Common mortality causes prevail in epilepsy patients

By Eleanor McDermid, Senior medwireNews Reporter

A prospective, community-based study confirms that patients with epilepsy usually die of the same causes as other people.

The analysis of the UK National General Practice Study of Epilepsy found that just 3.2% of the 189 deaths that occurred among 558 people over nearly 25 years were caused by epilepsy.

In these six cases, the patients’ deaths were directly attributed to epilepsy, with the immediate cause listed as sudden death in epilepsy (SUDEP) or status epilepticus.

In a further 22.8% of cases, the patients’ underlying cause of death was also the cause of their epilepsy; for example, cerebral neoplasm or cerebrovascular disease. The proportion of patients whose cause of death was also the cause of their epilepsy was highest during the first 2 years after their first seizure, at 57.5%, falling to 6.0% after 15 years.

The most common immediate cause of death, in 31.2% of patients, was pneumonia, “representing what is likely a common terminus in a fatal sequence of events”, say Josemir Sander (UCL Institute of Neurology, London, UK) and co-researchers.

But the most common underlying causes of death were cancer (excluding cerebral neoplasms), cardiovascular disease and cerebrovascular disease, together accounting for 58.7% of deaths. Other causes included cerebral neoplasms, external causes, congenital neurological disorders and neurodegenerative diseases. Epilepsy was the least common underlying cause of death.

In multivariate analysis, the presence of a number of comorbidities (based on ICD chapters) significantly increased the risk of death. These included cancer, substance abuse, traumatic brain injury, Parkinson’s disease and cerebrovascular disease.

“Our findings emphasize that comorbidities similar to those responsible for mortality in the general population are also the most important mediators of premature death in people with epilepsy”, the researchers write in Neurology.

They stress that “at the level of the general population, physician counseling of people with epilepsy with regards to neoplastic and atherosclerotic risk factors appears to be as important as counseling individuals on the risk of SUDEP or status epilepticus, if not more so.”

In a linked editorial, Jorge Burneo (Western University, London Health Sciences Center, Ontario, Canada) and Nathalie Jette (University of Calgary, Alberta, Canada) stress that the findings only apply to relatively affluent countries, and speculate that infectious diseases account for a lot more deaths among epilepsy patients in less developed regions.

They say it is “imperative” that similar prospective studies are initiated in low-resource countries “to guide future health care and policy and implement ways to reduce this tragic outcome across the world.”

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