Mortality in patients with epilepsy: a systematic review

Epilepsy is linked to a significantly higher risk of death, yet public awareness remains low. This study aims to investigate mortality characteristics, to reduce epilepsy-related deaths and improve prevention strategies.

This study systematically reviews mortality data in relevant literature from PubMed and Embase up until June 2024. Data quality is assessed using the Newcastle-Ottawa Scale, and analysis includes trends, regional differences, and the economic impact of premature death. Global Burden of Disease (GBD) data are used to validate trends. In addition, a review of guidelines and expert statements on sudden unexpected death in epilepsy (SUDEP) is included to explore intervention strategies and recommendations.

Annual mortality rates of epilepsy have gradually declined, mainly due to improvements in low-income countries, while high-income regions have experienced an upward trend. Male patients exhibit higher mortality rates than females. Age-based analysis shows that the elderly contributes most to this increase due to chronic conditions such as cardiovascular disease and pneumonia related to epilepsy. This may be a key factor contributing to the increased mortality among epilepsy patients in aging high-income regions. Accidents and suicides are more prevalent in low-income regions. The highest mortality risks occur in the early years post-diagnosis and during prolonged, uncontrolled epilepsy. SUDEP remains a leading cause of death.

This study highlights the impact of gender, region, and disease duration on epilepsy mortality. Future research should focus on elderly epilepsy patients mortality characteristics and personalized interventions for SUDEP.