From the Guidelines
Death from seizures is relatively rare, with the risk of dying from a seizure itself being approximately 1 in 1,000 per year for people with epilepsy, primarily through a condition called Sudden Unexpected Death in Epilepsy (SUDEP). The provided evidence does not directly address the mortality rate due to seizures, but it discusses the management and evaluation of adult patients presenting to the emergency department with seizures 1. According to the evidence, up to 5% of adults with epilepsy will have one episode of status epilepticus in their lifetime, which can increase the risk of mortality 1. However, most seizures stop on their own within a few minutes without causing lasting harm. Certain situations can increase the risk of death, such as prolonged seizures lasting over 5 minutes (status epilepticus), seizures occurring in water where drowning is possible, or seizures while driving or operating machinery.
Some key points to consider:
- The risk of early seizure recurrence is higher in certain populations, such as alcoholic patients with a history of seizures, and those with hyperglycemia or a Glasgow Coma Scale (GCS) score less than 15 1.
- Proper medication management is crucial to reduce the risk of seizure recurrence and mortality, with common anti-seizure medications including levetiracetam (Keppra), lamotrigine (Lamictal), and carbamazepine (Tegretol) 1.
- If you witness someone having a seizure, ensure they're in a safe position away from hazards, turn them on their side if possible, and call emergency services if the seizure lasts longer than 5 minutes or if the person doesn't regain consciousness.
It's essential to note that the evidence provided is limited, and more research is needed to fully understand the risk of mortality due to seizures. However, based on the available evidence, proper management and evaluation of seizures, as well as adherence to medication regimens, can help reduce the risk of mortality and improve quality of life for individuals with epilepsy.
From the Research
Incidence of Death from Seizures
- The incidence of sudden unexpected death in epilepsy (SUDEP) in adults is 1.2 per 1000 person-years 2.
- Generalized tonic-clonic seizures have consistently emerged as the leading risk factor for SUDEP, particularly when such seizures are uncontrolled 2.
- High seizure burden, lack of antiepileptic drug (AED) treatment, polytherapy, intellectual disability, and prone position at the time of death are other key risk factors for SUDEP 2.
Mortality Rates in Epilepsy
- Patients with epilepsy carry a risk of premature death which is on average two to three times higher than in the general population 3.
- The risk of death is not homogenously distributed over all ages, etiologies, and epilepsy syndromes, with people with drug-resistant seizures carrying the highest risk of death 3.
- Sudden unexplained death in epilepsy patients (SUDEP) is the most important cause of epilepsy-related deaths, especially in the young and middle-aged groups 3.
Status Epilepticus and Mortality
- The mortality of status epilepticus is substantially increased with case fatality rates between 4.6% and 39%, depending on its cause and duration, and the age of the population studied 3.
- Toxin-related seizures, such as those caused by alcohol withdrawal and cocaine use, can lead to status epilepticus and have a high mortality rate 4.
- Treatment of status epilepticus with antiseizure medications, such as levetiracetam, valproate, and fosphenytoin, can be effective in reducing mortality 5, 4, 6.