Changes in epilepsy causes of death: A US population study

Abstract

Objectives Since 2000, medical treatment for epilepsy and cardiovascular risk‐reduction strategies have advanced significantly in the United States (US). However, seizure‐free rates remain unchanged, and people with epilepsy are at higher risk than the general population for heart disease and stroke. The purpose of this study is to determine how cardiovascular, epilepsy‐related, and other causes of death are changing in epilepsy in comparison with the US population. Materials & Methods Changes in the 15 underlying causes of death in epilepsy (ICD‐10 G40‐G40.9) and the US population were analyzed and compared from 2000 to 2018. The CDC multiple cause‐of‐death database was utilized as the primary data source. Changes in the relative proportions for each cause‐of‐death over were evaluated using logistic regression. Results The proportions of deaths in epilepsy due to heart disease declined 34.4% (p < .001), a rate similar to the general population (39.9%). Epilepsy‐related deaths declined 25% as a percentage of all epilepsy deaths (p < .001). The proportions of deaths due to stroke and neoplasms increased significantly in epilepsy versus the US population (p < .001 linear trend). Conclusions The reduction in ischemic heart disease in epilepsy is a novel and highly significant finding, which reflects widespread implementation of cardiovascular risk‐factor reduction and treatment in the United States. Reductions in epilepsy‐related deaths are an exciting development which requires further investigation into causality. The increase in deaths due to neoplasms and stroke relative to the US population is concerning, warranting vigilance and increased efforts at recognition, prevention, and treatment.

Increasing epilepsy-related mortality: A multiple causes of death study in Northern Italy

“…In the case of epilepsy, the underestimation of its contribution to overall mortality is very large based on the underlying cause: during 2008-2019, the proportional mortality from epilepsy was 0.2%, compared to 1.1% based on multiple causes. In Northern Italy, the proportion of death certificates where epilepsy was selected as the underlying cause was as low as 17%, even lower than in England, 2001-2006 (48%) [2], in Northern Ireland, 2001-2015 (31%) [3], or in the US, 2018 (39%) [19].…”

“…In a total of 34 longitudinal cohort studies involving over 100,000 patients, the incidence rate of post stroke epilepsy was approximately 7% [21]. Advances in stroke treatment, including tissue plasminogen activator and endovascular treatment in the acute phase, have resulted in increased survival after stroke; therefore there might be an increasing number of stroke survivors who develop epilepsy [19]. Dementia of all types, but especially Alzheimer's disease, is a common cause of seizures in older age.…”

Long‐term outcome of convulsive status epilepticus: a 10‐year follow‐up

“…In both studies, there was an overall increase in neurological burden and other neurological disorders as the underlying cause of death. Considering SE specifically, its role as a contributing factor seemed to remain essentially the same during the study period [32]. Although the focus of these studies was epilepsy deaths in general rather than SE, some similarities can be identified.…”

“…In two recent studies [32,33], the authors reported that although epilepsy-related causes were still the leading causes of death, PWEs die increasingly more from other causes. In both studies, there was an overall increase in neurological burden and other neurological disorders as the underlying cause of death.…”

Increased cardiovascular risk in epilepsy

“…Age-adjusted mortality rates more than doubled from 5.6 per million in 2000 to 11.6 per million in 2017 ( p = 0.001) ( 3 ). Causes for the increase in epilepsy mortality are multifactorial and include increased reporting, increased prevalence and higher than expected rates of cardiovascular disease ( 3 , 4 ).…”