BACKGROUND: Prevalence data for sudden unexplained death in epilepsy (SUDEP) are hampered by its underuse as a final diagnosis on death certificates in appropriate cases. Few data exist about how coroners (COs) and medical examiners (MEs) in the United States use the diagnosis of SUDEP. METHODS: A survey instrument that addressed demographics, professional background, annual cases of epilepsy, seizure history, percentage of post-mortem examinations, cause of death, and use of SUDEP as a diagnosis was sent to all COs and MEs in the United States. Unadjusted comparisons between categorical variables used chi2 tests. A multiple regression model examined the odds of respondents considering SUDEP to be a valid diagnosis. RESULTS: Of 2995 surveys, 80.7% went to COs and 19.3% to MEs. The response rate was 15.9% for COs and 21.8% for MEs. Acknowledgment of SUDEP as a valid entity was greatest among pathologists (83.5%) versus other physicians and non-physicians (P< .001) and correlated with higher autopsy rates and seeing more cases of epilepsy. In actual practice, SUDEP was not used routinely as a death certificate diagnosis in most cases with no cause of death found at autopsy by any group in the survey regardless of title, educational background, location, autopsy rate, or number of seizure cases seen annually. CONCLUSIONS: SUDEP appears to be an underused final diagnosis by COs and MEs throughout the United States. There is a need to educate officials at all levels about this diagnosis in persons who have epilepsy with no other cause of death.
BACKGROUND: Prevalence data for sudden unexplained death in epilepsy (SUDEP) are hampered by its underuse as a final diagnosis on death certificates in appropriate cases. Few data exist about how coroners (COs) and medical examiners (MEs) in the United States use the diagnosis of SUDEP. METHODS: A survey instrument that addressed demographics, professional background, annual cases of epilepsy, seizure history, percentage of post-mortem examinations, cause of death, and use of SUDEP as a diagnosis was sent to all COs and MEs in the United States. Unadjusted comparisons between categorical variables used chi2 tests. A multiple regression model examined the odds of respondents considering SUDEP to be a valid diagnosis. RESULTS: Of 2995 surveys, 80.7% went to COs and 19.3% to MEs. The response rate was 15.9% for COs and 21.8% for MEs. Acknowledgment of SUDEP as a valid entity was greatest among pathologists (83.5%) versus other physicians and non-physicians (P< .001) and correlated with higher autopsy rates and seeing more cases of epilepsy. In actual practice, SUDEP was not used routinely as a death certificate diagnosis in most cases with no cause of death found at autopsy by any group in the survey regardless of title, educational background, location, autopsy rate, or number of seizure cases seen annually. CONCLUSIONS: SUDEP appears to be an underused final diagnosis by COs and MEs throughout the United States. There is a need to educate officials at all levels about this diagnosis in persons who have epilepsy with no other cause of death.
Authors: Esma Cihan; Dale C Hesdorffer; Michael Brandsoy; Ling Li; David R Fowler; Jason K Graham; Michael Karlovich; Elizabeth J Donner; Orrin Devinsky; Daniel Friedman Journal: Neurology Date: 2020-04-23 Impact factor: 9.910
Authors: Carrie K Shapiro-Mendoza; Sharyn E Parks; Jennifer Brustrom; Tom Andrew; Lena Camperlengo; John Fudenberg; Betsy Payn; Dale Rhoda Journal: Pediatrics Date: 2017-06-05 Impact factor: 7.124
Authors: Carri Cottengim; Sharyn Parks; Dale Rhoda; Tom Andrew; Kurt B Nolte; John Fudenberg; Mary Ann Sens; Jennifer Brustrom; Betsy Payn; Carrie K Shapiro-Mendoza Journal: Forensic Sci Med Pathol Date: 2019-11-18 Impact factor: 2.007
Authors: Francis Levira; David J Thurman; Josemir W Sander; W Allen Hauser; Dale C Hesdorffer; Honorati Masanja; Peter Odermatt; Giancarlo Logroscino; Charles R Newton Journal: Epilepsia Date: 2016-12-18 Impact factor: 5.864
Authors: Orrin Devinsky; Daniel Friedman; Jocelyn Y Cheng; Ellen Moffatt; Anthony Kim; Zian H Tseng Journal: Neurology Date: 2017-08-02 Impact factor: 9.910