Takeaway
- Epilepsy is still associated with premature mortality.
- The majority of deaths are epilepsy related and potentially preventable.
Why this matters
- Knowledge of modifiable causes of death and risk factors may enable intervention, reduce mortality.
Key results
- Between the 1950s and the 2010s, all-cause mortality in patients with epilepsy remained similarly elevated, with the median standardised mortality ratio (SMR) ranging from 2.2 to 3.4.
- Elevation of risk greater for:
- Children aged <18 years vs adults (median SMR, 7.5 vs 2.6).
- Epilepsy-related vs epilepsy-unrelated causes (median SMR, 3.8 vs 1.7).
- All-cause mortality was elevated most in patients with comorbidities affecting brain structure (brain tumours, intellectual disabilities/cerebral palsy, encephalopathies; SMR range, 24.0-41.5).
- Epilepsy-related deaths accounted for 60% of all deaths.
- Common epilepsy-related causes of death (median SMR range, 3.2-24.6):
- Alcohol.
- Drowning.
- Falls.
- Fires/burns.
- Pneumonia.
- Suicide.
Study design
- Systematic review of systematic reviews:
- Primary analysis: 6 reviews encompassing 103 observational studies of all-cause mortality, risk factors.
- Secondary analysis: 9 reviews of risk factors for individual epilepsy-related causes of death.
- Main outcome: mortality.
- Funding: Epilepsy Research UK; Juliet Bergqvist Memorial Fund; Epilepsy Action.
Limitations
- Classification system for epilepsy-related deaths has limitations.
- Inability to address confounding.
- Use of SMR.
- Possible misclassification of causes of death.
References
References
