Epilepsy-related mortality is low in children: a 30-year population-based study in Olmsted County, MN
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Researchers at the Mayo Clinic conducted a study of epilepsy-related mortality and sudden unexplained death in epilepsy (SUDEP) in a 30-year population-based cohort of children with epilepsy. The Medical Diagnostic Index of the Rochester Epidemiology Project was searched for all codes related to seizure and convulsion in children ≤17 years old living in Olmsted County, MN from 1980 through 2009. Medical records of the identified children were reviewed and those with new-onset epilepsy were included in the analyses. Data on potential risk factors such as seizure type and control, epilepsy syndrome, epilepsy outcome, and presence and severity of neurologic impairment were abstracted. If children were noted to have died, the cause of death and autopsy information were abstracted from the medical record. Children were followed for a median of 7.87 years after time of diagnosis (range 0.04-29.49 years).

A total of 467 children with new-onset epilepsy were identified; 16 (3.4%) died during the study period for a death rate of 3.51 deaths per 1,000 person-years. Two deaths were epilepsy-related, for a rate of 0.44 per 1,000 person-years. One of the 2 deaths was probably SUDEP and the other from aspiration during a seizure. The remaining 14 deaths (87.5%) were not epilepsy-related, but caused by complications of underlying neurologic or unrelated disease. Mortality risk factors included abnormal cognition, abnormal neurologic examination, structural/metabolic etiology of epilepsy, and poor seizure control. Epilepsy-related mortality was similar to expected mortality in the general population (observed deaths = 2, expected deaths = 1.77; P = .86).

The authors conclude that epilepsy-related death, including SUDEP, was rare and was more frequent in children with neurologic impairment and poorly controlled epilepsy.

The overall mortality in children with epilepsy in this study, 3.5 per 1,000 person-years, is higher than expected in the Olmsted County study population (1.77/1,000 person-years) and 10 times the national mortality rate for children (0.32/1,000 person-years). Although the mortality rate due to epilepsy alone was not greater than the expected mortality in general, several risk factors were identified that might increase the mortality risk in individual patients with epilepsy. The authors correctly conclude that parents may be reassured of the low risk of seizure-related mortality but they should be counseled that factors related to underlying neurologic disease might present an added risk.

In the treatment of epilepsy, the emphasis on the use of antiepileptic medications as well as general precautions and advice to the family regarding the immediate management of the child to prevent injury and respiratory arrest must not be neglected. In a case-control study of SUDEP, the risk was increased with a history of generalized tonic-clonic seizures in the previous 3 months. Supervision at night was found to be protective when a supervising individual shared the same bedroom or when a listening device...

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