Autopsy‐reported cause of death in a population‐based cohort of sudden unexpected death in epilepsy

Abstract

Objective Sudden unexpected death in epilepsy (SUDEP) is a diagnosis of exclusion; the definition includes individuals with epilepsy who die suddenly without an identifiable toxicological or anatomical cause of death. Limited data suggest underidentification of SUDEP as the cause of death on death certificates. Here, we evaluate the autopsy‐reported cause of death in a population‐based cohort of SUDEP cases. Methods Case summaries of forensic autopsies conducted in Ontario, Canada between January 2014 and June 2016 were retrospectively screened using a language processing script for decedents with a history of epilepsy or seizures. After manual review for potential SUDEP cases, two neurologists independently examined the autopsy reports and classified deaths by Nashef criteria. Demographic characteristics and consideration by the forensic pathologist of the role of epilepsy, seizure, and SUDEP in death were summarized. Results One hundred and eight Definite, 34 Definite Plus, and 22 Possible SUDEP cases were identified. Seventy‐five percent of Definite/Definite Plus SUDEP cases identified by the neurologists were attributed to SUDEP, epilepsy, or seizure disorder in the autopsy report. There was a significant association between the proportion of cases listed in the autopsy report as SUDEP, epilepsy, or seizure disorder and neurologists' SUDEP classification (86% of Definite, 38% of Definite Plus, 0% of Possible). Age was significantly associated with SUDEP classification; Definite cases were younger than Definite Plus, which were younger than Possible SUDEP cases. Significance Most SUDEP cases identified by neurologists were classified concordantly by forensic pathologists in Ontario, Canada; however, concordance decreased with increased case complexity. Although the role of epilepsy/seizures was considered in most Definite/Definite Plus cases, this study highlights the need for autopsy report review of potential SUDEP cases in research studies and assessments of the public health burden of SUDEP. The relationship between age and SUDEP classification has important public health implications; SUDEP incidence may be underappreciated in older adults.

Transforming epilepsy research: A systematic review on natural language processing applications

“…Most of the included studies exploited NLP techniques to identify—and discriminate between—patients based on their documented clinical history and conditions 16–30 . The process often entailed classifying patient reports or interviews into predefined categories based on the prominent differences in textual features.…”

“…Two studies explored the role of NLP in identifying patients in the context of sudden unexplained death in epilepsy (SUDEP) 25,27 . Barbour and colleagues developed rule‐based NLP algorithms that could distinguish patients at risk of SUDEP based on SUDEP risk variables in physician notes, including generalized tonic–clonic seizure (GTCS), refractory epilepsy, and potential or previous epilepsy surgery candidacy.…”

“…Keller and colleagues demonstrated the ability of an NLP algorithm to identify autopsy reports of patients with a history of epilepsy or seizures based on the presence of relevant features. The authors subsequently reviewed the reports distinguished by the model to manually determine whether an individual's death was attributed to SUDEP 27 …”

Epilepsy‐associated death in the Southwestern Ontario: A clinicopathological correlation study

“…For SUDEP cases with alternative CODs, undetermined or unascertained was often reported by Forensic pathologists, with epilepsy included as contributing factor or mentioned in case comments. Neurologists, on the other hand, tend to classify these cases as definite SUDEP plus [ 36 ]. Communication between epileptologists and pathologists, and a standard COD classification are needed for epilepsy‐associated death investigation.…”

Sudden unexpected death in epilepsy: A bibliometric overview

“…In many cases, SUDEP does not directly lead to death, however, it can give rise to accidental falls and trauma as well as drowning. The prevalence of SUDEP is underestimated (13). Previous studies have demonstrated that only ∼30% of SUDEP cases are reported as SUDEP, seizure, or epilepsy (4,14).…”