Childhood epilepsy that lasts into adulthood triples mortality

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 New England Journal of Medicine.
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 at the University of Cincinnati,
David Ficker, 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.”
“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.