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Is there any chance of epileptic seizure becoming life threatening or fatal if proper care is not taken?

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Yes. Most seizures are brief, resolving spontaneously within 1-2 minutes.1 These are rarely fatal. On the other hand, status epilepticus is not infrequently associated with death. Status epilepticus (sometime referred to in shorthand as just status) just means a prolonged seizure lasting at least 30 minutes. It can also refer to a situation that is technically multiple seizures back-to-back, but without complete return to baseline in between. A recent review of status epilepticus quoted the statistic:

The overall mortality associated with status epilepticus approaches 20%, with generalised convulsive status epilepticus representing about 45–74% of all cases.

However, it has long been recognized that it is very difficult to know whether the seizure itself or the factor that provoked the seizure is actually responsible for death.2 The strongest predictor of death from status is the underlying cause. For instance, in status attributable to hypoxia, death occurs over 50% of the time.1 That is because a seizure is likely to be provoked only by a pretty dire state of hypoxia — either not responsive to maximal interventions or occurring in a setting where such interventions are not available or not desired.

To the extent that death is directly attributable to the seizure, it is generally because of what doctors often refer has “inability to protect the airway.” Normal, conscious people have reflexes that “protect” the airway at the level of the oropharynx to prevent aspiration. People having a generalized seizure lack such reflexes and can aspirate on their own oral secretions causing hypoxemic respiratory failure.


References

1. Betjemann JP, Lowenstein DH. Status epilepticus in adults.. Lancet Neurol. 2015 Apr 20. [Epub ahead of print]
2. Jane G. Boggs, M.D. Mortality Associated with Status Epilepticus. Epilepsy Curr. 2004 Jan; 4(1): 25–27.

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