortality in Epilepsy

Gerard Tao; Clarissa Auvrez; Russell Nightscales; Sarah Barnard; Lara McCartney; Charles B Malpas; Piero Perucca; Zhibin Chen; Sophia Adams; Anne McIntosh; Sophia Ignatiadis; Patrick O'Brien; Mark J Cook; Patrick Kwan; Samuel F Berkovic; Wendyl D'Souza; Dennis Velakoulis; Terence J O'Brien

doi:10.1212/CPJ.0000000000001114

Association Between Psychiatric Comorbidities and Mortality in Epilepsy

Neurol Clin Pract. 2021 Oct;11(5):429-437. doi: 10.1212/CPJ.0000000000001114.

Authors

Gerard Tao¹, Clarissa Auvrez¹, Russell Nightscales¹, Sarah Barnard¹, Lara McCartney¹, Charles B Malpas¹, Piero Perucca¹, Zhibin Chen¹, Sophia Adams¹, Anne McIntosh¹, Sophia Ignatiadis¹, Patrick O'Brien¹, Mark J Cook¹, Patrick Kwan¹, Samuel F Berkovic¹, Wendyl D'Souza¹, Dennis Velakoulis¹, Terence J O'Brien¹

Affiliation

¹ Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia.

Abstract

Objective: To explore the impact of psychiatric comorbidities on all-cause mortality in adults with epilepsy from a cohort of patients admitted for video-EEG monitoring (VEM) over 2 decades.

Methods: A retrospective medical record audit was conducted on 2,709 adults admitted for VEM and diagnosed with epilepsy at 3 Victorian comprehensive epilepsy programs from 1995 to 2015. A total of 1,805 patients were identified in whom the record of a clinical evaluation by a neuropsychiatrist was available, excluding 27 patients who died of a malignant brain tumor known at the time of VEM admission. Epilepsy and lifetime psychiatric diagnoses were determined from consensus opinion of epileptologists and neuropsychiatrists involved in the care of each patient. Mortality and cause of death were determined by linkage to the Australian National Death Index and National Coronial Information System.

Results: Compared with the general population, mortality was higher in people with epilepsy (PWE) with a psychiatric illness (standardized mortality ratio [SMR] 3.6) and without a psychiatric illness (SMR 2.5). PWE with a psychiatric illness had greater mortality compared with PWE without (hazard ratio 1.41, 95% confidence interval 1.02-1.97) after adjusting for age and sex. No single psychiatric disorder by itself conferred increased mortality in PWE. The distribution of causes of death remained similar between PWE with psychiatric comorbidities and those without.

Conclusion: The presence of comorbid psychiatric disorders in adults with epilepsy is associated with increased mortality, highlighting the importance of identifying and treating psychiatric comorbidities in these patients.