Sudden Unexpected Death in Epilepsy in a Canadian Centre: Our experience.
Abstract number :
828
Submission category :
14. Neuropathology of Epilepsy
Year :
2020
Submission ID :
2423162
Source :
www.aesnet.org
Presentation date :
12/7/2020 9:07:12 AM
Published date :
Nov 21, 2020, 02:24 AM
Authors :
Ana Suller Marti, Western University; Jane Ding - Western University; Jorge G Burneo - Western University; Robert Hammond - Western University; Lee Cyn Ang - Western University; Qi Zhang - Western University;
Rationale:
Premature mortality among epilepsy patients is well recognized, with 3-fold increased risk of unnatural death compared to the general population. This risk is higher in patients with therapy resistant epilepsy. Some of these deaths fulfill the criteria of sudden unexpected death in epilepsy (SUDEP), but the pathological mechanisms underlying SUDEP remain poorly understood. The goal of this study is to describe the mortality in our epilepsy population and learn more about SUDEP.
Method:
We identified 152 autopsy cases with a known history of epilepsy, investigated at London Health Sciences Centre between 2000 and 2019. 89 were identified and they were classified as Definite (22), Probable (1), Possible (11), SUDEP plus (9), near SUDEP (1) and SUDEP not otherwise specified(45).
Results:
The median age of death was 36(IQR=20.5-29.8) and 93(61.2%) were male. The median age subjects developed epilepsy was 18.6 (IQR=2.29.8). Two had a history of cardiac arrhythmia, 79 psychiatric comorbidity and 43 intellectual disabilities. The most common types of epilepsy were generalized in 56 (37.8%), focal in 28(18.9%), and unknown in 81 (54.7%). The most common antiseizure medication was phenytoin (35). Eighty (59.3%) were treated only with medications, 7 (5.2%) had epilepsy surgery and 3(3.4%) were implanted with a neuromodulation device. 23(15.3%) were seizure free 3-6 months before death occurred. 59 (66.3%) of the patients had history of generalized tonic-clonic or focal with progression to bilateral tonic-clonic. 91(60%) were found dead at home and 29(19.1%) in a prone position. Macroscopic brain abnormalities were identified in 32 (36%) of cases. In 8 (9.1%) SUDEP cases, no pathological abnormality was found from neuropathological examination. The most common identifiable lesions are mesial temporal sclerosis 12(13.5%), prior CNS trauma 11 (12.4%), and focal cortical dysplasia(7.9%).
Conclusion:
This is the first study of neuropathological findings in SUDEP based on a Canadian patient population. In a large portion of patients who suffered SUDEP, their pathological finding did not show any abnormality. More detailed neuropathological analysis is required for a better understanding of SUDEP.
Funding:
:N/A
Neuropathology of Epilepsy