Recognizing and preventing epilepsy-related mortality

Abstract

Epilepsy is associated with a high rate of premature mortality from direct and indirect effects of seizures, epilepsy, and antiseizure therapies. Sudden unexpected death in epilepsy (SUDEP) is the second leading neurologic cause of total lost potential life-years after stroke, yet SUDEP may account for less than half of all epilepsy-related deaths. Some epilepsy groups are especially vulnerable: individuals from low socioeconomic status groups and those with comorbid psychiatric illness die more often than controls. Despite clear evidence of an important public health problem, efforts to assess and prevent epilepsy-related deaths remain inadequate. We discuss factors contributing to the underestimation of SUDEP and other epilepsy-related causes of death. We suggest the need for a systematic classification of deaths directly due to epilepsy (e.g., SUDEP, drowning), due to acute symptomatic seizures, and indirectly due to epilepsy (e.g., suicide, chronic effects of antiseizure medications). Accurately estimating the frequency of epilepsy-related mortality is essential to support the development and assessment of preventive interventions. We propose that educational interventions and public health campaigns targeting medication adherence, psychiatric comorbidity, and other modifiable risk factors may reduce epilepsy-related mortality. Educational campaigns regarding sudden infant death syndrome and fires, which kill far fewer Americans than epilepsy, have been widely implemented. We have done too little to prevent epilepsy-related deaths. Everyone with epilepsy and everyone who treats people with epilepsy need to know that controlling seizures will save lives.

Salicylic Acid Enhances Growth and Productivity in Cabbage (Brassica oleracea var. Capitata L.) Grown Under Saline Condition

“…In agreement with previous reports, stroke caused death in 32% of total population in this study [1][2][3][4][5][6][7][8][9][10][11]. Wolff V et al, in 2016 stated that stroke, is the major complication of reversible cerebral vasoconstriction syndrome that can result in persistent neurological disability, and rarely causes death [12].…”

“…It was conducted to Isfahan Kidney Transplantation Research Center (IKTRC). We used death reported data from 21 March 2011 to 19 March 2014, with linkage (using the de-identified patient number) of multiple data files included; demographic such as age and gender, final code of disease diagnosis, final code of death, date of admission, duration of hospital stay, discharge diagnoses', deceased family's paid and health system paid [1][2][3][4][5][6][7][8][9]. The statistical analyses of d-Base were performed using Microsoft Excel and SPSS v. 20 (Chicago, IL, USA) for windows.…”

“…In another publication increased mortality has been reported among persons with autism spectrum disorder (ASD), particularly between those who also have the comorbid complaint of epilepsy or intellectual incapacity [5]. Sudden unexpected death in epilepsy (SUDEP) is the second important neurologic cause of whole vanished potential life-years after stroke, yet SUDEP may justified for less than half of all epilepsy-associated death events' [6]. Follow-up investigations of children and adolescents with epilepsy have exposed an advanced risk of mortality in children [7].…”

Sudden unexpected death in epilepsy in patients treated with brain‐responsive neurostimulation

“…1,2 Most witnessed SUDEPs have occurred following seizures, especially generalized tonic-clonic seizures (GTCS) 2,3 and interventions to reduce seizure frequency and severity are the most effective preventive strategy. 4,5 The RNS System (NeuroPace, Mountain View, CA, USA) is a targeted direct brain responsive neurostimulator that is approved by the U.S. Food and Drug Administration (FDA) as an adjunctive therapy for adults (≥18 years) with TRE with frequent and disabling partial onset seizures localized to no more than 2 epileptogenic foci. 6,7 The neurostimulator detects and stimulates in response to electrocorticographic activity identified by the physician, such as epileptiform activity and electrographic seizures.…”

National Association of Medical Examiners position paper: Recommendations for the investigation and certification of deaths in people with epilepsy

“…4 Individuals with epilepsy have up to 11-fold higher mortality rates compared to matched controls. 2 Natural causes of death are increased 15-fold. Nonnatural causes are also increased (falls—8-fold; drowning—7.7-fold; drug poisoning—5.1-fold; suicide 3.5 to 5-fold).…”