Background
A provoked (or “acute symptomatic”) seizure is a seizure brought on by a sudden problem affecting the body or brain, such as a stroke, head injury, bleeding in the brain, serious infection, very low blood salt or sugar, or alcohol or drug use or withdrawal. Unlike epilepsy, these seizures don’t usually recur once the cause is treated. They account for almost 3 in 10 first seizures, but little recent research has looked at what happens to these patients in the longer term. This study followed everyone in Cork city and county who had a first provoked seizure during 2017.
Research
207 patients were followed for three years, and the registered death certificates were reviewed of those who died. Three in ten (29.5%) died within three years, despite a relatively young group (median age 55). That is about 10 times the death rate of people of the same age and sex in the general population. Deaths were most common early on, with about 1 in 8 patients dying within the first month. Alcohol or drug use was the most common trigger of seizures and carried the lowest risk of death. The highest risk followed brain damage from lack of oxygen, stroke and bleeding in the brain. Pneumonia was the most common cause of death, followed by heart, liver and kidney disease. Seizures themselves were rarely recorded as a cause of death.
Potential Impact
A first provoked seizure is a strong warning sign that a person is seriously unwell and at high risk of dying in the following months and years. Many of the causes of death in this group may be preventable or treatable. Structured follow-up after a first provoked seizure, similar to the care pathways that have reduced deaths after hip fracture, deserves further study.