Short report
Mortality in patients with epilepsy: 40 years of follow up in a
Dutch cohort study
a Department of
Clinical Epidemiology, Faculty of Medicine, Leiden University, The
Netherlands, b Instituut voor
Epilepsiebestrijding, Heemstede, The Netherlands
Correspondence to: Dr D G A Kasteleijn-Nolst Trenité, Instituut voor Epilepsiebestrijding, Meer en Bosch, De Cruquiushoeve, Achterweg 5, 2103 SW Heemstede, The Netherlands.
Received 23 December
1997 and in revised form 30 October 1998;
Accepted 20
November 1998
To investigate the extent of and the causes of excess mortality
in patients with epilepsy, mortality was studied in a cohort of
patients with newly diagnosed epilepsy over an extended follow up
period. All patients (both inpatients and outpatients) of the Instituut
voor Epilepsiebestrijding in Heemstede, the Netherlands between 1953 and 1967 were included in the study. Complete follow up was obtained
for 1355 patients, 746 men and 609 women. The mean follow up was 28 years (range 6 months-41 years). In total, 38 665 person years were
surveyed, in which 404 patients died. All cause mortality was threefold
increased (risk ratio (RR) 3.2; 95%CI 2.9-3.5), and was only slightly
higher for men than for women. Mortality was highest under 20 years of
age (RR 7.6; 95%CI 6.5-8.7), and during the first 2 years of follow
up (RR 16; 95%CI 12-20).
Mortality directly related to epilepsy accounted for 18 of the
53 deaths in the first 2 years after diagnosis, which is equivalent to
an incidence rate of 6.8 per 1000 person-years (95% CI 4.1-10). After
2 years 110 of the 351 deaths could be attributed to epilepsy itself,
or were epilepsy related, with an incidence rate of 3.1 per 1000 person-years (95% CI 2.5-3.6). The data presented suggest that the
increased mortality risk in patients with epilepsy is attributable in
part to epilepsy itself, and is predominantly present at younger age
and early after diagnosis. However, the absolute risk is moderate.
Keywords: epilepsy; epidemiology; mortality; standard mortality ratio
© 1999 by Journal of Neurology, Neurosurgery, and Psychiatry
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