Mortality, and life expectancy in Epilepsy and Status epilepticus—current trends and future aspects

Abstract

Patients with epilepsy carry a risk of premature death which is on average two to three times higher than in the general population. The risk of death is not homogenously distributed over all ages, etiologies, and epilepsy syndromes. People with drug resistant seizures carry the highest risk of death compared to those who are seizure free, whose risk is similar as in the general population. Most of the increased risk is directly related to the cause of epilepsy itself. Sudden unexplained death in epilepsy patients (SUDEP) is the most important cause of epilepsy-related deaths especially in the young and middle-aged groups. Population based studies with long-term follow up demonstrated that the first years after diagnosis carry the highest risk of death, while in the later years the mortality decreases. Improved seizure control and being exposed to a specialized comprehensive care centre may help to reduce the risk of death in patients with epilepsy. The mortality of status epilepticus is substantially increased with case fatality rates between 4.6% and 39%, depending on its cause and duration, and the age of the population studied. The epidemiological data on overall and cause specific mortality as well as their determinants and risk factors are critically reviewed and methodological issues pertinent to the studies on mortality of epilepsy and Status epilepticus are discussed.

Staged treatment response in status epilepticus: Lessons from the SENSE registry

“…3,4 A patient not responding to first-and second-line treatment is considered to have refractory SE (RSE), and therapeutic coma induction with general anesthesia (GA) should be considered, especially in generalized convulsive SE (GCSE). 5,6 SE of longer duration is associated with increased mortality and neurological morbidity [6][7][8][9][10] ; in addition, experimental and clinical observations suggest that it becomes progressively less responsive to therapy. 11,12 Various studies in human epilepsy have shown that the chance of becoming seizure-free decreases substantially after each unsuccessful ASM attempt.…”

Diagnosing nonconvulsive status epilepticus: Defining electroencephalographic and clinical response to diagnostic intravenous antiseizure medication trials

“…Population‐based studies on status epilepticus (SE) revealed a case fatality of up to 39% at 30 days 1–3 . Nonconvulsive SE (NCSE) with coma is associated with the worst outcome 4 .…”

“…Population-based studies on status epilepticus (SE) revealed a case fatality of up to 39% at 30 days. [1][2][3] Nonconvulsive SE (NCSE) with coma is associated with the worst outcome. 4 The Salzburg criteria for diagnosis of NCSE include several criteria to establish the diagnosis of NCSE.…”

Impact of noscapine on halting the progression of pentylenetetrazole induced kindling epilepsy in mice

“…Epilepsy is the most pervading neurological disorder arising from the imbalance between excitation and inhibition, characterized by the reoccurrence of seizures and motor, psychomotor and sensory impairments 1 . According to the World Health Organization (WHO), every year, ~50 million people are diagnosed with epilepsy, out of which 125,000 patients die yearly 2 . The imbalance between gamma amino butyric acid (GABA) and glutamate activity is the most known cause of epilepsy; still, other pathologies linked with the disease progression include oxidative stress, mitochondrial dysfunction, neuroinflammation, autophagy and apoptosis 3 .…”

“…1 According to the World Health Organization (WHO), every year, 50 million people are diagnosed with epilepsy, out of which 125,000 patients die yearly. 2 The imbalance between gamma amino butyric acid (GABA) and glutamate activity is the most known cause of epilepsy; still, other pathologies linked with the disease progression include oxidative stress, mitochondrial dysfunction, neuroinflammation, autophagy and apoptosis. 3 Although the exact cause of epilepsy is still debatable, glutamate excitotoxicity is considered more prominent.…”