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Mortality risks in new-onset childhood epilepsy
Anne T Berg1, Katherine Nickels, Elaine C Wirrell
1Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA. atberg@luriechildrens.org
Insights
Most excess deaths in children with epilepsy are not seizure-related. However, complicated epilepsy significantly increases mortality risk, with sudden unexpected death rates comparable to SIDS.
Area of Science:
- Pediatric Neurology
- Epilepsy Research
- Mortality Studies
Background:
- Epilepsy affects numerous children, with varying mortality risks.
- Understanding causes of death, particularly seizure-related, is crucial for risk assessment.
Purpose of the Study:
- To estimate seizure-related death risks in children with epilepsy.
- To compare these risks with other common causes of mortality in this population.
Main Methods:
- Combined data from four pediatric epilepsy cohorts.
- Classified causes of death: seizure-related (including SUDEP), natural, non-natural, and unknown.
Main Results:
- 13 seizure-related deaths (10 SUDEP) occurred among 79 total deaths.
- Overall death rate was 228 per 100,000 person-years, significantly higher in complicated epilepsy.
- Seizure-related death rates were 43 overall, 122 in complicated, and 14 in uncomplicated epilepsy.
Conclusions:
- Excess mortality in epilepsy is primarily due to non-seizure-related causes.
- Complicated epilepsy carries a higher mortality risk than uncomplicated epilepsy.
- SUDEP rates are comparable to SIDS; seizure-related deaths rival other causes in uncomplicated epilepsy.
Objectives:
Estimate the causes and risk of death, specifically seizure related, in children followed from onset of epilepsy and to contrast the risk of seizure-related death with other common causes of death in the population.
Methods:
Mortality experiences from 4 pediatric cohorts of newly diagnosed patients were combined. Causes of death were classified as seizure related (including sudden unexpected death [SUDEP]), natural causes, nonnatural causes, and unknown.
Results:
Of 2239 subjects followed up for >30 000 person-years, 79 died. Ten subjects with lethal neurometabolic conditions were ultimately excluded. The overall death rate (per 100 000 person-years) was 228; 743 in complicated epilepsy (with associated neurodisability or underlying brain condition) and 36 in uncomplicated epilepsy. Thirteen deaths were seizure-related (10 SUDEP, 3 other), accounting for 19% of all deaths. Seizure-related death rates were 43 overall, 122 for complicated epilepsy, and 14 for uncomplicated epilepsy. Death rates from other natural causes were 159, 561, and 9, respectively. Of 48 deaths from other natural causes, 37 were due to pneumonia or other respiratory complications.
Conclusions:
Most excess death in young people with epilepsy is not seizure-related. Mortality is significantly higher compared with the general population in children with complicated epilepsy but not uncomplicated epilepsy. The SUDEP rate was similar to or higher than sudden infant death syndrome rates. In uncomplicated epilepsy, sudden and seizure-related death rates were similar to or higher than rates for other common causes of death in young people (eg, accidents, suicides, homicides). Relating the risk of death in epilepsy to familiar risks may facilitate discussions of seizure-related mortality with patients and families.
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