Risk of death in children with epilepsy: Recommendations for prevention and management based on a review of the literature

摘要

Although the risk of death is well integrated into the management of adult patients with epilepsy, the subject is frequently overlooked for children. This difference can be explained by the lack of data in the literature, the idea that the risk of death is lower in children, and fear that the anxiety generated is more harmful than the risk of death itself. Work carried out by the Epilepsy Commission of the French Society of Pediatric Neurology proposes an inventory of the data in the literature and offers recommendations to guide practitioners in the management of these patients. The risk of death in children with epilepsy is 5-10 times greater than in the general population, and the mortality rate is 228/100,000 people per year. In children, deaths are dominated by causes unrelated to epilepsy (primarily pneumonia); sudden unexpected death in epilepsy patients (SUDEP) represents only 25% of causes, although the percentage can increase with follow-up in adulthood. The risk factors are well known: early epilepsy and drug resistance, presence of generalized tonicoclonic seizures, nocturnal seizures, comorbidities, poor compliance. This issue should be addressed from the onset of the disease, and plays a particular role in cases of early epilepsy and/or drug-resistant epilepsy. The challenge lies in providing information on prevention recommendations: compliance, optimization of epilepsy treatment, education on therapies, and information on activities of daily living and sports.