Mortality, and life expectancy in Epilepsy and Status epilepticus-current trends and future aspects

Abstract

Patients with epilepsy carry a risk of premature death which is on average two to three times higher than in the general population. The risk of death is not homogenously distributed over all ages, etiologies, and epilepsy syndromes. People with drug resistant seizures carry the highest risk of death compared to those who are seizure free, whose risk is similar as in the general population. Most of the increased risk is directly related to the cause of epilepsy itself. Sudden unexplained death in epilepsy patients (SUDEP) is the most important cause of epilepsy-related deaths especially in the young and middle-aged groups. Population based studies with long-term follow up demonstrated that the first years after diagnosis carry the highest risk of death, while in the later years the mortality decreases. Improved seizure control and being exposed to a specialized comprehensive care centre may help to reduce the risk of death in patients with epilepsy. The mortality of status epilepticus is substantially increased with case fatality rates between 4.6% and 39%, depending on its cause and duration, and the age of the population studied. The epidemiological data on overall and cause specific mortality as well as their determinants and risk factors are critically reviewed and methodological issues pertinent to the studies on mortality of epilepsy and Status epilepticus are discussed.

Keywords: case fatality; death rate; epilepsy; seizures; standardized mortality ratio.

Figure 1

The impact of burden model integrates the structural damage and metabolic derangement, the burden of status, the success of treatment, the burden of treatment, and the impact of these burdens in an individual patient [modified from Trinka and Leitinger, 2022 (127)].

Figure 2

Kaplan maier survival curves of 3,334 patients in tyrol, Austria, with more than 30 years observation; overall 48,595 person years. Seizure free patients have a significant better overall survival (log rank test χ = 80,3, p < 0.0001), [from Trinka, 2005 (79)].