Acta Neurol Scand 1997: 96: 138-141 Prinred in UK zyxwvutsrqponmlk - zyxwvutsr all righfs reserved Copyright zyx 0 Munksgaard 1997 zy ACTA NEUROLOGICA SCANDINAVICA ISSN 0001-6314 zyx A historical perspective on the mortality associated with chronic epilepsy O’Donoghue MF, Sander JWAS. A historical perspective on the mortality associated with chronic epilepsy. Acta Neurol Scand 1997: 96: 138-141. 0 Munksgaard 1997. Objective - To examine the secular trend in the mortality associated with chronic epilepsy. Material and methods - Using data from the Chalfont Centre for Epilepsy, UK, a residential centre for people with epilepsy, we determined the standardized mortality ratio (SMR) in the Chalfont population for each 5-year epoch from 1896 to 1965. Results - The SMR was found to be between 2 and 3 for most 5 year epochs from 1896 to 1965. Conclusion - Changes in the average age and disability of the residents at the Chalfont Centre confound a definite conclusion, but the evidence suggests the possibility that an excess mortality has been associated with chronic epilepsy for 100 years despite major changes in treatment. It is now well established that epilepsy is not a benign condition, with mortality both as a direct result of seizures as well as because of underlying conditions (for a review see (1)). That death may occur during or after a seizure, either as a con- sequence of accident or sudden death, was recog- nized by physicians in the last century. In 1868, G. Mackenzie Bacon writing in the Lancet (2), classi- fied the causes of death in epilepsy (excluding secondary causes) as “1. Those arising from the long continued effects of the disease on the body; 2. Deaths after a rapid succession of fits; 3. Sudden deaths in a fit; and 4. Accidents due to fits”. Similar observations were also made in the French litera- ture (3,4). In 1902 Spratling (5), and later Munson (6), reporting on their experience of the Craig Colony in Sonyea, New York State, were also in no doubt that epilepsy was associated with an increased mortality, and specifically a risk of death during a seizure. Spratling, whose broader contri- butions to epilepsy have been reviewed by Fine (7), recorded deaths due to status epilepticus, single seizures, aspiration pneumonia, suffocation and accidents, amongst other causes. More recently, when the mortality rate for people with epilepsy has been compared to the general population, a two-to-three-fold increase in the standardized mor- tality ratio (SMR) has typically been reported (1, 8). It remains unknown whether this increased mortality has changed over the last 100 years. An zyxwv M. F. O’Donoghue, J. W. A. S. Sander Epilepsy Research Group, The Institute of Neurology, Queen Square, London, W C I N 3BG. United Kingdom Key words: epilepsy; standardized mortality ratio; sudden death; secular trends Dr J W. A. S. Sander, The Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire SL9 ORJ. United Kingdom Accepted tor publication April 15, 1997 opportunity to explore this issue has arisen after we identified the annual reports of the medical officer at the Chalfont Centre for Epilepsy (CCE), an “epilepsy colony” in the United Kingdom. The National Society for the Employment of Epileptics (later changed to the National Society for Epilepsy - NSE) was established in the United Kingdom at the end of 1894 in order to promote the social and occupational well-being of people with epilepsy (9). For this purpose the NSE founded the “Chalfont Colony” (later called the Chalfont Centre for Epilepsy - CCE) based on the model of the colony in Bielefeld, Germany. The CCE started admitting adult males in 1894, women in 1897 and children in 1909. The population of the centre grew rapidly, and from the 1930s onwards over 500 adults and children were resident there. The total number remained relatively static from 1930-1965, though approximately 10% of the total were admitted or discharged each year. Mortality in the CCE population has been stud- ied twice before. First, in 1979 White et al. reported on the deaths occurring during the years 1951 to 1977 (10). The death rate and cause of death was determined whether or not the subjects were still resident at the centre and an SMR of 3.0 was ob- served. The leading cause of death (31%) was ascribed to epilepsy. The second study observed an SMR of 1.9 in people resident at the centre be- tween the years 1980 and 1990 (11). The leading 138