Mortality in patients with epilepsy: a systematic review

Area of Science:

• Neurology
• Public Health
• Epidemiology

Background:

• Epilepsy is associated with a significantly elevated risk of mortality, yet public awareness of this risk is notably low.
• Understanding epilepsy mortality patterns is crucial for developing effective prevention strategies and reducing premature deaths.

Purpose of the Study:

• To systematically investigate the characteristics of epilepsy-related mortality.
• To identify trends, regional disparities, and the economic impact of premature death in epilepsy patients.
• To review intervention strategies and recommendations for sudden unexpected death in epilepsy (SUDEP).

Main Methods:

• Systematic literature review of PubMed and Embase databases up to June 2024.
• Quality assessment using the Newcastle-Ottawa Scale and analysis of mortality trends, regional differences, and economic impact.
• Inclusion of Global Burden of Disease (GBD) data for trend validation and review of SUDEP guidelines.

Main Results:

• Epilepsy mortality rates show a declining trend globally, with improvements noted in low-income countries, contrasting with an upward trend in high-income regions.
• Elderly individuals, particularly those with comorbidities like cardiovascular disease and pneumonia, represent a growing proportion of epilepsy-related deaths in aging high-income regions.
• Higher mortality rates are observed in males, during the early years post-diagnosis, in cases of prolonged uncontrolled epilepsy, and SUDEP remains a primary cause of death. Accidents and suicides are more frequent in low-income regions.

Conclusions:

• Gender, geographic region, and epilepsy duration significantly influence mortality outcomes.
• Future research should prioritize understanding mortality characteristics in elderly epilepsy patients and developing personalized interventions for SUDEP.