Sudden Unexpected Death in Epilepsy (SUDEP): A Review of Risk Factors and Possible Interventions in Children

Sudden unexpected death in epilepsy (SUDEP) is a serious and devastating, yet poorly understood outcome in epilepsy. This review discusses the current knowledge and understanding of SUDEP in children and adolescents. Established risk factors for SUDEP include history of generalized tonic-clonic seizures and nocturnal seizures. Other proposed risk factors include the use of multiple antiseizure medications and poor medication adherence. Possible prevention strategies for SUDEP include improved medication adherence, surgical interventions, nighttime safety, seizure detection devices, and diet. Pediatric providers have a great opportunity to educate families about SUDEP, assess medication adherence, and provide families with tools to improve medication adherence and learn about SUDEP in children and adolescents with epilepsy. Future research in SUDEP aims to further understand the etiology and risk factors of SUDEP, while developing more intervention strategies to prevent SUDEP.

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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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Sudden unexpected death in epilepsy: current knowledge and future directions

The Lancet Neurology ◽

10.1016/s1474-4422(08)70202-3 ◽

2008 ◽

Vol 7 (11) ◽

pp. 1021-1031 ◽

Cited By ~ 411

Author(s):

Torbjörn Tomson ◽

Lina Nashef ◽

Philippe Ryvlin

Keyword(s):

Current Knowledge ◽

Sudden Unexpected Death ◽

Unexpected Death ◽

Future Directions

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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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TEXT messages to improve MEDication adherence and Secondary prevention (TEXTMEDS) after acute coronary syndrome: a randomised clinical trial protocol

BMJ Open ◽

10.1136/bmjopen-2017-019463 ◽

2018 ◽

Vol 8 (1) ◽

pp. e019463 ◽

Cited By ~ 10

Author(s):

Clara K Chow ◽

Aravinda Thiagalingam ◽

Karla Santo ◽

Cindy Kok ◽

Jay Thakkar ◽

...

Keyword(s):

Risk Factors ◽

Clinical Trial ◽

Acute Coronary Syndrome ◽

Medication Adherence ◽

Text Message ◽

Randomised Clinical Trial ◽

Text Messages ◽

Improve Medication Adherence ◽

Coronary Syndrome ◽

Secondary Outcomes

BackgroundIdentifying simple, low-cost and scalable means of supporting lifestyle change and medication adherence for patients following a cardiovascular (CV) event is important.ObjectiveThe TEXTMEDS (TEXT messages to improve MEDication adherence and Secondary prevention) study aims to investigate whether a cardiac education and support programme sent via mobile phone text message improves medication adherence and risk factor levels in patients following an acute coronary syndrome (ACS).Study designA single-blind, multicentre, randomised clinical trial of 1400 patients after an ACS with 12 months follow-up. The intervention group will receive multiple weekly text messages that provide information, motivation, support to adhere to medications, quit smoking (if relevant) and recommendations for healthy diet and exercise. The primary endpoint is the percentage of patients who are adherent to cardioprotective medications and the key secondary outcomes are mean systolic blood pressure (BP) and low-density lipoprotein cholesterol. Secondary outcomes will also include total cholesterol, mean diastolic BP, the percentage of participants who are adherent to each cardioprotective medication class, the percentage of participants who achieve target levels of CV risk factors, major vascular events, hospital readmissions and all-cause mortality. The study will be augmented by formal economic and process evaluations to assess acceptability, utility and cost-effectiveness.SummaryThe study will provide multicentre randomised trial evidence of the effects of a text message-based programme on cardioprotective medication adherence and levels of CV risk factors.Ethics and disseminationPrimary ethics approval was received from Western Sydney Local Health District Human Research Ethics Committee (HREC2012/12/4.1 (3648) AU RED HREC/13/WMEAD/15). Results will be disseminated via peer-reviewed publications and presentations at international conferences.Trial registration numberACTRN12613000793718; Pre-results.

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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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Automated detection of sudden unexpected death in epilepsy risk factors in electronic medical records using natural language processing

Epilepsia ◽

10.1111/epi.15966 ◽

2019 ◽

Cited By ~ 2

Author(s):

Kristen Barbour ◽

Dale C. Hesdorffer ◽

Niu Tian ◽

Elissa G. Yozawitz ◽

Patricia E. McGoldrick ◽

...

Keyword(s):

Risk Factors ◽

Natural Language Processing ◽

Natural Language ◽

Electronic Medical Records ◽

Language Processing ◽

Medical Records ◽

Automated Detection ◽

Sudden Unexpected Death ◽

Unexpected Death

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Sudden Unexpected Death in Epilepsy: Mechanisms, Risk Factors and the Role of the Nurse

British Journal of Neuroscience Nursing ◽

10.12968/bjnn.2019.15.2.64 ◽

2019 ◽

Vol 15 (2) ◽

pp. 64-72 ◽

Cited By ~ 1

Author(s):

Deborah L Brennan ◽

Andrew D Powell

Keyword(s):

Risk Factors ◽

Sudden Unexpected Death ◽

Unexpected Death

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Aging and Disability Among Hispanics in the United States: Current Knowledge and Future Directions

Innovation in Aging ◽

10.1093/geroni/igx020 ◽

2017 ◽

Vol 1 (2) ◽

Cited By ~ 3

Author(s):

Marc A Garcia ◽

Brian Downer ◽

Michael Crowe ◽

Kyriakos S Markides

Keyword(s):

United States ◽

Risk Factors ◽

Life Expectancy ◽

Literature Review ◽

Old Age ◽

Current Knowledge ◽

The United States ◽

Life Course Perspective ◽

Future Research ◽

Minority Population

Abstract Background and Objectives Hispanics are the most rapidly aging minority population in the United States. Our objective is to provide a summary of current knowledge regarding disability among Hispanics, and to propose an agenda for future research. Research Design and Methods A literature review was conducted to identify major areas of research. A life course perspective and the Hispanic Paradox were used as frameworks for the literature review and for identifying future areas of research. Results Four research areas were identified: (1) Ethnic disparities in disability; (2) Heterogeneity of the U.S. older Hispanic population; (3) Risk factors for disability; and (4) Disabled life expectancy. Older Hispanics are more likely than non-Hispanic whites to be disabled or to become disabled. Disability varied by country of origin, nativity, age of migration, and duration in the United States. Important risk factors for disability included chronic health conditions, depression, and cognitive impairment. Protective factors included positive affect and physical activity. Older Hispanics have longer life expectancy than non-Hispanic whites but spend a greater proportion of old age disabled. Future research should continue to monitor trends in disability as younger generations of Hispanics reach old age. Attention needs to be given to regional variation within the United States for disability prevalence, early-life risk factors, and factors that may contribute to variation in disabled life expectancy. There is also an urgent need for interventions that can effectively prevent or delay the onset of disability in older Hispanics. Discussion and Implications Considerable research has examined disability among older Hispanics, but continued research is needed. It is important that research findings be used to inform public policies that can address the burden of disability for older Hispanic populations.

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