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Three-Year Mortality After First Acute Symptomatic Seizure: A Prospective, Population-Based Study in Ireland
Michael J Murphy1,2,3, Eimer M Maloney1,3,4, Jessica Stack1,3
1Epilepsy Service, Department of Neurology, Cork University Hospital, Ireland.
Neurology. Clinical Practice
|August 10, 2026
Summary
Acute symptomatic seizures (ASyS) significantly increase 3-year mortality risk. This common seizure type indicates a higher long-term mortality, especially in complex medical cases.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- Acute symptomatic seizures (ASyS) are seizures occurring with systemic insults or brain injury.
- Understanding the long-term prognosis of ASyS is crucial for patient management.
Purpose of the Study:
- To determine the 3-year mortality rate following a first episode of ASyS.
- To assess the prognostic significance of ASyS as an indicator of long-term mortality.
Main Methods:
- Prospective, population-based cohort study of first seizures in 2017.
- Identification of ASyS cases using ILAE criteria.
- Mortality assessment at 30 days, 1 year, and 3 years, with calculation of standardized mortality ratios (SMRs).
Main Results:
- 61 deaths (29.5%) occurred within 3 years among 207 ASyS cases.
- 3-year mortality was 29.5%, with an SMR of 10.4 compared to the general population.
- Pneumonia was the leading cause of death; excluding substance use, 3-year mortality reached 45.5%.
Conclusions:
- ASyS is a common presentation associated with substantially increased 3-year mortality.
- ASyS serves as a critical clinical indicator of elevated long-term mortality risk.
- These findings highlight the importance of recognizing ASyS in prognostication, particularly for medically complex patients.