Rwandan institution releases a new study on mortality rates in persons with epilepsy

RWANDA – The longitudinal study at the Neuro-Psychiatric hospital Caraes Ndela and several primary healthcare centres in Rwanda revealed that the mortality rate of persons living with epilepsy was two to three-fold higher than in the general population.

The study, led by Dr Leme Garrrez, is titled “Mortality and sudden unexpected death in Epilepsy in a Cohort of 888 persons living with epilepsy in Rwanda,” 

Garrez’s longitudinal study showed that people living with epilepsy aged 15 years and above were enrolled between February and December 2018.

Results showed that people living with epilepsy who weren’t attending a close-out visit after 12 months were contacted.

According to the report, the median standardised mortality ratio in sub-Saharan Africa of 5.4, and sudden unexpected death in epilepsy (SUDEP) is the most common cause of epilepsy-related death.

The report revealed that neurologists travelled to meet family members and administered the WHO Verbal Autopsy Questionnaire to assess the cause of death.

Out of a total of 888 individuals with epilepsy (PwE), 10 deaths were recorded, resulting in a mortality rate of 11.4 per 1,000 person-years.

Seven deaths had an identified cause, four of which were directly related to epilepsy, including death following head trauma, brain hematoma, prolonged seizure, and status epilepticus.

No cause of death was identified in three cases and these were interpreted as possible SUDEP, yielding a SUDEP rate of 3.4 out of 1,000 person-years.

Mortality rates in tertiary and primary centres were comparable. Conclusions of mortality rates are high and in line with previous reports from Rwanda.

The report highlighted the need for better access to treatment and education for patients and their families regarding the risks of death, particularly SUDEP, in order to improve adherence to treatment and achieve better control over seizures.

Correlation with other mental health issues 

In another study by The National Institutes of Health (NIH), depression is highlighted as the most common psychiatric comorbidity for persons living with epilepsy.

In Rwanda, the prevalence of epilepsy and depression are high, with 4.9 per cent and 13.0 per cent respectively.

This prospective interventional study aimed to determine the prevalence and incidence of depression and the outcome of persons living with epilepsy with depression attending the outpatient neurology department of a tertiary centre.

Persons living with epilepsy enrolled between February and June 2018 in a screening cohort with a 12-month follow-up. At every three-month study visit, PwE were screened for depression using the Patient Health Questionnaire (PHQ-9).

Any positively screened subject was administered the Hamilton Depression Rating Scale (HDRS) to confirm the diagnosis and severity of depression.

In some of his research, together with other researchers, Dr Fidèle Sebera, the Head of the Department of Neurology at Ndera Neuropsychiatric Teaching Hospital, explained that epilepsy is characterised by unpredictable, recurrent seizures and may have cognitive, psychological, and socio‐economic consequences.

According to their research, more than 70 million individuals worldwide who have epilepsy are being impacted by this prevalent long-term illness.

 It is observed that approximately 85 per cent of these patients reside in low‐and-middle‐income countries.

“It contributes to nearly one per cent of the global burden of disease and 20 per cent of the global burden of epilepsy measured in disability‐adjusted life years (DALYs) in sub-Saharan Africa,” Sebera noted.

According to the World Health Organization, epilepsy accounts for a significant proportion of the world’s disease burden, affecting around 50 million people worldwide. 

The estimated proportion of the general population with active epilepsy (for instance continuing seizures or with the need for treatment) at a given time is between 4 and 10 per 1,000 people.

Globally, an estimated 5 million people are diagnosed with epilepsy each year. In high-income countries, there are estimated to be 49 per 100, 000 people diagnosed with epilepsy each year, WHO reports.

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