Abstracts

The many studies of sudden unexplained death in epilepsy (SUDEP) have yet to identify consistent risk factors for its occurrence. Further, no single mechanism has been elucidated. Mortality associated with SUDEP is population dependent. It is difficult to analyze SUDEP in that it occurs relatively infrequently. In this study, SUDEP cases were identified in a clinical practice of 30 years. Generally, all patients are known personally to the investigator (BBW) and the clinical and therapeutic information was similar., 3096 patient records were accumulated in a single practice between 1974 and 2004. Abstractions were performed on 711 cases including 26 SUDEP cases and 87 other death cases; the remainder are alive. Specific demographic, clinical, seizure, treatment and laboratory information was obtained using a developed abstracted tool. SUDEP cases were matched on gender and 5-year age intervals with 3 controls that have epilepsy and are alive. McNemar tests were performed using SAS., The rate of SUDEP was 4.2 per 1000 person-years. A history of generalized tonic clonic (GTC) seizures was seen more often in the SUDEP group (RR=5.0, 95% CI 1.90, 13.13). There was a trend towards persons who died of SUDEP being more likely to have ever experienced status epilepticus (p=0.08). Also, persons with SUDEP were more likely to have more than 1 type of seizure (p[lt]0.001), be taking more than 2 antiepileptic drugs (AEDs) at last visit (p[lt]0.001), to have ever taken 3+ AEDs (p[lt]0.001), and to have had a medication change in the 3 months prior to the last visit (p[lt]0.001). There was also a trend towards childhood onset epilepsy in the SUDEP cohort (p=0.07). No difference was observed in having a primary generalized epilepsy., The rate of SUDEP is consistent with other published findings from tertiary referral epilepsy clinics. This study included persons who attended a tertiary referral practice, and therefore likely had more severe epilepsy than general neurological populations. Results have also confirmed that cases of SUDEP are more likely to be taking more AEDs currently and in the past, have more than 1 type of seizure, and to have had a medication change within three months of death. It has been documented that type of seizure, mainly GTC, is associated with SUDEP; however, less documented is the type of epilepsy. Specifically, primary generalized epilepsy as JME was found equally in both SUDEP and matched cohorts. Trends towards ever having status epilepticus and childhood onset epilepsy should be explored further when more data is available., (Supported by Epilepsy Services [amp] Research, Inc.)