Mortality in children with severe epilepsy: 10 years of follow-up

Arida, Ricardo Mário; Fernandes, Regina Maria França; Wichert‐Ana, Lauro; Machado, Hélio Rubens; Sakamoto, Américo Ceiki

doi:10.1590/s0004-282x2011000600008

Cited by 15 publications

(23 citation statements)

References 25 publications

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“…and two articles reported separate findings from the same cohort . Thus, the articles contained 12 reports of findings from population‐based cohorts and eight reports from clinical cohorts . South America provided eight studies, Asia six studies, and Africa six studies .…”

Section: Resultsmentioning

confidence: 99%

“…Thus, the articles contained 12 reports of findings from population‐based cohorts and eight reports from clinical cohorts . South America provided eight studies, Asia six studies, and Africa six studies . Nine studies were conducted in rural populations only, six in urban only, and five in both urban and rural populations …”

Section: Resultsmentioning

confidence: 99%

“…There was insufficient information published in most studies to determine the basis of the diagnosis of epilepsy. Individuals in clinical cohorts often had epilepsy described as intractable or refractory . Cohorts of children with severe forms of epilepsy were also enrolled in several studies .…”

Section: Resultsmentioning

confidence: 99%

“…Six clinical cohort studies reported causes of death as PMRs for individuals with epilepsy (Table ) . The median PMR for direct and indirect causes of death attributable to epilepsy was 39.3% and 24%, respectively.…”

Section: Resultsmentioning

confidence: 99%

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Premature mortality of epilepsy in low‐ and middle‐income countries: A systematic review from the Mortality Task Force of the International League Against Epilepsy

et al. 2016

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SUMMARYTo determine the magnitude of risk factors and causes of premature mortality associated with epilepsy in low-and middle-income countries (LMICs). We conducted a systematic search of the literature reporting mortality and epilepsy in the World Bank-defined LMICs. We assessed the quality of the studies based on representativeness; ascertainment of cases, diagnosis, and mortality; and extracted data on standardized mortality ratios (SMRs) and mortality rates in people with epilepsy. We examined risk factors and causes of death. The annual mortality rate was estimated at 19.8 (range 9.7-45.1) deaths per 1,000 people with epilepsy with a weighted median SMR of 2.6 (range 1.3-7.2) among higherquality population-based studies. Clinical cohort studies yielded 7.1 (range 1.6-25.1) deaths per 1,000 people. The weighted median SMRs were 5.0 in male and 4.5 in female patients; relatively higher SMRs within studies were measured in children and adolescents, those with symptomatic epilepsies, and those reporting less adherence to treatment. The main causes of death in people with epilepsy living in LMICs include those directly attributable to epilepsy, which yield a mean proportional mortality ratio (PMR) of 27.3% (range 5-75.5%) derived from population-based studies. These direct causes comprise status epilepticus, with reported PMRs ranging from 5 to 56.6%, and sudden unexpected death in epilepsy (SUDEP), with reported PMRs ranging from 1 to 18.9%. Important causes of mortality indirectly related to epilepsy include drowning, head injury, and burns. Epilepsy in LMICs has a significantly greater premature mortality, as in high-income countries, but in LMICs the excess mortality is more likely to be associated with causes attributable to lack of access to medical facilities such as status epilepticus, and preventable causes such as drowning, head injuries, and burns. This excess premature mortality could be substantially reduced with education about the risk of death and improved access to treatments, including AEDs. Key Points • Mortality in people with epilepsy in low-and middleincome countries (LMICs) is estimated to be 2.6-fold higher (range 1.3-7.2) than in general populations of LMICs• The main causes of death in people with epilepsy in LMICs are epilepsy-related complications, that is, status epilepticus, SUDEP, and injuries• Estimates of the public health burden of epilepsyrelated mortality are higher in LMICs than estimates from high-income countries• Insufficient studies of good quality, high heterogeneity, and underrepresentation of diverse LMIC economies and culture were the main limitations of this systematic review• Improving access to medical facilities and antiepileptic drugs, and preventing injuries may substantially reduce premature mortality in epilepsy in LMICs Standardized mortality in people with epilepsy in highincome countries (HICs) is estimated to be up to 4-15 times higher than in the general population in community-based studies and selected high-risk populations, respectively.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Premature mortality of epilepsy in low‐ and middle‐income countries: A systematic review from the Mortality Task Force of the International League Against Epilepsy

et al. 2016

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“…Sudden unexpected death in epilepsy occurs more often in children with an underlying neuropathological disorder and high seizure rate [27]. We carried out a ten-year prospective cohort study of 1012 patients aged up to 18 years and identified 11 cases of SUDEP; 63% of which died while sleeping [28]. We concluded that SUDEP may be significantly associated with mortality in children and adolescents with epilepsy.…”

Section: Sudep In Children and Clinical Phenomenologymentioning

confidence: 97%