Epilepsy has been associated with a higher risk of premature death, but results among different studies vary depending on the population.
A recent nationwide population-based retrospective cohort study aimed to investigate the risk and causes of death in people with epilepsy (PWE), according to age, disease severity, disease course, comorbidities and socioeconomic status in Korea.
Data were derived from the National Health Insurance database in Korea linked with the national death register. Newly treated PWE were identified by antiseizure medication (ASM) prescriptions and diagnostic codes (2008 to 2016, observed until 2017).
Among 138,998 PWE, 20,095 deaths were observed (mean follow-up period about 5 years). Overall, standardized mortality ratio (SMR) was 2.25. In the monotherapy group, SMR was 1.56, while SMR in the group receiving >=4 ASMs was 4.93. In cases of no comorbidities, SMR was 1.61. SMR was higher in rural residents compared to urban residents (2.47 versus 2.03, respectively). The causes of death were cerebrovascular disease (18.9%, SMR 4.50), malignant neoplasms outside or inside the CNS (15.7%, SMR 1.37 and 6.7%, SMR 46.95, respectively), pneumonia (6.0%, SMR 2.08), and external causes (7.2%, SMR 2.17), including suicide (2.6%, SMR 2.07). Epilepsy itself including status epilepticus was responsible for 1.9% of the overall death.
In summary, epilepsy is associated with high mortality, even in those without comorbidities and those in monotherapy. Regional disparities and external causes of death suggest areas of intervention.
Active control of seizures, monitoring for suicidal ideation, education about injury prevention, and improvement of access to epilepsy care are necessary to reduce mortality.
Key Points:
• Epilepsy is associated with high mortality, even in those without comorbidities and those in monotherapy
• Standardized mortality ratio (SMR) was higher in rural residents compared to urban residents
• Causes of death were cerebrovascular disease, malignant neoplasms, pneumonia, and external causes, including suicide
• Active control of seizures, monitoring for suicidal ideation, education about injury prevention and improvement of access to epilepsy care are necessary to reduce mortality
References:
- Moon HJ, Lee H, Yoon D, Koo YS, Shin JY, Lee SY. Premature Mortality and Causes of Death Among People With Epilepsy: A Nationwide Population-Based Incident Cohort Study. Neurology. 2023 Mar 22:10.1212/WNL.0000000000207212. doi: 10.1212/WNL.0000000000207212. Epub ahead of print. PMID: 36948594.
Co-Author:
Melinda Magyari, Danish Multiple Sclerosis Centre, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
Dániel Bereczki, 1./ Department of Neurology, Semmelweis University, Budapest, Hungary 2./ MTA-SE Neuroepidemiological Research Group ELKH, Budapest, Hungary
Publish on behalf of the Scientific Panel on Neuroepidemiology