Mortality epilepsy

Lack of access to medicines and inappropriate doses result in serious morbidity and mortality, particularly for childhood infections and chronic diseases, such as hypertension, diabetes, epilepsy and mental disorders. Inappropriate use and over-use of medicines waste resources - often out-of-pocket payments by patients - and result in significant patient harm in terms of poor patient outcomes and adverse drug reactions. Furthermore, over-use of antimicrobials is leading to increased antimicrobial resistance and non-sterile injections to the transmission of hepatitis, HIV/AIDS and other blood-borne diseases. Finally, irrational over-use of medicines can stimulate inappropriate patient demand, and lead to reduced access and attendance rates due to medicine stock-outs and loss of patient confidence in the health system. 

Another concern in infants of mothers with epilepsy is a serious hemorrhagic disorder that is associated with a high (25-35%) mortality. This probably results from the finding that many AEDs can act as competitive inhibitors of vitamin K-dependent clotting factors. The competitive inhibition can be overcome by the administration of oral vitamin K supplements to the mother during the last week or 10 days of pregnancy. 

The adverse effects of most serious concern relate to the cardiovascular system and seizure threshold. Actions on the adrenergic and cholinergic systems probably contribute to both hypotensive and direct cardiac effects, including alterations in heart rate, quinidine-like delays in conduction, and reduced myocardial contractility. The seizure threshold is lowered, increasing the frequency of epileptic seizures. All of these adverse effects can occur at therapeutic dosages in susceptible populations, such as elderly people, children, and people with cardiac problems or epilepsy, but are also a major cause of morbidity and mortality in accidental or intentional overdosage. Doses in excess of 500 mg can be seriously toxic, and death is fairly common when doses of 2 g or more are taken. 

Ruptured arteriovenous malformations have a lower mortality than aneurysmal SAH and are less likely to rebleed, certainly in the early period after the initial hemorrhage (Mast et al. 1997). It is unclear how to identify lesions at particularly high risk of bleeding or epilepsy (Duong et al. 1998). 

A cla.ssillculion of the types of epilepsy has been widely accepted because its accuracy facilitate.s diagno.sis, drug selection. and precise discussion of. seizure di.sorders. - The major classification types are (a) generali zed. seizures, which c.s.scntially involve the entire brain and do not have an apparent local on.sct (b) unilateral. sei /.urc.s. which involve one entire side of the body (i) partial (or focal) sci /.ures that have a focus (i.c.. begin locally) (d) erratic seizures of the newborn and (e) unclassified seizures (severe seizures associated with high mortality such that time does nut permit a precise categorization). 

The direct costs of epilepsy include the cost of the drug, treatment of adverse events, emergency room visits, drug levels, laboratory tests, physician visits, rehabilitation, and transportation. Indirect costs include the costs associated with time lost from work, the inability to get a job, decreased productivity, and mortality. 

The estimated mortality rate in the United States following GCSE ranges between 22,000 and 42,000 individuals per year. Recent estimates suggest a mortality rate of up to 10% in children, 20% in adults," and 38% in the elderly. When compared with other populations, neonates with seizures have a higher mortality and more neurologic sequelae (e.g., mental retardation, cerebral palsy, and epilepsy). 

Acorus calamus Ayurvedic treatment for epilepsy also insomnia and hysteria. Controlled animal studies show CNS depressant effect. No efficacy against maximal electroshock (MES)-induced seizures. Significantly prolonged latency of seizure onset and reduced mortality following PTZ-induced seizures. 

Thus, influenza may have an incidence of 15% for the months December April 1999 in the UK, whereas the prevalence of influenza in the UK probably ranges between 0% and 10% on any given day. Perinatal (and maternal) mortality rates are usually stated annually and for specified country or region. These are thus measures of incidence. The proportion of a population that will experience at least one seizure or one migraine attack in their lives is a measure of incidence and would likely be expressed as a number per thousand (or per hundred thousand) person-years, whereas the proportion of a population suffering from epilepsy or migraine during the year 2000 is an expression of prevalence. 

Conclusions Some antiepileptic drugs, mainly carbamazepine, in particular circumstances, can affect the cardiac repolarization cycle and predispose to SUDEP, but data are still elusive. The susceptibility factors that are most consistently associated with SUDEP include poor seizure control, antiepileptic drug poly therapy, and a long duration of epilepsy [46 ]. In particular, seizure control seems to be of paramount importance in the prevention of SUDEP. In fact, some studies have shown that in a considerable proportion of people with chronic epilepsy, shortly after seizures, some electrocardiographic features occur that may predict an increase in the risk of cardiac mortality or sudden cardiac death [47 ]. Hence, antiepileptic drugs as a class may have a protective effect against SUDEP, since they prevent seizures or reduce their number. 

Nilsson, L., Tomson, T., Farahmand, B.Y., Diwan, V., and Persson, P.G., 1997. Cause-specific mortality in epilepsy a cohort study of more than 9,000 patients once hospitalized for epilepsy. Epilepsia. 38 1062-1068. 

It has also been considered that although the question of suicidality with these drugs is controversial, the adverse effects of failing to control epilepsy are not. If antiepileptic drugs are less frequently prescribed or taken, seizure control may worsen, with associated increases in accidents and mortality, or sudden unexplained death from seizures [20 ]. In a large study of people with epilepsy it has been reported that 21 % had an accident... 

The rate of completed suicides in the general population is 12.0/100 000 [24 ], with a marked predominance in men [25 ], while the lifetime prevalence of suicide attempts is 0.6-4.9% overall [26 ], with a preponderance in women. Epilepsy is co-morbid with suicidality [27 ] and with major depression [28P]. After a diagnosis of epilepsy, the risk of completed suicide increases the overall standardized mortality ratio ranges from 3.5 to 5.0 and is higher in the presence of a known psychiatric diagnosis [29 "]. In addition, suicidal ideation and behavior have been identified as psychiatric phenomena in patients with drug-resistant epilepsy [30 "]. 

Sander JW, Bell GS. Reducing mortality an important aim of epilepsy management. J Neurol Neurosurg Psychiatry 2004 75 349-51. 

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