Do antiepileptic drugs or generalized tonic-clonic seizure frequency increase SUDEP risk? A combined analysis

Objective:To develop and validate a tool for individualised prediction of Sudden Unexpected Death in Epilepsy (SUDEP) risk, we re-analysed data from one cohort and three case-control studies undertaken 1980-2005.Methods:We entered 1273 epilepsy cases (287 SUDEP, 986 controls) and 22 clinical predictor variables into a Bayesian logistic regression model.Results:Cross-validated individualized model predictions were superior to baseline models developed from only average population risk or from generalised tonic-clonic seizure frequency (pairwise difference in leave-one-subject-out expected log posterior density = 35.9, SEM +/-12.5, and 22.9, SEM +/-11.0 respectively). The mean cross-validated (95% Credibility Interval) Area Under the Receiver Operating Curve was 0.71 (0.68 to 0.74) for our model versus 0.38 (0.33 to 0.42) and 0.63 (0.59 to 0.67) for the baseline average and generalised tonic-clonic seizure frequency models respectively. Model performance was weaker when applied to non-represented populations. Prognostic factors included generalized tonic-clonic and focal-onset seizure frequency, alcohol excess, younger age of epilepsy onset and family history of epilepsy. Anti-seizure medication adherence was associated with lower risk.Conclusions:Even when generalised to unseen data, model predictions are more accurate than population-based estimates of SUDEP. Our tool can enable risk-based stratification for biomarker discovery and interventional trials. With further validation in unrepresented populations it may be suitable for routine individualized clinical decision-making. Clinicians should consider assessment of multiple risk factors, and not only focus on the frequency of convulsions.

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Mutational analysis of SCN2B, SCN3B and SCN4B in a large Chinese Han family with generalized tonic–clonic seizure

Neurological Sciences ◽

10.1007/s10072-010-0390-6 ◽

2010 ◽

Vol 31 (5) ◽

pp. 675-677 ◽

Cited By ~ 1

Author(s):

Yang Lu ◽

Weihua Yu ◽

Zhiqin Xi ◽

Zheng Xiao ◽

Xiaoqin Kou ◽

...

Keyword(s):

Mutational Analysis ◽

Clonic Seizure ◽

Tonic Clonic Seizure ◽

Chinese Han

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Ascending Tonic Clonic Seizure Syndrome after Percutaneous Vertebroplasty

Case Reports in Orthopedics ◽

10.1155/2015/870810 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Guido Zarattini ◽

Adam Farrier ◽

Federico Sibona

Keyword(s):

Percutaneous Vertebroplasty ◽

Rare Complication ◽

Cement Leakage ◽

Clonic Seizure ◽

Tonic Clonic Seizure ◽

Leg Pain ◽

Compression Fractures ◽

First Case ◽

Seizure Syndrome ◽

Osteoporotic Compression Fractures

Background Context. Cement leakage is not a rare complication of vertebroplasty, but ascending tonic clonic seizure syndrome is exceptionally rare. We herein report the first case to our knowledge of this complication related to vertebroplasty.Purpose. We herein report the first case of ascending tonic clonic seizure syndrome following epidural cement leakage after percutaneous vertebroplasty in a patient with multiple osteoporotic compression fractures.Study Design. Case report.Methods. A 64-year-old woman with T8, T10, L2, and L4 osteoporotic compression fractures underwent percutaneous vertebroplasty using polymethylmethacrylate. 40 minutes after the procedure the patient started suffering back and leg pain, having repetitive myoclonic jerks lasting 15 seconds of the lower extremities, spasm of the back, dyspnea, sinus tachycardia, hypoxemia, and metabolic acidosis.Results. The patient recovered completely due to a combination of early effective resuscitation and considered definitive management.Conclusions. Percutaneous vertebroplasty with polymethylmethacrylate is relatively safe but has few dangerous complications, which should be prevented by a meticulous technique and excellent image quality.

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Acute neurogenic pulmonary oedema following generalized tonic clonic seizure. A case report and a review of the literature

European Heart Journal ◽

10.1093/oxfordjournals.eurheartj.a062590 ◽

1988 ◽

Vol 9 (8) ◽

pp. 933-936 ◽

Cited By ~ 13

Author(s):

U. FREDBERG ◽

H. E. BøTKER ◽

F. K. RøMER

Keyword(s):

Case Report ◽

Pulmonary Oedema ◽

Clonic Seizure ◽

Tonic Clonic Seizure ◽

Review Of The Literature ◽

Neurogenic Pulmonary Oedema

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First, do no harm: the risks of overtreating children with epilepsy

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2007000100002 ◽

2007 ◽

Vol 65 (1) ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Eunice Chuang ◽

Marilisa M. Guerreiro ◽

Sara Y. Tsuchie ◽

Angelica Santucci ◽

Carlos A. M. Guerreiro ◽

...

Keyword(s):

Adverse Events ◽

Prospective Study ◽

Antiepileptic Drug ◽

Antiepileptic Drugs ◽

Seizure Frequency ◽

Seizure Control ◽

Control Method ◽

Refractory Epilepsy ◽

Do No Harm ◽

A Prospective Study

BACKGROUND: Although overtreatment with antiepileptic drugs contributes to the morbidity associated with epilepsy, many children still are overtreated. OBJECTIVE: To evaluate if the withdrawal of at least one antiepileptic drug (AED) in children with refractory epilepsy using polytherapy enable a better seizure control. METHOD: This was a prospective study. Children with refractory epilepsy using at least two AEDs were included. Once the patient, or guardian, agreed to participate in the study, one or more AED were slowly tapered off. The remaining AEDs dosages could be adjusted as needed, but a new AED could not be introduced. RESULTS: Fifteen patients were evaluated, three girls; ages ranging from 3 to 18 (mean=8.7 years). After at least one AED withdrawal, two (13.5%) patients became seizure free, seizures improved >50% in 5 (33.5%) patients, did not change in 5 (33.5%), and seizure frequency became worse in 3 (20%). Adverse events improved in 12 patients (80%). CONCLUSION: The withdrawal of at least one AED is a valuable option in the treatment of selected children with refractory epilepsy.

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