Abstracts

There is a known increased mortality rate in patients with epilepsy. In children most of the excess risk is in those with remote symptomatic epilepsy. The risk following a first seizure has not been well studied. We report the mortality rates and causes in a cohort of 407 children who initially presented with a first unprovoked seizure. In a prospective study, 407 children with a first unprovoked seizure were identified and followed for a mean of 14 years. Seizure etiology, seizure type and epilepsy syndrome were classified in accordance with the ILAE criteria. There were 9 deaths in the cohort. Two deaths were entirely unrelated (one meningitis in an infant, one gunshot wound in a 20 year old) and occurred in normal children who only had one seizure and were never treated. Three deaths were related to the underlying neurological disorder. Two of these children, both with severe neurological disability died more than 3 years after the initial and only seizure. Neither was taking medication. The third died due to the underlying disease 14 years after the initial seizure and was [gt]2 years seizure free at the time. In the remaining four cases, the deaths were possibly or definitely related to the seizure disorder. All 4 of these children were on AED therapy at the time of death. Two were severely neurologically abnormal and died suddenly more than 2 years after initial presentation without a witnessed seizure and are considered possible SUDEP. The other two were probable SUDEPs. One was 11 years old with intractable daily seizures and progressive neurologic decline who was found dead one morning. The other was an adolescent with primary generalized epilepsy (random grand mal). He was treated after his second seizure 4 months after the initial seizure. He died 2.5 years later in association with his ninth seizure. There is an increased mortality in children who present with a first unprovoked seizure. Delaying treatment until after the second or third seizure would not have altered mortality in this cohort. While a small risk can not be excluded, there are also risks associated with AED therapy. These data provide further support for the recent practice parameter of the American Academy of Neurology (Neurology 2003;60:166-175) that treatment following a first seizure in children does not alter prognosis. Concern about mortality risk should not be a major issue in decision regarding treatment after an initial seizure. (Supported by NIH grant NS 26151 from NINDS.)