Abstracts

Rationale: Recent guidelines published by the American Academy of Neurology (AAN) report the incidence of Sudden Unexpected Death in Epilepsy in adults is approximately 1.22 per 1000 adults with epilepsy annually.1 SUDEP is believed to be rarer in children; however, more recently rates in children have been documented to approach those in adults.2 We seek to understand the incidence of pediatric SUDEP in the diverse setting of Ontario, Canada. Methods: Cases of suspected pediatric SUDEP that occurred between January 1, 2014 and December 31, 2015 in the province of Ontario, Canada were eligible for inclusion. Cases were identified from three sources: a national pediatrician surveillance program, epileptologist reports, and screening of provincial forensic autopsies. Duplicate cases were identified by matching age, date of death, and region where death occurred. Information surrounding death was reviewed, and cases were classified according to criteria described by Nashef et al (2012).3 Overall SUDEP incidence and the incidence of definite or probable pediatric SUDEP were calculated using government estimates of the prevalence of pediatric epilepsy in Canada and the number of children living in Ontario. Results: Seventeen cases of pediatric SUDEP, including 11 definite and 3 probable, occurred during the two-year study period, resulting in an estimated overall annual incidence of 1.17 (95% CI: 0.68, 1.88) per 1000 children with epilepsy and estimated incidence of definite or probable SUDEP of 0.97 (95% CI: 0.53, 1.62) per 1000 children with epilepsy. Conclusions: Comparison of Ontario incidence of definite or probable pediatric SUDEP with that reported in the AAN guidelines (0.22 per 1000 person-years; 95% CI: 0.16, 0.31) indicates pediatric SUDEP in Ontario is much more common than expected and is close to the incidence reported in the AAN guideline for the adult epilepsy population (1.2 per 1000 person-years; 95% CI: 0.64, 2.32). This study offers further evidence that the incidence of SUDEP is not significantly lower in children versus adults with epilepsy.1.         Harden C, Tomson T, Gloss D, et al. Practice guideline summary: Sudden unexpected death in epilepsy incidence rates and risk factors. Neurology. 2017;88:1674-1680.2.         Sveinsson O, Andersson T, Carlsson S, Tomson T. The incidence of SUDEP: A nationwide population-based cohort study. Neurology. 2017; 89:xx-xx.3.         Nashef L, So EL, Ryvlin P, Tomson T. Unifying the definitions of sudden unexpected death in epilepsy. Epilepsia. 2012;53:227-233. Funding: This research was funded by the Ontario Brain Institute and Citizens United for Research in Epilepsy.