Short-term mortality after a first epileptic seizure: A population-based study

Purpose: To determine the short-term mortality in a prospective incidence c ohort of patients included after any kind of first afebrile epileptic seizu re (i.e., provoked and unprovoked). Methods: Information on death occurring within the first year of follow-up was collected in a cohort of 804 patients with a first seizure between Marc h 1. 1984, and February 28, 1985, in southwest France. The variables analyz ed were the etiology of seizure. cause of death, interval between seizure a nd death, and age of patients. Results. By the end of the 1-year follow-up, there were 149 deaths among th ese patients as compared with 16 expected deaths [standardized mortality ra tio (SMR), 9.3; 95% confidence interval (CI), 7.9-10.9]. There were no deat hs in patients with idiopathic seizures. Patients with cryptogenic seizures had slightly increased mortality (SMR, 1.6; 95% CI, 0.4-4.1). Mortality wa s increased for patients with remote symptomatic seizures (SMR, 6.5; 95% CI , 3.8-10.5), provoked seizures (SMR, 10.1; 95% CT, 8.1-12.4, and seizures d ue to a progressive neurologic condition (SMR, 19.8; 95% CI, 14.0-27.3). Ca uses of death were underlying pathology (64%), unrelated condition (20%), u nknown cause (9%), seizure-related death (6%), and one suicide. Conclusions: Early mortality clearly differed according to the etiology of the first seizure. The highest mortality was associated with provoked seizu res and with seizures caused by progressive central nervous system disorder s. Patients died far more often from underlying or unrelated conditions tha n from seizures.