JLE

Epilepsies

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Death circumstances for the patient with epilepsy Volume 14, issue 1, Mars 2002

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49, Ch-Stratford, Hampstead, PQ, Canada H3X 3C6

Epilepsy is associated with excess mortality compared to the general population. The all cause standardised mortality ratio (SMR) for all subjects with epilepsy is about 2.5 but this global figure does not reflect significant differences in different populations of patients with epilepsy. The SMR is higher with intractable epilepsy of all types, and with symptomatic epilepsy especially when associated with mental retardation or cerebral palsy. It is also increased with early-onset or progressive encephalopathies, and with seizure onset in infancy or early childhood. Excess mortality declines with duration of the disease and is also lower in idiopathic epilepsies than in the epileptic population as a whole. Patients with epilepsy have an increased risk of accidental death particularly by drowning, concentrated in those with severe epilepsy and cognitive or developmental handicaps. Pneumonia and sudden unexplained death (SUDEP) are also more frequent in this group: seizure frequency is an important risk factor. Convulsive status epilepticus carries a mortality of up to approximately 20% for each episode. Successful epilepsy surgery (Engel class 1A/1B) leads to a marked reduction in excess mortality.