Cynthia Harden1, Torbjörn Tomson1, David Gloss1, Jeffrey Buchhalter1, J Helen Cross1, Elizabeth Donner1, Jacqueline A French1, Anthony Gil-Nagel1, Dale C Hesdorffer1, W Henry Smithson1, Mark C Spitz1, Thaddeus S Walczak1, Josemir W Sander1, Philippe Ryvlin1. 1. From the Department of Neurology (C.H.), Mount Sinai Health System, New York, NY; Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (D.G.), CAMC Physicians, Charleston, WV; Departments of Pediatrics and Clinical Neurosciences (J.B.), Alberta Children's Hospital, University of Calgary, Canada; Department of Clinical Neurosciences, Institute of Child Health (J.H.C.), and Institute of Neurology (J.W.S.), University College London; Great Ormond Street Hospital for Children NHS Foundation Trust (J.H.C.), London, UK; Department of Paediatrics (E.D.), Division of Neurology, The Hospital for Sick Children, University of Toronto, Canada; Department of Neurology (J.A.F.), New York University Langone Comprehensive Epilepsy Center, New York; Department of Neurology (A.G.-N.), Hospital Ruber Internacional, Madrid, Spain; Gertrude H. Sergievsky Center and Department of Epidemiology (D.C.H.), Columbia University Medical Center, New York, NY; Department of General Practice (W.H.S.), University College Cork, Ireland; Anschutz Outpatient Pavilion (M.C.S.), University of Colorado Health, Aurora; Neurology Clinic (T.S.W.), University of Minnesota, Minneapolis; Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, the Netherlands; and the Department of Clinical Neurosciences (P.R.), CHUV, Lausanne, Switzerland.
Abstract
OBJECTIVE: To determine the incidence rates of sudden unexpected death in epilepsy (SUDEP) in different epilepsy populations and address the question of whether risk factors for SUDEP have been identified. METHODS: Systematic review of evidence; modified Grading Recommendations Assessment, Development, and Evaluation process for developing conclusions; recommendations developed by consensus. RESULTS: Findings for incidence rates based on 12 Class I studies include the following: SUDEP risk in children with epilepsy (aged 0-17 years) is 0.22/1,000 patient-years (95% confidence interval [CI] 0.16-0.31) (moderate confidence in evidence). SUDEP risk increases in adults to 1.2/1,000 patient-years (95% CI 0.64-2.32) (low confidence in evidence). The major risk factor for SUDEP is the occurrence of generalized tonic-clonic seizures (GTCS); the SUDEP risk increases in association with increasing frequency of GTCS occurrence (high confidence in evidence). RECOMMENDATIONS: Level B: Clinicians caring for young children with epilepsy should inform parents/guardians that in 1 year, SUDEP typically affects 1 in 4,500 children; therefore, 4,499 of 4,500 children will not be affected. Clinicians should inform adult patients with epilepsy that SUDEP typically affects 1 in 1,000 adults with epilepsy per year; therefore, annually 999 of 1,000 adults will not be affected. For persons with epilepsy who continue to experience GTCS, clinicians should continue to actively manage epilepsy therapies to reduce seizures and SUDEP risk while incorporating patient preferences and weighing the risks and benefits of any new approach. Clinicians should inform persons with epilepsy that seizure freedom, particularly freedom from GTCS, is strongly associated with decreased SUDEP risk.
OBJECTIVE: To determine the incidence rates of sudden unexpected death in epilepsy (SUDEP) in different epilepsy populations and address the question of whether risk factors for SUDEP have been identified. METHODS: Systematic review of evidence; modified Grading Recommendations Assessment, Development, and Evaluation process for developing conclusions; recommendations developed by consensus. RESULTS: Findings for incidence rates based on 12 Class I studies include the following: SUDEP risk in children with epilepsy (aged 0-17 years) is 0.22/1,000 patient-years (95% confidence interval [CI] 0.16-0.31) (moderate confidence in evidence). SUDEP risk increases in adults to 1.2/1,000 patient-years (95% CI 0.64-2.32) (low confidence in evidence). The major risk factor for SUDEP is the occurrence of generalized tonic-clonic seizures (GTCS); the SUDEP risk increases in association with increasing frequency of GTCS occurrence (high confidence in evidence). RECOMMENDATIONS: Level B: Clinicians caring for young children with epilepsy should inform parents/guardians that in 1 year, SUDEP typically affects 1 in 4,500 children; therefore, 4,499 of 4,500 children will not be affected. Clinicians should inform adult patients with epilepsy that SUDEP typically affects 1 in 1,000 adults with epilepsy per year; therefore, annually 999 of 1,000 adults will not be affected. For persons with epilepsy who continue to experience GTCS, clinicians should continue to actively manage epilepsy therapies to reduce seizures and SUDEP risk while incorporating patient preferences and weighing the risks and benefits of any new approach. Clinicians should inform persons with epilepsy that seizure freedom, particularly freedom from GTCS, is strongly associated with decreased SUDEP risk.
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: Ariane E Rhone; Christopher K Kovach; Gail Is Harmata; Alyssa W Sullivan; Daniel Tranel; Michael A Ciliberto; Matthew A Howard; George B Richerson; Mitchell Steinschneider; John A Wemmie; Brian J Dlouhy Journal: JCI Insight Date: 2020-03-26
Authors: Susanne G Mueller; Maromi Nei; Lisa M Bateman; Robert Knowlton; Kenneth D Laxer; Daniel Friedman; Orrin Devinsky; Alica M Goldman Journal: Hum Brain Mapp Date: 2018-08-10 Impact factor: 5.038
Authors: Inge C M Loonen; Nico A Jansen; Stuart M Cain; Maarten Schenke; Rob A Voskuyl; Andrew C Yung; Barry Bohnet; Piotr Kozlowski; Roland D Thijs; Michel D Ferrari; Terrance P Snutch; Arn M J M van den Maagdenberg; Else A Tolner Journal: Brain Date: 2019-02-01 Impact factor: 13.501