Abstracts

Rationale: Mortality in pediatric epilepsy is up to nine times higher than the general population. Causes of death may be related to seizures (aspiration, status epilepticus, accidents or sudden unexplained death in epilepsy (SUDEP)) or due to an underlying neurodevelopmental disability (aspiration pneumonia, infection). Children with neurologic impairment and those with poorly controlled seizures are at highest risk. We previously reported mortality in a 10 year population-based cohort that was 0.79 per 1000 person years, lower than other studies. The aim of this study is to expand the population-based cohort to 25 years to determine the mortality rate, cause of death, and risk factors for mortality in children with epilepsy. Methods: The Medical Diagnostic Index of the Rochester Epidemiology Project was searched for all children diagnosed with epilepsy while residents of Olmsted County from 1980-2004. These records were reviewed to last follow-up to determine the proportion of children who died, as well as the cause of death. In addition, all charts were reviewed to determine the age of onset of epilepsy, the number of anti-seizure medications (AEDs) used, seizure control, epilepsy syndrome, and the presence and severity of neurologic impairment. Results: There were 12 deaths among 356 children diagnosed with epilepsy while residents of Olmsted County from 1980-2004, with a follow-up of 4366.4 person-years. While the overall mortality was 2.75 per 1000 person-years, the epilepsy-related mortality was only 0.46 per 1000 person-years. One child died of probable SUDEP, and the second as a result of aspiration during a seizure. The other children died of respiratory complications of their underlying neurologic impairment (N=8) or from progressive neurometabolic/neurodegenerative disease (N=2). Significant risk factors for death included cognitive impairment, abnormal neurologic exam, frequent seizures, intractable epilepsy, and symptomatic epilepsy (p<0.001). No child with normal cognition and neurologic exam died. Conclusions: In our population-based study, mortality in children with epilepsy was low, 2.75 per 1000 person-years. This is similar to reported population-based studies, but is 90 times higher than the previously reported mortality rates for the general pediatric population. Only 2 children died of seizure-related causes, while the others died of complications of their underlying neurologic disease. Although mortality in children with epilepsy is higher than the general population, this is mostly related to underlying neurodevelopmental disability, rather than epilepsy.