Risk and Cause of Death in Children with Epilepsy
Notice bibliographique
Résumé
Source: Camfield CS, Camfield PR, Veugelers PJ. Death in children with epilepsy: a population-based study. Lancet. 2002;359:1891–1895.The risk factors and frequency of death in childhood epilepsy were assessed in a population-based cohort study at Dalhousie University, Halifax, Nova Scotia, Canada. Of 692 children who developed epilepsy during 1977–85, 26 (3.8%) had died by 1999. Frequency of death was 5.3 times higher than in the reference population of Nova Scotia children and young people in the 1980s and 8.8 times higher than in the 1990s. The mortality at 20 years after onset was 6.1% compared to .88% in the reference population, matched for age and gender. Onset of seizures in the first year carried a significantly increased risk of mortality compared to later onset epilepsy. Of 85 children with secondary generalized epilepsy, 15% died, compared to 2% of 510 with partial and primary generalized epilepsy and 1% of 97 with absence epilepsy. Severe disorders associated with functional neurological deficit were associated with 22 times greater risk of death and were the cause of death in 22 children at a mean age of 10 years (range 1–29), independent of gender, age, and epilepsy type. Aspiration pneumonia was the cause of death in 14, infection in 3, shunt malfunction 1, pulmonary embolism 1, congestive heart failure 1, gastroesophageal reflux 1, and status epilepticus in 1. The rate of death in patients without severe neurological deficit was .8% (of 591), similar to that in the reference population. Four deaths were unexpected, all in young adults, aged 18–30 years, without severe neurological deficits. Suicide was the cause in 2, homicide in 1, and there was 1 sudden unexpected death, which was unexplained at autopsy in a 21-year-old woman with tuberous sclerosis who had several seizures during sleep. Functional neurological deficit was the only independent determinant of mortality.Children with epilepsy have more than 5 times the risk of dying in the first 20 years after onset of seizures. Most deaths are related to comorbid, severe neurological disorders associated with functional neurological deficit and not to the epilepsy per se. Cerebral palsy is an example of a severe neurological disorder that predisposes to death in epilepsy.l The authors have demonstrated that death from seizures themselves is uncommon, a finding that should help to allay the fear often expressed by parents of a child with epilepsy.These findings are similar to those of a Netherlands study2 of a cohort of 472 children, which showed a mortality rate of 3.8/1,000 person-years, 7 times higher than expected. None of 328 children with nonsymptomatic (idiopathic) epilepsy died. In those with symptomatic epilepsy, the mortality risk was 22.9 versus .39 expected in a control population. Among the 9 deaths in this prospective study, none were sudden unexpected and unexplained (SUDEP). SUDEP risk factors are usually multiple and include early-onset epilepsy, poor seizure control, polytherapy with antiepileptic drugs (AED), and frequent dose adjustments or abrupt AED withdrawal.3An accurate initial diagnosis is important in counseling parents regarding the risk of mortality in childhood epilepsy. Children with secondary generalized epilepsy associated with functional neurological deficit are particularly at risk of a poor prognosis. Apart from the rare exception of SUDEP in children with tuberous sclerosis, deaths that occur in children with epilepsy are usually explainable.We hope pediatricians will also seize the opportunity to share the good news from this study with families of children with idiopathic epilepsy, ie, that the risk of death is no higher than those without epilepsy.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».