Risks with epilepsy
In the UK there are around 1,200 deaths related to epilepsy a year. Some of these deaths are caused by complications during or after a seizure. Other deaths may be due to accidents, such as falls, drowning or suicide. Recent studies show that the majority of premature deaths in people with epilepsy may be caused by another condition the person has alongside their epilepsy. These include underlying neurological problems which may have caused the epilepsy, heart or breathing conditions, anxiety, depression or other mental health conditions, and some cancers. Other deaths in people with epilepsy relate to drug or alcohol abuse.
Safety aids and equipment
There are various safety aids and equipment depending on what your epilepsy is like and your situation.
Seizure alarms and monitors
Some people choose to have an alarm, which is set off when they have a seizure, to get help. This can be helpful if you have seizures during the night or if you live alone.
There are different types of alarm for different types of seizure. Some are set off when someone falls in a seizure or has a tonic clonic seizure in bed. Others can be set off by the person themselves if they feel a seizure coming on.
Safety helmets help to protect someone from injury if their seizures cause them to fall suddenly. Some helmets have face guards to protect the face if the person falls forwards.
Risk assessments may be useful at work or school, for leisure activities, or for ways to make the home safer.
You might want to do a risk assessment yourself, or it may be appropriate that a carer, an employer, an occupational health worker or social services do this with you.
A risk assessment normally would include looking at whether you have seizures or not, how your seizures affect you, and what the environment or activity is. It might include the following:
- What is the activity?
- What are the risks to safety for anyone doing this activity?
- What is it about your epilepsy that may put you, or other people, at risk (depending on the type of seizure you have)?
- What would make the activity safer?
Risk assessments can help to identify practical ideas for reducing risk to make situations safer.
Women and risk
Some issues around risk are specific to girls and women with epilepsy. This depends on their age, type and number of seizures and any medication they are on.
Hormone levels change during puberty, periods, pregnancy and through the menopause. For some girls and women, there is a link between hormones and when they have seizures. This means that they may be more likely to have seizures, and be at greater risk of injury because of seizures, at these times.
There are specific issues around pregnancy for women with epilepsy. Most pregnant women with epilepsy have a normal pregnancy and a healthy baby. However, some anti-epileptic drugs (AEDs) can cause birth defects or developmental problems. The Medicines and Healthcare products Regulatory Agency (MHRA) states that sodium valproate should not be prescribed to girls or women who are pregnant, or who may become pregnant in future, unless it is the only effective drug for them and they are on a pregnancy prevention programme. This risk needs to be balanced with the risk of injury to the mother and baby if seizures are not controlled with medication. In rare cases, risks of uncontrolled seizures can mean very serious injury, or even death.
Because these issues are often complicated and specific to each woman, it is important that women talk to their epilepsy specialist before becoming pregnant. This is called 'preconception counselling' and focuses on making sure AED treatment is right, for the mother to get the best seizure control, and for the baby.
Can seizures damage the brain?
Everyone has some brain cell loss as they get older. Whether seizures cause any extra loss of brain cells is not clear. This may depend on the type and length of seizure that the person has.
Memory may be affected during or after a seizure. This can be because brain cells in parts of the brain responsible for memory can be sensitive to the effect of seizures. How long it takes to recover can vary from one person to another, and even after fully recovering from a seizure, some people's memory might be permanently affected. If you are worried about this, you might like to talk to your neurologist or doctor about how your epilepsy might affect you.
How serious can risks be?
As with many other medical conditions, for some people there is a risk of dying due to their epilepsy. In the UK there are around 1200 deaths related to epilepsy a year. Some of these deaths are caused by complications during or after a seizure. Other deaths may be due to accidents such as falls, or drowning, suicide, or they may be linked to another condition that a person may have alongside their epilepsy.
What is status epilepticus?
Usually a seizure will stop by itself. Sometimes this does not happen and a seizure is very long or one seizure happens after another without the person recovering in between. If this carries on for 5 minutes or more, it is called status epilepticus (or 'status').
If status happens in a tonic clonic seizure (where people fall down and shake), this is a medical emergency and an ambulance needs to be called. Emergency medication may need to be given to stop the seizure. If a convulsive seizure goes on for 30 minutes or more, this could cause lasting damage to the brain, or even death.
An ambulance should be called if:
- it is the person's first seizure
- they have injured themselves badly
- they have trouble breathing after the seizure
- one seizure immediately follows another with no recovery in between
- the seizure lasts two minutes longer than usual for that person
- the seizure lasts for five minutes.
What is SUDEP?
On rare occasions people die suddenly for no clear reason. When this happens to someone with epilepsy it may be called Sudden Unexpected Death in Epilepsy (or SUDEP).
SUDEP is when a person with epilepsy dies suddenly and where no other cause of death is found. It may be that they died during or after a seizure. Because SUDEP often happens when the person is asleep and is not witnessed, it is hard to be sure why it happens. It may be that the person's breathing or heartbeat have been affected. In the UK around 600 people die from SUDEP each year. This is 1 in 1000 people with epilepsy, so SUDEP is relatively rare.
But these figures do not show the risk of SUDEP for an individual because everyone’s individual level of risk will depend on their epilepsy, lifestyle, any conditions they have alongside epilepsy and other factors, such as their age and sex.
Research shows that SUDEP is related to seizures. So a key way to reduce the risk is to try to get the best seizure control possible, in particular for tonic clonic seizures.
Things that can help reduce risks of SUDEP include:
- taking your AEDs as prescribed
- avoiding sudden changes to your AEDs
- having good seizure control especially at night, and using a seizure alarm if you have seizures at night
- having regular reviews with your doctor or specialist to monitor your epilepsy and your general health.
Your specialist can discuss with you your individual epilepsy, and whether these risks apply to you.
Epilepsy deaths are not common but do happen, and while not all deaths are avoidable, some are. SUDEP Action is dedicated to raising awareness of epilepsy risks and tackling epilepsy deaths. They are the only UK charity specialised in supporting and involving people bereaved by epilepsy. If you have been affected by an epilepsy death please visit sudep.org or contact the SUDEP Action support team on 01235 772852.
Quality of life
Many people with epilepsy enjoy a full and active life. But for some, epilepsy may affect their health and quality of life more than just because of having seizures: their epilepsy may come alongside anxiety, stress, or depression.
Not everyone with epilepsy has anxiety or depression but they are the most commonly reported mental health problems for people with epilepsy. Epilepsy can make anxiety or depression worse due to not knowing when seizures will happen, concerns about side effects of medication, or feeling isolated. Everyone is different in how they cope with anxiety or depression, but this may increase the risk of long term problems or even suicide.
Read more about epilepsy and mood.
Talk to someone
To talk about concerns around epilepsy and premature mortality, please call the Epilepsy Society helpline on 01494 601 400.
If you would like to contact other people who have epilepsy, there are some support groups in the UK, call our helpline for details.
Self management UK runs free courses in the UK for anyone living with a long term condition. The courses cover quality of life issues such as wellbeing, self-esteem, depression and anxiety.
If you are concerned about anything you have read on this page, it is worth remembering that not all of the risks may apply to you. Risks depend on the type and number of seizures you have and how they affect you. There may also be things you can do to help reduce your risk. You could also talk to your doctor or specialist about any concerns.
What is risk?
In all areas of our lives, we take risks. Risk is the chance of something happening such as loss or injury, and so it is often about uncertainty. Sometimes taking a risk can mean trying something new and challenging yourself in a positive way. But, risk can also mean the chance of injury, danger or damage to your health.
Epilepsy varies greatly from person to person, so risks due to epilepsy depend on:
- whether you currently have seizures
- the number and type of seizures you have
- how your seizures affect you, and
- whether you have other medical conditions, such as heart or breathing problems.
Possible risks to your health and safety can be difficult or frightening. But looking at risks can also be positive if this helps you to find ways of reducing risk or making activities safer. It may also make you feel more in control and help you to work out what risks are relevant to your situation, so that you can see what is important for you.
People may also face specific risks because of their epilepsy, such as the risk of injury or accident or injury. Looking at ways of managing risk may also help you do the things you enjoy and be as independent as possible while still keeping safe.
Whether your epilepsy carries a risk depends on what your epilepsy is like: the number and type of seizures you have, and how your seizures affect you. Here are some examples.
- If you have a seizure warning (when you know that a seizure is going to happen), this might mean that you can get to a safe place before a seizure happens, and so reduce the risk of an accident or injury.
- If you have seizures where you become unconscious (for example, going 'blank' or falling down) or you become confused or are only partly aware of what is happening around you, your surroundings could be a safety risk. This could be important if, for example, you are near water, at a height or using machinery.
- If your seizures are controlled (stopped) with medication then there will be no specific risks to you related to having seizures.
Putting someone in the recovery position.
The recovery position can help someone recover after a tonic clonic (convulsive) seizure. These steps should be followed once the shaking (convulsing) has stopped.
Keeping safe with epilepsy
Statistics about risk can be helpful but they do not show what the individual risks is for you, which may depend on your epilepsy, lifestyle or conditions you have alongside epilepsy.
Making choices about risk
Everyone is different. You may find it helpful to look at your own situation to see what you think the risks are to you because of your seizures. Being involved in making decisions about things that affect you may help you to feel more in control of your epilepsy and confident about making decisions in the future.
Depending on your age and situation, you might include other people when making decisions, such as your parents, partner or carer and your social care or healthcare professionals.
Getting good seizure control
Often the best way to reduce risks due to epilepsy, is to stop seizures from happening. For most people this is by taking anti-epileptic drugs (AEDs) as prescribed.
To work best, AEDs need to be taken every day. Using a pill box or drug wallet can help you to remember when to take your medication.
Some medication affects how other medications work, which can in turn affect seizures. So it is often a good idea to check with your doctor or pharmacist before taking other medications alongside your AEDs. As with any medication, AEDs can have side effects. Possible side effects include tiredness, confusion and changes in mood. For some people these side effects mean that they don't want to continue taking AEDs. But suddenly stopping AEDs can cause seizures to happen again.
If you continue to have seizures even with AEDs or if you are having side effects, you can talk to your doctor or neurologist about it. There may be other AEDs or doses you can try or other types of treatment may be an option.
Some people have triggers for their seizures: situations that bring on a seizure, such as stress or tiredness. If you know you have a trigger for your seizures you might be able to avoid the trigger so that you have fewer seizures.
It is often worth remembering that some surroundings or activities may have risks whether you have epilepsy or not. This might include some leisure activities such as mountain climbing or skiing.
Making an activity or environment safer will often depend on how your seizures affect you and what the activity or environement is.
For example, safety measures at home include looking at risks around cooking, fire safety and bathing. Outside of the home, you may be able to make activities such as cycling or swimming safer if you have someone with you who knows how to help if you have a seizure.
Telling people how your seizures affect you may mean they feel more confident helping you to keep safe, and knowing what to do if you have a seizure. Some people carry an ID card which says they have epilepsy and how to help during a seizure. There are also companies that make medical jewellery.
Taken from our Risk leaflet. Order this leaflet from our online shop as part of our 'first five free' offer, or download the pdf using the link below.