Sudden death in children with epilepsy usually not due to seizures

Although children with epilepsy are at moderately increased risk of mortality, the cause of death is not usually related to the occurrence of seizures, investigators report in the Archives of Pediatric and Adolescent Medicine for December. Instead, increased risk appears to be more closely related to severe underlying conditions.

Dr. Anne T. Berg, at Northern Illinois University in DeKalb, and her colleagues prospectively followed a cohort of 613 children from the day they were diagnosed with epilepsy, between 1993 and 1997. Underlying etiology was cryptogenic or idiopathic in 492.

In 121 cases, epilepsy was "symptomatic," related to an identified neurological abnormality or uterine insult.

During median follow-up of 7.9 years, 13 study participants died. Only two deaths involved patients who were neurologically normal except for the epilepsy, the authors report. Ten deaths were associated with the underlying cause of the seizures, one was unrelated to the illness, and two were associated with seizures.

Dr. Berg's group points out that the overall death rate in Connecticut, where the study was conducted, for individuals up to 25 years old, was 0.47 per 1000 person-years. In their cohort, the corresponding rate was 0.52 among those with idiopathic epilepsy and 12.6 in the symptomatic group.

"Because most of the deaths were inevitable (associated with fatal neurodegenerative conditions) or associated with severe neurological dysfunction, prevention of mortality translates into prevention of the underlying causes and, to an extent, better control of seizures," Dr. Berg and her team conclude.

Arch Pediatr Adolesc Med 2004;158:1147-1152.