Citation

Ding D, Wang W, Wu J, Yang H, Li S, Dai X, Yang B, Wang T, Yuan C, Ma G, Bell GS, Kwan P, de Boer HM, Hong Z, Sander JW. Epilepsia 2013; 54(3): 512-517.

Affiliation

Institute of Neurology, WHO Collaborating Center for Research and Training in Neurosciences, Huashan Hospital, Fudan University, Shanghai, China Beijing Neurosurgical Institute, Capital Medical University, Beijing, China China Association Against Epilepsy, Beijing, China Ningxia Medical University Affiliated Hospital, Ningxia, China Jiaozuo People's Hospital, Jiaozuo, Henan, China Zezhou County Hospital, Zezhou, Shanxi, China Department of Neurology, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China Epilepsy Hospital, Mudanjiang, Heilongjiang, China Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, United Kingdom Epilepsy Society, Chalfont St Peter, Buckinghamshire, United Kingdom Departments of Medicine and Neurology, The University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China WHO Collaborating Center for Research, Training and Treatment of Epilepsy, Heemstede, The Netherlands SEIN - Epilepsy Institute in the Netherlands Foundation, Heemstede, The Netherlands.

Copyright

(Copyright © 2013, John Wiley and Sons)

DOI

10.1111/epi.12048

PMID

23215769

Abstract

Purpose:  Detailed data on the mortality of epilepsy are still lacking from resource-poor settings. We conducted a long-term follow-up survey in a cohort of people with convulsive epilepsy in rural areas of China. In this longitudinal prospective study we investigated the causes of death and premature mortality risk among people with epilepsy. Methods:  We attempted to trace all 2,455 people who had previously participated in a pragmatic assessment of epilepsy management at the primary health level. Putative causes of death were recorded for those who died, according to the International Classification of Diseases. We estimated proportional mortality ratios (PMRs) for each cause, and standardized mortality ratios (SMRs) for each age-group and cause. Survival analysis was used to detect risk factors associated with increased mortality. Key Findings:  During 6.1 years of follow-up there were 206 reported deaths among the 1,986 people with epilepsy who were located. The highest PMRs were for cerebrovascular disease (15%), drowning (14%), self-inflicted injury (13%), and status epilepticus (6%), with probable sudden unexpected death in epilepsy (SUDEP) in 1%. The risk of premature death was 2.9 times greater in people with epilepsy than in the general population. A much higher risk (SMRs 28-37) was found in young people. Duration of epilepsy and living in a waterside area were independent predictors for drowning. Significance:  Drowning and status epilepticus were important, possibly preventable, causes of death. Predictors of increasing mortality suggest interventions with efficient treatment and education to prevent premature mortality among people with epilepsy in resource-poor settings.

Language: en