Abstracts

Rationale: Sudden unexplained death in epilepsy (SUDEP) is one of the leading causes of mortality in epilepsy, often occurring in otherwise young and healthy individuals. In this study, we reviewed cases identified as definite SUDEP by the Bexar County Medical Examiner (BCME), with particular attention directed toward obesity, non-compliance, and potential use of organ weights as a biomarker. Methods: BCME office death reports were reviewed between 1983-2018, and 286 cases of definite SUDEP were identified. These reports included the investigators’ on-site documentation, which included medical history, medication list, the position at the time of death, and review of the autopsy results. Heart, lungs, and brain weights were obtained and referenced to trauma victims of different body mass index (BMI) categories (BMI<18.5, BMI 18.5-25, 25≤BMI<30, and BMI≥30). Non-compliance was determined in SUDEP victims with nondetectable AED levels. Binary logistic regression models were used to assess the cross-sectional associations among BMI categories, organ weights, and non-compliance using models adjusted for clinical variables. Results: The median age was 37.47±14.34 years old (65% males). At least one anti-seizure medication was reportedly prescribed in 171 (60%) cases. Patients died in a prone position in 96 (33.6%) of reported cases. Associated co-morbidities included cardiomegaly (23.8%), dilated cardiomyopathy (12%), substance abuse (15%), neurocognitive disorder (5.2%), depression (4.9%), schizophrenia (4.2%), and bipolar disorder (3.1%). Non-compliance was identified in 185 (64.7%). Abnormal lung, heart, and brain weights were recognized in 48 (16.8%), 67 (23.4%), and 43 (15.0%) of SUDEP patients, respectively. Those with BMI<18.5 were 29 (10.1%), BMI 18.5-25 were 87 (30.4%), and 166 (58.1%) BMI≥25. BMI>30 and 25