title: Identifying clinical correlates for suicide among epilepsy patients in South Korea: A case-control study.
abstract: OBJECTIVE
  Suicide is a major cause of premature mortality in patients with epilepsy. We aimed to identify the clinical correlates of suicide in these patients.
  
  
  METHODS
  We conducted a matched, case-control study based on a clinical case registry of epilepsy patients (n = 35,638) treated between January 1994 and December 2011 at an academic tertiary medical center in Seoul, Korea. Each epilepsy patient in the suicide group (n = 74) was matched with three epilepsy patients in the nonsuicide group (n = 222) by age, gender, and approximate time at first treatment. The clinical characteristics of the patients in both groups were then compared.
  
  
  RESULTS
  In a univariate analysis, seizure frequency during the year before suicide, use of antiepileptic drug polytherapy, lack of aura before seizure, diagnosis of temporal lobe epilepsy, use of levetiracetam, psychiatric comorbidity, and use of antidepressants were all significantly higher in the suicide group than in the nonsuicide group. Multivariate analysis revealed that a high seizure frequency (odds ratio [OR] 3.3, 95% confidence interval [CI] 1.04-10.2), a lack of aura before seizure (OR 4.0, 95% CI 1.7-9.3), temporal lobe epilepsy (OR 3.7, 95% CI 1.6-8.6), and use of levetiracetam (OR 7.6, 95% CI 1.1-53.7) and antidepressants (OR 7.2, 95% CI 1.5-34.1) were all associated with a higher probability of suicide.
  
  
  CONCLUSIONS
  Patients with temporal lobe epilepsy who experience seizures weekly or more frequently, experience a lack of aura, use levetiracetam, or take antidepressants are all at a higher risk of suicide and should be monitored closely.
authors.affiliation: Department of Psychology, Seoul National University, Seoul, Korea.
authors.forename: Sung-Jin
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, U.S.A.
authors.forename: Hochang Benjamin
authors.initials: HB
authors.lastname: Lee
authors.affiliation: Department of Psychiatry, Asan Medical Center, College of Medicine University of Ulsan, Seoul, Korea.
authors.forename: Myung Hee
authors.initials: MH
authors.lastname: Ahn
authors.affiliation: Department of Psychiatry, Seoul National University, Seoul, Korea.
authors.forename: Subin
authors.initials: S
authors.lastname: Park
authors.affiliation: Department of Neurology, Asan Medical Center, College of Medicine University of Ulsan, Seoul, Korea.
authors.forename: Eun Ju
authors.initials: EJ
authors.lastname: Choi
authors.affiliation: Department of Psychology, Seoul National University, Seoul, Korea.
authors.forename: Hoon-Jin
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Department of Neurology, Asan Medical Center, College of Medicine University of Ulsan, Seoul, Korea.
authors.forename: Han Uk
authors.initials: HU
authors.lastname: Ryu
authors.affiliation: Department of Neurology, Asan Medical Center, College of Medicine University of Ulsan, Seoul, Korea.
authors.forename: Joong-Koo
authors.initials: JK
authors.lastname: Kang
authors.affiliation: Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jin Pyo
authors.initials: JP
authors.lastname: Hong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D004827:Epilepsy / Q000401:mortality / Q000523:psychology*; D004833:Epilepsy, Temporal Lobe / Q000401:mortality / Q000523:psychology; D005260:Female; D006801:Humans; D000077287:Levetiracetam; D008297:Male; D008875:Middle Aged; D010889:Piracetam / Q000031:analogs & derivatives / Q000627:therapeutic use; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D013405:Suicide / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D000928:Antidepressive Agents; D000077287:Levetiracetam; D010889:Piracetam
keywords: Aura; Levetiracetam; Seizure frequency; Temporal lobe epilepsy