Nevalainen Olli, Ansakorpi Hanna, Simola Mikko, Raitanen Jani, Isojärvi Jouko, Artama Miia, Auvinen Anssi
From the Medical School (O.N.) and the School of Health Sciences (J.R., A.A.), University of Tampere; the Medical Research Center Oulu (H.A., M.S., J.I.), Oulu University Hospital and University of Oulu; UKK Institute for Health Promotion (J.R.), Tampere, Finland; Lundbeck (J.I.), Deerfield, IL; University of Helsinki (M.A.); and the Pediatric Research Center (A.A.), Tampere University Hospital and University of Tampere, Finland.
Neurology. 2014 Nov 18;83(21):1968-77. doi: 10.1212/WNL.0000000000001005. Epub 2014 Oct 22.
We systematically synthesized the epidemiologic literature on mortality in patients with epilepsy (PWE) by epilepsy-related clinical characteristics with an aggregate data meta-analysis.
We systematically searched 15 electronic databases, browsed reference lists of pertinent publications, and contacted authors in the field. We were interested in cohort studies that reported the relative risk of death in representative epilepsy populations relative to the general population, with exclusion of highly selected subpopulations of PWE, such as patients with intellectual disabilities or epilepsy surgery series. Search, data abstraction, and study quality assessment with the Newcastle-Ottawa Scale were all performed in duplicate.
Pooled mortality was threefold (relative risk 3.33, 95% confidence interval 2.83-3.92) in 38 epilepsy cohorts including 165,879 patients (79.6% from Nordic countries). Among incident cases, idiopathic epilepsies did not associate with materially increased mortality (1.29, 0.75-2.20; 4 studies), whereas mortality was almost twofold in cryptogenic epilepsy (1.75, 1.20-2.54; 5 studies), and highly elevated in patients with symptomatic epilepsy (4.73, 3.27-6.83; 12 studies) and especially in epilepsies due to congenital or developmental causes (10.3, 4.03-26.2; 2 studies). Newly diagnosed patients who attained seizure freedom did not have elevated mortality (0.97, 0.73-1.30; 2 studies).
Excess mortality was highly related to the etiology of epilepsy in all ages. In adult patients without neuroradiologic abnormalities or other identifiable cause of epilepsy, only patients with cryptogenic epilepsy exhibited excess mortality. Risk of premature death was lowest in idiopathic epilepsy and in PWE who attained seizure freedom.
我们通过汇总数据的荟萃分析，按癫痫相关临床特征系统地综合了有关癫痫患者（PWE）死亡率的流行病学文献。
我们系统检索了15个电子数据库，浏览了相关出版物的参考文献列表，并联系了该领域的作者。我们感兴趣的是队列研究，这些研究报告了代表性癫痫人群相对于一般人群的死亡相对风险，排除了高度特定的PWE亚组，如智力残疾患者或癫痫手术系列。检索、数据提取以及使用纽卡斯尔-渥太华量表进行研究质量评估均重复进行。
在包括165,879名患者（79.6%来自北欧国家）的38个癫痫队列中，汇总死亡率为三倍（相对风险3.33，95%置信区间2.83 - 3.92）。在新发病例中，特发性癫痫与死亡率实质性增加无关（1.29，0.75 - 2.20；4项研究），而隐源性癫痫的死亡率几乎为两倍（1.75，1.20 - 2.54；5项研究），症状性癫痫患者的死亡率大幅升高（4.73，3.27 - 6.83；12项研究），尤其是先天性或发育性原因导致的癫痫（10.3，4.03 - 26.2；2项研究）。达到无癫痫发作的新诊断患者死亡率未升高（0.97，0.73 - 1.30；2项研究）。
各年龄段的超额死亡率与癫痫病因高度相关。在无神经放射学异常或其他可识别癫痫病因的成年患者中，只有隐源性癫痫患者表现出超额死亡率。特发性癫痫以及达到无癫痫发作的PWE过早死亡风险最低。
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