Epilepsy: excess mortality potentially preventable

  • Mbizvo GK & al.
  • Epilepsy Res
  • 27 Aug 2019

  • International Clinical Digest
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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
    • 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.