LAUSR

Abstract Suicide accounts for three-quarters of violent deaths in the U.S. Epilepsy is diagnosed in 1.2% of the U.S. population. Within persons with epilepsy, the risk of suicide is 22% higher than in typical adults. Neuropsychologists are a part of epilepsy center care teams, yet to date there is no literature addressing the neuropsychology or brain-behavior relationship of suicide in persons with epilepsy. In this review, we summarized and integrated the literature on epilepsy and suicide. Findings included persons with epilepsy run a two-fold risk of suicidal behavior; risk increased with comorbidity, type of epilepsy, and neurosurgical intervention; no association was consistently evidenced between suicidality and recency of epilepsy diagnosis or duration of seizure or control, nor was a relationship confirmed between lethality of attempt and neurocognitive sequelae. Findings supported the bidirectionality of risk in epilepsy and suicidality. We reviewed potential neurobiological origins of suicide and epilepsy in the hypothalamic-pituitary-adrenal axis, hippocampus, and serotonergic, noradrenergic, and glutamatergic/GABAergic pathways, and of epilepsy in cellular plasticity, inflammatory response, and excitatory-inhibitory dysfunction. Neuropsychological theories of suicide were also reviewed. Neuropsychological domains of assessment were surveyed, and clinical implications discussed. Directions for further research were proposed.