Abstracts

Rationale: Epilepsy is a common pediatric neurologic disorder. Mortality in epilepsy is higher than the general population. Causes of death include aspiration, asphyxia, status epilepticus, accidents, and sudden unexplained death in epilepsy (SUDEP). Children with neurologic impairment and those with poorly controlled seizures have been reported to have a significantly higher rate of death. Current studies demonstrate widely variable data regarding mortality in pediatric epilepsy, from 3.8% to18%. Deaths in children due to SUDEP were rare. Therefore, the aim of this study is to determine the risk of mortality and SUDEP in a population-based cohort of children with epilepsy. Methods: The Medical Diagnostic Index of the Rochester Epidemiology Project was searched for all children diagnosed with epilepsy from 1990-2000. Records of all children ages 1 month-16 years who were diagnosed with new-onset epilepsy while resident of Olmsted County, MN from 1990-2000 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 of neurologic impairment. Results: Of the 159 children diagnosed with epilepsy while residents of Olmsted County from 1990-2000, only 2 (1.3%) died. This was 0.79 per 1000 person-years. Neither of these deaths was due to SUDEP. One of the deaths was seizure-related, one was not. The seizure-related death occurred in the setting of seizure recurrence following AED withdrawal, but AEDs had been initiated prior to the time of death. The seizure control in both of these patients was poor, having seizures at least once per week. In addition, both had symptomatic epilepsy with neurologic impairment. Conclusions: In this population-based study, mortality in children with epilepsy in the study was very low, 0.79 per 1000 person-years. This is lower than previously reported population-based studies. However, when compared to a study of mortality in children age 1-19 years, this mortality rate is 40 times higher than the general population. Furthermore, both children had poorly-controlled, symptomatic epilepsy, as well as neurologic impairment. Children with neurologic impairment have significantly higher mortality rates than the general population, proportional to the severity of impairment. Previous studies have demonstrated five-year survival rates for children with cerebral palsy ranged from 73-100%. Therefore, the percentage of children who died in this study was not higher than would be expected for their degree of neurologic impairment. Furthermore, neither of the deaths was related to SUDEP, supporting the rarity of SUDEP in children seen in previous studies. Thus, mortality in children with epilepsy is higher than the general population, but this may be related to their co-morbidities.