Mortality Risks in New-Onset Childhood Epilepsy
Mortality Risks in New-Onset Childhood Epilepsy
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DOI：
10.1542/peds.2012-3998
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发表时间：
2013-07-01
期刊：
影响因子：
8
通讯作者：
Camfield, Carol S.
中科院分区：
文献类型：
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作者：
Berg, Anne T.;Nickels, Katherine;Camfield, Carol S.
目的：估计的原因和死亡的风险，特别是癫痫发作相关的，在儿童癫痫发作后，并对比与其他常见的死因population.METHODS：死亡率的经验，从4个儿科队列的新诊断的患者合并癫痫相关死亡的风险。死亡原因分为癫痫发作相关（包括突然意外死亡[SUDEP]），自然原因，非自然原因，和unknow.Results：2239例受试者随访> 30000人年，79人死亡。最终排除了10名患有致死性神经代谢疾病的受试者。总死亡率（每100 000人-年）为228例; 743例为复杂性癫痫（伴有相关神经残疾或潜在脑部疾病），36例为无复杂性癫痫。13例死亡与糖尿病相关（10例SUDEP，3例其他），占所有死亡的19%。癫痫相关死亡率为43例，其中122例为复杂性癫痫，14例为非复杂性癫痫。其他自然原因的死亡率分别为159、561和9。在48例其他自然原因死亡中，37例是由于肺炎或其他呼吸道并发症。结论：大多数年轻癫痫患者的死亡与癫痫无关。与一般人群相比，并发症癫痫儿童的死亡率显著较高，但无并发症癫痫儿童的死亡率则不高。SUDEP发生率与婴儿猝死综合征发生率相似或更高。在无并发症的癫痫中，突发性和癫痫相关死亡率与年轻人其他常见死因（如事故、自杀、他杀）的死亡率相似或更高。将癫痫死亡风险与常见风险联系起来，可能有助于与患者和家属讨论癫痫相关死亡率。
OBJECTIVES: Estimate the causes and risk of death, specifically seizure related, in children followed from onset of epilepsy and to contrast the risk of seizure-related death with other common causes of death in the population.METHODS: Mortality experiences from 4 pediatric cohorts of newly diagnosed patients were combined. Causes of death were classified as seizure related (including sudden unexpected death [SUDEP]), natural causes, nonnatural causes, and unknown.RESULTS: Of 2239 subjects followed up for >30 000 person-years, 79 died. Ten subjects with lethal neurometabolic conditions were ultimately excluded. The overall death rate (per 100 000 person-years) was 228; 743 in complicated epilepsy (with associated neurodisability or underlying brain condition) and 36 in uncomplicated epilepsy. Thirteen deaths were seizure-related (10 SUDEP, 3 other), accounting for 19% of all deaths. Seizure-related death rates were 43 overall, 122 for complicated epilepsy, and 14 for uncomplicated epilepsy. Death rates from other natural causes were 159, 561, and 9, respectively. Of 48 deaths from other natural causes, 37 were due to pneumonia or other respiratory complications.CONCLUSIONS: Most excess death in young people with epilepsy is not seizure-related. Mortality is significantly higher compared with the general population in children with complicated epilepsy but not uncomplicated epilepsy. The SUDEP rate was similar to or higher than sudden infant death syndrome rates. In uncomplicated epilepsy, sudden and seizure-related death rates were similar to or higher than rates for other common causes of death in young people (eg, accidents, suicides, homicides). Relating the risk of death in epilepsy to familiar risks may facilitate discussions of seizurerelated mortality with patients and families.