Bain Eva, Keller Anne E, Jordan Ho, Robyn Whitney, Pollanen Michael S, Williams Andrew S, Donner Elizabeth J
The Hospital for Sick Children, Division of Neurology, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
Ontario Forensic Pathology Service & Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
Epilepsy Res. 2018 Sep;145:123-126. doi: 10.1016/j.eplepsyres.2018.06.010. Epub 2018 Jun 20.
The risk of drowning is reported to be 15-19 times greater in people with epilepsy compared to the general population. Despite this disproportionate burden, there is limited data about the circumstances surrounding drowning deaths in people with epilepsy. This population-based case series characterizes drowning deaths in people with epilepsy.
Postmortem data from coroner-ordered autopsies conducted in Ontario between 2014 and 2016 were screened for cases of drowning in people with a history of seizures. Demographic information, epilepsy characteristics, and circumstances surrounding death were extracted from post mortem reports. The incidence of drowning in people with epilepsy was calculated using government estimates of the Ontario population and the number of people with epilepsy.
Twenty-five people with epilepsy drowned during the three-year study period, giving an estimated incidence of 1.5 per 10,000 epilepsy person-years (95% CI: 0.98, 2.23). Decedents were mostly young (mean age 36 years) and without physical or developmental disability. Approximately one-third had psychiatric comorbidities. Epilepsy severity ranged from well-controlled to drug refractory. Only 3 people had alcohol or illicit drugs detected on toxicological analysis. Forty-four percent of deaths were the result of an unwitnessed drowning in a bathtub.
This population-based case series confirms people with epilepsy drown at a rate nearly ten times greater than the general population (1.5 per 10,000 epilepsy person-years compared to the estimated provincial average of 0.13 per 10,000). Drowning deaths in people with epilepsy most often occur in the bathtub. These deaths are only rarely associated with intoxication. People with epilepsy should receive counseling on the increased risk of drowning, including information regarding the significant risk associated with bathtub use, the potential protective roles of anti-epileptic drug (AED) adherence and supervision when in or around water, and the fact that all people with epilepsy remain at an increased risk of drowning regardless of their apparent seizure control.
据报道，癫痫患者溺水风险比普通人群高15至19倍。尽管负担不成比例，但关于癫痫患者溺水死亡相关情况的数据有限。本基于人群的病例系列描述了癫痫患者的溺水死亡情况。
对2014年至2016年在安大略省进行的法医下令的尸检的死后数据进行筛查，以查找有癫痫发作史的溺水病例。从死后报告中提取人口统计学信息、癫痫特征和死亡相关情况。使用安大略省人口的政府估计数和癫痫患者人数计算癫痫患者的溺水发生率。
在三年研究期间，有25名癫痫患者溺水，估计发生率为每10,000癫痫人年1.5例（95%可信区间：0.98，2.23）。死者大多年轻（平均年龄36岁），无身体或发育残疾。约三分之一有精神疾病合并症。癫痫严重程度从控制良好到药物难治性不等。毒理学分析仅在3人身上检测到酒精或非法药物。44%的死亡是在浴缸中无人目睹溺水所致。
本基于人群的病例系列证实，癫痫患者溺水发生率几乎比普通人群高十倍（每10,000癫痫人年1.5例，而该省估计平均每10,000人0.13例）。癫痫患者溺水死亡最常发生在浴缸中。这些死亡很少与中毒有关。癫痫患者应接受关于溺水风险增加的咨询，包括与使用浴缸相关的重大风险、服用抗癫痫药物（AED）的潜在保护作用以及在水中或水边时的监督，以及所有癫痫患者无论其癫痫发作控制情况如何，溺水风险均会增加这一事实。
