Epilepsy-related and other causes of mortality in people with epilepsy: A systematic review of systematic reviews

Gashirai K Mbizvo; Kyle Bennett; Colin R Simpson; Susan E Duncan; Richard F M Chin

doi:10.1016/j.eplepsyres.2019.106192

Epilepsy-related and other causes of mortality in people with epilepsy: A systematic review of systematic reviews

Epilepsy Res. 2019 Nov:157:106192. doi: 10.1016/j.eplepsyres.2019.106192. Epub 2019 Aug 27.

Authors

Gashirai K Mbizvo¹, Kyle Bennett², Colin R Simpson³, Susan E Duncan⁴, Richard F M Chin⁵

Affiliations

¹ Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK; Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK. Electronic address: gashirai.mbizvo@ed.ac.uk.
² Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK. Electronic address: s1103639@sms.ed.ac.uk.
³ Faculty of Health, Victoria University of Wellington, Wellington, New Zealand; Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK. Electronic address: c.simpson@ed.ac.uk.
⁴ Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK; Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK. Electronic address: susan.duncan@ed.ac.uk.
⁵ Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK; Royal Hospital for Sick Children, Edinburgh, UK. Electronic address: rchin@exseed.ed.ac.uk.

PMID: 31526975
DOI: 10.1016/j.eplepsyres.2019.106192

Abstract

Background: This systematic review of epilepsy mortality systematic reviews evaluates comparative risks, causes, and risk factors for all-cause mortality in people with epilepsy (PWE) to specifically establish the burden of epilepsy-related deaths.

Methods: MEDLINE and Embase were searched from conception to 26/12/2018 for systematic reviews evaluating all-cause mortality in PWE of any age. Independent study selection, data extraction and quality assessment were performed. Deaths were separated into epilepsy-related and unrelated using a recently published classification system. Outcomes included standardized mortality ratio (SMR) and mortality rate (MR) in a primary analysis of comparative risks, causes, and risk factors for all-cause and epilepsy-related mortality. A narrative synthesis of review findings was used to present results, including from a secondary analysis of individual epilepsy-related death risk factors.

Results: Six moderate or high-quality systematic reviews were included in the primary analysis, evaluating 103 observational studies. All-cause mortality remained similarly high between 1950 and present (median SMR range 2.2-3.4). Africa had the highest SMR (median 5.4, range 2.6-7.2). SMRs were also higher for children <18 years (median 7.5, range 3.1-22.4) than adults (median 2.6, range 1.3-8.7), and for epilepsy-related (median 3.8, range 0.0-82.4,) than unrelated causes (median 1.7, range 0.7-17.6). Structural brain disease conferred the greatest risk for all-cause mortality (SMR range 24.0-41.5). Common epilepsy-related causes included alcohol, drowning, pneumonia, and suicide. In secondary analysis of nine additional systematic reviews, epilepsy-related death risk factors were reported for sudden unexpected death in epilepsy (SUDEP), drowning and suicide.

Conclusions: Premature all-cause mortality remains a major problem in PWE globally, particularly in children and young adults, with most being epilepsy-related and potentially preventable. SUDEP is only one of several other common and important epilepsy-related causes of death.

Keywords: Case-control study; Cohort study; Death; Overview of reviews; SUDEP; Seizures.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Cause of Death
Death, Sudden / etiology*
Epilepsy / complications*
Humans