Complications

Hyperthermia, cardiorespiratory deficits, and excitatory toxicity, which can cause irreversible tissue damage, especially to the CNS (e.g., cortical laminar necrosis) and, in turn, increase the risk of further seizures

Postictal transient anion gap metabolic acidosis with increased lactic acid and reduced serum bicarbonate (usually resolves spontaneously within 60–90 minutes after seizure activity stops)

Physical trauma, such as:

• Tongue biting

• Posterior dislocation of the glenohumeral joint due to falling

• Polytrauma from a car accident

Status epilepticus

Psychiatric

• Anxiety

• Depression and risk of suicide

• Cognitive impairment

• Psychosis (interictal psychosis, postictal psychosis, or secondary to antiepileptic drugs)

• Psychosocial distress (e.g., at the workplace)

Sleep disturbances and insomnia

Bone disease (osteomalacia, osteoporosis) associated with antiepileptic drugs

The sudden death of a person with diagnosed epilepsy that cannot be attributed to trauma or drowning and occurs with or without evidence of preceding seizure in the absence of any underlying medical conditions that could explain the event

Usually occurs while the patient is asleep

Is more common in patients with intractable epilepsy, frequent seizures (especially tonic-clonic seizures), and early age of onset

Risk of seizure recurrence

• After the first unprovoked seizure [66][67]

  • With no underlying brain insult (stroke, trauma, or CNS infection): ∼ 40–50% within 2 years

    • 80% of recurrences occur within 2 years of the initial seizure.

  • Occurring after at least 1 week after a brain insult: ∼ 65% over the next 10 years

• After the second unprovoked seizure: 60% within 1 year

• After an acute symptomatic seizure: ∼ 19% over the next 10 years

Treatment outcomes [68]

• 60–70% of all treated patients become seizure-free at 10 years after first seizure

• 60–90% of children and 35–57% of adults remain seizure-free after discontinuing medical therapy following a 2-year seizure-free period on antiepileptic drugs.

Legal regulations: State laws vary with regard to the requirements for individuals with epilepsy to operate vehicles and heavy machinery. [69]

Mortality [70]

• Risk of all-cause mortality is 1.6–3 times higher in individuals with epilepsy than in the general population.

• The worldwide incidence of SUDEP is 1.2–6.3 per 1,000 individuals with epilepsy.