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Research paper
Outcome of seizures in the general population after 25 years: a prospective follow-up, observational cohort study
  1. Gail S Bell1,2,
  2. Aidan Neligan3,
  3. Christina Giavasi1,
  4. Mark R Keezer1,
  5. Jan Novy4,
  6. Janet L Peacock5,6,
  7. Anthony L Johnson7,
  8. David M G Goodridge8,
  9. Simon D Shorvon1,
  10. Josemir W Sander1,2,9
  1. 1Department of Clinical and Experimental Epilepsy, NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, UK
  2. 2Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
  3. 3Department of Neurology, Homerton University Hospital, London, UK
  4. 4Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland
  5. 5Division of Health and Social Care Research, King's College London, London UK
  6. 6NIHR Biomedical Research Centre at Guy's and St Thomas’ NHS Foundation Trust and King's College London, London, UK
  7. 7MRC Clinical Trials Unit at UCL, London, UK
  8. 8c/o Warders Medical Centre, Tonbridge, UK
  9. 9Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
  1. Correspondence to Professor Ley Sander, Box 29, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; l.sander{at}


Objectives We investigated long-term (to 25 years) seizure prognosis and survival in people with newly diagnosed epilepsy in the community. We explored whether prognosis is different in those with epilepsy (>2 unprovoked seizures) and those with a single seizure at presentation.

Methods This is a prospective observational cohort study of people with newly diagnosed seizures. We investigated seizure outcome and survival in people presenting with a single seizure and in those presenting with >2 seizures (epilepsy).

Results 695 people (median follow-up 23.6 years) had unprovoked epileptic seizures. For seizure analysis we excluded 38 people with missing data leaving 657 (309 male, and 249 aged <18 years). Seizures recurred in 67%. The 354 people with epilepsy were only slightly more likely to have further seizure recurrence than the 302 people with a single seizure at presentation (HR 1.32, 95% CI 1.09 to 1.59). In 327 people with complete follow-up, 268 (82%, 95% CI 77% to 86%) were in terminal remission; (80%, (95% CI 73% to 85%) in those with epilepsy at presentation). Premature mortality was increased in people with epilepsy (standardised mortality ratio 1.67; 95% CI 1.40 to 1.99) and those with a single seizure at presentation (standardised mortality ratio 2.65; 95% CI 2.23 to 3.15). It is also high in those with early remission.

Conclusions People with epilepsy and with single seizures at presentation in the community generally have good prognosis for seizure control with prolonged follow-up. The risk of premature mortality is significantly increased in both groups.


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