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Epilepsy

Hayley C Gorton, Roger T Webb, Mathew J Carr, Marcos Delpozo-Banos, Ann John, Darren M Ashcroft

Type
Disease or Syndrome
ID
PH467
Version ID
934
Data Sources
Valid event data range
01/01/1998 - 31/03/2014
Sex
Female, Male
Agreement Date
2018-04-09
Coding system
Read codes v2
Tags /Collections
ClinicalCodes Repository Phenotype Library

Definition

Importance:

People with epilepsy are at increased risk of mortality, but, to date, the cause-specific risks of all unnatural causes have not been reported.

Objective:

To estimate cause-specific unnatural mortality risks in people with epilepsy and to identify the medication types involved in poisoning deaths.

Design, Setting, and Participants:

This population-based cohort study used 2 electronic primary care data sets linked to hospitalization and mortality records, the Clinical Practice Research Datalink (CPRD) in England (from January 1, 1998, to March 31, 2014) and the Secure Anonymised Information Linkage (SAIL) Databank in Wales (from January 1, 2001, to December 31, 2014). Each person with epilepsy was matched on age (within 2 years), sex, and general practice with up to 20 individuals without epilepsy. Unnatural mortality was determined using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes V01 through Y98 in the Office for National Statistics mortality records. Hazard ratios (HRs) were estimated in each data set using a stratified Cox proportional hazards model, and meta-analyses were conducted using DerSimonian and Laird random-effects models. The analysis was performed from January 5, 2016, to November 16, 2017.

Exposures:

People with epilepsy were identified using primary care epilepsy diagnoses and associated antiepileptic drug prescriptions.

Main Outcomes and Measures:

Hazard ratios (HRs) for unnatural mortality and the frequency of each involved medication type estimated as a percentage of all medication poisoning deaths.

Results:

In total, 44678 individuals in the CPRD and 14 051 individuals in the SAIL Databank were identified in the prevalent epilepsy cohorts, and 891 429 (CPRD) and 279 365 (SAIL) individuals were identified in the comparison cohorts. In both data sets, 51% of the epilepsy and comparison cohorts were male, and the median age at entry was 40 years (interquartile range, 25-60 years) in the CPRD cohorts and 43 years (interquartile range, 24-64 years) in the SAIL cohorts. People with epilepsy were significantly more likely to die of any unnatural cause (HR, 2.77; 95% CI, 2.43-3.16), unintentional injury or poisoning (HR, 2.97; 95% CI, 2.54-3.48) or suicide (HR, 2.15; 95% CI, 1.51-3.07) than people in the comparison cohort. Particularly large risk increases were observed in the epilepsy cohorts for unintentional medication poisoning (HR, 4.99; 95% CI, 3.22-7.74) and intentional self-poisoning with medication (HR, 3.55; 95% CI, 1.01-12.53). Opioids (56.5% [95% CI, 43.3%-69.0%]) and psychotropic medication (32.3% [95% CI, 20.9%-45.3%)] were more commonly involved than antiepileptic drugs (9.7% [95% CI, 3.6%-19.9%]) in poisoning deaths in people with epilepsy.

Conclusions and Relevance:

Compared with people without epilepsy, people with epilepsy are at increased risk of unnatural death and thus should be adequately advised about unintentional injury prevention and monitored for suicidal ideation, thoughts, and behaviors. The suitability and toxicity of concomitant medication should be considered when prescribing for comorbid conditions.

Publications

  • Hayley C Gorton, Roger T Webb, Mathew J Carr, Marcos Delpozo-Banos, Ann John, Darren M Ashcroft, Risk of Unnatural Mortality in People With Epilepsy. JAMA Neurology, 75(8), 929-038, 2018.

Clinical Code List

Rows: 97
Code Description Entity type Category Coding System (Read)
Eu80300 [X]Acquired aphasia with epilepsy [Landau - Kleffner] res55: epilepsy diagnostic Read
F132100 Progressive myoclonic epilepsy res55: epilepsy diagnostic Read
F250y00 Other specified generalised nonconvulsive epilepsy res55: epilepsy diagnostic Read
F250z00 Generalised nonconvulsive epilepsy NOS res55: epilepsy diagnostic Read
F251.00 Generalised convulsive epilepsy res55: epilepsy diagnostic Read
F251011 Tonic-clonic epilepsy res55: epilepsy diagnostic Read
F251100 Neonatal myoclonic epilepsy res55: epilepsy diagnostic Read
F251y00 Other specified generalised convulsive epilepsy res55: epilepsy diagnostic Read
F251z00 Generalised convulsive epilepsy NOS res55: epilepsy diagnostic Read
F254.00 Partial epilepsy with impairment of consciousness res55: epilepsy diagnostic Read
F254100 Psychomotor epilepsy res55: epilepsy diagnostic Read
F254200 Psychosensory epilepsy res55: epilepsy diagnostic Read
F254300 Limbic system epilepsy res55: epilepsy diagnostic Read
F254z00 Partial epilepsy with impairment of consciousness NOS res55: epilepsy diagnostic Read
F255.00 Partial epilepsy without impairment of consciousness res55: epilepsy diagnostic Read
F255100 Sensory induced epilepsy res55: epilepsy diagnostic Read
F255200 Somatosensory epilepsy res55: epilepsy diagnostic Read
F255400 Visual reflex epilepsy res55: epilepsy diagnostic Read
F255y00 Partial epilepsy without impairment of consciousness OS res55: epilepsy diagnostic Read
F25A.00 Juvenile myoclonic epilepsy res55: epilepsy diagnostic Read
F25B.00 Alcohol-induced epilepsy res55: epilepsy diagnostic Read
F25C.00 Drug-induced epilepsy res55: epilepsy diagnostic Read
F25D.00 Menstrual epilepsy res55: epilepsy diagnostic Read
F25E.00 Stress-induced epilepsy res55: epilepsy diagnostic Read
F25y.00 Other forms of epilepsy res55: epilepsy diagnostic Read
1473 H/O: epilepsy res55: epilepsy diagnostic Read
1B1W.00 Transient epileptic amnesia res55: epilepsy diagnostic Read
1O30.00 Epilepsy confirmed res55: epilepsy diagnostic Read
2823 O/E - petit mal fit res55: epilepsy diagnostic Read
2824 O/E - focal (Jacksonian) fit res55: epilepsy diagnostic Read
2824.11 O/E - Jacksonian fit res55: epilepsy diagnostic Read
2825 O/E - psychomotor fit res55: epilepsy diagnostic Read
2828 Absence seizure res55: epilepsy diagnostic Read
667B.00 Nocturnal epilepsy res55: epilepsy diagnostic Read
667N.00 Epilepsy severity res55: epilepsy diagnostic Read
Eu05212 [X]Schizophrenia-like psychosis in epilepsy res55: epilepsy diagnostic Read
Eu05y11 [X]Epileptic psychosis NOS res55: epilepsy diagnostic Read
Eu06013 [X]Limbic epilepsy personality res55: epilepsy diagnostic Read
F132200 Myoclonic encephalopathy res55: epilepsy diagnostic Read
F25..00 Epilepsy res55: epilepsy diagnostic Read
F25.z.11 Fit (in known epileptic) NOS res55: epilepsy diagnostic Read
F250.00 Generalised nonconvulsive epilepsy res55: epilepsy diagnostic Read
F250000 Petit mal (minor) epilepsy res55: epilepsy diagnostic Read
F250011 Epileptic absences res55: epilepsy diagnostic Read
F250100 pykno-epilepsy res55: epilepsy diagnostic Read
F250200 Epileptic seizures - atonic res55: epilepsy diagnostic Read
F250300 Epileptic seizures - akinetic res55: epilepsy diagnostic Read
F250400 Juvenile absence epilepsy res55: epilepsy diagnostic Read
F250500 Lennox-Gastaut syndrome res55: epilepsy diagnostic Read
F251000 Grand mal (major) epilepsy res55: epilepsy diagnostic Read
F251111 Otohara syndrome res55: epilepsy diagnostic Read
F251200 Epileptic seizures - clonic res55: epilepsy diagnostic Read
F251300 Epileptic seizures - myoclonic res55: epilepsy diagnostic Read
F251400 Epileptic seizures - tonic res55: epilepsy diagnostic Read
F251500 Tonic-clonic epilepsy res55: epilepsy diagnostic Read
F251600 Grand mal seizure res55: epilepsy diagnostic Read
F252.00 Petit mal status res55: epilepsy diagnostic Read
F253.00 Grand mal status res55: epilepsy diagnostic Read
F253.11 Status epilepticus res55: epilepsy diagnostic Read
F254000 Temporal lobe epilepsy res55: epilepsy diagnostic Read
F254400 Epileptic automatism res55: epilepsy diagnostic Read
F254500 Complex partial epileptic seizure res55: epilepsy diagnostic Read
F255000 Jacksonian, focal or motor epilepsy res55: epilepsy diagnostic Read
F255011 Focal epilepsy res55: epilepsy diagnostic Read
F255012 Motor epilepsy res55: epilepsy diagnostic Read
F255300 Visceral reflex epilepsy res55: epilepsy diagnostic Read
F255311 Partial epilepsy with autonomic symptoms res55: epilepsy diagnostic Read
F255500 Unilateral epilepsy res55: epilepsy diagnostic Read
F255600 Simple partial epileptic seizure res55: epilepsy diagnostic Read
F255z00 Partial epilepsy without impairment of consciousness NOS res55: epilepsy diagnostic Read
F256.00 Infantile Spasms res55: epilepsy diagnostic Read
F256.11 Lightning spasms res55: epilepsy diagnostic Read
F256.12 West Syndrome res55: epilepsy diagnostic Read
F256000 Hypsarrhthymia res55: epilepsy diagnostic Read
F256100 Salaam attacks res55: epilepsy diagnostic Read
F256z00 Infantile Spasms NOS res55: epilepsy diagnostic Read
F257.00 Kojevnikov's epilepsy res55: epilepsy diagnostic Read
F259.00 Early infant epileptic encephalopathy with suppression bursts res55: epilepsy diagnostic Read
F259.11 Ohtahara syndrome res55: epilepsy diagnostic Read
F25F.00 Photosensitive epilepsy res55: epilepsy diagnostic Read
F25G.00 Severe myoclonic epilepsy in infancy res55: epilepsy diagnostic Read
F25X.00 Status epilepticus, unspecified res55: epilepsy diagnostic Read
F25y000 Cursive (running) epilepsy res55: epilepsy diagnostic Read
F25y100 Gelastic epilepsy res55: epilepsy diagnostic Read
F25y200 Locl-rlt(foc)(part)idiop epilep&epilptic syn seiz locl onset res55: epilepsy diagnostic Read
F25y300 Complex partial status epilepticus res55: epilepsy diagnostic Read
F25y400 Benign Rolandic epilepsy res55: epilepsy diagnostic Read
F25y500 Panayiotopoulos syndrome res55: epilepsy diagnostic Read
F25yz00 Other forms of epilepsy NOS res55: epilepsy diagnostic Read
F25z.00 Epilepsy NOS res55: epilepsy diagnostic Read
Fyu5000 [X]Other generalized epilepsy and epileptic syndromes res55: epilepsy diagnostic Read
Fyu5100 [X]Other epilepsy res55: epilepsy diagnostic Read
Fyu5200 [X]Other status epilepticus res55: epilepsy diagnostic Read
Fyu5900 [X]Status epilepticus, unspecified res55: epilepsy diagnostic Read
SC20000 Traumatic epilepsy res55: epilepsy diagnostic Read
ZS82.00 Acquired epileptic aphasia res55: epilepsy diagnostic Read
ZS82.11 Landau-Kleffner syndrome res55: epilepsy diagnostic Read

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH467/version/934/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH467/version/934/detail/?format=json
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get details of phenotype

details = get_phenotype_detail_by_version('PH467', '934', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH467/version/934/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH467/version/934/export/codes/?format=json
CSV site_root/phenotypes/PH467/version/934/export/codes/
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get codelists of phenotype

codelists = get_phenotype_code_list('PH467', '934', api_client=client)

Version History

Version
ID
Name Owner Publish date
934 Epilepsy ieuan.scanlon 2021-10-06 currently shown

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