Onset of epilepsy during childhood triples the long term mortality risk
, suggests a recently published study in a medical journal. Epilepsy is a condition characterised by recurrent seizures. It is perhaps the second most common chronic neurological condition seen by neurologists. Three to five per cent of the population have a seizure at some stage in their life.
The risk for death related to epilepsy remains unclear. Patients with uncontrolled seizures are supposed to suffer a high mortality rate. Seizures controlled by medication or surgery apparently do not increase the long term risk of death.
Long-term follow-up of children with epilepsy has shed light on the factors related to increased mortality. A large population-based cohort study of 245 patients who had onset of epilepsy during childhood was conducted to assess the mortality and associated risk factors. This study group was tracked for a median of 40 years. The study revealed that epilepsy-related mortality is higher than originally estimated. Of 60 deaths 33 deaths (55%) were related to epilepsy, and 18 of these were sudden unexplained death in epilepsy (SUDEP). SUDEP is the sudden, unexpected death of someone with epilepsy, but who was otherwise healthy, and for whom no other cause of death can be found. 85% deaths occurred in patients who were not seizure-free (defined as 5-year terminal remission).
The study has also given facts worth a smile. 'More than half of the children with epilepsy will outgrow it, and those people are not at risk for SUDEP,' studies reveal. The results were published in the New England Journal of Medicine.
It is now obvious that we really need to look into this disease more seriously. The study raises the question of how aggressive epilepsy treatment should be. A risk-benefit assessment of epilepsy surgery should be done for individual patients. In cases where the mortality risk is so high it might be better to perform a surgery irrespective of the operative risk, even if the patient may not become seizure free following the operation. The current study thus makes us ponder about the kind of vigour that we attach to treating seizures. Those seizures that can be curbed by timely medications or surgeries do not increase the long term mortality.
The findings underline the need for neurologists to introduce the difficult reality to their patients. In addition to the advices regarding lifelong medication and risks for child-bearing, the risk of death should also be explained. People should be motivated to comply with their medications and try as hard as they can to get seizures under control.
Reference: The New England Journal of Medicine