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Seizure control and mortality in epilepsy.

M R Sperling¹, H Feldman, J Kinman

¹Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.

Annals of Neurology

|July 13, 1999

Summary

Achieving seizure freedom after epilepsy surgery significantly lowers mortality rates, bringing them in line with the general population. Uncontrolled seizures post-surgery remain a major risk factor for increased mortality.

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Area of Science:

Neurology
Neurosurgery
Public Health

Background:

People with epilepsy face increased mortality rates, particularly those with uncontrolled seizures.
Epilepsy surgery offers seizure elimination for some patients, presenting an opportunity to study mortality influences.

Purpose of the Study:

To test the hypothesis that complete seizure relief after epilepsy surgery leads to lower mortality compared to persistent seizures.
To examine the impact of seizure control on long-term survival in an epilepsy surgery population.

Main Methods:

A cohort of 393 patients undergoing epilepsy surgery (1986-1996) was followed for long-term survival.
Multivariate survival analysis compared mortality in seizure-free patients versus those with recurrent seizures.
Standardized mortality ratios (SMR) and confidence intervals were calculated.

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Main Results:

Seizure-free patients exhibited a lower mortality rate than those with persistent seizures.
No deaths occurred in 199 seizure-free patients, while 11 deaths occurred in 194 patients with recurrent seizures (SMR=4.69).
Mortality for seizure-free patients was indistinguishable from the general US population.

Conclusions:

Eliminating seizures through surgery reduces epilepsy-related mortality to general population levels.
Uncontrolled seizures are a significant risk factor for excess mortality in epilepsy.
Epilepsy surgery in suitable candidates may offer a lower long-term risk than continued medical management for refractory epilepsy.