Mortality in the first 30 days following incident acute symptomatic seizures

Purpose: Very little is known about short-term mortality after acute symptomatic seizure. One study found an increased mortality in the first year after acute symptomatic seizure, like mortality following acute symptomatic status epilepticus. Methods: We studied mortality in the first 30 days after an acute symptomatic seizure in two cohorts. In Washington Heights, New York City, we reviewed the medical records of all adults aged 20 years and older seen at Columbia Presbyterian Medical Center from January 1, 1990 through December 13, 1994 to identify incident acute symptomatic seizure. In Rochester, Minnesota, the medical records of all Rochester residents were reviewed to identify incident acute symptomatic seizure from January 1, 1965 through December 31, 1984. Case fatality (CF) and standardized mortality ratio (SMR) were calculated for deaths in the first 30 days. Results: A total of 323 adults were identified in Washington Heights and 428 in Rochester. The CF was 20% in both cohorts. CF was greatly increased in the people aged 65 years and older (28.4% in Washington Heights and 40.5% in Rochester) versus younger individuals (17.7% in Washington Heights and 11.2% in Rochester). In both cohorts, the SMR was greatly increased overall ( 102. 1 in Wash in ngton Heights and 149.4 in Rochester), and separately for males, females, all etiologies except head trauma in Washington Heights, and younger individuals. In older individuals, the SMR was increased in Washington Heights but not in Rochester. Conclusion: Acute symptomatic seizures are associated with increased mortality in the first 30 days. It is unknown how seizures contribute to this mortality or whether mortality is due solely to the underlying medical condition.