Current issues in the management of epilepsy: the impact of frequent seizures on cost of illness, quality of life, and mortality.

Cost of illness, quality of life (QOL), and sudden unexpected death in epilepsy are disease-related issues that have become increasingly prominent. Because new treatments for epilepsy are now becoming widely available, it is useful to attempt to determine the clinical factors most closely correlated with high disease management costs, excess mortality, and reduced QOL as a basis for considering whether new antiepileptic drugs (AEDs) or AED regimens may favorably influence these aspects of the chronic condition. Findings of recent studies in these diverse areas of epilepsy research indicate that a common clinical factor, seizure frequency, is closely associated with poorer outcomes with respect to cost of illness, QOL, and mortality. To the extent that newer AEDs can provide clinically significant reductions in seizure frequency among patients currently not optimally controlled with AEDs, a meaningful incremental benefit in each of these areas is a reasonable hypothesis. Prospective studies to assess the impact of better seizure control on these important outcomes are warranted.