Abstract
Objectives: To explore the trend of sudden unexpected death in epilepsy (SUDEP) incidence rate over time in rural west China.Methods: We scanned probable SUDEP patients from the epilepsy program between 2010 and 2019 in rural West China and performed a verbal autopsy for each eligible patient. We calculated the crude and sex-adjusted incidence rate of SUDEP per person-year over a calendar year and the year of follow-up. We calculated the incidence rate ratio with the Poisson model in STATA 12.0 and calculated the annual percentage change (APC) and average annual percentage change in Joinpoint Trend Analysis Software 4.8.0.1 to analyze the trend of SUDEP incidence rate.Results: In 2010–2019, 44 probable SUDEPs were identified from 10,128 patients with a total person-year of 31,347. The crude and sex-adjusted incidence rates of SUDEP were 1.40 and 1.45%0. Twenty-five (56.8%) of the 44 probable SUDEPs had no generalized tonic-clonic seizure 3 months before their death. The incidence of probable SUDEP decreased significantly in the calendar year [APC = −11.7, 95% confidence interval (CI): −21.7 to −0.3] and in time of follow-up (average annual percentage change = −21.2, 95% CI: −34.3 to −5.4). Comparing the first 5 years in follow-up with the subsequent 3 years, the incidence rate of SUDEP decreased significantly (estimated incidence rate ratio = 0.4, 95% CI: 0.2 to 0.8).Significance: SUDEP happened to 1.4 cases per thousand patient-years in convulsive epilepsy in rural west China between 2010 and 2019. The incidence rate of SUDEP presented a downward trend over the time of follow-up.
Highlights
Sudden unexpected death in epilepsy (SUDEP) is the leading cause of mortality in patients with epilepsy (PWE), estimated to be 1.2 SUDEP cases per 1,000 PWE in a meta-analysis of population-based studies [1]
44 probable SUDEP patients had been reported in the program, and the total crude incidence rate of probable SUDEP was 1.40 cases per thousand patient-years
The crude incidence rate of probable SUDEP in 2010– 2014 was not significantly higher than the rate in 2015–2019
Summary
Sudden unexpected death in epilepsy (SUDEP) is the leading cause of mortality in patients with epilepsy (PWE), estimated to be 1.2 SUDEP cases per 1,000 PWE in a meta-analysis of population-based studies [1]. In a recent study of the vagus nerve stimulator, Ryvlin reported that the incidence rate of SUDEP decreased significantly from 2.5 to 1.7 per 1,000 person-years with a 10-year follow-up in refractory PWE [2]. A Chinese community-based cohort showed that the incidence of probable SUDEP was 2.0 per 1,000 person-years, which is higher than the rate in high-income countries [8]. In rural West China, our team previously reported that the incidence of probable SUDEP was 1.7 cases per thousand patient-years in people with convulsive epilepsy in 2015 [9]. It is unknown whether the SUDEP incidence rate is decreasing in low-income countries. This article aims to reveal SUDEP incidence rate trends in rural western China
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