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was 5.3, with functional neurological deficit being the only independent predictor of mortality
(occurring in 85% of cases)17.

In a Finnish cohort of 245 children with epilepsy identified between 1961 and 1964 and followed
up prospectively, 44 had died by the follow-up in 1992. Of these 75% had remote symptomatic
epilepsy18 (similar to that found in childhood mortality studies from Australia4 and Nova
Scotia17). Most (89%) of those who died were not in remission at the time of death, with a relative
risk of death in those with active epilepsy compared with those in remission of 9.3 (95% CI 3.8,
22.7). The cause of death was definitely or probably related to a seizure in 45% of cases. There
were three cases of sudden unexplained death in epilepsy (SUDEP) in people with idiopathic
epilepsy, none of whom was in remission at the time of death18. In the extended follow-up of the
cohort up to 2002, 60 (24%) had died, of whom 51 (85%) were not in terminal remission (≥ 5
years seizure free) at the time of death. Those with a remote symptomatic aetiology were three
times as likely to die as those with idiopathic/cryptogenic aetiologies (37% vs 12%). Of the 60
deaths, 33 (55%) were felt to be epilepsy related, including 18 deaths from SUDEP, giving a
cumulative risk of SUDEP of 7% at 40 years (12% for those not in terminal remission and not
taking AEDs19).

Table 1. Population studies of mortality in people with epilepsy with standardised mortality rates
(with 95% confidence intervals).

Country SMR Ages Comments
Poland41 1.8 All
Retrospective
United States5 2.3 (1.9, 2.6) All prevalent cohort

United States22 2.1 (1.9, 2.5) All Historic
incident cohort
Iceland6 1.6 (1.2, 2.2) All (Rochester)
France12 4.1 (2.5, 6.2) All
SMR for IHD
Sweden55 2.5 (1.2, 3.2) 17 years elevated in those
<65 years
Canada17 5.3 (2.3, 8.3) <17 years
Historic incident
China13 2.9 (2.6, 3.4) >2 years cohort

United 2.6 (2.2, 2.9)* All Prospective,
Kingdom7 2.2 (2.0, 2.5)** incident cohort
1 year mortality

Prospective
incident cohort
with first seizure

Historic incident
cohort

Prospective
prevalent cohort

Prospective
incident cohort
(NGPSE)
1984–2009

*definite epilepsy
**definite and possible epilepsy