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
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摘要
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。
引文
1Forsgren L, Hauser WA, Olafsson E, et al. Mortality of epilepsy in developed countries:a review. Epilepsia, 2005, 46(Suppl 11):18-27.
2Nevalainen O, Ansakorpi H, Simola M, et al. Epilepsy-related clinical characteristics and mortality:a systematic review and metaanalysis. Neurology, 2014, 83(21):1968-1977.
3Newton CR, Garcia HH. Epilepsy in poor regions of the world.Lancet, 2012, 380(9848):1193-1201.
4Ngugi 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.
5Ngugi AK, Kariuki SM, Bottomley C, et al. Incidence of epilepsy:a systematic review and meta-analysis. Neurology, 2011, 77(10):1005-1012.
6Mbuba 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.
7Banerjee TK, Ray BK, Das SK, et al. A longitudinal study of epilepsy in Kolkata, India. Epilepsia, 2010, 51(12):2384-2391.
8Kochen S, Melcon MO. Prognosis of epilepsy in a communitybased study:8 years of follow-up in an Argentine community. Acta Neurol Scand, 2005, 112(6):370-374.
9Meinardi H, Scott RA, Reis R, et al. The treatment gap in epilepsy:the current situation and ways forward. Epilepsia, 2001, 42(1):136-149.
10Meyer 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.
11Diop 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.
13Thurman 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.
14World Bank. Data:Country and Lending Groups, 2015. Available at:http://data.worldbank.org/about/country-and-lending-groups.Accessed October 26, 2015.
15ILAE. Guidelines for epidemiologic studies on epilepsy. Epilepsia,1993, 34(4):592-596.
16Berg 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.
17Thurman DJ, Beghi E, Begley CE, et al. Standards for epidemiologic studies and surveillance of epilepsy. Epilepsia, 2011,52 (Suppl 7):2-26.
18Shorvon S, Tomson T. Sudden unexpected death in epilepsy.Lancet, 2011, 378(9808):2028-2038.
19Rothman KJ, Greenland S, Lash TL. Modern epidemiology.Philadelphia, PA:Lippincott, Williams,&Wilkins, 2008.
20Nashef L. Sudden unexpected death in epilepsy:terminology and definitions. Epilepsia, 1997, 38(Suppl 11):6-8.
21Nashef L, So EL, Ryvlin P, et al. Unifying the definitions of sudden unexpected death in epilepsy. Epilepsia, 2012, 53(2):227-233.
22Stroup 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.
23Aspray TJ. The use of verbal autopsy in attributing cause of death from epilepsy. Epilepsia, 2005, 46(Suppl 11):15-17.
24Baiden F, Bawah A, Biai S, et al. Setting international standards for verbal autopsy. Bull World Health Organ, 2007, 85(8):570-571.
25Mateen FJ, Kalter HD. Verbal autopsy for neurological diseases.Am J Trop Med Hyg, 2012, 86(2):237-239.
26Higgins JP. Commentary:Heterogeneity in meta-analysis should be expected and appropriately quantified. Int J Epidemiol, 2008,37(5):1158-1160.
27Carpio A, Bharucha NE, Jallon P, et al. Mortality of epilepsy in developing countries. Epilepsia, 2005, 46(Suppl 11):28-32.
28Ding 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.
29Ding 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.
30Houinato 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.
31Kaiser 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.
33Mu 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.
34Nicoletti 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.
35Ngugi 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.
36Almeida 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.
37Devilat BM, Rivera GG, Gomez MV, et al.[Mortality in children with epilepsy. A clinical prospective study]. Rev Neurol, 2004,38(7):607-614.
38Terra 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.
39Terra 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.
40Terra 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.
41Thomas SV, Reghunath B, Sankara SP. Mortality among epilepsy patients attending a tertiary referral center in a developing country.Seizure, 2001, 10(5):370-373.
42Escalaya AL, Tellez-Zenteno JF, Steven DA, et al. Epilepsy and mortality in Latin America. Seizure, 2015, 25:99-103.
43World 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.
44Preux PM, Druet-Cabanac M. Epidemiology and aetiology of epilepsy in sub-Saharan Africa. Lancet Neurol, 2005, 4(1):21-31.
45Newton CR, Kariuki SM. Status epilepticus in sub-Saharan Africa:new findings. Epilepsia, 2013, 54(Suppl. 6):50-53.
46Mushi 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.
47de Boer HM, Mula M, Sander JW. The global burden and stigma of epilepsy. Epilepsy Behav, 2008, 12(4):540-546.
48Birbeck 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.
49Hoyert 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.
2Nevalainen O, Ansakorpi H, Simola M, et al. Epilepsy-related clinical characteristics and mortality:a systematic review and metaanalysis. Neurology, 2014, 83(21):1968-1977.
3Newton CR, Garcia HH. Epilepsy in poor regions of the world.Lancet, 2012, 380(9848):1193-1201.
4Ngugi 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.
5Ngugi AK, Kariuki SM, Bottomley C, et al. Incidence of epilepsy:a systematic review and meta-analysis. Neurology, 2011, 77(10):1005-1012.
6Mbuba 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.
7Banerjee TK, Ray BK, Das SK, et al. A longitudinal study of epilepsy in Kolkata, India. Epilepsia, 2010, 51(12):2384-2391.
8Kochen S, Melcon MO. Prognosis of epilepsy in a communitybased study:8 years of follow-up in an Argentine community. Acta Neurol Scand, 2005, 112(6):370-374.
9Meinardi H, Scott RA, Reis R, et al. The treatment gap in epilepsy:the current situation and ways forward. Epilepsia, 2001, 42(1):136-149.
10Meyer 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.
11Diop 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.
13Thurman 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.
14World Bank. Data:Country and Lending Groups, 2015. Available at:http://data.worldbank.org/about/country-and-lending-groups.Accessed October 26, 2015.
15ILAE. Guidelines for epidemiologic studies on epilepsy. Epilepsia,1993, 34(4):592-596.
16Berg 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.
17Thurman DJ, Beghi E, Begley CE, et al. Standards for epidemiologic studies and surveillance of epilepsy. Epilepsia, 2011,52 (Suppl 7):2-26.
18Shorvon S, Tomson T. Sudden unexpected death in epilepsy.Lancet, 2011, 378(9808):2028-2038.
19Rothman KJ, Greenland S, Lash TL. Modern epidemiology.Philadelphia, PA:Lippincott, Williams,&Wilkins, 2008.
20Nashef L. Sudden unexpected death in epilepsy:terminology and definitions. Epilepsia, 1997, 38(Suppl 11):6-8.
21Nashef L, So EL, Ryvlin P, et al. Unifying the definitions of sudden unexpected death in epilepsy. Epilepsia, 2012, 53(2):227-233.
22Stroup 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.
23Aspray TJ. The use of verbal autopsy in attributing cause of death from epilepsy. Epilepsia, 2005, 46(Suppl 11):15-17.
24Baiden F, Bawah A, Biai S, et al. Setting international standards for verbal autopsy. Bull World Health Organ, 2007, 85(8):570-571.
25Mateen FJ, Kalter HD. Verbal autopsy for neurological diseases.Am J Trop Med Hyg, 2012, 86(2):237-239.
26Higgins JP. Commentary:Heterogeneity in meta-analysis should be expected and appropriately quantified. Int J Epidemiol, 2008,37(5):1158-1160.
27Carpio A, Bharucha NE, Jallon P, et al. Mortality of epilepsy in developing countries. Epilepsia, 2005, 46(Suppl 11):28-32.
28Ding 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.
29Ding 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.
30Houinato 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.
31Kaiser 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.
33Mu 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.
34Nicoletti 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.
35Ngugi 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.
36Almeida 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.
37Devilat BM, Rivera GG, Gomez MV, et al.[Mortality in children with epilepsy. A clinical prospective study]. Rev Neurol, 2004,38(7):607-614.
38Terra 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.
39Terra 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.
40Terra 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.
41Thomas SV, Reghunath B, Sankara SP. Mortality among epilepsy patients attending a tertiary referral center in a developing country.Seizure, 2001, 10(5):370-373.
42Escalaya AL, Tellez-Zenteno JF, Steven DA, et al. Epilepsy and mortality in Latin America. Seizure, 2015, 25:99-103.
43World 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.
44Preux PM, Druet-Cabanac M. Epidemiology and aetiology of epilepsy in sub-Saharan Africa. Lancet Neurol, 2005, 4(1):21-31.
45Newton CR, Kariuki SM. Status epilepticus in sub-Saharan Africa:new findings. Epilepsia, 2013, 54(Suppl. 6):50-53.
46Mushi 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.
47de Boer HM, Mula M, Sander JW. The global burden and stigma of epilepsy. Epilepsy Behav, 2008, 12(4):540-546.
48Birbeck 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.
49Hoyert 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.