The long-term risk of premature mortality in people with epilepsy
Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK. Brain
(Impact Factor: 9.2).
02/2011; 134(Pt 2):388-95. DOI: 10.1093/brain/awq378
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.
Available from: Udaya Seneviratne
- "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   . The mortality risk remains elevated irrespective of the degree of seizure control . Cause-specific mortality analyses in the cohort with epilepsy demonstrate a higher proportion of deaths from malignant neoplasms, pneumonia and other respiratory diseases, cerebrovascular diseases, and cardiovascular causes. "
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ABSTRACT: Sudden unexpected death in epilepsy (SUDEP) is a major cause of mortality in epilepsy. Despite its devastating consequences, SUDEP appears to be poorly discussed with patients by health professionals. The risk of causing psychological distress to the patient is highlighted as a reason for not discussing SUDEP. However, no studies have assessed the adult patients' views on this important question. We conducted this cross-sectional study to evaluate the awareness and perspectives on SUDEP among adult patients with epilepsy.
One hundred five consecutive adult patients with epilepsy, referred to the Epilepsy Clinic of a tertiary hospital between October 2012 and November 2013, were surveyed to ascertain their views and understanding of SUDEP. The data were analyzed using logistic regression to explore the association between patients' awareness of SUDEP and characteristics such as age, gender, duration of epilepsy, level of education, and employment.
Awareness of SUDEP among adult patients with epilepsy was poor (14.3%). However, the vast majority (89.5%) wished to be informed about SUDEP, and 59% requested detailed information. The treating neurologist was considered to be the most appropriate source of SUDEP information by 85.6% of patients. Multivariable analysis of the data showed no association between characteristics of patients (age, gender, duration of epilepsy, level of education, and employment) and their awareness of SUDEP or desire to get SUDEP-related information.
Our study suggests that the majority of adult patients wish to be informed about SUDEP. This is in contrast to the general reluctance of medical professionals to inform all patients routinely about this condition.
Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.
Available from: Eugen Trinka
- "The SMR for pneumonia was particularly high (7.9) . In the Finnish study of childhood-onset epilepsy , 55% of deaths were epilepsyrelated (30% to 38% with SUDEP, 10% with drowning), 20% were from pneumonia, 13% were from cardiovascular disease, and 3% were from suicide . "
Available from: Carla Alessandra Scorza
- "Epilepsy is one of the most common serious neurological disorders, and it is estimated that a third of all patients have intractable epilepsy      . People with epilepsy have a 2.6-fold increased risk of premature death compared with the general population, and sudden unexpected death in epilepsy (SUDEP) represents the leading cause of mortality in individuals with uncontrolled seizures   . Current epidemiological studies indicate that SUDEP is responsible for 7.5% to 17% of all deaths in individuals with epilepsy and has an incidence among adults between 1:500 and 1:1000 patient-years [10,11]. "
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