Seizure natural history, complications and prognosis

The recurrence rate of seizure within two years is 35% to 40% in patients with a first-time unprovoked seizure. Status epilepticus occurs in about 6%-7% of the patients with seizure in the emergency department (ED). The overall mortality rate of status epilepticus is approximately 22% (3% in pediatric patients to 26% in adults). Simple febrile seizures are considered normal in childhood and the prognosis is generally excellent. The recurrence rate is about 12% in children that have their first febrile seizure in infancy and about 50% in those who have their first febrile seizure later.

• The recurrence rate of seizure within 2 years is 35% to 40% in patients with a first-time unprovoked seizure.^[1]
• In a cohort study that followed patients for 10 years after an acute symptomatic seizure in an ED visit (excluding children with febrile seizure), the risk of recurrence was 13% in those patients who had an unprovoked seizure and 41% in those who had acute symptomatic status epilepticus.^[2]
• Status epilepticus occurs in about 6%-7% of the patients with seizure in the emergency department (ED).^[3][4][5]

Some complications that have been suggested in seizure include:^[6]

• Accidents and injuries
  • Mostly cranial soft tissue contusions or lacerations
• Lifestyle and psychosocial impact
  • Financial, social, and relationship problems such as driving, work-related activities, reduced productivity, stigma in society
• Comorbidities
  • Medical: stroke, ischaemic heart disease, cancer, migraine, vertigo, and sleep disorders
  • Psychiatric: depression and anxiety
  • Neurodegenerative diseases: dementia and Alzheimer disease (AD)
• Death

• Simple febrile seizures are considered normal in childhood and the prognosis is generally excellent.
  • The recurrence rate is about 12% in children that have their first febrile seizure in infancy and about 50% in those who have their first febrile seizure later.^[7][8]
  • The risk of epilepsy is the same as children without any history of febrile seizure.
• Complex febrile seizures increase the risk for epilepsy, and but do not increase the risk for a future simple febrile seizure.^[9]
• The overall mortality rate of status epilepticus is approximately 22% (3% in pediatric patients to 26% in adults).^[10]