Epilepsy is the most common neurological disorder in cats. However, information on the long-term outcomes and predictive survival factors based on neurological and clinicopathological findings is limited. We aimed to evaluate the clinical manifestations, survival rates, and hazard factors influencing survival in cats with epilepsy by analyzing the medical records of 90 cats diagnosed via brain magnetic resonance imaging (MRI). The cats were divided into the survival and non-survival groups. Univariate and multivariable logistic regression analyses were conducted to identify the significant survival factors. The mortality rates at one and two years were 33.2% and 37.8%, respectively. The median age of cats in the non-survival and survival group were 3 and 1 years, respectively. Age over 7 years (p = 0.002), paresis (p = 0.001), structural brain lesions (p = 0.015), leukocytosis (p = 0.001), neutrophilia (p = 0.001), hyperproteinemia (p = 0.037), hypoalbuminemia (p = 0.001), hyperglobulinemia (p = 0.003), and an elevated neutrophil-to-lymphocyte ratio (p = 0.041), were associated with an increased mortality rate. A multivariable analysis identified several predictors of early mortality in cats with epilepsy, including age over 7 years (p = 0.045), presence with paresis (p = 0.012), structural brain lesions (p = 0.042), leukocytosis (p = 0.005), and hypoalbuminemia (p = 0.030). Older age and structural brain lesions were shown to be key predictors of mortality and were important for prognosis prediction and management.