Abstracts

RATIONALE:_Thirty day mortality is high in people with acute symptomatic seizures (AS). Few data are available on long-term mortality after AS. METHODS:_Review of medical records of the 2823 residents of Washington Heights NYC seen at New York-Presbyterian Hospital, the primary source of care for the community, between 1990-1994 for whom a diagnosis of a seizure disorder or status epilepticus was coded. We identified all residents with first AS in those ? 20 years of age. Standardized mortality ratios (SMRs) were calculated based upon observed deaths more than 30 days following AS versus that expected using the 1990 age and gender specific US mortality as referent. Kaplan-Meier estimates were used to estimate long-term (5 years) survival. The difference between etiologic groups was tested with the log-rank test. The contribution of different prognostic factors to mortality was determined through a Cox proportional hazards model. RESULTS: 331 episodes of AS were identified in 323 patients, 255 of whom survived 30 days after the AS. 54 individuals (21.2%) died in the subsequent 5 years. SMR by 5 years was 1.4 (95% CI 1.0, 1.7). SMR was elevated only in males (SMR 1.6; 95% CI 1.1, 2.2). The risk of death by 5 years after AS was 38% for CNS infections, 19% for CVD, 32% for metabolic insults and 13% for all other causes (log-rank test = 14.73; degrees of freedom = 3; p=.002). The risk of death was significantly higher for patients with CNS infection (RR 3.7; 95% CI 1.8, 7.6) or stroke (RR 2.4; 95% CI 1.2, 4.9) as a precipitating cause of AS. Individuals age 65 or older at the time of AS had increased mortality (RR 2.8; 95% CI 1.4, 5.3). CONCLUSIONS: People with AS have a small but significant increase in mortality when compared to that expected in the general population, which is significant only for men. Risk of death is increased only for those with stroke or CNS infections, both conditions associated with increased mortality.