NDLI: Long-term mortality in childhood-onset epilepsy.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Shinnar, Shlomo Sillanpää, Matti
Spatial Coverage	Finland
Description	Author Affiliation: Sillanpää M ( Department of Pediatric Neurology, University of Turku and Turku University Hospital, Turku, Finland.)
Abstract	BACKGROUND: There are few studies on long-term mortality in prospectively followed, well-characterized cohorts of children with epilepsy. We report on long-term mortality in a Finnish cohort of subjects with a diagnosis of epilepsy in childhood. METHODS: We assessed seizure outcomes and mortality in a population-based cohort of 245 children with a diagnosis of epilepsy in 1964; this cohort was prospectively followed for 40 years. Rates of sudden, unexplained death were estimated. The very high autopsy rate in the cohort allowed for a specific diagnosis in almost all subjects. RESULTS: Sixty subjects died (24%); this rate is three times as high as the expected age- and sex-adjusted mortality in the general population. The subjects who died included 51 of 107 subjects (48%) who were not in 5-year terminal remission (i.e., ≥5 years seizure-free at the time of death or last follow-up). A remote symptomatic cause of epilepsy (i.e., a major neurologic impairment or insult) was also associated with an increased risk of death as compared with an idiopathic or cryptogenic cause (37% vs. 12%, P<0.001). Of the 60 deaths, 33 (55%) were related to epilepsy, including sudden, unexplained death in 18 subjects (30%), definite or probable seizure in 9 (15%), and accidental drowning in 6 (10%). The deaths that were not related to epilepsy occurred primarily in subjects with remote symptomatic epilepsy. The cumulative risk of sudden, unexplained death was 7% at 40 years overall and 12% in an analysis that was limited to subjects who were not in long-term remission and not receiving medication. Among subjects with idiopathic or cryptogenic epilepsy, there were no sudden, unexplained deaths in subjects younger than 14 years of age. CONCLUSIONS: Childhood-onset epilepsy was associated with a substantial risk of epilepsy-related death, including sudden, unexplained death. The risk was especially high among children who were not in remission. (Funded by the Finnish Epilepsy Research Foundation.).
ISSN	00284793
Issue Number	26
Volume Number	363
e-ISSN	15334406
Journal	New England Journal of Medicine
Language	English
Publisher	Massachusetts Medical Society (United States)
Publisher Date	2010-12-23
Publisher Place	United States
Access Restriction	Subscribed
Subject Keyword	Cause Of Death Death, Sudden Epidemiology Epilepsy Mortality Adolescent Adult Age Of Onset Child Child, Preschool Cohort Studies Etiology Complications Female Finland Humans Infant Male Middle Aged Risk Factors Young Adult Journal Article Research Support, Non-U.S. Gov't Medicine
Content Type	Text
Resource Type	Article
Subject	Medicine

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