A study indicates that mortality from epilepsy is increasing

Epilepsy is a global public health problem that requires an adequate response.

According to WHO reports, an estimated 50 to 69 million people suffer from epilepsy.

People with epilepsy (PWE) have a higher death rate than the general population. Epilepsy-related deaths have increased even though all-cause mortality has decreased in the general population prior to COVID-19. We hypothesize that clinical and lifestyle factors can identify people at higher risk.

Epilepsy is a global public health problem that requires an adequate response. It is a clinical condition with self-referral in up to 50% of cases. According to WHO reports, an estimated 50 to 69 million people suffer from this disease, the majority living in developing countries.

Many more people, however (an estimated 200,000,000), are also affected by this disorder, as it is the family members and friends who live with these patients. It can be asserted that epilepsy affects between 1-2% of the world population.

Two million new cases occur in the world each year. The annual incidence of crisis unprovoked epileptic conditions is 33-198 per 100,000 population / year, and the incidence of epilepsy is 23 to 190 per 100,000 population / year.

It is significant that around 45 million (65%) of people with epilepsy live in rural areas of countries classified as developing and of these, 17 million reside in urban areas. However, seven million patients (10%) live in countries considered developed. Everything this relates to the high incidence, prevalence and mortality of epilepsy in socioeconomic classes lower.

The global prevalence of active epilepsy (a person with epilepsy who has had at least one seizure in the previous 5 years, regardless of antiepileptic treatment), varies from 2.7 to 41 per 1,000 inhabitants, although in the majority reportedly the rate of active epilepsy is in the variation of 4-8 per 1 000 inhabitants.

This disease, in turn, can lead to death, a danger that is not always taken into account and could be preventable. It can reduce life expectancy by 10 years in patients with symptomatic epilepsy and by 2 years in those with idiomatic epilepsy.

International statistics show annual mortality rates of 2.1 per 100,000 inhabitants per year, varying from 1 to 8 in different countries. The causes of death from epilepsytherefore, they must be identified and actions taken, including treatment and education, to avoid preventable deaths.

Mortality associated with epilepsy can be related to the following categories:

– That caused directly by epileptic seizures. It is the most frequent and occurs due to complications in the course of status epilepticus prolonged, accidents being frequent, including drowning.

– That associated indirectly, or in part, with epilepsy, such as suicide and depression, which have an important role in the causes of premature mortality.

– The one that is due to other factors, for example, the causes of the disease or its complications.

– Exists an increased risk of death sudden unexplained epilepsy (SUDEP), with an estimated incidence of 1.8 per 1000 patients / year. This is the major cause of premature mortality in patients with epilepsy and even more so if it is difficult to control. The most important risk factor is the history of a generalized tonic-clonic crisis. The risk has been estimated 24 times higher in young people than in people of the same age.

– An increase in mortality in patients with intellectual disabilities has also been reported with the long-term use of antiepileptic drugs (AEDs) and in post-stroke epilepsy in young patients.

The study indicates that the results obtained add to the existing evidence that deaths from epilepsy are increasing. Future studies could focus on identifying high-risk PWEs and addressing them with clinical interventions or better self-management. Identifying specific risk factors for younger people should be a priority, as epilepsy can be a factor in nearly half of PWE deaths under 35 years of age.

Clinical implications

The need for better management of epilepsy is at the core of our findings. Several risk factors are linked within this topic, such as emergency department attendance, polypharmacy, absence of injuries, and seizures.

Visits to the ED or emergency admissions were associated with a three times higher risk of death, the highest risk in our model. Visits to emergency services are associated with injury, experiencing a seizure or a change in the normal presentation of a seizure, and having less confidence in self-care.

Therefore, attendance at the emergency department for epilepsy could be considered a surrogate marker for poorer control of epilepsy.

“The National Audit for the Management of Seizures in Hospitals, carried out during our study period in 2011 and 2013, found that 63% of the PWE that came to the emergency services for seizures had not been seen by a specialist in the previous year In addition, only half of the attendees were seen by an on-site neurologist or referred to one upon discharge. 34 These are missed opportunities to follow up on patients who may need a clinical review and help with self-care, to mitigate their increased risk of death “, refers the study presented.

Source consulted: Here

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