中低收入国家癫痫过早死亡：国际抗癫痫联盟死亡率专业组系统评价_Journal of Epilepsy

Authors：

 LeviraF , ThurmanDJ , SanderJW , 陆璐　译 , 童馨　慕洁　审

Corresponding author：

LeviraF, Email: cnewton@kemri-wellcome.org

Keywords：

痫性发作; 强直; 死亡; 病死; 发展中国家; 资源贫乏国家; 早亡

DOI：

10.7507/2096-0247.20190010

Video：

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为了确定中低收入国家（Low- and middle-income countries，LMICs）癫痫相关的危险因素大小与过早死亡原因，专业组对来自 LMICs（世界银行定义）的死亡率及癫痫相关文献报道进行系统检索，根据代表性，病例、诊断和死亡率的确证度对研究进行评估，并提取癫痫患者中的标准化死亡比（Standardized mortality ratios，SMR）和死亡率数据。研究调查了死亡的危险因素和原因。据估计，在高质量的群体研究中，癫痫患者年死亡率为 19.8/1 000（9.7/1 000～45.1/1 000），加权中位 SMR 为 2.6（1.3～7.2）。而临床队列研究显示的死亡率为 7.1/1 000（1.6/1 000～25.1/1 000），加权中位 SMR 在男性中为 5.0，女性中为 4.5。在儿童和青少年、症状性癫痫或治疗依从性低的患者中发现了相对较高的 SMR。群体研究显示，LMICs 癫痫患者死亡的主要原因中直接归因于癫痫的平均比例死亡比（Proportional mortality ratio，PMR）为 27.3%（5.0%～73.5%）。这些直接原因包括癫痫持续状态（报道的 PMR 为 5.0%～56.5%）和癫痫猝死（Sudden unexpected death in epilepsy，SUDEP）（报道的 PMR 为 1.0%～18.9%），与癫痫相关的间接死亡原因包括溺水、头部创伤和烧伤。LMICs 癫痫患者的早亡率明显高于高收入国家。在 LMICs，死亡率过高可能与患者难以获得医疗资源有关，例如发生癫痫持续状态时，以及包括溺水、头外伤和烧伤在内的可预防死因。这类过高的早亡率可以通过进行关于死亡风险的教育，提高治疗，包括抗癫痫药物治疗的可得性而大大降低。

Citation： LeviraF, ThurmanDJ, SanderJW, 陆璐　译, 童馨　慕洁　审. 中低收入国家癫痫过早死亡：国际抗癫痫联盟死亡率专业组系统评价. Journal of Epilepsy, 2019, 5(1): 47-56. doi: 10.7507/2096-0247.20190010 Copy

1.	Forsgren L, Hauser WA, Olafsson E, et al. Mortality of epilepsy in developed countries: a review. Epilepsia, 2005, 46(Suppl 11): 18-27.
2.	Nevalainen O, Ansakorpi H, Simola M, et al. Epilepsy-related clinical characteristics and mortality: a systematic review and meta-analysis. Neurology, 2014, 83(21): 1968-1977.
3.	Newton CR, Garcia HH. Epilepsy in poor regions of the world. Lancet, 2012, 380(9848): 1193-1201.
4.	Ngugi AK, Bottomley C, Kleinschmidt I, et al. Estimation of the burden of active and life-time epilepsy: a meta-analytic approach. Epilepsia, 2010, 51(5): 883-890.
5.	Ngugi AK, Kariuki SM, Bottomley C, et al. Incidence of epilepsy: a systematic review and meta-analysis. Neurology, 2011, 77(10): 1005-1012.
6.	Mbuba CK, Ngugi AK, Newton CR, et al. The epilepsy treatment gap in developing countries: a systematic review of the magnitude, causes, and intervention strategies. Epilepsia, 2008, 49(9): 1491-1503.
7.	Banerjee TK, Ray BK, Das SK, et al. A longitudinal study of epilepsy in Kolkata, India. Epilepsia, 2010, 51(12): 2384-2391.
8.	Kochen S, Melcon MO. Prognosis of epilepsy in a community-based study: 8 years of follow-up in an Argentine community. Acta Neurol Scand, 2005, 112(6): 370-374.
9.	Meinardi H, Scott RA, Reis R, et al. The treatment gap in epilepsy: the current situation and ways forward. Epilepsia, 2001, 42(1): 136-149.
10.	Meyer AC, Dua T, Ma J, et al. Global disparities in the epilepsy treatment gap: a systematic review. Bull World Health Organ, 2010, 88(4): 260-266.
11.	Diop AG, Hesdorffer DC, Logroscino G, et al. Epilepsy and mortality in Africa: a review of the literature. Epilepsia, 2005, 46(Suppl 11): 33-35.
12.	Jilek-Aall L, Rwiza HT. Prognosis of epilepsy in a rural African community: a 30-year follow-up of 164 patients in an outpatient clinic in rural Tanzania. Epilepsia, 1992, 33(4): 645-650.
13.	Thurman DJ, Logroscino G, Beghi E, et al. The burden of premature mortality of epilepsy in high-income countries: a systematic review from the Mortality Task Force of the International League Against Epilepsy. Epilepsia, 2016, 58(1): 17-26.
14.	World Bank. Data: Country and Lending Groups, 2015. Available at: http://data.worldbank.org/about/country-and-lending-groups. Accessed October 26, 2015.
15.	ILAE. Guidelines for epidemiologic studies on epilepsy. Epilepsia, 1993, 34(4): 592-596.
16.	Berg AT, Berkovic SF, Brodie MJ, et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia, 2010, 51(4): 676-685.
17.	Thurman DJ, Beghi E, Begley CE, et al. Standards for epidemiologic studies and surveillance of epilepsy. Epilepsia, 2011, 52(Suppl 7): 2-26.
18.	Shorvon S, Tomson T. Sudden unexpected death in epilepsy. Lancet, 2011, 378(9808): 2028-2038.
19.	Rothman KJ, Greenland S, Lash TL. Modern epidemiology. Philadelphia, PA: Lippincott, Williams, & Wilkins, 2008.
20.	Nashef L. Sudden unexpected death in epilepsy: terminology and definitions. Epilepsia, 1997, 38(Suppl 11): 6-8.
21.	Nashef L, So EL, Ryvlin P, et al. Unifying the definitions of sudden unexpected death in epilepsy. Epilepsia, 2012, 53(2): 227-233.
22.	Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA, 2000, 283(15): 2008-2012.
23.	Aspray TJ. The use of verbal autopsy in attributing cause of death from epilepsy. Epilepsia, 2005, 46(Suppl 11): 15-17.
24.	Baiden F, Bawah A, Biai S, et al. Setting international standards for verbal autopsy. Bull World Health Organ, 2007, 85(8): 570-571.
25.	Mateen FJ, Kalter HD. Verbal autopsy for neurological diseases. Am J Trop Med Hyg, 2012, 86(2): 237-239.
26.	Higgins JP. Commentary: Heterogeneity in meta-analysis should be expected and appropriately quantified. Int J Epidemiol, 2008, 37(5): 1158-1160.
27.	Carpio A, Bharucha NE, Jallon P, et al. Mortality of epilepsy in developing countries. Epilepsia, 2005, 46(Suppl 11): 28-32.
28.	Ding D, Wang W, Wu J, et al. Premature mortality in people with epilepsy in rural China: a prospective study. Lancet Neurol, 2006, 5: 823-827.
29.	Ding D, Wang W, Wu J, et al. Premature mortality risk in people with convulsive epilepsy: long follow-up of a cohort in rural China. Epilepsia, 2013, 54(3): 512-517.
30.	Houinato D, Yemadje LP, Glitho G, et al. Epidemiology of epilepsy in rural Benin: prevalence, incidence, mortality, and follow-up. Epilepsia, 2013, 54(4): 757-763.
31.	Kaiser C, Asaba G, Kasoro S, et al. Mortality from epilepsy in an onchocerciasis-endemic area in West Uganda. Trans R Soc Trop Med Hyg, 2007, 101(1): 48-55.
32.	Kamgno J, Pion SD, Boussinesq M. Demographic impact of epilepsy in Africa: results of a 10-year cohort study in a rural area of Cameroon. Epilepsia, 2003, 44(7): 956-963.
33.	Mu J, Liu L, Zhang Q, et al. Causes of death among people with convulsive epilepsy in rural West China: a prospective study. Neurology, 2011, 77(2): 132-137.
34.	Nicoletti A, Sofia V, Vitale G, et al. Natural history and mortality of chronic epilepsy in an untreated population of rural Bolivia: a follow-up after 10 years. Epilepsia, 2009, 50(10): 2199-2206.
35.	Ngugi AK, Bottomley C, Fegan G, et al. Premature mortality in active convulsive epilepsy in rural Kenya: causes and associated factors. Neurology, 2014, 82(7): 582-589.
36.	Almeida AG, Nunes ML, Palmini AL, et al. Incidence of SUDEP in a cohort of patients with refractory epilepsy: the role of surgery and lesion localization. Arq Neuropsiquiatr, 2010, 68(6): 898-902.
37.	Devilat BM, Rivera GG, Gomez MV, et al. [Mortality in children with epilepsy. A clinical prospective study]. Rev Neurol, 2004, 38(7): 607-614.
38.	Terra VC, Scorza FA, Arida RM, et al. Mortality in children with severe epilepsy: 10 years of follow-up. Arq Neuropsiquiatr, 2011, 69(5): 766-769.
39.	Terra VC, Scorza FA, Cavalheiro EA, et al. Pediatric epilepsy surgery and sudden unexpected death epilepsy: the contribution of a Brazilian epilepsy surgery program. Childs Nerv Syst, 2010, 26(8): 1075-1079.
40.	Terra VC, Scorza FA, Sakamoto AC, et al. Does sudden unexpected death in children with epilepsy occur more frequently in those with high seizure frequency?. Arq Neuropsiquiatr, 2009, 67(4): 1001-1002.
41.	Thomas SV, Reghunath B, Sankara SP. Mortality among epilepsy patients attending a tertiary referral center in a developing country. Seizure, 2001, 10(5): 370-373.
42.	Escalaya AL, Tellez-Zenteno JF, Steven DA, et al. Epilepsy and mortality in Latin America. Seizure, 2015, 25: 99-103.
43.	World Health Organization. World Health Statistics, 2015., 2015. Available at: http://apps.who.int/iris/bitstream/10665/170250/1/9789240694439_eng.pdf?ua=1. Accessed March 2, 2016.
44.	Preux PM, Druet-Cabanac M. Epidemiology and aetiology of epilepsy in sub-Saharan Africa. Lancet Neurol, 2005, 4(1): 21-31.
45.	Newton CR, Kariuki SM. Status epilepticus in sub-Saharan Africa: new findings. Epilepsia, 2013, 54(Suppl. 6): 50-53.
46.	Mushi D, Hunter E, Mtuya C, et al. Social-cultural aspects of epilepsy in Kilimanjaro Region, Tanzania: knowledge and experience among patients and carers. Epilepsy Behav, 2011, 20(2): 338-343.
47.	de Boer HM, Mula M, Sander JW. The global burden and stigma of epilepsy. Epilepsy Behav, 2008, 12(4): 540-546.
48.	Birbeck G, Chomba E, Atadzhanov M, et al. The social and economic impact of epilepsy in Zambia: a cross-sectional study. Lancet Neurol, 2007, 6(1): 39-44.
49.	Hoyert DL. The changing profile of autopsied deaths in the United States, 1972–2007. NCHS Data Brief, 2011, 67: 1-7.
50.	Schraeder PL, Delin K, McClelland RL, et al. Coroner and medical examiner documentation of sudden unexplained deaths in epilepsy. Epilepsy Res, 2006, 68(2): 137-143.

1. Forsgren L, Hauser WA, Olafsson E, et al. Mortality of epilepsy in developed countries: a review. Epilepsia, 2005, 46(Suppl 11): 18-27.
2. Nevalainen O, Ansakorpi H, Simola M, et al. Epilepsy-related clinical characteristics and mortality: a systematic review and meta-analysis. Neurology, 2014, 83(21): 1968-1977.
3. Newton CR, Garcia HH. Epilepsy in poor regions of the world. Lancet, 2012, 380(9848): 1193-1201.
4. Ngugi AK, Bottomley C, Kleinschmidt I, et al. Estimation of the burden of active and life-time epilepsy: a meta-analytic approach. Epilepsia, 2010, 51(5): 883-890.
5. Ngugi AK, Kariuki SM, Bottomley C, et al. Incidence of epilepsy: a systematic review and meta-analysis. Neurology, 2011, 77(10): 1005-1012.
6. Mbuba CK, Ngugi AK, Newton CR, et al. The epilepsy treatment gap in developing countries: a systematic review of the magnitude, causes, and intervention strategies. Epilepsia, 2008, 49(9): 1491-1503.
7. Banerjee TK, Ray BK, Das SK, et al. A longitudinal study of epilepsy in Kolkata, India. Epilepsia, 2010, 51(12): 2384-2391.
8. Kochen S, Melcon MO. Prognosis of epilepsy in a community-based study: 8 years of follow-up in an Argentine community. Acta Neurol Scand, 2005, 112(6): 370-374.
9. Meinardi H, Scott RA, Reis R, et al. The treatment gap in epilepsy: the current situation and ways forward. Epilepsia, 2001, 42(1): 136-149.
10. Meyer AC, Dua T, Ma J, et al. Global disparities in the epilepsy treatment gap: a systematic review. Bull World Health Organ, 2010, 88(4): 260-266.
11. Diop AG, Hesdorffer DC, Logroscino G, et al. Epilepsy and mortality in Africa: a review of the literature. Epilepsia, 2005, 46(Suppl 11): 33-35.
12. Jilek-Aall L, Rwiza HT. Prognosis of epilepsy in a rural African community: a 30-year follow-up of 164 patients in an outpatient clinic in rural Tanzania. Epilepsia, 1992, 33(4): 645-650.
13. Thurman DJ, Logroscino G, Beghi E, et al. The burden of premature mortality of epilepsy in high-income countries: a systematic review from the Mortality Task Force of the International League Against Epilepsy. Epilepsia, 2016, 58(1): 17-26.
14. World Bank. Data: Country and Lending Groups, 2015. Available at: http://data.worldbank.org/about/country-and-lending-groups. Accessed October 26, 2015.
15. ILAE. Guidelines for epidemiologic studies on epilepsy. Epilepsia, 1993, 34(4): 592-596.
16. Berg AT, Berkovic SF, Brodie MJ, et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia, 2010, 51(4): 676-685.
17. Thurman DJ, Beghi E, Begley CE, et al. Standards for epidemiologic studies and surveillance of epilepsy. Epilepsia, 2011, 52(Suppl 7): 2-26.
18. Shorvon S, Tomson T. Sudden unexpected death in epilepsy. Lancet, 2011, 378(9808): 2028-2038.
19. Rothman KJ, Greenland S, Lash TL. Modern epidemiology. Philadelphia, PA: Lippincott, Williams, & Wilkins, 2008.
20. Nashef L. Sudden unexpected death in epilepsy: terminology and definitions. Epilepsia, 1997, 38(Suppl 11): 6-8.
21. Nashef L, So EL, Ryvlin P, et al. Unifying the definitions of sudden unexpected death in epilepsy. Epilepsia, 2012, 53(2): 227-233.
22. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA, 2000, 283(15): 2008-2012.
23. Aspray TJ. The use of verbal autopsy in attributing cause of death from epilepsy. Epilepsia, 2005, 46(Suppl 11): 15-17.
24. Baiden F, Bawah A, Biai S, et al. Setting international standards for verbal autopsy. Bull World Health Organ, 2007, 85(8): 570-571.
25. Mateen FJ, Kalter HD. Verbal autopsy for neurological diseases. Am J Trop Med Hyg, 2012, 86(2): 237-239.
26. Higgins JP. Commentary: Heterogeneity in meta-analysis should be expected and appropriately quantified. Int J Epidemiol, 2008, 37(5): 1158-1160.
27. Carpio A, Bharucha NE, Jallon P, et al. Mortality of epilepsy in developing countries. Epilepsia, 2005, 46(Suppl 11): 28-32.
28. Ding D, Wang W, Wu J, et al. Premature mortality in people with epilepsy in rural China: a prospective study. Lancet Neurol, 2006, 5: 823-827.
29. Ding D, Wang W, Wu J, et al. Premature mortality risk in people with convulsive epilepsy: long follow-up of a cohort in rural China. Epilepsia, 2013, 54(3): 512-517.
30. Houinato D, Yemadje LP, Glitho G, et al. Epidemiology of epilepsy in rural Benin: prevalence, incidence, mortality, and follow-up. Epilepsia, 2013, 54(4): 757-763.
31. Kaiser C, Asaba G, Kasoro S, et al. Mortality from epilepsy in an onchocerciasis-endemic area in West Uganda. Trans R Soc Trop Med Hyg, 2007, 101(1): 48-55.
32. Kamgno J, Pion SD, Boussinesq M. Demographic impact of epilepsy in Africa: results of a 10-year cohort study in a rural area of Cameroon. Epilepsia, 2003, 44(7): 956-963.
33. Mu J, Liu L, Zhang Q, et al. Causes of death among people with convulsive epilepsy in rural West China: a prospective study. Neurology, 2011, 77(2): 132-137.
34. Nicoletti A, Sofia V, Vitale G, et al. Natural history and mortality of chronic epilepsy in an untreated population of rural Bolivia: a follow-up after 10 years. Epilepsia, 2009, 50(10): 2199-2206.
35. Ngugi AK, Bottomley C, Fegan G, et al. Premature mortality in active convulsive epilepsy in rural Kenya: causes and associated factors. Neurology, 2014, 82(7): 582-589.
36. Almeida AG, Nunes ML, Palmini AL, et al. Incidence of SUDEP in a cohort of patients with refractory epilepsy: the role of surgery and lesion localization. Arq Neuropsiquiatr, 2010, 68(6): 898-902.
37. Devilat BM, Rivera GG, Gomez MV, et al. [Mortality in children with epilepsy. A clinical prospective study]. Rev Neurol, 2004, 38(7): 607-614.
38. Terra VC, Scorza FA, Arida RM, et al. Mortality in children with severe epilepsy: 10 years of follow-up. Arq Neuropsiquiatr, 2011, 69(5): 766-769.
39. Terra VC, Scorza FA, Cavalheiro EA, et al. Pediatric epilepsy surgery and sudden unexpected death epilepsy: the contribution of a Brazilian epilepsy surgery program. Childs Nerv Syst, 2010, 26(8): 1075-1079.
40. Terra VC, Scorza FA, Sakamoto AC, et al. Does sudden unexpected death in children with epilepsy occur more frequently in those with high seizure frequency?. Arq Neuropsiquiatr, 2009, 67(4): 1001-1002.
41. Thomas SV, Reghunath B, Sankara SP. Mortality among epilepsy patients attending a tertiary referral center in a developing country. Seizure, 2001, 10(5): 370-373.
42. Escalaya AL, Tellez-Zenteno JF, Steven DA, et al. Epilepsy and mortality in Latin America. Seizure, 2015, 25: 99-103.
43. World Health Organization. World Health Statistics, 2015., 2015. Available at: http://apps.who.int/iris/bitstream/10665/170250/1/9789240694439_eng.pdf?ua=1. Accessed March 2, 2016.
44. Preux PM, Druet-Cabanac M. Epidemiology and aetiology of epilepsy in sub-Saharan Africa. Lancet Neurol, 2005, 4(1): 21-31.
45. Newton CR, Kariuki SM. Status epilepticus in sub-Saharan Africa: new findings. Epilepsia, 2013, 54(Suppl. 6): 50-53.
46. Mushi D, Hunter E, Mtuya C, et al. Social-cultural aspects of epilepsy in Kilimanjaro Region, Tanzania: knowledge and experience among patients and carers. Epilepsy Behav, 2011, 20(2): 338-343.
47. de Boer HM, Mula M, Sander JW. The global burden and stigma of epilepsy. Epilepsy Behav, 2008, 12(4): 540-546.
48. Birbeck G, Chomba E, Atadzhanov M, et al. The social and economic impact of epilepsy in Zambia: a cross-sectional study. Lancet Neurol, 2007, 6(1): 39-44.
49. Hoyert DL. The changing profile of autopsied deaths in the United States, 1972–2007. NCHS Data Brief, 2011, 67: 1-7.
50. Schraeder PL, Delin K, McClelland RL, et al. Coroner and medical examiner documentation of sudden unexplained deaths in epilepsy. Epilepsy Res, 2006, 68(2): 137-143.

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