Mortality in a cohort of patients with first unprovoked tonic-clonic seizure

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Background. Population-based studies and clinical series show a higher mortality rate for people with epilepsy compared to the general population. Less information exists for patients with a first ever seizure. Objective. To evaluate mortality in a cohort of patients with a first unprovoked seizure. Methods. The First Seizure Trial Group (FIRST) promoted a multicenter, randomized, open trial comparing immediate to delayed treatment in patients with a first unprovoked epileptic seizure to assess the effects of the earliest possible treatment on the long-term prognosis of epilepsy. Starting in February 1988, we recruited 419 patients with a first, witnessed, primarily or secondarily generalized tonic-clonic seizure. The exclusion criteria were acute symptomatic seizures, progressive neurologic disorders, alcohol or drug addiction, and overt psychiatric illness. The last day of the follow-up was set on July 30, 1999. Centers were asked to assess whether the patients were alive or dead through telephone or clinic visits. Ten patients (7 women, 3 men) died during the follow-up. Standardized mortality ratios (SMR) were calculated, applying to each patient the sex-, age-, and calendar year-specific mortality rate of the Italian population. Results. The entire cohort had a mortality rate higher than that of the Italian population (SMR = 3.3, 95% confidence limits = 1.5-6.4). The SMR was 9.2 (3.4-20.1) for women and 1.5 (0.3-4.3) for men. The SMRs were higher for the younger decades: 10.8 (1.3-39.0) for 10-19 years, 5.3 (0.1-29.5) for 20-29; 19.3 (2.3-69.5) for 30-39; 5.2 (0.1-29.0) for 40-49; 1.9 (0.1-10.8) for 50-59; 1.1 (0.1-6.3) for 60-69; and 1.7 (0.1-9.5) for patients 70 years or older. Conclusions. Mortality in patients with a first, unprovoked tonic-clonic seizure is higher than that of the general population.

Original languageEnglish
JournalNeurological Sciences
Issue number4 SUPPL.
Publication statusPublished - 2000

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)


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