Cause of death in patients with poststroke epilepsy: Results from a nationwide cohort study

Abstract

The risk of death is increased for persons with epilepsy. The literature on causes of death in epilepsy is based mainly on cohorts with epilepsy of mixed aetiologies. For clinical purposes and improved understanding of mortality in different epilepsies, more information is needed on mortality in epilepsies of specific causes. In poststroke epilepsy (PSE), seizures occur in a setting of vascular disease and high mortality rates. The extent to which epilepsy contributes to mortality in this patient group is poorly understood. We therefore aimed to describe causes of death (COD) in PSE on a national scale. A previously identified cohort of 7740 patients with epilepsy or seizures after a stroke in 2005–2010 was investigated. A total of 4167 deaths occurred before the end of 2014. The standardized mortality ratio for the study cohort was 3.56 (95% CI: 3.45–3.67). The main underlying causes of death were disorders of the circulatory system (60%) followed by neoplasms (12%). Diseases of the nervous system were the sixth leading underlying COD (3%), and epilepsy or status epilepticus was considered the underlying COD in approximately a similar proportion of cases as neurodegenerative disorders (0.9% and 1.1%, respectively). Epilepsy was considered a contributing COD in 14% of cases. Our findings highlight the importance of optimal management of vascular morbidity in patients with PSE. The large proportion of patients with epilepsy as a contributing COD indicate the need of high ambitions also regarding the management of seizures in patients with PSE.

Retention rate of first antiepileptic drug in poststroke epilepsy: A nationwide study

“…This is a cause for concern. Seizure-associated risks are not sufficient to explain the increased risk of death, and judging from death certificates, most patients with PSE die from vascular disease [21]. Our interpretation is that patients with PSE may be a cardiovascular high-risk group, which should be taken into account when treating PSE.…”

Outcome and predictive factors in post-stroke seizures: A retrospective case-control study

“…A large series of 7740 post-stroke patients found a standardized mortality rate of 3.56 [3]. Recurrent seizures were listed as a contributing factor in 14% of deaths [3]. The main cause of death in this population were vascular disorders, though the impact of PSS on mortality was felt to be clinically relevant [3].…”

“…Overall, the risk of death is increased in patients with epilepsy compared to the general population [6]. In patients with PSS, seizures occur in the setting of diffuse vascular disease and therefore have higher mortality rates [3]. The extent to which epilepsy contributes to mortality in this patient group is poorly understood [6].…”

“…In a prospective study with 109 patients with ischemic stroke (n = 46) and intraparenchymal hemorrhage (n = 63) that underwent continuous EEG monitoring, seizures were associated with cerebral edema producing a midline shift on MRI independent of associated intraparenchymal hemorrhage and predicted worse overall outcome and higher mortality than those without seizures [43]. A large series of 7740 post-stroke patients found a standardized mortality rate of 3.56 [3]. Recurrent seizures were listed as a contributing factor in 14% of deaths [3].…”

“…Stroke is the fifth leading cause of death for Americans [1]. Stroke is a commonly identified cause of epilepsy in patients older than 35, and the most common cause of seizures in the elderly [2,3]. From stroke registry data, 5-20% of all patients who have suffered stroke will develop seizures [4].…”