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From the Department of Clinical & Experimental Epilepsy (G.S.B., A.G., J.W.S.), UCL Institute of Neurology, and National Hospital for Neurology and Neurosurgery, UCL Hospitals NHS Foundation Trust, Queen Square, London; Bristol Medical School (C.L.B.); MRC Biostatistics Unit (A.L.J.), Institute of Public Health, University Forvie Site, Cambridge, UK; and SEIN–Epilepsy Institutes of the Netherlands Foundation (J.W.S.), The Netherlands.
Address correspondence and reprint requests to Prof. Ley Sander, Box 29, Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK lsander{at}ion.ucl.ac.uk
Background: People with epilepsy are known to be at increased risk of death by drowning but there are few data available regarding the size of the risk. We aimed to quantify the risk using meta-analysis.
Methods: A literature search identified 51 cohorts of people with epilepsy in whom the number of deaths by drowning in people with epilepsy and the number of person-years at risk could be estimated. Population data were taken from the WHO Statistical Information Service or from the UK Office for National Statistics where available. Standardized mortality ratios (SMRs) with 95% CIs were calculated for each cohort, for groups of cohorts, and for the total population. Additionally, an SMR for drowning in people with epilepsy in England and Wales (1999–2000) was calculated using National Registries.
Results: Eighty-eight drowning deaths were observed compared with 4.70 expected, giving an SMR of 18.7 (95% CI 15.0 to 23.1). Compared with community-based incident studies (SMR 5.4), the SMR was significantly raised in prevalent epilepsy (SMR 18.0), in people with epilepsy and learning disability (SMR 25.7), in those in institutional care (SMR 96.9), and in those who had a temporal lobe excision (SMR 41.1). The SMR for people with epilepsy in England and Wales was 15.3.
Conclusion: The risk of drowning in people with epilepsy is raised 15- to 19-fold compared with people in the general population. It is important that people with epilepsy and their carers be informed of these risks so that deaths can be prevented.
Abbreviations: PYFU = person-years of follow-up; SMR = standardized mortality ratio; SUDEP = sudden unexpected death in epilepsy.
Supplemental data at www.neurology.org
Supported by the UK National Society for Epilepsy and by UCLH/UCL, who received a proportion of funding from the Department of Health’s NIHR Biomedical Research Centres funding scheme.
Disclosure: J.W.S. has received honoraria, consultancy fees, grants, and travel grants from various pharmaceutical companies including Novartis, Pfizer, UCB, Eisai, Schwarz Pharma, Janssen-Cilag, Sanofi-Aventis, and GSK. The National Society for Epilepsy endows his current position. He has been a member of the Management Committee of the International League against Epilepsy and the Executive Committee of the International Bureau for Epilepsy. He is currently a Council member of the British chapter of the International League against Epilepsy and of the charity Epilepsy Action.
Received November 20, 2007. Accepted in final form May 20, 2008.
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