Mortality related to convulsive disorders in a developing country in Asia: trends over 20 years

The cause of death as recorded in 37125 death certificates (DC) issued in the Kandy District over 20 years at five-year intervals beginning 1967 was analysed to determine the trends in mortality caused by convulsive disorders in the community. Convulsions accounted for 881 (23.7/1000) deaths, the highest number being in infancy (35.8%). A slight male preponderance of 51.5% was observed. Most of the deaths occurred in the periphery (51.6%) and in the tea estates (36.3%) as opposed to town area (12.0%). "Febrile convulsions' was the most common diagnosis in 396 (44.9%) deaths. "Convulsions' which included neonatal and infantile convulsions accounted for 186 (21.1%) deaths. Other causes included chest complications (60, 6.8%), drowning (28, 3.2%), asphyxia (20, 2.3%), status epilepticus (19, 2.2%), burns (7, 0.8%), and poisoning (2, 0.2%). The proportion of deaths due to convulsive disorders showed a decrease from 37.28/1000 in 1967 to 9.55/1000 in 1987, which was most evident in the periphery, from 60.49/1000 to 13.19/1000. This parallelled a drop in the proportion of deaths attributed to "febrile convulsions' and "convulsions'. The study shows the need to educate the public about first-aid and the subsequent management of convulsions, especially in childhood. Health personnel in developing countries should consider it mandatory to make a specific diagnosis in children who present as febrile convulsions. Appropriate antiepileptic medication and compliance can prevent death due to status epilepticus and injuries associated with seizures.