Abstract
The risk of death is increased for persons with epilepsy. The literature on causes of death in epilepsy is based mainly on cohorts with epilepsy of mixed aetiologies. For clinical purposes and improved understanding of mortality in different epilepsies, more information is needed on mortality in epilepsies of specific causes. In poststroke epilepsy (PSE), seizures occur in a setting of vascular disease and high mortality rates. The extent to which epilepsy contributes to mortality in this patient group is poorly understood. We therefore aimed to describe causes of death (COD) in PSE on a national scale. A previously identified cohort of 7740 patients with epilepsy or seizures after a stroke in 2005–2010 was investigated. A total of 4167 deaths occurred before the end of 2014. The standardized mortality ratio for the study cohort was 3.56 (95% CI: 3.45–3.67). The main underlying causes of death were disorders of the circulatory system (60%) followed by neoplasms (12%). Diseases of the nervous system were the sixth leading underlying COD (3%), and epilepsy or status epilepticus was considered the underlying COD in approximately a similar proportion of cases as neurodegenerative disorders (0.9% and 1.1%, respectively). Epilepsy was considered a contributing COD in 14% of cases. Our findings highlight the importance of optimal management of vascular morbidity in patients with PSE. The large proportion of patients with epilepsy as a contributing COD indicate the need of high ambitions also regarding the management of seizures in patients with PSE.
Highlights
Persons with epilepsy have an increased risk of death compared to the standard population; previous work has demonstrated that the standardized mortality ratio (SMR) for patients with epilepsy in general is 1.5–3 [1, 2]
A total of 4167 deaths occurred until the end of 2014, resulting in a SMR of 3.56
International Classification of Disease (ICD)-10 codes for Alzheimers disease, vascular dementia, dementia in other diseases, and unspecified dementia (F00-F03) accounted for 96% of this category (5.5%, 95% CI: 4.8–6.2)
Summary
Persons with epilepsy have an increased risk of death compared to the standard population; previous work has demonstrated that the standardized mortality ratio (SMR) for patients with epilepsy in general is 1.5–3 [1, 2]. The cause of death (COD) is often linked to the underlying aetiology of epilepsy, and more so if death occurs within the first few years of the epilepsy diagnosis [3]. The current literature is most often based on relatively small cohorts with rather few deaths occurring in each aetiological category [3,4,5,6,7]. Exceptions exist, but the focus of these larger studies was mortality associated with epilepsy in general [8, 9].
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