Mortality after a first-ever unprovoked seizure.

Area of Science:

• Neurology
• Public Health
• Epidemiology

Background:

• Epilepsy is associated with increased mortality, but data on outcomes after a first seizure are limited.
• Understanding mortality after a first-ever unprovoked seizure is crucial for early intervention and risk stratification.

Purpose of the Study:

• To assess mortality rates following a first-ever unprovoked seizure.
• To identify the causes of death (CODs) and risk factors associated with this event.

Main Methods:

• A prospective cohort study in Western Australia (1999-2015) compared patients with a first unprovoked seizure to matched controls.
• Mortality data and CODs were collected using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes.

Main Results:

• Patients with a first unprovoked seizure had a 2- to 3-fold increased hazard ratio (HR) for death compared to controls (HR=3.06).
• Increased mortality was observed regardless of seizure recurrence, normal imaging, or identified cause.
• Key mortality predictors included advanced age, remote symptomatic causes, seizure clusters/status epilepticus at presentation, neurological disability, and antidepressant use.

Conclusions:

• Mortality is significantly elevated after a first unprovoked seizure, independent of seizure recurrence or underlying neurological etiology.
• Higher rates of death from substance overdose and suicide emphasize the importance of evaluating psychiatric comorbidity and substance use in these patients.