In:
Epilepsia, Wiley, Vol. 58, No. 1 ( 2017-01), p. 6-16
Abstract:
To determine the magnitude of risk factors and causes of premature mortality associated with epilepsy in low‐ and middle‐income countries ( LMIC s). We conducted a systematic search of the literature reporting mortality and epilepsy in the World Bank‐defined LMIC s. We assessed the quality of the studies based on representativeness; ascertainment of cases, diagnosis, and mortality; and extracted data on standardized mortality ratios ( SMR s) and mortality rates in people with epilepsy. We examined risk factors and causes of death. The annual mortality rate was estimated at 19.8 (range 9.7–45.1) deaths per 1,000 people with epilepsy with a weighted median SMR of 2.6 (range 1.3–7.2) among higher‐quality population‐based studies. Clinical cohort studies yielded 7.1 (range 1.6–25.1) deaths per 1,000 people. The weighted median SMR s were 5.0 in male and 4.5 in female patients; relatively higher SMR s within studies were measured in children and adolescents, those with symptomatic epilepsies, and those reporting less adherence to treatment. The main causes of death in people with epilepsy living in LMIC s include those directly attributable to epilepsy, which yield a mean proportional mortality ratio ( PMR ) of 27.3% (range 5–75.5%) derived from population‐based studies. These direct causes comprise status epilepticus, with reported PMR s ranging from 5 to 56.6%, and sudden unexpected death in epilepsy (SUDEP), with reported PMR s ranging from 1 to 18.9%. Important causes of mortality indirectly related to epilepsy include drowning, head injury, and burns. Epilepsy in LMIC s has a significantly greater premature mortality, as in high‐income countries, but in LMIC s the excess mortality is more likely to be associated with causes attributable to lack of access to medical facilities such as status epilepticus, and preventable causes such as drowning, head injuries, and burns. This excess premature mortality could be substantially reduced with education about the risk of death and improved access to treatments, including AED s.
Type of Medium:
Online Resource
ISSN:
0013-9580
,
1528-1167
DOI:
10.1111/epi.2017.58.issue-1
Language:
English
Publisher:
Wiley
Publication Date:
2017
detail.hit.zdb_id:
2002194-X
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