When it comes to leading causes of death, epilepsy doesn’t rank in the same way as heart disease and cancer, which top the list. Still, epilepsy can affect life expectancy directly and indirectly. In fact, the risk of premature (early) death is two to three times higher in people living with epilepsy than in the general population.

Many people with epilepsy live long and fulfilling lives, even into old age. However, the type of seizures you or your child experience, how well epilepsy is managed, and other factors can all affect life expectancy. Here, we’ll cover seven ways epilepsy may raise the risk of a shortened lifespan.

1. Drug-Resistant Seizures and Status Epilepticus Increase Risk

Certain types of seizures carry a higher risk of leading to premature death than others. Your doctor can tell you more about which types of seizures you experience based on where your seizures start inside your brain and what they look or feel like.

Your doctor will also consider how long your seizures last and how they respond to treatment. The following seizure-related factors may carry a higher risk of premature death.

Drug-Resistant Seizures

People who experience drug-resistant seizures, or seizures that don’t respond to anti-seizure medications, carry the highest risk of premature death. Your doctor or neurologist may diagnose you with drug-resistant seizures if you’ve tried two or more properly chosen and tolerated anti-seizure medications without becoming and staying seizure-free.

Drug-resistant seizures and status epilepticus (long-lasting or back-to-back seizures) have a higher risk of causing premature death.

Status Epilepticus

Status epilepticus occurs when seizures are especially long-lasting or happen back-to-back. You can have repeated seizures without enough time for your brain to recover in between them — in other words, without returning to normal consciousness. Status epilepticus can occur in people with epilepsy or any other seizure-causing condition.

Status epilepticus can involve a generalized tonic-clonic seizure, which is a seizure characterized by muscle stiffening followed by jerking movements. “Generalized” means the seizure involves activity on both sides of your brain.

Health experts estimate the mortality risk (risk of death) for status epilepticus to be somewhere between 4.6 percent and 39 percent. The level of risk can vary based on your age, the underlying cause, and how long the seizure lasts.

Status epilepticus can cause permanent brain damage. It’s important to treat status epilepticus as an emergency and seek immediate medical care.

2. Sudden Unexpected Death in Epilepsy Can Affect Young or Middle-Aged People

Sudden unexpected death in epilepsy, or SUDEP, is considered one of the main causes of premature death in young and middle-aged people with epilepsy. The main risk factors for SUDEP are:

• Having seizures often
• Having seizures at night
• Having generalized tonic-clonic seizures

SUDEP affects more than 1 in 1,000 people with epilepsy each year. Researchers aren’t sure exactly why SUDEP occurs, but breathing problems or irregular heartbeat after a seizure may be possible explanations. Seizures may also interfere with brainstem areas that help control breathing and heart rate.

3. Seizures Can Lead to Life-Threatening Accidents

Research suggests that accidents cause up to 16 percent of deaths in people with epilepsy. Having a seizure while driving, for example, can lead to a car crash. Car accidents, accidental drownings, and serious falls can all occur during a seizure that affects awareness or body movements.

It’s also possible to have an accident because of medication side effects or conditions that occur with your epilepsy.

Accidents such as car crashes, drowning, and serious falls are a major cause of death in people with epilepsy.

Not every accident can be prevented. Still, you and your family can take precautions to prevent or prepare for accidents ahead of time. Be sure to read up on your state’s driving restrictions, avoid swimming alone, and remove safety hazards from your home.

4. Mental Health Is Important

Depression, anxiety, and bipolar disorder are common among people who live with epilepsy. In some cases, depression can become severe enough to lead to suicidal thoughts. Seizures, the search for effective treatments, discrimination, and other challenges can all affect your quality of life and mental health.

Research findings on suicide deaths in people with epilepsy vary. Some research suggests that up to 21 percent of deaths in people with epilepsy are from suicide, while other research estimates the rate to be less than 1 percent. Still, suicide risk is up to five times higher in people with epilepsy than in the general population.

In any case, it’s important to take care of your mental health while navigating life with epilepsy. Seek professional help if you or a loved one with epilepsy feels hopeless, talks about wanting to die, or shows other possible signs of declining mental health. Call the 988 Suicide & Crisis Lifeline at 988 if you or a loved one is at immediate risk of self-harm.

5. Epilepsy Can Occur With Other Health Conditions

Epilepsy can carry an increased risk of comorbidities (other health conditions occurring alongside epilepsy), and some of them can also affect your life expectancy.

Some health problems may be related to epilepsy itself, its underlying causes, or complications such as status epilepticus — for example, status epilepticus can cause heart damage, kidney failure, or a dangerously high body temperature that can damage the brain.

Beyond depression and other mood disorders, people with epilepsy may also have an increased risk of the following conditions, some of which may affect overall health and, in some cases, life expectancy:

• High blood pressure
• Stroke
• Chronic obstructive pulmonary disease (COPD)
• Migraine or frequent headache
• High cholesterol
• Diabetes
• Chronic pain (pain that affects you most days or every day)

1. 6. Structural Changes in the Brain May Raise Your Risk

Epilepsy linked to a specific structural abnormality in the brain is associated with a higher risk of premature death than idiopathic epilepsy (epilepsy with no clear cause). This can include brain tumors that cause epilepsy, brain injuries such as head trauma, strokes, or structural abnormalities that have been present since birth.

7. Controlling Epilepsy May Help You Live Longer

Managing your epilepsy with effective treatment is one of the most important steps you can take to reduce the risk of premature death. When epilepsy is untreated or poorly managed, it’s more likely to lead to life-threatening complications like SUDEP and status epilepticus. Epilepsy is also more likely to lead to suicidal ideation and life-threatening accidents if it isn’t well controlled.

Managing your epilepsy with effective treatment is the No. 1 step you can take to reduce the risk of premature death.

It’s important to note that the risk of premature death is highest in the first years after receiving an epilepsy diagnosis. As you adjust to life with epilepsy and manage your condition, this risk may decrease over time.

Work With Your Healthcare Team

Talk to your neurologist if you notice any changes in your or your loved one’s seizures, including when and how often they occur. Be sure to attend follow-up visits, and let your neurology team know if any medications aren’t working well to control seizures. Keeping your neurology team up to date helps you manage epilepsy as effectively as possible.

You should also work closely with your healthcare team to manage any epilepsy comorbidities, including mood disorders like depression. If you feel that you need extra support, talk to your providers about therapy or other mental health resources in your area. All of these steps may help support your long-term health and quality of life as you manage epilepsy.

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