Abstracts

Rationale: Mortality in patients with epilepsy is reported to be considerably higher than in the general population. There are few data from developing countries, because incidence studies are difficult, death certificates are not very reliable, autopsies are also not easy to obtain, and the cause of death is not usually known with certainty. Comparison of epilepsy mortality data across countries would identify conditions that require regional specific treatment or medical attention.Methods: To assess the mortality of epilepsy in Latin America we conducted a systematic review and analysis of published studies. Studies were identified by searching MEDLINE, EMBASE and LILACS. We reviewed the literature published until April 2011. Articles in English, Spanish and Portuguese were reviewed.Results: We found 17 mortality studies from 9 different countries. Different study types and reference populations have been used. All Causes of Mortality: SMRs in community-based studies range from 1.34 to 2.45, a significant increased risk of death was found for patients with remote symptomatic epilepsy. Studies based on hospital or epilepsy center cohorts produced SMRs of 3.21 to 6.23. Studies obtained from death certificates in the general population revealed mortality rates ranging from 0.9/100000 to 4.6/100000 person-year. Epilepsy mortality rates have declined over time. Cause-specific Mortality: The SUDEP rate in one study of incidence cases was 2.6 per 1,000 patient-years. Chronic uncontrolled epilepsy was related to SUDEP in a cohort of children. In status epilepticus, the case fatality rates ranged from 2.4 to 19.8%; the most frequent etiologies of deaths were stroke and CNS infections, almost all affecting the group with no previous history of epilepsy. Conclusions: The existing studies suggest an increased risk of dying and a greater proportion of deaths in patients with epilepsy in Latin America. Prospective studies are needed in order to follow a large new-onset cohort with epilepsy for a defined length of time to determine the mortality.