The burden of premature mortality of epilepsy in high-income countries: A systematic review from the Mortality Task Force of the International League Against Epilepsy

David J Thurman, Giancarlo Logroscino, Ettore Beghi, W Allen Hauser, Dale C Hesdorffer, Charles R Newton, Fulvio Alexandre Scorza, Josemir W Sander, Torbjörn Tomson, Epidemiology Commission of the International League Against Epilepsy, David J Thurman, Giancarlo Logroscino, Ettore Beghi, W Allen Hauser, Dale C Hesdorffer, Charles R Newton, Fulvio Alexandre Scorza, Josemir W Sander, Torbjörn Tomson, Epidemiology Commission of the International League Against Epilepsy

Abstract

Since previous reviews of epidemiologic studies of premature mortality among people with epilepsy were completed several years ago, a large body of new evidence about this subject has been published. We aim to update prior reviews of mortality in epilepsy and to reevaluate and quantify the risks, potential risk factors, and causes of these deaths. We systematically searched the Medline and Embase databases to identify published reports describing mortality risks in cohorts and populations of people with epilepsy. We reviewed relevant reports and applied criteria to identify those studies likely to accurately quantify these risks in representative populations. From these we extracted and summarized the reported data. All population-based studies reported an increased risk of premature mortality among people with epilepsy compared to general populations. Standard mortality ratios are especially high among people with epilepsy aged <50 years, among those whose epilepsy is categorized as structural/metabolic, those whose seizures do not fully remit under treatment, and those with convulsive seizures. Among deaths directly attributable to epilepsy or seizures, important immediate causes include sudden unexpected death in epilepsy (SUDEP), status epilepticus, unintentional injuries, and suicide. Epilepsy-associated premature mortality imposes a significant public health burden, and many of the specific causes of death are potentially preventable. These require increased attention from healthcare providers, researchers, and public health professionals.

Keywords: Convulsions; Death; Developed countries; Premature mortality; Resource-rich countries; Seizures.

Conflict of interest statement

Disclosure of Conflict of Interest

DJT receives consultant fees under contract with UCB, Inc. GL has no conflict of interest. DCH receives personal fees from UpsherSmith, Cyberonics, the Department of Rehabilitation, Mount Sinai Medical Center, and the New York University Langone Comprehensive Epilepsy Center, as well as grants from the National Institutes of Health, the Centers for Disease Control and Prevention, The Epilepsy Study Consortium, and Epilepsia. CN is funded by the Wellcome Trust, United Kingdom. JWS is based at the University College London Hospitals Bio-Medical Research Centre, which received a proportion of funding from the Department of Health’s NIHR Biomedical Research Centres funding scheme; his current position is endowed by United Kingdom Epilepsy Society and he has received research support from the Marvin Weil Epilepsy Research Fund. His department has received research grants from GlaxoSmithKline (GSK), Eisai, UCB, European Union, Dutch Epilepsy Funds, World Health Organization (WHO), and United Kingdom Epilepsy Society. He has received honoraria from UCB, Eisai, GSK, Lundbeck, and Teva. TT has received research grants and/or speakers honoraria to his institution from: Eisai, GlaxoSmithKline, Novartis, Bial, and UCB. He has also received grants from Citizens United for Research in Epilepsy (CURE), Stockholm County Council, and European Union. We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

Figures

Figure 1
Figure 1
Results of systematic search. Flowchart describes search process. Epilepsia © ILAE
Figure 2
Figure 2
Standardized mortality ratios by age: Deaths from all causes among people with epilepsy. Data points represent findings from four class 1 and class 2 studies.,,, Epilepsia © ILAE
Figure 3
Figure 3
Standardized mortality ratios by interval from epilepsy diagnosis. Data points represent the midpoint of intervals from diagnosis described in individual studies. Error bands indicate 95% confidence intervals. Epilepsia © ILAE

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Source: PubMed

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