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Cited by 197Epilepsy research and treatmentMental Health Treatment and AccessPharmacological Effects and Toxicity Studies

Premature mortality of epilepsy in low‐ and middle‐income countries: A systematic review from the Mortality Task Force of the International League Against Epilepsy

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Levira, Francis, Thurman, David J., Sander, Josemir W., Hauser, W. Allen, Hesdorffer, Dale C., Masanja, Honorati, Odermatt, Peter, Logroscino, Giancarlo +2 more·2017·Epilepsia
DOI 10.1111/epi.13603PMC PMC7012644
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Abstract

Summary: To determine the magnitude of risk factors and causes of premature mortality associated with epilepsy in low‐ and middle‐income countries (LMIC s). We conducted a systematic search of the literature reporting mortality and epilepsy in the World Bank‐defined LMIC s. We assessed the quality of the studies based on representativeness; ascertainment of cases, diagnosis, and mortality; and extracted data on standardized mortality ratios (SMR s) 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 SMR s were 5.0 in male and 4.5 in female patients; relatively higher SMR s 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 LMIC s 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 PMR s ranging from 5 to 56.6%, and sudden unexpected death in epilepsy (SUDEP), with reported PMR s ranging from 1 to 18.9%. Important causes of mortality indirectly related to epilepsy include drowning, head injury, and burns. Epilepsy in LMIC s has a significantly greater premature mortality, as in high‐income countries, but in LMIC s 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 AED s.

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  • Previous studies have observed the highest mortality risk in old-aged patients with epilepsy.

    “In previous studies, the highest mortality risk has been observed in old-aged patients with epilepsy [15,16].”

    From Impact of a Prison-Based Religious Program on Mental Health State and Aggression Level Among Female Inmates (2019) · cites this paper as [16]

    The Results section, “Mortality risk by age” (page not provided), reports that the three population-based studies found the highest standardized mortality ratios in the youngest age groups, with ratios declining as age increased. That is contrary to the attributed claim that mortality risk was highest in older patients. The passage addresses relative mortality risk, not age-specific absolute death rates. (LLM, conf=0.88)

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Authors
Levira, F., Thurman, D. J., Sander, J. W., Hauser, W. A., Hesdorffer, D. C., Masanja, H., Odermatt, P., Logroscino, G., Newton, C. R., & the Epidemiology Commission of the International League Against Epilepsy
Affiliations
  • Ifakara Health Institute (TZ)
  • Emory University (US)
  • UCL Biomedical Research Centre (GB)
  • Columbia University Irving Medical Center (US)
  • Swiss Tropical and Public Health Institute (CH)
  • University of Bari Aldo Moro (IT)
  • Muhimbili University of Health and Allied Sciences (TZ)
Corresponding author
Newton, Charles R.
ORCID
Venue
Epilepsia
Publisher
Wiley
Published
2016-12-18
Volume
58
Issue
1
Pages
6-16
ISSN
  • 0013-9580 (ISSN-L)
  • 1528-1167
DOI
10.1111/epi.13603
PMC
PMC7012644
OpenAlex
W2564409675
Cited by
197
References
4
Citations by year
2026: 17 · 2025: 35 · 2024: 20 · 2023: 26 · 2022: 18 · 2021: 16 · 2020: 24 · 2019: 23 · 2018: 11 · 2017: 5
FWCI
1.86
Type
journal article
Language
en
Open access
Licence
Locations
  • Epilepsia (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • IHI Repository (acceptedVersion)
  • PubMed Central (acceptedVersion, cc-by)
  • UCL Discovery (University College London) (submittedVersion)
  • CINECA IRIS Institutional Research Information System (University of Bari Aldo Moro) (submittedVersion, other-oa)
Funders
Wellcome Trust (203077)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmacological Effects and Toxicity Studies
Keywords
epilepsy, premature mortality, low- and middle-income countries, standardized mortality ratio, causes of death, status epilepticus, sudden unexpected death in epilepsy, drowning, traumatic brain injury, burns, antiepileptic drugs, medication adherence, sex differences in mortality, children and adolescents, health care access
MeSH terms
Adolescent, Age Factors, Child, Death, Sudden, Developing Countries, Epilepsy, Female, Humans, Male, Risk Factors, Sex Factors, Socioeconomic Factors, Databases, Bibliographic, Mortality, Premature

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