Full-Length Original Research
Epilepsy and risk of death and sudden unexpected death in the young: A nationwide study
Article first published online: 29 JUL 2013
Wiley Periodicals, Inc. © 2013 International League Against Epilepsy
Volume 54, Issue 9, pages 1613–1620, September 2013
How to Cite
Holst, A. G., Winkel, B. G., Risgaard, B., Nielsen, J. B., Rasmussen, P. V., Haunsø, S., Sabers, A., Uldall, P. and Tfelt-Hansen, J. (2013), Epilepsy and risk of death and sudden unexpected death in the young: A nationwide study. Epilepsia, 54: 1613–1620. doi: 10.1111/epi.12328
- Issue published online: 6 SEP 2013
- Article first published online: 29 JUL 2013
- Manuscript Accepted: 24 JUN 2013
- The Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC)
- John and Birthe Meyer Foundation
- The Danish Heart Foundation. Grant Numbers: 07–10-R60-A1751-B743–22412, 12-04-R91-A3790-22689
- The Research Foundation at the Heart Centre
- Rigshospitalet, and the Villadsen Family Foundation
- Sudden unexpected death;
- Sudden unexpected death in epilepsy;
- Sudden death;
Patients with epilepsy are at increased risk of premature death from all causes and likely also from sudden unexplained death (SUD). Many patients with epilepsy have significant comorbidity, and it is unclear how much of the increased risk can be explained by epilepsy itself. We aimed to chart the incidence of sudden unexpected death in epilepsy (SUDEP) and estimate the risk of death from all causes and SUD conferred by epilepsy independently.
We conducted a historical cohort study using data from Danish registries and a complete manual review of all death certificates. The population studied consisted of all Danish residents in the age group 1–35 years, in the period 2000–2006 (inclusive), and the main outcome measures were risk of death and SUD.
We identified 33,022 subjects with epilepsy (median follow-up 3.7 years) and 3,001,952 subjects without (median follow-up 7.0 years). Among 685 deaths in the population with epilepsy, we identified 50 cases of definite and probable SUDEP corresponding to an incidence rate of 41.1 (95% confidence interval [CI] 31.6–54.9) per 100,000 person-years. Incidence rates increased with age from 17.6 (95% CI 9.5–32.8) in the age group 1–18 years to 73.8 (95% CI 52.5–103.8) for the age group 24–35 years. Having epilepsy increased the crude risk of death with a hazard ratio (HR) of 11.9 (95% CI 11.0–12.9). When adjusting for sex and comorbidities often encountered in patients with epilepsy (neurologic disease including cerebral palsy, psychiatric disease including mental retardation, and congenital disorders), as well as the Charlson comorbidity score, the HR fell to 5.4 (95% CI 4.9–6.0). The crude HR for SUD was 27.5 (95% CI 18.1–41.8) and fell to 16.3 (95% CI 9.8–26.9) when adjusted for the same covariates as above.
Epilepsy in and of itself carries a significant risk of premature death and SUD. These findings highlight the potential gains of risk factor modification for the prevention of premature death and SUDEP in patients with epilepsy.