Epilepsy-related causes of mortality in people with epilepsy: a systematic review of systematic reviews. Issue 6 (27th May 2022)

• Record Type: Journal Article
• Authors: Mbizvo, Gashirai K; Bennett, Kyle; Simpson, Colin R; Duncan, Susan E; Chin, Richard FM
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 93:Issue 6(2022)
• Page Start: A9
• Page End: A9
• Publication Date: 2022-05-27
• Subjects: Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2022-ABN.26
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Purpose: 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. Method: MEDLINE and Embase were searched from conception to 26/12/2018 for systematic reviews evaluating all-cause mortality in PWE of any age. Two authors performed independent study selection, data extraction and quality assessment. Deaths were separated into epilepsy-related and unrelated using a recently published classification system. Outcomes included standardised 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. Results: Six moderate- or high-quality systematic reviews were included, 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 death causes included SUDEP, alcohol, drowning, pneumonia, and suicide. Conclusion: 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. [e-mail]