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PEDIATRICS Vol. 107 No. 6 June 2001, pp. 1259-1263

Mortality Risk in Children With Epilepsy: The Dutch Study of Epilepsy in Childhood

Received May 16, 2000; accepted Sep 13, 2000.

Petra M. C. Callenbach*, Rudi G. J. WestendorpDagger , Ada T. Geerts§, Willem Frans M. Artsparallel , Els A. J. Peeters, Cees A. van Donselaar§, A. C. Boudewyn Peters#, Hans Stroink**, and Oebele F. Brouwer*

From the * Department of Neurology, Leiden University Medical Center, Leiden; Dagger  Department of Clinical Epidemiology, Leiden University Medical Center, Leiden; § Department of Neurology, University Hospital Rotterdam, Rotterdam; parallel  Department of Pediatric Neurology, University Hospital Rotterdam and Sophia Children's Hospital, Rotterdam;  Departments of Neurology, Westeinde Hospital and Juliana Children's Hospital, The Hague; # Department of Pediatric Neurology, University Hospital Utrecht and Wilhelmina Children's Hospital, Utrecht; and ** Department of Pediatric Neurology, St. Elisabeth Hospital, Tilburg, The Netherlands.

Objective.  Long-term follow-up studies of patients with epilepsy have revealed an increased mortality risk compared with the general population. Mortality of children who have epilepsy in modern times is as yet unknown. Therefore, the objective of this study was to determine mortality of children who have epilepsy in comparison with the general population.

Methods.  Between August 1988 and August 1992, 472 children, aged 1 month to 16 years, who presented in 1 of the participating hospitals with 2 or more newly diagnosed unprovoked seizures or at least 1 status epilepticus were enrolled in the study. All children were followed for 5 years or until death. The number of deaths observed during follow-up was compared with the expected number of deaths in the same age group in the general population in the Netherlands.

Results.  Nine children died during follow-up, amounting to a mortality rate of 3.8/1000 person-years, which is sevenfold higher than expected (95% confidence interval = 2.4-11.5). No deaths were observed among the 328 children who had epilepsy of nonsymptomatic cause. All deceased children had epilepsy that was caused by a static or progressive neurologic disorder (mortality risk = 22.9; 95% confidence interval = 7.9-37.9). None of them died from sudden unexpected and unexplained death of epilepsy.

Conclusions.  In our cohort, we found no indication that children who have nonsymptomatic epilepsy have an increased mortality risk compared with the general population, whereas children who have symptomatic epilepsy have a 20-fold increased mortality risk. These data provide guidance for counseling parents of children who have epilepsy.  Key words:  mortality, epilepsy, children, follow-up, Netherlands.




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