Premature mortality risk in people with convulsive epilepsy: Long follow‐up of a cohort in rural China

Abstract

and yyySEIN -Epilepsy Institute in the Netherlands Foundation, Heemstede, The Netherlands SUMMARY Purpose: Detailed data on the mortality of epilepsy are still lacking from resource-poor settings. We conducted a long-term follow-up survey in a cohort of people with convulsive epilepsy in rural areas of China. In this longitudinal prospective study we investigated the causes of death and premature mortality risk among people with epilepsy. Methods: We attempted to trace all 2,455 people who had previously participated in a pragmatic assessment of epilepsy management at the primary health level. Putative causes of death were recorded for those who died, according to the International Classification of Diseases. We estimated proportional mortality ratios (PMRs) for each cause, and standardized mortality ratios (SMRs) for each age-group and cause. Survival analysis was used to detect risk factors associated with increased mortality.Key Findings: During 6.1 years of follow-up there were 206 reported deaths among the 1,986 people with epilepsy who were located. The highest PMRs were for cerebrovascular disease (15%), drowning (14%), self-inflicted injury (13%), and status epilepticus (6%), with probable sudden unexpected death in epilepsy (SUDEP) in 1%. The risk of premature death was 2.9 times greater in people with epilepsy than in the general population. A much higher risk (SMRs 28-37) was found in young people. Duration of epilepsy and living in a waterside area were independent predictors for drowning. Significance: Drowning and status epilepticus were important, possibly preventable, causes of death. Predictors of increasing mortality suggest interventions with efficient treatment and education to prevent premature mortality among people with epilepsy in resource-poor settings.

Premature mortality in a Georgian cohort of people with epilepsy

“…One striking finding was that in the 5-19 year age groups the mortality rate was up to twelve times higher than in the general population. This is in agreement with other studies (Ding et al, 2013;Mu et al, 2011).…”

“…Premature death among people with epilepsy is probably more common in resource poor-countries, where some data suggest mortality rates three to five times as high as in the general population (Mu et al, 2011;Ding et al, 2013). Among people who were located we found a significantly increased overall premature mortality compared with the general population in Georgia.…”

Outcome predictors for status epilepticus—what really counts

“…epilepsy was 2.9 times greater than in the general population. 41 In this report, the highest proportional mortality ratios were detected for cerebrovascular disease (15%), drowning (14%), self-inflicted injury (13%) and SE (6%), with a further 1.4% attributed to sudden unexpected death related to epilepsy. 41 The SE-related mortality rate in patients with epilepsy and low levels of AEDs is 3-4%, but ranges from 20-70% in patients without known epilepsy who develop SE secondary to brain insult.…”

“…41 In this report, the highest proportional mortality ratios were detected for cerebrovascular disease (15%), drowning (14%), self-inflicted injury (13%) and SE (6%), with a further 1.4% attributed to sudden unexpected death related to epilepsy. 41 The SE-related mortality rate in patients with epilepsy and low levels of AEDs is 3-4%, but ranges from 20-70% in patients without known epilepsy who develop SE secondary to brain insult. 5,42 According to a 7-year observational study of 160 patients with SE, a history of epilepsy is known prior to SE onset in 15% of cases, and poor outcome is largely associated with acute aetiology.…”

Impacto da cirurgia de epilepsia no desempenho cognitivo de pacientes com esclerose mesial temporal unilateral

“…No Brasil, os estudos indicam prevalência entre 1% a 2% (Marino et al, 1986;Borges et al, 2004). Estimase que a expectativa de vida de pessoas com epilepsia seja reduzida em dois a dez anos (Gaitatzis et al, 2004); a taxa de mortalidade é mais elevada neste grupo, podendo chegar a 37 vezes a da população geral, particularmente nos países em desenvolvimento (Ding et al, 2013).…”