Standard mortality ratios (SMRs) of patients with newly diagnosed epilepsy were determined in a prospective national population-based study at the Epilepsy Research Group, National Hospital, London; Chalfont Centre for Epilepsy; and the Institute of Public Health, Cambridge, UK. Of 1091 patients attending one of 275 UK general practices from 1984-1987, 564 were classified as definite epilepsy, 228 as possible epilepsy, 220 as febrile seizures, and 79 as not epilepsy after 6 months follow-up. Over a median follow-up of 6.9 years, the SMR for patients with definite epilepsy was 3.0. It was highest during the first year after diagnosis (5.1), and declined to 2.5 at 3 years and 1.3 at 5 years. The SMR was highest in cases of remote symptomatic epilepsy (4.3), it was 2.9 with acute symptomatic epilepsy, 1.6 with idiopathic epilepsy, and 0 for febrile seizures. The commonest causes of death were pneumonia, cancer, and stroke. 
COMMENT. The high mortality in patients with epilepsy was due mainly to the underlying cause, although idiopathic epilepsy itself carries an increased risk. The death rate was highest in the first year after diagnosis, the result of associated diseases such as stroke and tumor, and then decreased progressively. Heart disease was not a factor. An increased incidence of suicide previously reported in patients with epilepsy was not confirmed in this study.
Heautoscopy, epilepsy, and suicide. A 21 year-old man with complex partial seizures who tried to commit suicide during the experience of heautoscopy is reported from the University Hospital, Zurich, Switzerland. As the classic doppelganger experience, heautoscopy, the reduplicative hallucination of one’s own person, combines features of autoscopy (a mirror reflection of one’s body) and an out of body experience (illusion of physical separation from one’s own body). Seizures associated with heautoscopy usually originate in parietal or deep temporal foci.