Causes of Death in Institutionalized Epileptics

Iivanainen, Matti; Lehtinen, Janne

doi:10.1111/j.1528-1157.1979.tb04830.x

Cited by 53 publications

(49 citation statements)

References 9 publications

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“…The majority of these studies were based on observations of institutionalized patients. Three additional studies from institutions in Finland and the United Kingdom have reported epilepsy as the main cause of death in 19% [15], 31% [39], and 20% [18]. High proportions of epilepsy-related deaths have also been reported in two more recent studies of children with epilepsy.…”

Section: Cause-specific Mortalitymentioning

confidence: 81%

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Mortality in epilepsy

Tomson¹

2000

Journal of Neurology

102

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Both community-based studies and reports from more selected epilepsy populations consistently reveal persons with epilepsy to have a mortality rate two to three times that of the general population. This increased rate is most pronounced in patients with remote symptomatic epilepsy, although many studies also report a significant excess mortality also among those with idiopathic epilepsy. The highest standardized mortality ratios (SMR) are seen in young age groups, mainly due to the low expected mortality in children, and during the first 5-10 years after diagnosis. Many of these observations suggest that the higher mortality is partly related to the underlying disorder causing epilepsy rather than a direct consequence of the seizures. For example, mortality in cerebrovascular diseases is increased, with SMRs ranging from 1.8 to 5.3 in the various studies. Deaths due to neoplasms, and in particular brain tumors, is also increased among patients with epilepsy. Accidents, status epilepticus, and sudden unexpected death (SUD) are more directly seizure-related causes of death. The incidence of such deaths vary considerably depending on the population being studied. While rare among patients with new-onset epilepsy, seizure-related deaths may account for up to 40% of all deaths in patients with chronic epilepsy. SUD is probably the most frequent seizure-related cause of death among young adults with epilepsy, with an SMR more than 20 compared with the general population. Seizure-induced autonomic cardiorespiratory effects have been suggested, but the mechanisms behind SUD are far from fully understood. It appears, however, that the risk of SUD is closely related to seizure frequency, being 40 times higher in patients who continue to have seizures than in those who are seizure-free.

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Section: Cause-specific Mortalitymentioning

confidence: 81%

“…Proportional mortality has been reported in a number of epilepsy cohorts based on institutions and hospitals as well as community samples [5,13,15,18,29,39]. In these studies neoplasms account for 5-26% of deaths.…”

Section: Cause-specific Mortalitymentioning

confidence: 97%

Mortality in epilepsy

Tomson¹

2000

Journal of Neurology

102

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“…Most previous studies of mortality rates in epilepsy have been based on clinical series of patients from institutions or referral centers (3,(6)(7)(8). Such studies generally provide valid data on the diagnosis and classification of epilepsy and on the cause of death, but the populations studied are often highly selected and the external validity of the results is limited.…”

Section: Discussionmentioning

confidence: 99%

Cause‐Specific Mortality in Epilepsy: A Cohort Study of More Than 9,000 Patients Once Hospitalized for Epilepsy

Nilsson¹,

Tomson²,

Farahmand³

et al. 1997

Epilepsia

300

262

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Summary: Purpose:We studied overall and cause-specific mortality rates in a large cohort of patients with epilepsy compared with mortality rates of the general population in the same geographic area.Methods: The cohort consisted of all patients (N = 9,061) aged >15 years admitted with a diagnosis of epilepsy for inpatient care in Stockholm during the years 1980-1989. All patients were followed in the National Cause-of-Death Register, from which the causes of death were obtained, until December 31, 1992. Thus, 53,520 person-years were observed. Mortality rates were compared with those of the general population of Stockholm.Results: We observed 4,001 deaths in the cohort, compared with an expected number of 1,109 deaths in the general population. This yielded a standardized mortality ratio (SMR) of 3.6[95% confidence interval (CI) 3.5-3.71. Although highest in the younger patients, the SMR was significantly increased in all age groups. The excess mortality rate in the cohort was due to a wide range of causes of death, including malignant neoplasms [SMR 2.6 (2.4-2. Conclusions: Our results demonstrate that this large subgroup of patients with a diagnosis of epilepsy, once hospitalized and discharged, is a population at risk, with an excess mortality rate due to several different causes. Key Words: Epilepsy-Mortality-Standardized mortality ratio-Epidemiology-Cause of death.Patients with epilepsy have consistently been found to have a higher death rate than the general population (1-5). Although overall mortality rate has been analyzed in several studies, few researchers have investigated causespecific mortality rates in patients with epilepsy.In previous studies based on patients in institutions (6,7) and referral centers (3,s) researchers have analyzed a highly selected population with severe epilepsy. Studies (9,lO) based on cause-of-death registers have comprised large cohorts of patients. However, the validity of the diagnosis and the patients selection are uncertain in these studies because epilepsy is seldom entered as a diagnosis on death certificates. On the other hand, population-based studies, which provide valid information representative of the epilepsy population in general, have, on the whole, comprised a comparatively small number of patient-years and deaths (1,2,4). Therefore,

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“…The other reported unnatural cause of death among epileptics is suicide. Zielinski [1974], and Iivanainen and Lahtinen [1979] reported higher suicide rates in epileptics. We did not find such an association in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…Schwade and Otto [ 1954] and Iivanainen and Lahtinen [1979] observed that in only 6-19% of all epileptic deaths was the underlying cause of death epilepsy. In Rochester, Minn., epilepsy was listed as the underlying cause of death in only 5 of the 187 certificates on which epilepsy was men tioned [Hauser et al, 1980].…”

Section: Discussionmentioning

confidence: 99%

Case-Control Study of Associated Conditions at the Time of Death in Patients with Epilepsy

1988

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Analysis of mortality data based on underlying cause of death in epileptic patients is of limited value in view of the low case-fatality ratio of epilepsy. Recently the National Center for Health Statistics has made available all conditions mentioned on each death certificate for the entire US population. Using a case-control study design, we have analyzed all the associated conditions at the time of death in patients with epilepsy for the year 1978. Association between epilepsy and the following conditions reached statistical significance: mental retardation, cerebral palsy, cerebrovascular disease, myocardial ischemia, dementia, foreign body in pharynx and larynx, pneumonia, alcoholism and cirrhosis of liver. Early recognition and proper management of some of these factors could significantly reduce the mortality and morbidity in epileptic patients.

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Causes of Death in Institutionalized Epileptics

Cited by 53 publications

References 9 publications

Mortality in epilepsy

Mortality in epilepsy

Cause‐Specific Mortality in Epilepsy: A Cohort Study of More Than 9,000 Patients Once Hospitalized for Epilepsy

Case-Control Study of Associated Conditions at the Time of Death in Patients with Epilepsy

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