History of Epilepsy Increases Pediatric Self-Injurious Behavior Risk

A teenager in her loneliness surrounded by darkness.
Children, adolescents, and young adults have greater risk of self-injurious behavior and suicide ideation if they have a childhood history of epilepsy.

Children, adolescents, and young adults are at a greater risk of self-injurious behavior and suicide ideation if they have a childhood history of epilepsy, a study in Epilepsia suggests.

Previous pediatric research regarding epilepsy and self-injurious behavior risk are limited. In this study, researchers sought to compare the risk of such behavior in a population-based cohort of childhood epilepsy to controls.

Data for this study were from the Rochester Epidemiology Project (REP), which houses medical records of almost all individuals who reside in Olmsted County, Minnesota. This retrospective study included 339 children with new-onset epilepsy from the REP, diagnosed between ages 1 month through 17 years between 1980 and 2009. Another 678 age- and sex-matched controls without epilepsy were also included. Patients with epilepsy and controls were followed to a median age of 24.7 years and 23.4 years, respectively.

In the overall cohort, researchers identified 98 individuals with self-injurious behavior or suicidal ideation, including 43 patients with epilepsy and 55 age- and sex-matched controls.

The risk of any self-injurious behavior and suicidal ideation was significantly higher in patients with epilepsy compared with controls (hazard ratio [HR], 1.56; 95% CI, 1.04-2.35; P =.032). Additionally, the risk of suicidal ideation and attempt was approximately 1.5-times higher in patients with epilepsy compared with controls, but this did not reach statistical significance (HR, 1.48; 95% CI, 0.93-2.37; P =.10).

Study researchers found that preceding attention-deficit/hyperactivity disorder was significantly more common in the patients with epilepsy than those in the control group (39.5% vs 18.2%, respectively; P =.02). In addition, findings showed that there was no specific variable related to epilepsy that was associated with higher or lower risk of self-injurious behavior or suicidal ideation.

A limitation of this study included its retrospective design, which likely prohibited the investigators from identifying the true rate of suicidal ideation in this patient population. Furthermore, researchers acknowledged that suicidal behavior is not always diagnosed independently of other psychiatric diagnoses, which may further have affected results.

According to the researchers, the findings from this study highlight “the need for careful screening of mental health concerns as part of routine epilepsy care.”


Wirrell EC, Bieber ED, Vanderwiel A, Kreps S, Weaver AL. Self-injurious and suicidal behavior in young adults, teens, and children with epilepsy: A population-based study. Epilepsia. Published online July 22, 2020. doi: 10.1111/epi.16618