Abstracts

To evaluate the overall mortality and cause specific mortality in epilepsy patients in Tyrol, Austria as well as their risk factors. All pts with definite epilepsy (n=3334) treated at the seizure clinic Universitätsklinik für Neurologie, Innsbruck, Tyrol, Austria between 1970 and 2000 were included. 1530 of them were incident cases. Diagnosis was based on ILAE classification. Living or dead status was obtained from the Institut für Klinische Epidemiologie, TILAK using a specialized probabilistic record linkage. Pts. were followed until death or end of 2003. A total of 48.595 person-years were analyzed. Standardized mortality rates (SMRs ) were calculated by comparisons with those living in the same geographic area in Tyrol. Exact 95% confidene intervals were calcualted by assuming a poisson distribution, using stata [reg] statistical package. We observed 648 deaths compared to expexted 297.4 resulting in a overall SMR 2.2[2.0-2.4] after [gt]30 Years of follow-up. The highest mortality was found in the younger age groups (26-45yrs, SMR 6.8[3.8-11.2]) and in symptomatic epilepsies (3.1[2.3-4.9]) as compared to those with idiopathic (2.7[0.7-7.0]) or cryptogenic etiology (2.2[1.6-3.1]). Elevated SMR after 2 years follow-up were not related to any specific seizure type but was strongly increased in those with persistent seizures as compared to seizure free pts. (SMR 3.3[2.6-4.4] vs. 1.4[0.8-2.3], p[lt]0.0001). Pts of the cohort 1995-2000 had significantly lower mortality rates than those between 1985-1989 (1.8[1.1-2.9] vs. 4.7[3.3-6.4]). The most common causes of death were cerebrovascular diseases (26%), neoplasms excl. brain tumors (23%) and cardiovascular diseases (15%). The highest cause specific SMR were found for epielpsy (91.6[66.3-123.4]), brain tumors (22,7[15,7-31,8]), and external causes (2,4[1,8-3,3]). The mortality of pts with epilepsy in Tyrol is substantially increased. There is a strong relation to persistent seizure activity and excess mortality possibly amenable to prevention. A reduction of the SMR in the past decade indicats an improved health service in the province.