Risk of Unnatural Mortality in People With Epilepsy

Key Points

Question  What is the risk and medication contribution to cause-specific unnatural mortality in people with epilepsy?

Findings  In this population-based cohort study, more than 50 000 people with epilepsy and 1 million matched individuals without epilepsy were identified in 2 data sets from the general populations of England and Wales. People with epilepsy had a 3-fold increased risk of any unnatural mortality and a 5-fold increased risk of unintentional medication poisoning; psychotropic and opioid, but not antiepileptic, drugs were most commonly used in poisoning.

Meaning  Clinicians should provide advice on unintentional injury and poisoning and suicide prevention and consider the toxicity of concomitant medication when prescribing drugs for people with epilepsy.


Importance  People with epilepsy are at increased risk of mortality, but, to date, the cause-specific risks of all unnatural causes have not been reported.

Objective  To estimate cause-specific unnatural mortality risks in people with epilepsy and to identify the medication types involved in poisoning deaths.

Design, Setting, and Participants  This population-based cohort study used 2 electronic primary care data sets linked to hospitalization and mortality records, the Clinical Practice Research Datalink (CPRD) in England (from January 1, 1998, to March 31, 2014) and the Secure Anonymised Information Linkage (SAIL) Databank in Wales (from January 1, 2001, to December 31, 2014). Each person with epilepsy was matched on age (within 2 years), sex, and general practice with up to 20 individuals without epilepsy. Unnatural mortality was determined using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes V01 through Y98 in the Office for National Statistics mortality records. Hazard ratios (HRs) were estimated in each data set using a stratified Cox proportional hazards model, and meta-analyses were conducted using DerSimonian and Laird random-effects models. The analysis was performed from January 5, 2016, to November 16, 2017.

Exposures  People with epilepsy were identified using primary care epilepsy diagnoses and associated antiepileptic drug prescriptions.

Main Outcomes and Measures  Hazard ratios (HRs) for unnatural mortality and the frequency of each involved medication type estimated as a percentage of all medication poisoning deaths.

Results  In total, 44 678 individuals in the CPRD and 14 051 individuals in the SAIL Databank were identified in the prevalent epilepsy cohorts, and 891 429 (CPRD) and 279 365 (SAIL) individuals were identified in the comparison cohorts. In both data sets, 51% of the epilepsy and comparison cohorts were male, and the median age at entry was 40 years (interquartile range, 25-60 years) in the CPRD cohorts and 43 years (interquartile range, 24-64 years) in the SAIL cohorts. People with epilepsy were significantly more likely to die of any unnatural cause (HR, 2.77; 95% CI, 2.43-3.16), unintentional injury or poisoning (HR, 2.97; 95% CI, 2.54-3.48) or suicide (HR, 2.15; 95% CI, 1.51-3.07) than people in the comparison cohort. Particularly large risk increases were observed in the epilepsy cohorts for unintentional medication poisoning (HR, 4.99; 95% CI, 3.22-7.74) and intentional self-poisoning with medication (HR, 3.55; 95% CI, 1.01-12.53). Opioids (56.5% [95% CI, 43.3%-69.0%]) and psychotropic medication (32.3% [95% CI, 20.9%-45.3%)] were more commonly involved than antiepileptic drugs (9.7% [95% CI, 3.6%-19.9%]) in poisoning deaths in people with epilepsy.

Conclusions and Relevance  Compared with people without epilepsy, people with epilepsy are at increased risk of unnatural death and thus should be adequately advised about unintentional injury prevention and monitored for suicidal ideation, thoughts, and behaviors. The suitability and toxicity of concomitant medication should be considered when prescribing for comorbid conditions.



Monthly brain cycles predict seizures in patients with epilepsy


Brain-damaging vaccines, pesticides and medicines generate nearly $800 billion a year in medical revenues.

‘The current estimated annual cost for nine of the most common neurological disorders in the U.S. was a hefty $789 billion, a recent paper revealed. According to the paper, these conditions include Alzheimer’s disease and other forms of dementia, traumatic brain injury and Parkinson’s disease, as well as epilepsy, multiple sclerosis, and spinal cord injury.

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Researchers also projected that health care costs associated with brain damage will continue to increase as the number of elderly patients were expected to double between 2011 and 2050. Data showed that medical costs related to dementia and stroke alone were estimated to be more than $600 billion by 2030.

“The findings of this report are a wake-up call for the nation, as we are facing an already incredible financial burden that is going to rapidly worsen in the coming years. Although society continues to reap the benefits of the dramatic research investments in heart disease and cancer over the last few decades, similar levels of investment are required to fund neuroscience research focused on curing devastating neurological diseases such as stroke and Alzheimer’s, both to help our patients and also to avoid costs so large they could destabilize the entire health care system and the national economy,” said lead author Dr. Clifton Gooch, ScienceDaily.com reports.’


This MAN Healed 5000 People from Cancer: This Is a Recipe That Kills Tumors in 90 Days – See more at: http://www.choiceandtruth.com/2016/08/this-man-healed-5000-people-from-cancer.html#sthash.6q55okXx.dpuf

Hemp or cannabis oil was used by numerous people for centuries, but it was banned in the second half of the 20th century, as a result of the rise of the billion-dollar pharmaceutical industry.

Rick Simpson is a mechanical engineer and a self-taught doctor, who was diagnosed with skin cancer in 2002 and fought this disease using this miraculous oil. Nowadays, he is one of the greatest world activists for legalization of hemp oil. Using this treatment, he has cured over 5,000 people.

He attended a debate organized in Belgrade, the capital of Serbia, on this topic. He states that hemp or cannabis oil can cure a vast variety of serious health issues, like diabetes, arteriosclerosis, multiple sclerosis, epilepsy, asthma, psoriasis, as well as some of the deadliest forms of cancer.

Rick recounted his story to the Serbian magazine Telegraph “I always tell people – Cannabis will cure you, and you will see that at present, it is the best cure there is in the world!”

He began his story: “It was 2002. The doctors had given up on me because I’d had more than one unsuccessful operation on three pigmented lesions on my face’s skin. As soon as these were removed, they would reappear even more infected! Since I had been studying plants as a hobby for years, one day as I was looking at my wounds in the mirror, I remembered a study from the University of Virginia that said that THC, an active component of cannabis could cure cancer. I took some cannabis oil I had prepared beforehand from the cabinet and dripped a few drops directly on the wound.”
No significant results could be noticed at first. He bandaged his wounds again after applying the oil and waited for few days.

Then, he went on: “After four days I removed the bandages and I couldn’t believe my eyes! The wound was no longer there, and my skin was regenerated! I immediately started talking to people about how I had cured skin cancer with cannabis oil… Everyone laughed at me, but then eleven and a half years have passed, and the cancer still hasn’t returned.”

From then on, Simpson decided to help people in need for this cure, and his work resulted in thousands of cases effectively solved. His last case was an 80-year-old man who was dying from lung cancer.

“The man was all swollen from chemotherapy, open wounds on his legs and was barely breathing! After the doctors had given him no more than 48 hours, his son brought him to me. As I had recommended cannabis oil therapy, the young man had also consulted his father’s doctor. The doctor, of course, rejected such treatment, so in the end the young man took the oil from me, soaked a small cracker in it and gave it to his father.”

In less than thirty minutes, the old man finally started breathing normally again and his breathing completely stabilized during the night.

“Although the doctors “explained” that before death, his vital functions would return briefly, his son didn’t want to wait any longer so he checked his father out of the hospital the next morning. He also stopped all of his father’s prescribed therapy. After six weeks of cannabis oil treatment, the old man no longer needed insulin, and after three months he was completely cured from cancer,”says Rick/
Moreover, he stated that cannabis oil therapy is equally effective in all cases, for it knows no age limit. It can even be given to babies.

In order to supply fresh raw ingredients for his hemp oil, Rick soon started growing marijuana, but his field was raided four times in three years by the police. People who publicly claim to cure cancer are threatened 5-40-year imprisonment, according to laws in North America.

So, Jack was imprisoned for four days in Canada in 2005, for cultivating, owning and selling marijuana. However, at one point he was liable for 12 year imprisonment. He was fined 2,000 dollars.
“The worst of all was that the jurors were people whose dearest I had cured with cannabis oil. Even the judge knew it was all a farce! At one point he even told me that I should be rewarded, instead of tried! All knew, and no one could do anything! They didn’t even allow ten patients I have cured to testify! They also didn’t allow the doctors to come out on the bench, nor me to show a pile of medical documents about the effects of my oil. If you don’t know the meaning of a “coward court,” go to Canada and you will see what I mean,” claims Jack.

Rick claims that he has never sold weed, but only hemp oil, and as he was deeply disappointed by the Canadian government and corrupted doctors, he even put the recipe for hemp oil on the web page phoenixtears.ca.

According to him, the preparation of this miraculous oil is extremely easy. Simpson’s treatment starts with several drops of hemp oil three times a day.

“The usual dose I give to cancer patients is 60 grams within 90 days. And, it is never too late for the patient to start cannabis oil therapy. There isn’t such an excuse as, “It is late”… If you ask me, if I approve of smoking marijuana, I will tell you it isn’t as effective as cannabis oil, but it is scientifically proven that people who smoke marijuana live six years longer than those who don’t.”
Moreover, he adds that as opposed to Europe, North America still puts a blind eye when it comes to legalization of cannabis. He believes that every country in the world should allow their citizens to cultivate and use cannabis for medical purposes. He also points out that pharmacies should be opened for those who can’t cultivate it.

“Little is known that cannabis has been used as one of the most healing remedies hundreds of years before Christ. In the ancient Persian religious scripts, which among other things describe the most healing herbs, cannabis takes the first place,” concludes Rick.
His biggest wish and goal is to live in a world without cancer. – See more at: http://www.choiceandtruth.com/2016/08/this-man-healed-5000-people-from-cancer.html#sthash.6q55okXx.dpuf

Cardiological Factors On Sudden Unexpected Death In Epilepsy

Epilepsy is a group of neurological diseases characterized by epileptic seizures. Epileptic seizures are episodes that can vary from brief and nearly undetectable to long periods of vigorous shaking. Recently from the bits of research, the fact is coming in a picture that epileptic patients have a risk of unexpected death due to cardiological factors. This article entails the link between cardiological parameters and sudden death in Epilepsy. SUDEP is defined specifically as the sudden, unexpected, witnessed or unwitnessed, non-traumatic and non-drowning death in patients with epilepsy with or without evidence for a seizure, and excluding documented status epilepticus, in which post-mortem examination does not reveal a structural or toxicological cause for death.

This condition is referred as Sudden Unexpected death in epilepsy (SUDEP). The cause of SUDEP is not known. Observations in individual cases have suggested possible cardiogenic, pulmonary, and primary neurological etiologies. It may be that SUDEP is a heterogeneous condition. The vast majority of witnessed cases have been associated with a seizure, and the main risk factor is uncontrolled seizures, especially convulsions. Incidence: SUDEP causes between 2 and 18 percent of all deaths in patients with epilepsy. This proportion may be moderately higher in children, as high as 30 percent in one cohort study. The estimated rate of SUDEP is approximately 1000 person/year based on the studies which incorporated a small number of cases. The lifetime cumulative risk for SUDEP by age 40 has been estimated at 7 percent overall, or 12 percent in those with persistent epilepsy. The cumulative full lifetime risk has been estimated to be 35 percent Pathophysiology of SUDEP: There are several factors which are taken into consideration based on the different studies being carried out on sudden unexpected death in epilepsy.

While SUDEP is only rarely witnessed, most observations suggest that SUDEP occurs in the context of a seizure. No singular mechanism has been established, and multiple pathophysiologic factors may be involved, including cardiac arrhythmia, seizure-induced respiratory changes and pulmonary dysfunction, and neurogenic cardiorespiratory depression. The major factors are listed below Cardiogenic Factors Some indirect evidence suggests, cardiac arrhythmias and cardiovascular disease, may be involved some cases of SUDEP, some factors are described below Ictal bradycardia and asystole: Ictal Bradycardia and asystole can be observed and even asystole is observed in some patients with epilepsy.

There is a strong possibility that some cases of SUDEP can be explained by this phenomenon. However, the relationship between the ictal heart and SUDEP is not strongly established. But it is a noted that known cases of ictal bradycardia or asystole have an increased risk of SUDEP compared with those who do not have these features. The rate of bradycardia and asystole in patients with epilepsy is ambivalent One study monitored electrocardiogram using an implantable loop recorder for an average of 18 months in 19 months with refractory epilepsy. Four patients had bradycardia or periods of asystole, prompting subsequent pacemaker placement; three of these episodes occurred during a clinical. One more study reviewed the monitoring data on 1277 seizures on 69 patients identified 5 patients in whom ictal bradycardia occurred in 18 percent There was another study in which the ictal asystole was observed on a long term, EEG monitoring in 10 of 6825 patients (0.15%). This occurrence was not associated with cardiovascular risk factors or abnormal baseline ECG. Apparently, bradycardia and asystole in epilepsy patients are most commonly analyzed. There is a possibility that partial seizures are connected with ventricular tachyarrhythmias.

In one case study, a 51-year-old woman developed ictal ventricular tachycardia evolving into a ventricular fibrillation arrest acquiring resuscitation. Prolonged QT interval and Tachyarrhythmias The suggested mechanism in SUDEP is also characterized by Seizure-induced changes in the QT interval or autonomic instability, predisposing to the malignant arrhythmias. This mechanism is bolstered by the fact that some patients carry a pathogenic mutation in one of the genes associated with congenital long QT syndrome. Seizure-induced changes in the QT interval have been described, although their significance is not clear. A number of case series of combined EEG-ECG telemetry have noted prolongation of the QT interval during seizures in 12 to 23 percent of patients. This finding may be associated with potentially fatal ventricular arrhythmias. However, in a matched case-control study, a prolonged QT interval was not specifically associated with SUDEP Cardiovascular Disease A case-control study in Stockholm found a history of epilepsy is a risk factor for an acute myocardial dysfunction.

They tested 57 patients and found the correlation of the epileptic factors and cardiovascular disease. This supports the link of Epilepsy and cardiovascular disease. Respiratory Dysfunction Alternatively, ventilatory failure with ictal hypoxemia and hypercapnia from centrally-mediated apnea may underlie some cases of SUDEP; frank apnea is sometimes observed. There are many studies which provide the evidence of the clear link between the above-mentioned factors. The data suggested above clearly, mentions the link between the cardiological factors and Epilepsy. It is apparent to stay alerted while treating the Epileptic patients for SUDEP. The follow up with Epilepsy patients is helpful and monitoring the parameters mentioned above can be taken into a consideration while treating patients.

Type 1 diabetes increases risk for epilepsy

Children with type 1 diabetes have a threefold greater risk for developing epilepsy, possibly due to increased hypoglycemia, according to study results.

In a retrospective, population-based study, I-Ching Chou, of China Medical University Children’s Hospital in Taichung, Taiwan, and colleagues analyzed claims data from the Taiwan National Health Insurance Research Database. Each patient with type 1 diabetes (n = 2,568; mean age, 10 years) was matched by sex, residence area and index year to 10 patients without type 1 diabetes (n = 25,680; mean age, 11 years). Both cohorts were 46.5% boys, with approximately 60% of children living in highly urbanized areas. Researchers used Cox proportional hazard regression analysis to estimate the effects of type 1 diabetes on epilepsy risk. Confounding comorbidities included prior epilepsy, head injury, intellectual disabilities and low birth weight.

Researchers found the incidences of epilepsy were 33.7 per 10,000 person-years for children with type 1 diabetes vs. 10.4 per 10,000 person-years in the control group. After adjustment for age, sex, urbanization level, prior epilepsy, intellectual disabilities, low birth weight and head injury, the risk for epilepsy remained higher for children with type 1 diabetes (HR = 2.84; 95% CI, 2.11-3.83).

The risk for epilepsy increased further for children with type 1 diabetes and documented hypoglycemia vs. those without hypoglycemia (HR = 16.5; 95% CI, 5.19-52.3 vs. HR = 2.67; 95% CI, 1.97-3.62). Epilepsy also increased with type 1 diabetes severity (P < .0001 for trend).

“This result is consistent with those of previous studies in that epilepsy or seizures are observed in many autoimmune or inflammatory disorders and are linked to the primary disease or secondary to proinflammatory processes,” the researchers wrote. “Moreover, we determined that the proportion of intellectual disabilities in the type 1 diabetes cohort was significantly greater than that in the comparison cohort. Furthermore, children with an intellectual disability exhibited a significantly increased risk for epilepsy.” – by Regina Schaffer

AIIMS doctors develop novel surgical procedure to treat epilepsy

Doctors at All India Institute of Medical Sciences (AIIMS), New Delhi, have developed a novel and minimally invasive endoscopy-assisted surgical procedure to treat epilepsy.

Dr P Sarat Chandra

According to Dr P Sarat Chandra, professor of neurosurgery, AIIMS, New Delhi, the new surgical procedure is minimally invasive and it involves using endoscopy to create a complete unilateral hemispheric disconnection of the brain.

“The technique is especially helpful for young children in whom large incisions and the resultant blood loss becomes difficult to bear,” Dr Chandra told India Medical Times.

The endoscopy-assisted interhemispheric transcallosal hemispherotomy was performed in five children between April 2013 and June 2014.

Dr Chandra said, “Typically, hemispherotomy is a very complex surgical procedure, performed on some children with quite severe epilepsy, which involves a large cranial incision, followed by a major surgery where an entire affected hemisphere is either removed or disconnected from the healthier opposite side.”

“The conventional opening is around 15 cm large; our method has converted this into an endoscopic procedure by making the incision size 3X4 cm. Moreover, the entire surgery is performed using neuronavigation, a sophisticated computer aided device along with the use of brain suite, where MRI is performed immediately after surgery to confirm complete disconnection. This has made the procedure more effective, safer and reduced the duration of surgery,” he said.

The details of this technique have been published in the international journal Neurosurgery. This technique was also demonstrated during a workshop held on epilepsy surgery at AIIMS, New Delhi on April 9-10, 2015.

“The technique is very significant because it represents a revolution in the world of epilepsy surgery. It has brought in the use of endoscope and minimally invasive surgery into the realm of epilepsy surgery,” Dr Chandra added.

Watch the video.URL:https://youtu.be/MqvQwUNbJrY

Antidepressants for people with epilepsy and depression.


Depressive disorders are the most common psychiatric comorbidity in patients with epilepsy, affecting around one-third, with a significant negative impact on quality of life. There is concern that patients may not be receiving appropriate treatment for their depression because of uncertainty regarding which antidepressant or class works best and the perceived risk of exacerbating seizures. This review aims to address these issues and inform clinical practice and future research.


We aimed to review and synthesise evidence from randomised controlled trials of antidepressants and prospective non-randomised studies of antidepressants used for treating depression in patients with epilepsy. The primary objectives were to evaluate the efficacy and safety of antidepressants in treating depressive symptoms and the effect on seizure recurrence.


We conducted a search of the following databases: the Cochrane Epilepsy Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL 2014, Issue 5), MEDLINE (Ovid), SCOPUS, PsycINFO, http://www.clinicaltrials.gov and conference proceedings, including studies published up to 31 May 2014. There were no language restrictions.


We included randomised controlled trials (RCTs) and prospective non-randomised cohort controlled and uncontrolled studies investigating children or adults with epilepsy treated with an antidepressant for depressive symptoms. The intervention group consisted of patients receiving an antidepressant drug in addition to an existing antiepileptic drug regimen. The control group(s) consisted of patients receiving a placebo, comparative antidepressant, psychotherapy or no treatment in addition to an existing antiepileptic drug regimen.


We extracted data on trial design factors, patient demographics and outcomes for each study. The primary outcomes were changes in depression scores (proportion with a greater than 50% improvement or mean difference) and change in seizure frequency (mean difference or proportion with a seizure recurrence or episode of status epilepticus, or both). Secondary outcomes included the number of patients withdrawing from the study and reasons for withdrawal, as well as any adverse events. Two authors undertook data extraction separately for each included study. We then cross-checked the data extraction. We assessed risk of bias using a version of the extended Cochrane Collaboration tool for assessing risk of bias in both randomised and non-randomised studies. We presented binary outcomes as risk ratios (RRs) with 95% confidence intervals (CIs). We presented continuous outcomes as standardised mean differences (SMDs) with 95% CIs, and mean differences (MDs) with 95% CIs. If possible we intended to use meta-regression techniques to investigate possible sources of heterogeneity however this was not possible due to lack of data.


We included in the review eight studies (three RCTs and five prospective cohort studies) including 471 patients with epilepsy treated with an antidepressant. The RCTs were all single-centre studies comparing an antidepressant versus active control, placebo or no treatment. The five non-randomised prospective cohort studies reported on outcomes mainly in patients with partial epilepsy treated for depression with a selective serotonin reuptake inhibitor (SSRI). We rated all the RCTs and one prospective cohort study as having unclear risk of bias. We rated the four other prospective cohort studies as having high risk of bias. We were unable to perform any meta-analysis for the proportion with a greater than 50% improvement in depression scores because the studies reported on different treatment comparisons. The results are presented descriptively and show a varied responder rate of between 24% and 97%, depending on the antidepressant given. For the mean difference in depression score we were able to perform a limited meta-analysis of two prospective cohort studies of citalopram, including a total of 88 patients. This gave low quality evidence for the effect estimate of 1.17 (95% CI 0.96 to 1.38) in depression scores. Seizure frequency data were not reported in any RCTs and we were unable to perform any meta-analysis for prospective cohort studies due to the different treatment comparisons. The results are presented descriptively and show that treatment in three studies with a selective serotonin reuptake inhibitor did not significantly increase seizure frequency. Patients given an antidepressant were more likely to withdraw due to adverse events than inefficacy. Reported adverse events for SSRIs included nausea, dizziness, sedation, gastrointestinal disturbance and sexual dysfunction. Across three comparisons we rated the evidence as moderate quality due to the small sizes of the contributing studies and only one study each contributing to the comparisons. We rated the evidence for the final comparison as low quality as there was concern over the study methods in the two contributing studies.


Existing evidence on the effectiveness of antidepressants in treating depressive symptoms associated with epilepsy is very limited. Only one small RCT demonstrated a statistically significant effect of venlafaxine on depressive symptoms. We have no high quality evidence to inform the choice of antidepressant drug or class of drug in treating depression in people with epilepsy. This review provides low quality evidence of safety in terms of seizure exacerbation with SSRIs, but there are no available comparative data on antidepressant classes and safety in relation to seizures. There are currently no comparative data on antidepressants and psychotherapy in treating depression in epilepsy, although psychotherapy could be considered in patients unwilling to take antidepressants or where there are unacceptable side effects. Further comparative clinical trials of antidepressants and psychotherapy in large cohorts of patients with epilepsy and depression are required to better inform treatment policy in the future.

14 Effects of Epilepsy on the Body

Epilepsy is a chronic neurological condition. The main symptom is unpredictable seizures.


Dazed and Confused
What Happened?
Labored Breathing
Uncontrollable Movements
Lack of Control
Signs in the Eyes
Abnormal Heartbeat
Loss of Muscle Tone
The Scream
Epilepsy is a chronic neurological condition. The main symptom is unpredictable seizures.

The Effects of Epilepsy on the Body

Epilepsy is a disorder of the brain that causes recurring seizures. According to Johns Hopkins Medicine, almost three million Americans are living with epilepsy. Epilepsy can be triggered by illness or injury, but most of the time, there is no known cause. Because it is a disorder of the central nervous system, effects can be felt throughout the body. Due to the unpredictability of seizures, there can also be a great emotional toll.

Central Nervous System

The brain is the central hub for all voluntary and involuntary movements in your body. Electrical activity running through nerve cells help your brain tell your body what to do. When abnormal signals interrupt the brain’s normal functioning, you can have a seizure. There are several different types of seizures.

Focal/Partial Seizures

Focal seizures, also called partial seizures, are when abnormal electrical functions happen on only one side of the brain. Some people feel an aura, or a feeling of euphoria or doom, right before having a seizure. Other pre-seizure symptoms include changes to sight, hearing, or smell perception.

In a simple focal seizure, symptoms depend on which area of the brain is involved. The seizure may be accompanied by nausea or sweating. A complex focal seizure happens in the temporal lobe, which affects memory and emotion. This type of seizure usually involves loss of consciousness or lack of awareness of what’s happening. Symptoms may include screaming, crying, laughing, or lip smacking. There’s usually a feeling of sleepiness following a complex focal seizure.

Generalized Seizures

When both sides of the brain are involved, it’s called a generalized seizure, which may cause loss of consciousness. Absence seizures, or petit mal seizures, are short, usually lasting half a minute or less. A person having an absence seizure may appear to be staring and will have no awareness of what happened. There may be some facial twitching or rapid blinking. In atonic seizures, or drop attacks, there’s a sudden loss of muscle tone, causing you to fall without warning.

In a generalized tonic-clonic seizure, or grand mal seizure, the body and limbs contract and extend. This is followed by tremor, after which the muscles relax. Other symptoms include fatigue, severe headache, and body aches. Sometimes there are speech and vision disturbances. People who have numerous tonic-clonic seizures are at increased risk of sudden unexplained death in epilepsy (SUDEP). Myoclonic seizures involve sudden, jerky muscle movements. This type of seizure usually happens multiple times a day over several days.

Status epilepticus describes a seizure that lasts for an extended time – usually from 5 to 30 minutes. It can also mean you’re having multiple seizures without coming to consciousness in between. Status epilepticus increases the risk of permanent damage to the brain.

According to the Epilepsy Foundation Michigan, about 30 percent of people with epilepsy eventually develop clinical depression. Epileptic seizures can also make you more prone to falls and injuries. There’s a common misconception that you can swallow your tongue when you’re having a seizure, but that’s not possible.

Circulatory and Respiratory Systems

Epileptic seizures can interfere with your heart rhythm and breathing. Symptoms include shortness of breath and coughing. In rare cases, choking occurs. Over the long term, epilepsy increases risk of heart disease and stroke. Some cases of SUDEP are thought to be due to heart and breathing problems.

Muscular and Digestive Systems

During a seizure, misfires from the brain can tell your muscles to contract and relax. A seizure may cause muscles to jerk uncontrollably. In some cases, you can lose muscle tone so quickly that you fall down. When muscles surrounding your vocal cords seize up, it pushes out air. It sounds like a cry or a scream.

Epilepsy, and some of the drugs used to treat it, can cause digestive problems like heartburn, nausea, and vomiting. Constipation and diarrhea can also be problematic. In children, epileptic seizures can cause abdominal pain. During a seizure, or immediately following one, you may lose bowel or bladder control.

Reproductive System

Although epilepsy doesn’t affect the reproductive system directly, it can have an impact on pregnancy. Among women with epilepsy, about 25 to 40 percent experience a higher number of seizures during pregnancy, according to the University of Rochester Medical Center.

Most women with epilepsy have healthy pregnancies and deliver healthy babies. However, there is a higher risk of hypertension, delivering an underweight baby, and stillbirth. Pregnant women with epilepsy should be closely monitored.


Pain Complaints, Opioid Use Higher With Epilepsy

Individuals with epilepsy had insurance claims for opioid prescriptions and diagnoses of painful conditions that were substantially more common than in a control group of nonepileptic patients, according to a database study reported here.

Among 10,271 health plan members with a diagnosis of epilepsy in 2012, 26% had received an opioid prescription versus 18% of 20,542 members of the same plans matched for gender, age range, and insurance type (P<0.001), said Andrew Wilner, MD, of Angels Neurological Centers in Abington, Mass.

He also reported that the epilepsy patients had significantly greater rates of each of 16 pain-related conditions analyzed; overall, records of 51% of the epilepsy patients included diagnoses of at least one of these conditions compared with 39% of controls (P<0.05).

Wilner presented the findings during a poster session at the American Epilepsy Societyannual meeting here.

He said the study design didn’t permit firm conclusions about the potential links between pain syndromes, opioid use, and seizure disorders. But the findings may reflect increased likelihood of pain-related comorbidities that may accompany epilepsy, he said.

“Epilepsy is not [itself] a painful condition,” Wilner noted, but seizures can trigger falls and resulting injuries. He said previous studies had found fracture rates in epilepsy patients that were double those seen in otherwise similar individuals.

He conducted the study with researchers from the Accordant Health Services unit of CVS Caremark, which funded the analysis. The group used claims data in 2012 from members of nine geographically diverse health plans contracting with Accordant for epilepsy care management. More than 3.6 million people were served by these plans, of whom 10,271 had epilepsy and were eligible for inclusion in the analysis.

The control group was drawn from the same health plans and were matched 2:1 to the epilepsy patients. Plan members with HIV, any type of malignancy, various kinds of rheumatological and genetic diseases, and organ transplant recipients were excluded from the control group, in recognition of their greater-than-average use of healthcare services.

In addition to checking for records of plan-paid opioid prescriptions, Wilner and colleagues also counted diagnoses of such pain-related conditions as headache, sciatica, sinusitis, and joint pain — a total of 16 in all.

Wilner noted that, for many of these conditions, opioids are considered ineffective, but nevertheless these are commonly prescribed in ordinary practice. He said the point of the study was to get a snapshot of how epilepsy patients are diagnosed and treated in real life.

He said the increased rates of pain diagnoses and opioid use may result from seizures or other factors directly related to epilepsy. Alternatively, patients with epilepsy may have more frequent encounters with the healthcare system (these were not counted in the study) which, in turn, could make diagnoses of other conditions more likely, Wilner suggested.

But the bottom line, he said, was that the relatively high frequency of opioid use among the epilepsy patients deserves more research in order to identify the reasons and to determine the extent to which it is or is not appropriate.