Risk and Cause of Death in Children with Epilepsy
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".