Abstract
Sudden unexpected death in epilepsy (SUDEP) is rare in well-controlled epilepsy. However, SUDEP is a common cause of death in drug-resistant epilepsy. Over the last 30 years, multiple cohort and population studies have identified clinical risk factors associated with an increased risk for SUDEP. To identify and rank the leading SUDEP risk factors from major cohort and population-based studies. The incidence of SUDEP is also evaluated in special clinical situations, including antiepileptic drug treatment, epilepsy surgery, devices, and assignment to placebo in clinical trials. A PubMed search for English language human cohort studies for the terms Sudden, Death, and Epilepsy was performed for the years 1987-2017. Risk factors for SUDEP were identified and ranked by the weighted log adjusted odds ratio (OR)/relative risk ratio (RR). The top 10 leading risk factors ranked from highest to lowest log adjusted OR/RR are the following: ≥3 GTC seizures per year; ≥13 seizures in the last year; No Antiepileptic Drug (AED) treatment; ≥3 AEDs; ≥3 GTCs in the past year; 11-20 GTC seizures in the last 3 months; age of onset 0-15 years old; IQ < 70; 3-5 AED changes in the last year; ≥3 AEDs. Two risk factors from separate sources (≥3 GTC seizures and ≥3 AEDs) occur twice in the top 10 risk factors. The top 10 risk factors for SUDEP are identified and ranked. A ranking of the top risk factors could help clinicians identify patients at highest risk for SUDEP.
Highlights
Sudden unexpected death in epilepsy (SUDEP) is an important cause of death in people with epilepsy (1, 2)
The purpose of this report is to review and rank the leading SUDEP risk factors from studies published in core clinical and epilepsy journals from 1987 to 2017
We review the incidence of SUDEP in specific clinical situations
Summary
Sudden unexpected death in epilepsy (SUDEP) is an important cause of death in people with epilepsy (1, 2). SUDEP is relatively common in persons with drug-resistant epilepsy, accounting for 14.7–17.4% of deaths with an incidence of 2.46–5.94 per 1,000 persons/year (5–8). The purpose of this report is to review and rank the leading SUDEP risk factors from studies published in core clinical and epilepsy journals from 1987 to 2017. We review the incidence of SUDEP in specific clinical situations. Sudden unexpected death in epilepsy (SUDEP) is rare in well-controlled epilepsy. SUDEP is a common cause of death in drug-resistant epilepsy. Over the last 30 years, multiple cohort and population studies have identified clinical risk factors associated with an increased risk for SUDEP
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