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

Journal article

Objective: We estimated premature mortality and identified causes of death and associated factors in people with active convulsive epilepsy (ACE) in rural Kenya.

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.

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%.

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.

Authors: Ngugi, A; Bottomley, C; Fegan, G; Chengo, E; Odhiambo, R

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: American Academy of Neurology
• Journal: Neurology
• Volume: 82
• Issue: 7
• Pages: 582-589
• Publication date: 2014-01-17
• Acceptance date: 2013-09-30
• DOI: 10.1212/wnl.0000000000000123
• EISSN: 1526-632X
• ISSN: 0028-3878
• Language: English
• Keywords: Rural Population; Middle Aged; Child; Cross-Sectional Studies; Humans; Aged; Infant, Newborn; Infant; Male; Prospective Studies; Young Adult; Adolescent; Risk Factors; Mortality, Premature; Female; Epilepsy; Kenya; Adult; Child, Preschool