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Neurology. 2014 Feb 18;82(7):582-9. doi: 10.1212/WNL.0000000000000123. Epub 2014 Jan 17.

Premature mortality in active convulsive epilepsy in rural Kenya: causes and associated factors.

Author information

  • 1From the KEMRI/Wellcome Trust Research Programme (A.K.N., G.F., E.C., R.O., E.B., C.R.N.), Centre for Geographic Medicine Research-Coast, Kilifi, Kenya; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health (A.K.N., C.B., I.K.), London School of Hygiene and Tropical Medicine, United Kingdom; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.N., E.B., C.R.N.), Accra, Ghana; Research Support Unit, Faculty of Health Sciences (A.K.N.), Aga Khan University (East Africa), Nairobi, Kenya; MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health (C.B., I.K.), London School of Hygiene and Tropical Medicine, United Kingdom; Nuffield Department of Medicine (G.F.), Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, United Kingdom; Neurosciences Unit (B.N., C.R.N.), UCL Institute of Child Health, London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy (J.W.S.), UCL Institute of Neurology, London, United Kingdom; Epilepsy Society (J.W.S.), Chalfont St Peter, United Kingdom; SEIN - Stichting Epilepsie Instellingen Nederland (J.W.S.), Heemstede, the Netherlands; Clinical Research Unit (C.R.N.), London School of Hygiene and Tropical Medicine, United Kingdom; and Department of Psychiatry (C.R.N.), University of Oxford, United Kingdom.

Abstract

OBJECTIVE:

We estimated premature mortality and identified causes of death and associated factors in people with active convulsive epilepsy (ACE) in rural Kenya.

METHODS:

In this prospective population-based study, people with ACE were identified in a cross-sectional survey and followed up regularly for 3 years, during which information on deaths and associated factors was collected. We used a validated verbal autopsy tool to establish putative causes of death. Age-specific rate ratios and standardized mortality ratios were estimated. Poisson regression was used to identify mortality risk factors.

RESULTS:

There were 61 deaths among 754 people with ACE, yielding a rate of 33.3/1,000 persons/year. Overall standardized mortality ratio was 6.5. Mortality was higher across all ACE age groups. Nonadherence to antiepileptic drugs (adjusted rate ratio [aRR] 3.37), cognitive impairment (aRR 4.55), and age (50+ years) (rate ratio 4.56) were risk factors for premature mortality. Most deaths (56%) were directly related to epilepsy, with prolonged seizures/possible status epilepticus (38%) most frequently associated with death; some of these may have been due to sudden unexpected death in epilepsy (SUDEP). Possible SUDEP was the likely cause in another 7%.

CONCLUSION:

Mortality in people with ACE was more than 6-fold greater than expected. This may be reduced by improving treatment adherence and prompt management of prolonged seizures and supporting those with cognitive impairment.

PMID:
24443454
[PubMed - indexed for MEDLINE]
PMCID:
PMC3963418
Free PMC Article
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