The long-term risk of premature mortality in people with epilepsy

Abstract

People with epilepsy have an increased risk of premature death. The risk is highest soon after onset of seizures. We report the findings of a long-term follow-up population-based study of people with epilepsy with regards to premature mortality. The National General Practice Study of Epilepsy is a prospective study flagged at the National Health Service Information Centre in the UK. Over 1000 people with new onset seizures were followed from the mid 1980s until April 2009. Of these, 564 people were classified at 6 months as having definite epileptic seizures, 228 as having possible epileptic seizures and 220 as having febrile seizures. The remainder were excluded (n=104 because of an unknown prior diagnosis of epilepsy or neonatal seizures) or classified as not having epilepsy (n=79). At median follow-up of 22.8 years there had been 301 deaths in the cohort; 300 of these were in people with definite or possible seizures. Death certificates were obtained for all but three of those who died. The overall standardized mortality ratio for those with definite or possible epilepsy was 2.2 (95% confidence interval 1.97-2.47), and was higher in those with definite seizures (2.6). In those who were alive at 20 years follow-up, the standardized mortality ratio in the subsequent years remained significantly elevated (2.2, 95% confidence interval 1.6-3.2). Pneumonia (standardized mortality ratio 6.6, 95% confidence incidence 5.1, 8.4) was a common cause of death with a consistently elevated standardized mortality ratio throughout follow-up. The standardized mortality ratio for ischaemic heart disease was significantly elevated for the first time in the last 5 years of follow-up (3.3, 95% confidence interval 1.6-7.0). Few people died from epilepsy-related causes. The risk of premature death remains significantly elevated at 20-25 years after the index seizure despite most of the cohort being in terminal remission (defined as 5 years or more seizure-free, on or off anti-epileptic medication) at the last follow-up. Further studies are needed to explore the reasons for this long-term increase in premature mortality.

Determinants of premature mortality in a city population: An eight-year observational study concerning subjects aged 18–64

“…The problem of premature deaths has been a burning issue for many years and focused attention of researchers both in Poland [52,53] and abroad [54][55][56][57][58][59][60][61]. Many authors point out that the level of the health status and mortality is different for different regions of Poland.…”

Epilepsikirurgi - utredning og pasientseleksjon

“…Noen blir mobbet eller stigmatisert. Det er også 5 -6 ganger økt risiko for plutselig anfallsrelatert død (8,9). I tillegg er det en betydelig psykiatrisk komorbiditet i denne pasientgruppen (10).…”

Sudden unexpected death in epilepsy: a silent killer

“…It has been estimated that 65 million people live with epilepsy worldwide [2]. Long-term, population based, prospective studies have shown an increased risk of premature mortality in patients with epilepsy by more than twice that of the general population [3][4][5]. The higher proportion of deaths in the epilepsy cohort is due to many aetiologies including malignant neoplasms, pneumonia and other respiratory diseases, cerebrovascular diseases and cardiovascular diseases [4,5].…”

“…Long-term, population based, prospective studies have shown an increased risk of premature mortality in patients with epilepsy by more than twice that of the general population [3][4][5]. The higher proportion of deaths in the epilepsy cohort is due to many aetiologies including malignant neoplasms, pneumonia and other respiratory diseases, cerebrovascular diseases and cardiovascular diseases [4,5]. Causes of mortality as a direct consequence of seizures and epilepsy include sudden unexpected death in epilepsy (SUDEP), accidental deaths due to epileptic seizures and deaths from status epilepticus.…”