Childhood epilepsy that lasts into adulthood triples mortality

Finnish study over 40 years shows added risk occurs in patients whose seizures persist

Epilepsy that strikes in childhood and lingers into adulthood triples an individual’s risk of dying, researchers find. But children who “outgrow” epilepsy and see their seizures fade as adults don’t have this added mortality risk, researchers report in the Dec. 23 New England Journal of Medicine.

EPILEPSY BREAKDOWN During a 40-year study of 245 epilepsy patients in Finland, 60 died. Causes of these deaths are shown; non-epilepsy deaths were mainly due to pneumonia and heart disease. NEJM

The findings, from a 40-year study in Finland, provide a long-term look that doctors can use as they puzzle over whether to recommend surgery for patients or continue with medication, says neurologist David Ficker of the University of Cincinnati, who wasn’t involved in the study. “We probably should be treating epilepsy aggressively in people who aren’t seizure-free,” he says.

Doctors tracked the fate of 245 children diagnosed with epilepsy in the early 1960s. Half of the patients had epilepsy stemming from no clear cause and were neurologically normal, apart from having seizures. The other half had a clear epilepsy trigger, such as severe head trauma, brain injury from meningitis or encephalitis, or other brain damage that was identifiable on scans such as magnetic resonance imaging.

All the patients got checkups every five years until 2002. By then, 60 had died, a rate three times the average for people in Finland of comparable age, ranging up to 54 years. Of those 60 deaths, 51 occurred in the 107 patients who were still having seizures. Only five occurred in the 35 who had been in remission for five years or more with the help of medication, and four deaths occurred in the 103 people whose seizures had been in remission for that long without medication. Overall, 33 deaths were tied to epilepsy. The other deaths were mainly due to pneumonia and heart disease.

“The cumulative risk is quite high among the seizure-related groups,” says neurologist Shlomo Shinnar of the Albert Einstein College of Medicine and the Montefiore Medical Center in New York City who teamed with physician Matti Sillanpää of the University of Turku in Finland on the study. It’s less clear whether people taking medication to suppress seizures are still at an increased risk of death. “Quite possibly, in fact, they are,” he says.  “But those who outgrow seizures and are off meds don’t appear to be at [extra] risk.”

Surgery for epilepsy has been shown to outperform medication and help some patients dramatically (SN: 8/4/01, p. 69), and recent refinements have made surgery an option for more people (SN: 9/8/07, p. 158). But even with these advances many doctors believe surgery remains underused (SN: 7/9/05, p. 30).

“There’s a perception out in the medical community,” Ficker says, “that surgery is a highly aggressive and risky procedure. But in many cases, it may offer the patient a great chance to be seizure-free.”

Previous studies have shown that rates of unexplained deaths in patients with epilepsy decrease in patients if surgery ends their seizures, “suggesting that the risk is potentially modifiable,” the authors note.

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