One year of seizure freedom reduces premature death in people with epilepsy in rural China: A 10-year cohort study

Xiaowen Zhou; Yan Ge; Bin Yang; Guoxing Zhu; Patrick Kwan; Wenzhi Wang; Josemir W Sander; Ding Ding

doi:10.1002/epi.70173

One year of seizure freedom reduces premature death in people with epilepsy in rural China: A 10-year cohort study

Epilepsia. 2026 Feb 24. doi: 10.1002/epi.70173. Online ahead of print.

Authors

Xiaowen Zhou^{1

2

3}, Yan Ge^{1

2}, Bin Yang⁴, Guoxing Zhu^{1

2}, Patrick Kwan^{5

6}, Wenzhi Wang⁷, Josemir W Sander^{8

9

10}, Ding Ding^{1

2

3}

Affiliations

¹ Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
² National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, China.
³ National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.
⁴ Jiaozuo People's Hospital, Jiaozuo, China.
⁵ Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
⁶ Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China.
⁷ Beijing Neurosurgical Institute, Beijing, China.
⁸ Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
⁹ Queen Square Institute of Neurology, University College London, London, UK.
¹⁰ Chalfont Centre for Epilepsy, Chalfont St. Peter, UK.

PMID: 41732923
DOI: 10.1002/epi.70173

Abstract

Objective: Epilepsy carries an increased risk of premature mortality. Although seizure freedom may reduce deaths, most population-based evidence originates from high-income countries. Data from low-income settings, such as rural China, remain scarce. We update mortality patterns and evaluate their associations with achieving 1-year seizure freedom among rural populations in China.

Methods: People with epilepsy living in rural Henan, China, were enrolled between 2010 and 2011 and followed up at three subsequent time points over 10 years. We collected demographic and clinical data, including survival outcomes. Seizure freedom was defined as a 12-month seizure-free interval recorded in any follow-up period. Causes of death were assessed using a structured verbal autopsy questionnaire and adjudicated by a multidisciplinary panel. We estimated mortality rates, standardized mortality ratios (SMRs), and cause-specific distributions, and used regression models to identify mortality predictors and associations with seizure freedom.

Results: Among the 610 participants enrolled (57.5% male), 67 had died over 10-year follow-up, yielding an all-cause mortality rate of 13.5/1000 person-years (95% confidence interval [CI] = 10.5-17.2) and an age- and sex-adjusted SMR of 2.4 (95% CI = 2.3-2.5). Epilepsy-related deaths accounted for 48% of deaths, with sudden unexpected death in epilepsy being predominant (33%). People who had ever achieved 12-month seizure freedom (n = 317) had significantly lower SMRs than those who never did (n = 293). Ever achieving seizure freedom was independently associated with a lower risk of all-cause mortality (odds ratio [OR] = .30, 95% CI = .17-.52) and epilepsy-related death (OR = .29, 95% CI = .12-.63). This protective effect was most pronounced in women, older adults, those with seizure onset during adulthood, and those without comorbidities.

Significance: Mortality in this cohort remains more than twice that of the general population, with sudden death accounting for one third of cases. Achieving 1-year seizure freedom even once during follow-up substantially reduced mortality risk and altered cause-of-death distributions. This finding underscores seizure control as a practical and encouraging treatment goal in resource-limited settings.

Keywords: causes of death; mortality; outcomes.

Abstract

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