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[Mortality patterns of children with epilepsies in a children's medical center]
Insights
Children with epilepsy have a high mortality rate, often from respiratory issues rather than seizures. Many deaths occur at home, highlighting the need for better management strategies for pediatric epilepsy patients.
Area of Science:
- Pediatric Neurology
- Epileptology
- Childhood Mortality Studies
Context:
- Review of 237 pediatric deaths at Kanagawa Children's Medical Center (1975-1989).
- Epilepsies accounted for 54% of deaths, often with co-occurring central nervous system (CNS) disorders.
- 11% of total hospital deaths involved children seen in the Neurology Division.
Purpose:
- To analyze the causes and circumstances of death in children with epilepsy.
- To identify specific epilepsy syndromes with higher mortality risks.
- To emphasize the need for improved management to prevent avoidable deaths.
Summary:
- Pneumonia, respiratory failure, and suffocation were the primary causes of death (60%), while status epilepticus or convulsions caused 14%.
- High mortality rates were observed in infantile spasms (11%) and severe myoclonic epilepsy in infancy (50%).
- Approximately 40% of deaths occurred outside the hospital (home or emergency room) without effective resuscitation.
Impact:
- Findings underscore the critical need for proactive and comprehensive management of pediatric epilepsy.
- Highlights the importance of addressing non-convulsive causes of mortality and ensuring timely medical intervention.
- Suggests that improved care protocols could significantly reduce accidental deaths in children with epilepsy.
Abstract:
Two hundred and thirty-seven children have died who were seen in the Division of Neurology, Kanagawa Children's Medical Center from 1975 to 1989. They corresponded to about 11% of the total death in the hospital. A total of 128 cases of 237 deaths (54.0%) were suffering from epilepsies, most of whom were also complicated with other CNS disorders. The causes of death were pneumonia, respiratory failure and suffocation in 60%, whereas status epilepticus or convulsions only in 14%. About 40% of victims died at home or in an emergency room without effective resuscitation. Mortality was considered high in infantile spasms (16 out of 146, 11%) and in severe myoclonic epilepsy in infancy (4 out of 8, 50%). It was note worthy that 3 cases of severe myoclonic epilepsy in infancy died of status epilepticus and 2 died at home. Sixteen cases whose chief problems were partial epilepsies and severe myoclonic epilepsy in infancy, died of status epilepticus in 10 cases, convulsions after tonsillectomy, etc. Causes of death of these 16 cases were related to convulsions except in two cases whose causes were pneumonia in one and unknown in the other. About a half of them (7 cases) died at home. Adequate managements appeared necessary to prevent accidental deaths of children with epilepsies.