Premature mortality in active convulsive epilepsy in rural Kenya: Causes and associated factors.


Ngugi, AK; Bottomley, C; Fegan, G; Chengo, E; Odhiambo, R; Bauni, E; Neville, B; Kleinschmidt, I; Sander, JW; Newton, CR; (2014) Premature mortality in active convulsive epilepsy in rural Kenya: Causes and associated factors. Neurology, 82 (7). pp. 582-9. ISSN 0028-3878 DOI: https://doi.org/10.1212/WNL.0000000000000123

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Abstract

OBJECTIVE: We estimated premature mortality and identified causes of death and associated factors in people with active convulsive epilepsy (ACE) in rural Kenya.<br/> METHODS: In this prospective population-based study, people with ACE were identified in a cross-sectional survey and followed up regularly for 3 years, during which information on deaths and associated factors was collected. We used a validated verbal autopsy tool to establish putative causes of death. Age-specific rate ratios and standardized mortality ratios were estimated. Poisson regression was used to identify mortality risk factors.<br/> RESULTS: There were 61 deaths among 754 people with ACE, yielding a rate of 33.3/1,000 persons/year. Overall standardized mortality ratio was 6.5. Mortality was higher across all ACE age groups. Nonadherence to antiepileptic drugs (adjusted rate ratio [aRR] 3.37), cognitive impairment (aRR 4.55), and age (50+ years) (rate ratio 4.56) were risk factors for premature mortality. Most deaths (56%) were directly related to epilepsy, with prolonged seizures/possible status epilepticus (38%) most frequently associated with death; some of these may have been due to sudden unexpected death in epilepsy (SUDEP). Possible SUDEP was the likely cause in another 7%.<br/> CONCLUSION: Mortality in people with ACE was more than 6-fold greater than expected. This may be reduced by improving treatment adherence and prompt management of prolonged seizures and supporting those with cognitive impairment.<br/>

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: Tropical Epidemiology Group
PubMed ID: 24443454
Web of Science ID: 336498300009
URI: http://researchonline.lshtm.ac.uk/id/eprint/1472206

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