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Mortality increased in adults with childhood epilepsy

Clinical Question:
What is the long-term prognosis for children with epilepsy?

Bottom Line:
People with childhood epilepsy who do not go into remission are at an increased risk of sudden unexplained death and all-cause death, especially if the epilepsy is secondary to a serious neurologic insult. (LOE = 2b)

Reference:
Sillanpää M, Shinnar S. Long-term mortality in childhood-onset epilepsy. N Engl J Med 2010;363:2522-2529.  [PMID:21175314]

Study Design:
Cohort (prospective)

Funding:
Government

Setting:
Population-based

Synopsis:
The longest previous studies of childhood epilepsy have been limited to 10 years. In this Finnish study, children diagnosed with epilepsy by the end of 1964 were followed up for up to 40 years. All patients had suffered at least 2 unprovoked seizures; children with febrile seizure or a single seizure were excluded. All participants (N =245) were evaluated every 5 years; only 5 participants who had emigrated were lost to follow-up. The cause of death was either clinically obvious (eg, aggressive cancer) or was established by autopsy in most other cases. Of 60 deaths, most were related to epilepsy and included witnessed seizure, probable seizure, or status epilepticus (n = 14), drowning (n = 6), or unexplained sudden death (n = 18). The likelihood of death was 6.9 per 1000 patient years, corresponding to a standardized mortality ratio approximately 6 times higher than that expected for an age-adjusted and sex-adjusted comparison group without epilepsy. The rate was particularly high among those patients with epilepsy caused by a remote, major neurologic abnormality. Risk was only increased in patients who were not in remission for at least 5 years.

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