title: Premature mortality of epilepsy in low- and middle-income countries: A systematic review from the Mortality Task Force of the International League Against Epilepsy.
abstract: To determine the magnitude of risk factors and causes of premature mortality associated with epilepsy in low- and middle-income countries (LMICs). We conducted a systematic search of the literature reporting mortality and epilepsy in the World Bank-defined LMICs. We assessed the quality of the studies based on representativeness; ascertainment of cases, diagnosis, and mortality; and extracted data on standardized mortality ratios (SMRs) and mortality rates in people with epilepsy. We examined risk factors and causes of death. The annual mortality rate was estimated at 19.8 (range 9.7-45.1) deaths per 1,000 people with epilepsy with a weighted median SMR of 2.6 (range 1.3-7.2) among higher-quality population-based studies. Clinical cohort studies yielded 7.1 (range 1.6-25.1) deaths per 1,000 people. The weighted median SMRs were 5.0 in male and 4.5 in female patients; relatively higher SMRs within studies were measured in children and adolescents, those with symptomatic epilepsies, and those reporting less adherence to treatment. The main causes of death in people with epilepsy living in LMICs include those directly attributable to epilepsy, which yield a mean proportional mortality ratio (PMR) of 27.3% (range 5-75.5%) derived from population-based studies. These direct causes comprise status epilepticus, with reported PMRs ranging from 5 to 56.6%, and sudden unexpected death in epilepsy (SUDEP), with reported PMRs ranging from 1 to 18.9%. Important causes of mortality indirectly related to epilepsy include drowning, head injury, and burns. Epilepsy in LMICs has a significantly greater premature mortality, as in high-income countries, but in LMICs the excess mortality is more likely to be associated with causes attributable to lack of access to medical facilities such as status epilepticus, and preventable causes such as drowning, head injuries, and burns. This excess premature mortality could be substantially reduced with education about the risk of death and improved access to treatments, including AEDs.
authors.affiliation: Ifakara Health Institute, Dar-es-Salaam, Tanzania.|Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Francis
authors.initials: F
authors.lastname: Levira
authors.affiliation: Department of Neurology, Emory University, Atlanta, Georgia, U.S.A.
authors.forename: David J
authors.initials: DJ
authors.lastname: Thurman
authors.affiliation: NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, United Kingdom.|Epilepsy Institute in The Netherlands (SEIN), Heemstede, The Netherlands.
authors.forename: Josemir W
authors.initials: JW
authors.lastname: Sander
authors.affiliation: Sergievsky Center, Columbia University Medical Center, New York, New York, U.S.A.
authors.forename: W Allen
authors.initials: WA
authors.lastname: Hauser
authors.affiliation: Sergievsky Center, Columbia University Medical Center, New York, New York, U.S.A.
authors.forename: Dale C
authors.initials: DC
authors.lastname: Hesdorffer
authors.affiliation: Ifakara Health Institute, Dar-es-Salaam, Tanzania.
authors.forename: Honorati
authors.initials: H
authors.lastname: Masanja
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Odermatt
authors.affiliation: University of di Bari Aldo Moro, Bari, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Logroscino
authors.affiliation: Department of Neurosciences, Institute of Child Health, University College London, London, United Kingdom.|Department of Pediatrics, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.|Department of Psychiatry, University of Oxford, Oxford, United Kingdom.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Newton
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D003645:Death, Sudden / Q000209:etiology; D003906:Developing Countries; D004827:Epilepsy / Q000453:epidemiology* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D061213:Mortality, Premature; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors
keywords: Case fatality; Convulsions; Death; Developing countries; Premature mortality; Resource-poor countries; Seizures