While it is commonly known that patients with epilepsy face increased mortality, a recent study published in Neurology.org indicates that patients who are newly diagnosed and treated also suffer from increased morbidity and mortality.

Researchers of the study analysed the data of 7,461 epilepsy patients who commenced treatment in Hong Kong’s public hospitals between September 2005 and September 2010. Median age of the study population was 60 years.

Surprisingly, 29% of these patients died during the 5-year study. Comparing with the general population, the hospitalisation rate for these patients went up to 6.76. While the mortality rate was highest among patients with physical or psychiatric comorbidity, the study found that patients who were free of physical comorbidity also faced elevated risks of developing stroke, ischemic heart disease, and cancer for male patients.

Diagnosing and treating epilepsy in the elderly remains a challenge


Cerebrovascular disease occurred in almost 80% of the study population. The relatively older age of the patients might be one of the reasons contributing to such results.

Besides stroke and dementia, epilepsy is a very common neurological disorder among the elderly population. They make up a large and often neglected group in the epileptic community. Currently, there is no reliable methods to confirm the diagnosis of epilepsy and it heavily relies on the professional judgement and experience of the physician. What complicates the situation is that the elderly might have other comorbidities that may also lead to a loss of consciousness.

Apart from the difficulties in diagnosing epilepsy, management of the disease for the elderly patients also remains to be challenge. According to the research findings, the patients are particularly sensitive to adverse effects of anti-epileptic agents. It revealed that patients treated with enzyme-inducing anti-epileptic drugs (EIAEDs) had a higher risk of developing physical comorbidities compared to those on non-EIAEDs.

Poor understanding on epilepsy in Hong Kong


In a separate study investigating the awareness, attitude and understanding of epilepsy amongst the Hong Kong population, 19% of the survey participants admitted that they preferred to hide the diagnosis of epilepsy of their family member. While some cited ‘feeling ashamed for the family’ as the reason, more of them were ‘afraid of being discriminated’.

Additionally, the survey discovered that the general public’s understanding of the disease was poor. Although 58% of the survey participants had heard of epilepsy, 71% believed that it was genetically inheritable. 10.4% believed that epilepsy was equivalent to a psychiatric disorder and 15.8% believed that children with epilepsy would have subnormal intelligence.

Summary of survey on the myths and misunderstandings about epilepsy in Hong Kong. (Source: Epilepsia)
Summary of survey on the myths and misunderstandings about epilepsy in Hong Kong. (Source: Epilepsia)

The label of epilepsy may be more debilitating than the disease itself


Patients with epilepsy have to live under the social stigma attached to the disease. Every aspect of their lives ranging from education and employment opportunities to personal relationships are dictated by the severity and frequency of their seizures.

“I urinated in the pantry of my office during a complex partial seizure,” a male epileptic patient shared.

Due to the immense stress and embarrassment caused by the disease, epileptic patients tend to find themselves isolated and withdrawn from the society.

A study published in the International Review of Neurobiology has also identified that 25-50% of epileptic patients suffered from psychiatric disorders such as depression and anxiety. MIMS

Read more:
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Reflex epilepsy 101
CUHK study: "Five-a-day" keeps dementia away
From electrotherapy to wearable brain stimulation devices – Treating depression and elevating mood

Sources:
http://www.neurology.org/content/early/2016/07/15/WNL.0000000000002984.short
http://www.medscape.com/viewarticle/872119
http://www.medscape.com/viewarticle/733423_1
https://www.ncbi.nlm.nih.gov/pubmed/12904612
https://www.ncbi.nlm.nih.gov/pubmed/12904612
https://miami.pure.elsevier.com/en/publications/chapter-20-psychiatric-comorbidities-in-epilepsy
http://www.fmshk.org/database/articles/03mb04_4.pdf
http://onlinelibrary.wiley.com/doi/10.1046/j.1528-1157.2002.31901.x/full