Abstracts

Rationale: SUDEP occurs in 0.001% of people with epilepsy. A literature search was done to highlight current risk factors for SUDEP to develop a communication tool. The search identified ID as a risk in some reviews. Studies appeared to vary in their interest in exploring the role of ID. Further investigation was done to see if ID was a risk or a protective factor. The search was expanded to see if the type of health care system and country had a role in considering ID as a risk factor. Methods: A literature search was undertaken in pubmed using search terms such as 'sudden' 'death', ‘mortality', 'epilepsy', 'risk factor', ‘protective factor', 'learning disability', 'mental retardation', 'intelligence' and ‘intellectual disability' in different permutations and combinations. Papers were excluded if they explored one (non ID related) risk factor or non-SUDEP deaths in epilepsy. Each paper was then examined to see if ID was investigated as a risk factor, noted to be either a risk or a protective factor and for the country of investigation. We researched the type of health care utilized in the country of investigation. The literature search found over 300 studies. After the exclusion criteria were applied, 50 papers were identified to be suitable. None of the papers found ID was a protective factor. Of the 50 papers 23 (46%) investigated ID as a risk factor and 12(24%) identified it as a risk factor. Results: We compared ID risk factor studies against the country of origin and the health care system of the country. 35 (70%) studies were conducted in Europe compared to 12 (24%) in Northern America. Australasia produced 3. 31 (62%) of the 50 papers were written from countries having a public health care system. Of these 31, 14 explored and 9 identified LD as a risk. 10 (20%) of the 50 papers came from countries with a predominantly private health care system of which 4 had explored and 2 identified ID as a risk. 9 of the 50 papers arose from countries having mixed health funding of varying proportions of private and public liaison. Of these 9 (18%), 5 explored ID and 1 identified ID as a risk. 62% of the papers were researched in countries where the health care systems are publicly funded (UK, Sweden and Canada). The remaining papers were researched in nearly equally between private and dual health care (USA, Australia). Of the 23 studies investigating ID as a risk factor, 13 of them were from publicly funded heath care systems compared to 4 from private. Conclusions: ID is looked into as a risk factor by predominantly papers emerging from countries with public health systems. There could be a discrepancy in the level of attention paid to ID as a risk factor based on the place an individual lives. There needs to be more work done to neutralize the skew currently existing regarding the understanding of ID as a risk factor for SUDEP. It is important that research is done to estimate ID as a risk factor in all health systems to help identify if a difference exists in national care models to private health insurance led models towards epilepsy care for people with ID.