TY - JOUR
T1 - Epilepsy-related and other causes of mortality in people with epilepsy: a systematic review of systematic reviews
AU - Mbizvo, Gashirai
AU - Bennett, Kyle
AU - Simpson, Colin R
AU - Duncan, Susan
AU - Chin, Richard
PY - 2019/11
Y1 - 2019/11
N2 - 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 individual epilepsy-related death risk
factors.
Results: Six moderate/high-quality systematic reviews were included in the primary analysis, evaluating 103
observational studies. All-cause mortality remained similarly high between 1950–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, 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.
AB - 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 individual epilepsy-related death risk
factors.
Results: Six moderate/high-quality systematic reviews were included in the primary analysis, evaluating 103
observational studies. All-cause mortality remained similarly high between 1950–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, 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.
U2 - 10.1016/j.eplepsyres.2019.106192
DO - 10.1016/j.eplepsyres.2019.106192
M3 - Review article
SN - 0920-1211
VL - 157
JO - Epilepsy research
JF - Epilepsy research
ER -