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Childhood-Onset Epilepsy Tied to Much Higher Death Risk

Study finds increased risk of death associated with the absence of five-year terminal remission

THURSDAY, Dec. 23 (HealthDay News) -- Childhood-onset epilepsy is associated with a substantially increased risk of epilepsy-related death, including sudden, unexplained death, especially among those not in five-year terminal remission, according to a study published in the Dec. 23 issue of the New England Journal of Medicine.

Matti Sillanpää, M.D., Ph.D., of the Turku University Hospital in Finland, and Shlomo Shinnar, M.D., Ph.D., of the Albert Einstein College of Medicine in Bronx, N.Y., evaluated seizure outcomes and mortality in a population-based cohort of 245 children diagnosed with epilepsy in 1964 and prospectively followed for 40 years.

The investigators found that 24 percent of participants died, which was three times as high as the expected age- and sex-adjusted mortality in the general population. The participants who died included 48 percent of those who were not at least five years seizure-free at the time of death or last follow-up. Compared with an idiopathic or cryptogenic cause of epilepsy, a remote symptomatic cause of epilepsy was associated with an elevated risk of death (37 versus 12 percent). The investigators also found 55 percent of deaths were attributed to epilepsy, including sudden, unexplained death in 30 percent of subjects; definite or probable seizure in 15 percent; and accidental drowning in 10 percent. While there were no sudden, unexplained deaths in participants younger than 14 years of age with idiopathic or cryptogenic epilepsy, the cumulative risk of sudden, unexplained death was 7 percent at 40 years overall and 12 percent in an analysis limited to participants who were not in long-term remission and not receiving medication.

"The most important risk factor for death from any cause as well as for epilepsy-related death specifically was the absence of five-year terminal remission," the authors write.

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