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Seizures, safety and submersion: sense and sensibility
  1. Richard E Appleton
  1. Correspondence to Professor Richard E Appleton, Neurophysiology Department, The Roald Dahl EEG Unit, Alder Hey Childrens Hospital, Alder Hey Childrens NHS Foundation Trust, Liverpool L12 2AP, UK; richardappleton55{at}hotmail.co.uk

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Patients of all ages with an epilepsy are at an increased risk of a premature death. The standardised mortality rate in all patients with an epilepsy is between 1.6 and 4.1 but considerably higher (up to 10) in those with a medically-refractory epilepsy and with additional childhood-onset comorbid problems including learning difficulties and severe four-limb spastic cerebral palsy. Mortality in epilepsy may be seizure-related (eg, resulting in an accident, including submersion1 or in convulsive status epilepticus) or associated with an underlying neurological disorder. Only a few of the factors associated with the increased mortality risk are outside the patient’s (or the family’s, in the case of children) control and largely non-preventable, notably sudden unexpected death in epilepsy and complications of the underlying neurological disorder responsible for the epilepsy. Most other factors are under some degree of control, which, although not certain to prevent premature death, may substantially reduce the risk. These include the optimisation of seizure control to prevent or at least reduce the risk of frequent tonic-clonic or tonic seizures, the recognition and appropriate management of convulsive status epilepticus and the provision of appropriate advice and action on safety and lifestyle; the latter includes specific advice on water-related activities, both in and outside the home.

The retrospective study by Franklin et al 2 identified epilepsy as a risk factor in childhood drowning deaths, with a prevalence of 4.1% of drowning fatalities, compared with 0.7%–1.7% among the general, 0–14 years population (relative risk: 2.4–5.8). There was no increased risk associated with other pre-existing medical conditions, including asthma and intellectual disabilities. The study would seem to confirm the well-recognised association between drowning and epilepsy and that drowning remains the most common …

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