Causes of death in remote symptomatic epilepsy

Abstract

Abstract-Objective:To determine the causes of death of individuals with developmental disabilities that occur more frequently among those with remote symptomatic epilepsy (i.e., epilepsy occurring in persons with developmental delay or identified brain lesions) than for those without. Methods: The authors compared causes of mortality in persons with (n ϭ 10,030) and without (n ϭ 96,163) history of epilepsy in a California population of persons with mild developmental disabilities, 1988 to 2002. Subjects had traumatic brain injury, cerebral palsy, Down syndrome, autism, or a developmental disability with other or unknown etiology. There were 721,759 person-years of data, with 2,397 deaths. Underlying causes of death were determined from the State of California's official mortality records. Cause-specific death rates and standardized mortality ratios (SMRs) were computed for those with and without epilepsy relative to subjects in the California general population. Comparisons were then made between SMRs of those with and without epilepsy, and CIs on the ratios of SMRs were determined. Results: Death rates for persons with epilepsy were elevated for several causes. The greatest excess was due to seizures (International Classification of Diseases-9 [ICD-9] 345; SMR 53.1, 95% CI 28.0 to 101.0) and convulsions (ICD-9 780.3; SMR 25.2, 95% CI 11.7 to 54.2). Other causes occurring more frequently in those with epilepsy included brain cancer (SMR 5.2, 95% CI 2.2 to 12.1), respiratory diseases (SMR 1.7, 95% CI 1.2 to 2.5), circulatory diseases (SMR 1.3, 95% CI 1.0 to 1.7), and accidents (SMR 2.7, 95% CI 1.9 to 3.7), especially accidental drowning (SMR 12.8, 95% CI 7.0 to 23.2). Conclusions: Remote symptomatic epilepsy is associated with an increased risk of death. Seizures, aspiration pneumonia, and accidental drowning are among the leading contributors. NEUROLOGY 2005;65:216-222 Persons with epilepsy are at increased risk of death compared with the general population.

Suicide in people with epilepsy: How great is the risk?

“…The meta-analysis confirms that the rate of suicide is increased in people with epilepsy, with only one study apparently showing a protective effect of epilepsy (Day et al, 2005). The subgroup analysis, although using generalizations to combine the studies, seems to confirm that, although the death rate is increased in communitybased incident and new diagnosis studies, it may not be as high as studies in hospital settings have previously suggested.…”

“…2). The SMR was significantly low (0.34, 95% CI 0.070-0.99) overall in the two community-based studies of people with epilepsy and developmental disability [although only the one larger study (Day et al, 2005) had a low SMR]. Of the 34 postsurgery patients who committed suicide, in 19 there is no information on seizure control available, 4 were known to be seizure-free, 6 probably had improved seizure control, 2 still had seizures, and in 3 seizures were worse.…”

“…The reason for this low SMR is unclear, particularly as people with developmental disabilities have sometimes been found to be at higher risk of suicide (Hiroeh et al, 2001). It is unlikely that it is due to increased supervision of those with developmental disability, as the SMR for drowning in this group was high (Day et al, 2005).…”

“…Only one study located has an SMR for suicide in epilepsy of significantly less than one (Day et al, 2005); this is a study of cause of death in people with developmental disability in which the SMR for suicide was low in people with epilepsy, but was even lower in those without epilepsy. The reason for this low SMR is unclear, particularly as people with developmental disabilities have sometimes been found to be at higher risk of suicide (Hiroeh et al, 2001).…”

Mortality and cancer incidence in males with Y polysomy in Britain: a cohort study

“…Identifying details were sent to the National Health Service Central Registers to enable notiWcation to the investigators of information relating to mortality, cancer incidence, emigrations and other reasons for exit from the study. Underlying cause of death reported on the death certiWcate was coded to the appropriate International ClassiWcation of Diseases (ICD) revision that was in force in Britain at the time: ICD7 from 1959ICD7 from to 1967ICD8 from 1968ICD8 from to 1978ICD9 from 1979to 1999in England and Wales and 1979to 2000and ICD10 from 2000to 2005in England and Wales and 2001to 2005 in Scotland. We bridge-coded between ICD revisions to give the ICD9 categories shown in Table 2.…”