Bial, Eisai, GlaxoSmithKline, Janssen-Cilag, Novartis, Pfizer, Sanofi-Aventis, UCB, the Netherlands Epilepsy Foundation, and Stockholm County Council.

Summary:Purpose: We sought to investigate mortality risk in an adult cohort with newly diagnosed unprovoked epileptic seizures.Methods: One hundred seven patients who were at least 17 years old and had newly diagnosed unprovoked epileptic seizures were prospectively identified during a period of 20 months between 1985 and 1987. Patients were followed until the date of death or the end of 1996. The standard mortality ratio (SMR) was analyzed in the whole cohort and in the portion of the cohort with recurrent seizures at inclusion. The influences on the SMR of time since diagnosis, sex, age at diagnosis, seizure cause, seizure type, and cause of death were also investigated.Results: The SMR was significantly increased (SMR, 2.5; 95% confidence interval LCI], 1.2-3.2). This significantly increased risk was found during the first 2 years after diagnosis (year 1: SMR, 7.3; 95% CI, 4.4-12.1; year 2: SMR, 3.6; 95% CI, 1.6-8.1) and at years 9-1 1 (SMR, 5.4; 95% CI, 2.7-1 1.2). The increased mortality risk was most pronounced when the seizures occurred before the age of 60 years. Mortality risk was elevated among patients with remote symptomatic epilepsy (SMR, 3.3; 95% CI, 2.44.5) but not idiopathic epilepsy.Conclusions: There is increased mortality risk in an adult cohort with newly diagnosed unprovoked epileptic seizures. This increase is found in symptomatic patients, young patients, and during the first 2 years after the diagnosis. Key Words: Epilepsy-Mortality-Standard mortality ratio-Population based-Prospective.Being affected by a seizure disorder has many important consequences, for both the patient and his or her family. In addition to the fear of future seizures and lifestyle restriction regarding activities such as driving, swimming, and the operation of certain machinery, there also is a fear, often unspoken, of seizure-related death.Patients with epilepsy have an increased mortality risk compared with the general population (1). Studies on mortality risks in patients with epilepsy have been based on death certificates, institutionalized patients, and community cohorts. To gain knowledge of the deaths of all patients with epilepsy, population-based studies will render the least bias in patient selection. We are aware of five population-based studies on death in patients with epilepsy (2-6).The overall accuracy in the diagnosis and case ascertainment of epileptic seizures will probably be higher in a prospectively collected cohort than in a retrospective cohort. With a retrospectively collected cohort, there also is a risk of missing patients with mild cases and elderly

The majority of patients with epilepsy maintain seizure control during pregnancy. The apparently higher risk of seizures among women treated with oxcarbazepine and the more frequent increases in drug load in the oxcarbazepine and lamotrigine cohorts prompts further studies on relationships with pharmacokinetic changes. Risks associated with status epilepticus appear to be lower than previously reported.

Summary:Purpose: To investigate the probability of achieving remission of seizures after a newly diagnosed unprovoked epileptic seizure in an adult population-based cohort.Methods: 107 patients aged 17 years or older with a newly diagnosed unprovoked epileptic seizure (index seizure) in 1985 through 1987 were followed up until the date of death or to the end of 1996. The proportion of cases during follow-up that attained a 1-year, 3-year, 5-year remission was calculated by actuarial analyses. Variables for stratification were age at diagnosis, seizure type, etiology, EEG, and the occurrence of seizures within 1 year of initiation of antiepileptic drug (AED) therapy.Results: Cumulative 1-, 3-and 5-year remission rates were 68, 64, and 58%. There was no statistically significant difference regarding time points of achieving a 1-year remission after epilepsy diagnosis and the subsequent probability during follow-up of attaining a 5-year remission. Having seizures within 1 year after beginning with an AED was a statistically significant predictor of never achieving 1-year remission of seizures during follow-up (refractory seizures). Other stratified variables were not statistically significant predictors.Conclusions: Seizure prognosis for the majority of patients with newly diagnosed epilepsy is good. The time required after epilepsy diagnosis to achieve a 1-year remission of seizures does not affect the probability of additionally achieving a 5-year remission. Patients with refractory seizures can be identified within a few years from diagnosis of epilepsy. These patients must be targeted early for optimization of pharmacologic treatment, possible surgery, and psychosocial intervention.

We described clinical manifestations, outcomes, prognostic indicators and clinico-epidemiological subgroups for 53 adult patients with Guillain-Barré syndrome (GBS) in Sweden during the period 1996-97. These patients were identified from a population of 2.8 million inhabitants and prospectively followed up for one year by a network of neurologists. An additional 10 cases, of whom five were adults who had not been prospectively followed up, were not included in the analyses. At 6 months after onset 80% of the patients could walk without aid, while at 1 year 46% were fully recovered, 42% had mild residual signs or symptoms, 4% had moderate and 6% severe disabilities, and 2% had died. Intravenous human immunoglobulin or plasmapheresis were used in 72% of the patients. The sum of the Medical Research Council (MRC) score at nadir was found as the only significant predictor for residual signs at 1 year in a multivariate model. Three subgroups, with different clinico-epidemiological characteristics, were identified by using cluster analysis. In conclusion, GBS in Sweden is frequently preceded by a respiratory infection, is often treated with immunomodulatory therapies, and exhibits a high recovery rate and a low fatality rate.