Somatic co-morbidities in epilepsy

People with epilepsy seem to have more concomitant medical conditions than the general population. The burden of somatic co‐morbidities plays an important role in the premature mortality in epilepsy. I sought to explore the relation between somatic co‐morbidities and epilepsy, attempting to avoid biases in previous studies. In a first study, I collected clinical, demographic and somatic co‐morbidity data in 2016 consecutive people with epilepsy referred for assessment at a tertiary centre and in 1297 people with epilepsy in the community. In a second study, I analysed the lifelong course of epilepsy of an historical cohort of 235 people who were in residential care at the Chalfont Centre for Epilepsy: 122 had comprehensive post‐mortem examination. Confounders (causes or consequences of epilepsy/ its treatment) were distinguished from co‐morbidities. In the first study, somatic co‐morbidities were significantly more frequent in the referral centre than in the community (49% vs 37%). Consistent risk factors were found in both cohorts. When adjusting for age, epilepsy duration, and absence of underlying brain lesion were independently associated with an increased burden of somatic conditions. In the second study, age at death showed an early peak of mortality between 45‐50 years old. High seizure frequency was an independent predictor of early death due to co‐morbidities. Those who survived increasingly went into spontaneous remission lasting until death; older age and presence of neuropathologically‐confirmed degenerative changes were independent predictors of terminal remission. Somatic co‐morbidities do not occur randomly in relation with epilepsy. Greater epilepsy severity seems to be a risk factor; several other consistent predictors were identified. Epilepsy may cause premature death indirectly through co‐morbid conditions. Ageing and degenerative changes could improve epilepsy drug responsiveness.