Prognosis

After the first seizure, for two years from then onwards, about 60 percent of the untreated persons will have no further seizures.(1)

Remissions (being free of seizures for 5 years, on or off treatment) will occur in about 70% of the patients with epilepsy.(1)

• the rest of the 20-30% of people will develop chronic epilepsy, which is usually treated with Anti-epileptics (1)

People with epilepsy (PWE) have a higher mortality rate than the general population (2)

In a UK based study (2) number of deaths within the database increased by 69% between the first and last year of the study (2014 compared with 2004)

• epilepsy was considered as a contributing cause in approximately 45% of deaths of PWE under 35
• factors associated with increased risk of death included
  • attendance at emergency departments and/or emergency admissions
  • antiepileptic drug (AED) polytherapy
  • status epilepticus
  • depression
  • and injuries
• no seizures in the prior year was associated with a reduced risk of death

UK Biobank study (n=329,432; 2699 with epilepsy) found pts with epilepsy had an increased risk of all cardiac arrhythmias (HR 1.36; 95% CI 1.21-1.53), atrial fibrillation (AF) (1.26) & other cardiac arrhythmias (1.56) especially in those using carbamazepine and valproic acid vs pts without epilepsy (3)

Reference:

• (1) Maguire M et al. Clinical Evidence Handbook. A Publication of BMJ Publishing Group. Epilepsy (Generalized and Partial).Am Fam Physician. 2011;83(4):461-463
• (2) Wojewodka G, Gulliford MC, Ashworth M, et al. Epilepsy and mortality: a retrospective cohort analysis with a nested case-control study identifying causes and risk factors from primary care and linkage-derived data.BMJ Open 2021;11:e052841. doi: 10.1136/bmjopen-2021-052841
• (3) Wang J and others, Epilepsy and long-term risk of arrhythmias, European Heart Journal, 2023;, ehad523, https://doi.org/10.1093/eurheartj/ehad523