Pharmacological and non-pharmacological approaches to life threatening conditions in epilepsy

SUMMARY Background A higher degree of mortality may be attributed to patients with epilepsy. There are several main reasons responsible – sudden unexpected death in epilepsy (SUDEP), status epilepticus (SE) and central nervous system damage. Also, epilepsy associated accidents and suicidal attempts have to be highlighted. Aim Epidemiology and therapeutic or preventive (pharmacological or non-pharmacological strategies) of the conditions increasing mortality have been reviewed so as to minimize the mortality rate in patients with epilepsy. Discussion and Conclusions Generally, the treatment of convulsive SE entails the need to achieve rapid stabilization of a patient and an appropriate choice of antiepileptic drugs (AEDs) so as to stop seizure activity. In the event of no response the treatment has to be continued under general anaesthesia. For minimizing the risk of SUDEP in young adults or patients with childhood epilepsy, adequate treatments with AEDs must be initiated or possible surgery considered. Patients with uncontrolled epilepsy require AED optimization. Although a possible link between taking AEDs and increased suicidality is questionable, patients with epilepsy are advised to be evaluated for possible symptoms of depression or anxiety. Surgical treatment of epilepsy may increase the risk of depression development, so a careful psychiatric examination is recommended prior to surgery.