Abstracts

Rationale: Sudden unexpected death in epilepsy (SUDEP) is an important cause of premature mortality among patients with epilepsy. There is paucity of data regarding characteristics of patients with SUDEP and large studies are difficult to conduct because of its unexpected nature. Thus it is desirable to conduct studies of small groups of patients to expand the base of knowledge on SUDEP. Methods: Vanderbilt University Medical Center (VUMC) has an epilepsy clinic that caters to a large population of patients with epilepsy. We reviewed the charts of the SUDEP cases that have occurred in patients of the epilepsy clinic of VUMC and analyzed the characteristics of these patients. Results: We identified 15 cases (7 females and 8 males) of SUDEP that occurred between 2005 and 2013. Mean age of the patients was 31.5 (31.5 ± 11.9) years with mean age at seizure onset being 11.6 (11.6 ± 12.8) years. Significant comorbidities included developmental delay (n = 4), migraine (n = 2), diabetes mellitus (n = 1), and hypothyroidism (n = 1). Focal seizure with (n = 8) or without (n = 5) secondary generalization was the most common seizure type in these patients; 3 patients had generalized seizures. Six patients reported nocturnal seizures. Long term EEG monitoring in the epilepsy monitoring unit was done in 7 patients - seizure focus was either frontal (n = 4; right = 2, left = 1, bilateral = 1) or temporal (n = 2; left = 1, bilateral = 1); one patient did not have seizure during the hospital stay. While most patients had poor seizure control, 2 of the patients were seizure free for more than a year. Three patients had history of epilepsy surgery with one of them being seizure free after surgery. Three patients each were on 4 and 3 antiepileptic drugs (AEDs) respectively at the time of death, and 8 of the patients were on 2 AEDs at the time of death. Levetiracetam was the most common AED (n = 8) followed by lamotrigine (n = 7) and zonisamide (n = 7); 3 patients were on oxcarbazepine and 2 patients were on clonazepam. Autopsy was performed on 7 patients but autopsy report (which supported SUDEP) was available for 2 of these patients only. Five of the patients were found dead in the morning while death occurred during the daytime for 2 patients. Four patients were found in prone position with face down; one patient was in lateral and another patient was in sitting position when found dead. Conclusions: The main finding of this study is that the patients with SUDEP are relatively young with seizure onset at a young age, and developmental delay is a relatively common association.