Prevention of Sudden Unexpected Death in Epilepsy

Sudden unexpected death in epilepsy (SUDEP) is the most common cause of death related to epilepsy and is associated with treatment resistance and the presence of generalised tonic-clonic seizures (GTCS, of either focal or generalised onset). While the causative mechanisms of SUDEP are yet to be fully elucidated, it is thought that seizure-induced brainstem suppression, and respiratory and cardiac dysfunction may be involved. Research into SUDEP has identified several risk factors (including frequency of GTCS and male gender) but has also indicated proven or potential preventive strategies, including more effective seizure control. Despite increasing awareness and research into SUDEP, its underlying mechanisms and preventive strategies remain poorly defined. More research is needed into the pathophysiology of SUDEP and to identify predictive biomarkers. Furthermore, clinical trials are warranted to assess outcomes with preventive interventions. We review SUDEP epidemiology and risk factors, and discuss potential measures to reduce SUDEP risk.

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Practice guideline summary: Sudden unexpected death in epilepsy incidence rates and risk factors

Neurology ◽

10.1212/wnl.0000000000003685 ◽

2017 ◽

Vol 88 (17) ◽

pp. 1674-1680 ◽

Cited By ~ 184

Author(s):

Cynthia Harden ◽

Torbjörn Tomson ◽

David Gloss ◽

Jeffrey Buchhalter ◽

J. Helen Cross ◽

...

Keyword(s):

Risk Factors ◽

Evaluation Process ◽

Incidence Rates ◽

Sudden Unexpected Death ◽

Seizure Freedom ◽

Unexpected Death ◽

New Approach ◽

Assessment Development ◽

Clonic Seizures ◽

Patients With Epilepsy

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.

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Sudden cardiac death in epilepsy disappoints, but epileptologists keep faith

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20160086 ◽

2016 ◽

Vol 74 (7) ◽

pp. 570-573 ◽

Cited By ~ 7

Author(s):

Fulvio A. Scorza ◽

Esper A. Cavalheiro ◽

Jaderson Costa da Costa

Keyword(s):

Risk Factors ◽

Sudden Cardiac Death ◽

Cause Of Death ◽

Cardiac Death ◽

Seizure Control ◽

Intractable Epilepsy ◽

Sudden Unexpected Death ◽

Unexpected Death ◽

Common Cause ◽

Preventative Measures

ABSTRACT Sudden unexpected death in epilepsy (SUDEP) is the most common cause of death in people with intractable epilepsy. Probably, optimization of seizure control will prevent some of these deaths. Briefly, we integrated in this paper some data about the epidemiology, risk factors, etiology, and preventative measures in the management of SUDEP.

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Sudden Unexpected Death in Epilepsy - An Overview of Current Understanding and Future Perspectives

European Neurological Review ◽

10.17925/enr.2012.07.01.67 ◽

2012 ◽

Vol 7 (1) ◽

pp. 67 ◽

Cited By ~ 1

Author(s):

Daniel Friedman ◽

Lawrence J Hirsch ◽

◽

Keyword(s):

Seizure Control ◽

Healthy Person ◽

Sudden Unexpected Death ◽

Future Perspectives ◽

Prevention Strategies ◽

Treatment Resistant ◽

Unexpected Death ◽

Cerebral Dysfunction ◽

Clonic Seizures ◽

Related Mortality

Sudden unexpected death in epilepsy (SUDEP) is likely to be the most common cause of disease-related mortality in people with epilepsy. The most commonly encountered scenario is that a previously healthy person is found dead in bed by family. Patients with frequent generalised tonic-clonic seizures are at highest risk but SUDEP can occur in patients who have never had convulsions. The mechanisms of SUDEP are poorly understood but seem to be related to seizure-related cardiac, respiratory or cerebral dysfunction. Seizure control is the only clear strategy to prevent SUDEP but that is not possible in the 30 % of patients with treatment-resistant epilepsy. Understanding the pathophysiology of SUDEP may lead to prevention strategies for patients who continue to have seizures despite maximal therapy.

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Sudden Unexpected Death in Epilepsy—An Overview of Current Understanding and Future Perspectives

US Neurology ◽

10.17925/usn.2012.08.01.42 ◽

2012 ◽

Vol 08 (01) ◽

pp. 42

Author(s):

Daniel Friedman ◽

Lawrence J Hirsch ◽

◽

Keyword(s):

Seizure Control ◽

Healthy Person ◽

Sudden Unexpected Death ◽

Future Perspectives ◽

Prevention Strategies ◽

Treatment Resistant ◽

Unexpected Death ◽

Cerebral Dysfunction ◽

Clonic Seizures ◽

Related Mortality

Sudden unexpected death in epilepsy (SUDEP) is likely to be the most common cause of disease-related mortality in people with epilepsy. The most commonly encountered scenario is that a previously healthy person is found dead in bed by family. Patients with frequent generalized tonic-clonic seizures are at highest risk but SUDEP can occur in patients who have never had convulsions. The mechanisms of SUDEP are poorly understood but seem to be related to seizure-related cardiac, respiratory or cerebral dysfunction. Seizure control is the only clear strategy to prevent SUDEP but that is not possible in the 30 % of patients with treatment-resistant epilepsy. Understanding the pathophysiology of SUDEP may lead to prevention strategies for patients who continue to have seizures despite maximal therapy.

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Sudden unexpected death in epilepsy: A search for risk factors

Epilepsy & Behavior ◽

10.1016/j.yebeh.2006.11.010 ◽

2007 ◽

Vol 10 (1) ◽

pp. 138-141 ◽

Cited By ~ 96

Author(s):

Nikolas Hitiris ◽

Suraya Suratman ◽

Kevin Kelly ◽

Linda J. Stephen ◽

Graeme J. Sills ◽

...

Keyword(s):

Risk Factors ◽

Sudden Unexpected Death ◽

Unexpected Death

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Practice Guideline Summary: Sudden Unexpected Death in Epilepsy Incidence Rates and Risk Factors: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society

Epilepsy Currents ◽

10.5698/1535-7511.17.3.180 ◽

2017 ◽

Vol 17 (3) ◽

pp. 180-187 ◽

Cited By ~ 25

Author(s):

Cynthia Harden ◽

Torbjörn Tomson ◽

David Gloss ◽

Jeffrey Buchhalter ◽

J. Helen Cross ◽

...

Keyword(s):

Risk Factors ◽

Guideline Development ◽

Evaluation Process ◽

Incidence Rates ◽

Sudden Unexpected Death ◽

Dissemination And Implementation ◽

Seizure Freedom ◽

High Confidence ◽

Unexpected Death ◽

Assessment Development

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% CI 0.16–0.31) (high 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.

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Sudden Unexpected Death of Two Infants in Baby Carriers

Klinische Pädiatrie ◽

10.1055/a-1545-4590 ◽

2021 ◽

Author(s):

Dennis Storz ◽

Christof Dame ◽

Anke Wendt ◽

Alexander Gratopp ◽

Christoph Bührer

Keyword(s):

Risk Factors ◽

Infant Development ◽

Sudden Infant Death ◽

Developed Countries ◽

Bottle Feeding ◽

Sudden Unexpected Death ◽

Sudden Infant ◽

Unexpected Death ◽

Sleeping Position ◽

Prone Sleeping Position

Sudden unexpected death in infancy (SUDI), previously termed sudden infant death syndrome (SIDS), is the second leading cause of death in infants beyond the neonatal period in Germany, and a major cause of infant mortality in economically well developed countries (OECD Health Statistics, 2019). The risk of SUDI peaks at the age of 2–4 months and then decreases continuously till the end of the first year. A complex multifactorial cause, rather than a single characteristic factor, may cause SUDI within a critical period of infant development (Guntheroth WG et al., Pediatrics 2002; 110: e64–e64). Risk factors include prematurity, male gender, bottle-feeding, prone sleeping position, overheating, as well as exposure to smoke amongst others (Carpenter RG et al., Lancet 2004; 363: 185–191). Thus, health professionals consistently advise and educate parents about avoidable risk factors of SUDI at routine well-baby examinations. Since the advent of SUDI prevention strategies in the 1980s, the incidence has decreased 10fold, from 1,55/1.000 live births in 1991 to 0,15/1000 in 2015. This number seems to have reached a steady state (Statistisches Bundesamt Germany, 2015).

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