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Objective: People with epilepsy (PWE) may be at an increased risk of severe COVID-19. It is important to characterize this risk to inform PWE and for future health and care planning. We assessed whether PWE were at higher risk of being hospitalized with, or dying from, COVID-19., Methods: We performed a retrospective cohort study using linked, population-scale, anonymized electronic health records from the SAIL (Secure Anonymised Information Linkage) databank. This includes hospital admission and demographic data for the complete Welsh population (3.1 million) and primary care records for 86% of the population. We identified 27 279 PWE living in Wales during the study period (March 1, 2020 to June 30, 2021). Controls were identified using exact 5:1 matching (sex, age, and socioeconomic status). We defined COVID-19 deaths as having International Classification of Diseases, 10th Revision (ICD-10) codes for COVID-19 on death certificates or occurring within 28 days of a positive SARS-CoV-2 polymerase chain reaction (PCR) test. COVID-19 hospitalizations were defined as having a COVID-19 ICD-10 code for the reason for admission or occurring within 28 days of a positive SARS-CoV-2 PCR test. We recorded COVID-19 vaccinations and comorbidities known to increase the risk of COVID-19 hospitalization and death. We used Cox proportional hazard models to calculate hazard ratios., Results: There were 158 (.58%) COVID-19 deaths and 933 (3.4%) COVID-19 hospitalizations in PWE, and 370 (.27%) deaths and 1871 (1.4%) hospitalizations in controls. Hazard ratios for COVID-19 death and hospitalization in PWE compared to controls were 2.15 (95% confidence interval [CI] = 1.78-2.59) and 2.15 (95% CI = 1.94-2.37), respectively. Adjusted hazard ratios (adjusted for comorbidities) for death and hospitalization were 1.32 (95% CI = 1.08-1.62) and 1.60 (95% CI = 1.44-1.78)., Significance: PWE are at increased risk of being hospitalized with, and dying from, COVID-19 when compared to age-, sex-, and deprivation-matched controls, even when adjusting for comorbidities. This may have implications for prioritizing future COVID-19 treatments and vaccinations for PWE., (© 2024 The Authors. Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.)

Objective: This study was undertaken to characterize changes in health care utilization and mortality for people with epilepsy (PWE) during the COVID-19 pandemic., Methods: We performed a retrospective study using linked, individual-level, population-scale anonymized health data from the Secure Anonymised Information Linkage databank. We identified PWE living in Wales during the study "pandemic period" (January 1, 2020-June 30, 2021) and during a "prepandemic" period (January 1, 2016-December 31, 2019). We compared prepandemic health care utilization, status epilepticus, and mortality rates with corresponding pandemic rates for PWE and people without epilepsy (PWOE). We performed subgroup analyses on children (<18 years old), older people (>65 years old), those with intellectual disability, and those living in the most deprived areas. We used Poisson models to calculate adjusted rate ratios (RRs)., Results: We identified 27 279 PWE who had significantly higher rates of hospital (50.3 visits/1000 patient months), emergency department (55.7), and outpatient attendance (172.4) when compared to PWOE (corresponding figures: 25.7, 25.2, and 87.0) in the prepandemic period. Hospital and epilepsy-related hospital admissions, and emergency department and outpatient attendances all reduced significantly for PWE (and all subgroups) during the pandemic period. RRs [95% confidence intervals (CIs)] for pandemic versus prepandemic periods were .70 [.69-.72], .77 [.73-.81], .78 [.77-.79], and .80 [.79-.81]. The corresponding rates also reduced for PWOE. New epilepsy diagnosis rates decreased during the pandemic compared with the prepandemic period (2.3/100 000/month cf. 3.1/100 000/month, RR = .73, 95% CI = .68-.78). Both all-cause deaths and deaths with epilepsy recorded on the death certificate increased for PWE during the pandemic (RR = 1.07, 95% CI = .997-1.145 and RR = 2.44, 95% CI = 2.12-2.81). When removing COVID deaths, RRs were .88 (95% CI = .81-.95) and 1.29 (95% CI = 1.08-1.53). Status epilepticus rates did not change significantly during the pandemic (RR = .95, 95% CI = .78-1.15)., Significance: All-cause non-COVID deaths did not increase but non-COVID deaths associated with epilepsy did increase for PWE during the COVID-19 pandemic. The longer term effects of the decrease in new epilepsy diagnoses and health care utilization and increase in deaths associated with epilepsy need further research., (© 2024 The Authors. Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.)

Importance: People with epilepsy are at increased risk of mortality, but, to date, the cause-specific risks of all unnatural causes have not been reported., Objective: To estimate cause-specific unnatural mortality risks in people with epilepsy and to identify the medication types involved in poisoning deaths., Design, Setting, and Participants: This population-based cohort study used 2 electronic primary care data sets linked to hospitalization and mortality records, the Clinical Practice Research Datalink (CPRD) in England (from January 1, 1998, to March 31, 2014) and the Secure Anonymised Information Linkage (SAIL) Databank in Wales (from January 1, 2001, to December 31, 2014). Each person with epilepsy was matched on age (within 2 years), sex, and general practice with up to 20 individuals without epilepsy. Unnatural mortality was determined using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes V01 through Y98 in the Office for National Statistics mortality records. Hazard ratios (HRs) were estimated in each data set using a stratified Cox proportional hazards model, and meta-analyses were conducted using DerSimonian and Laird random-effects models. The analysis was performed from January 5, 2016, to November 16, 2017., Exposures: People with epilepsy were identified using primary care epilepsy diagnoses and associated antiepileptic drug prescriptions., Main Outcomes and Measures: Hazard ratios (HRs) for unnatural mortality and the frequency of each involved medication type estimated as a percentage of all medication poisoning deaths., Results: In total, 44 678 individuals in the CPRD and 14 051 individuals in the SAIL Databank were identified in the prevalent epilepsy cohorts, and 891 429 (CPRD) and 279 365 (SAIL) individuals were identified in the comparison cohorts. In both data sets, 51% of the epilepsy and comparison cohorts were male, and the median age at entry was 40 years (interquartile range, 25-60 years) in the CPRD cohorts and 43 years (interquartile range, 24-64 years) in the SAIL cohorts. People with epilepsy were significantly more likely to die of any unnatural cause (HR, 2.77; 95% CI, 2.43-3.16), unintentional injury or poisoning (HR, 2.97; 95% CI, 2.54-3.48) or suicide (HR, 2.15; 95% CI, 1.51-3.07) than people in the comparison cohort. Particularly large risk increases were observed in the epilepsy cohorts for unintentional medication poisoning (HR, 4.99; 95% CI, 3.22-7.74) and intentional self-poisoning with medication (HR, 3.55; 95% CI, 1.01-12.53). Opioids (56.5% [95% CI, 43.3%-69.0%]) and psychotropic medication (32.3% [95% CI, 20.9%-45.3%)] were more commonly involved than antiepileptic drugs (9.7% [95% CI, 3.6%-19.9%]) in poisoning deaths in people with epilepsy., Conclusions and Relevance: Compared with people without epilepsy, people with epilepsy are at increased risk of unnatural death and thus should be adequately advised about unintentional injury prevention and monitored for suicidal ideation, thoughts, and behaviors. The suitability and toxicity of concomitant medication should be considered when prescribing for comorbid conditions.

There are limited epilepsy mortality data from developing countries and Latin America in particular. We examined national epilepsy mortality data from Cuba and contrasted them with comparable data from England and Wales. National epilepsy mortality data for Cuba between the years 1987 and 2010 were obtained from the Medical Records and Health Statistics Bureau of the Cuban Public Health Ministry (www.sld.cu/sitios/dne/) with the corresponding mortality data from England and Wales obtained from the UK Office of National Statistics (ONS, www.ons.gov.uk). Indirect standardization with calculation of a standardized mortality ratio (SMR) was used to compare trends. The overall trend was of a slight decrease in mortality rates over the 23 years in Cuba, with higher mortality rates primarily occurring in young people. Annual age-adjusted rates were consistently lower in Cuba than those seen in England and Wales, with the SMR ranging from 0.35 (95% confidence interval (CI): 0.30 to 0.48) in 2007 to 1.00 (95% CI: 0.85 to 1.15) in 1994. Cuban epilepsy mortality rates are consistently lower than those of England and Wales. Reasons for this disparity in mortality rates are not immediately apparent but are likely to be multifactorial., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: We attempted to establish whether month and season, or lunar phase, are risk factors for sudden unexpected death in epilepsy (SUDEP), as these have all been suggested as potential risk factors., Methods: We used the dataset of the National Sentinel Clinical Audit of Epilepsy-Related Death; all death certificates of people who died in England and Wales between September 1999 and August 2000 and in which epilepsy was mentioned were reviewed. We identified people who probably died of SUDEP during that time. We compared the number of observed SUDEP cases with those expected according to month of death, season of death, minimum external temperature, mean external temperature, and lunar phase., Results: Of 2,412 deaths, we identified 409 probable SUDEPs. We found no evidence for an association between either mean temperature group or minimum temperature group and SUDEP, although there appeared to be a slight excess of sudden deaths in the coldest (mean temperature) groups. We also found no association between SUDEP and month, season, or lunar phase., Discussion: Some causes of death appear to be related to temperature, but we found no convincing evidence to support a link between temperatures or seasons and sudden unexpected death in epilepsy. It is important to identify risk factors for SUDEP, but it is also important that evidence is established before hypotheses are accepted.

This article examines trends in mortality and hospital admissions associated with epilepsy in England and Wales during the 1990s. Mortality data were analysed for the period 1993 to 2000. Data on hospital admissions where the main diagnosis was epilepsy were obtained from the Hospital Episode Statistics information service of the Department of Health and analysed for the period 1991/92 to 2000/01. There were about 800 deaths per year where epilepsy was the underlying cause and about 37,000 admissions where epilepsy was the main diagnosis. Both mortality and hospital admission rates for epilepsy remained relatively stable during the periods examined.

Objective: To estimate the number of sudden unexpected epilepsy deaths occurring annually in England and Wales in those 16-50 years of age., Methods: All 1997 death entries mentioning epilepsy as a cause of death in those 16-50 years were examined and classified as sudden unexpected death in epilepsy (SUDEP), other epilepsy related deaths, or non-epilepsy deaths., Results: 612 death entries were obtained with postmortem examination having been performed in 498 cases. Forty four deaths were certified as being attributable to SUDEP and a further 292 deaths were considered to be probable SUDEP cases., Conclusion: It is estimated that between 350 and 400 cases of SUDEP occurred in England and Wales in 1997 in those 16-50 years. SUDEP is the commonest category of epilepsy related death and accurate certification of such deaths is vital for the monitoring of trends in mortality.

The aim of this study was to analyze time trends in epilepsy mortality in England and Wales and the United States between 1950 and 1994. The authors calculated age- and sex-specific epilepsy mortality rates for the nine quinquennia from 1950-1954 to 1990-1994. Mortality rates were modeled as a function of age, period of death, and cohort of birth by using Poisson regression techniques. From 1950 to 1994, there were more than 110,000 deaths from epilepsy in the two countries. The secular trends in mortality were similar for both sexes and in both countries. Among people younger than age 20 years, epilepsy mortality declined steeply after 1950. For young and middle-aged adults, the rate of decline was lower. In the geriatric population, mortality declined between 1950 and 1974 but then increased. The Poisson model showed pronounced birth cohort effects. In the United States, epilepsy mortality fell with each successive birth cohort after 1905. In England and Wales, there was a similar decline in birth cohort mortality after 1905 for women but not until after 1950 for men. The pronounced birth cohort effect supports explanations that focus on antenatal and developmental factors as the cause for the decline in epilepsy mortality in all but the oldest age groups between 1950 and 1994.

Objective: To estimate the incidence and prevalence of epilepsy during childhood and early adult life in England, Scotland, and Wales., Design: Prospective study of 17,414 children born in England, Scotland, and Wales between 3 and 9 March 1958, followed up at 7, 11, 16, and 23 years of age, with a review of those with epilepsy at age 28., Subjects: People with epilepsy developing at or before age 23., Main Outcome Measures: The age specific incidence, cumulative incidence, and prevalence of epilepsy., Results: 124 young people had a confirmed diagnosis of epilepsy during their first 23 years (cumulative incidence 8.4 per 1000; 95% confidence interval 6.8 to 10.0). 6 had died by age 23.46 (37%) had neurological impairment or another major health problem in addition to epilepsy. The prevalence of active epilepsy at age 23 was 6.3 per 1000 (4.9 to 7.7)., Conclusions: A wide variety of seizure disorders is included under the term epilepsy. A third of cases had generalised seizures. In only a quarter was the onset of seizures attributed to a specific cause. Children with additional health problems were more likely to continue to have seizures in early adult life than those with epilepsy alone. 1 in 8 were prescribed drug treatment for 6 years or more after their last seizure. All deaths occurred in young adults over the age of 16.

Sudden unexpected death in epilepsy (SUDE) remains an under-investigated area. Little progress has been made in prospective evaluation of its incidence and causes. We report an audit of Cardiff Epilepsy Unit data that identified 14 cases of SUDE within a time period of 7000 patient-treatment years. These data suggest that SUDE occurs in 1 in 500 of our patients per year. Males were affected twice as often as females. The mean age of affected patients was 35 years, and most were in the 20-40 year age bracket. Eleven had epilepsy for more than 6 years, 12 were taking one or two antiepileptic drugs, and nine had been experiencing four or fewer seizures per month. Ten patients had idiopathic generalized seizures, and only one patient did not experience tonic-clonic seizures. Antiepileptic drug usage favoured carbamazepine. Most patients were not living alone but 11 of 14 (79%) were either unmarried, separated or widowed. In comparison with other patients attending the Epilepsy Unit (more than 1820 patients), SUDE patients were significantly (chi 2 < 0.05) more likely to be male, to have idiopathic generalized tonic-clonic seizures, or to be taking carbamazepine (monotherapy or in combination with another drug). There were no statistically significant differences in age, duration of epilepsy, number of drugs, or seizure frequency between the SUDE patients and our other patients. Correct case identification, and controlled, prospective, ante-mortem studies are needed so that the true incidence, associated risk factors and causes of sudden unexpected death in epilepsy can be accurately ascertained.

Over 2000 epileptic patients admitted to the Chalfont Centre for Epilepsy between 1931 and 1971 and taking anticonvulsants were followed up to the end of 1977. Mortality between 1951 and 1977 was greatly in excess of that in the general population of England and Wales in that period allowing for age and sex. Some of the excess was directly attributable to epilepsy, but there were also more deaths from suicide and circulatory, respiratory, and malignant disease than would be expected. Apart from the brain and central nervous system, no particular site had a significant excess of tumours. In particular, there were no liver tumours (and only one gallbladder carcinoma). This makes it unlikely that the liver tumours produced on feeding phenobarbitone to mice are indicators of major human risk.