Cohort Study of Incidence of Sudden Unexplained Death in Persons with Seizure Disorder Treated with Antiepileptic Drugs in Saskatchewan, Canada

Tennis, Patricia; Cole, Thomas B.; Annegers, John F.; Leestma, Jan E.; McNutt, Mary; Rajput, Ali H.

doi:10.1111/j.1528-1157.1995.tb01661.x

Cited by 177 publications

(103 citation statements)

References 13 publications

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“…Twelve Class I studies provided incidence rate data. [6][7][8][9][10][11][12][13][14][15][16][17] Imprecision in study findings resulted in moderate confidence in the evidence for SUDEP rates in childhood and low confidence in the evidence for SUDEP rates in adulthood and overall (table 1). Because of imprecision in the incidence study results with a lack of overlap of 95% confidence interval (CIs) between several comparable study populations, the guideline panel performed a randomeffects meta-analysis to provide summary measures of the absolute or relative risk of SUDEP.…”

mentioning

confidence: 99%

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

et al. 2017

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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. This document summarizes information provided in the complete guideline, available at Neurology.org. Appendix e-6, cited in the full guideline (data supplement), is available at Neurology.org.Sudden unexpected death in epilepsy (SUDEP) is a poorly understood and catastrophic risk of epilepsy.The sensitive nature of discussions of this infrequent but important risk with patients and families has prompted the need for evidence-based information about SUDEP. The goal of this practice guideline is to examine evidence for the SUDEP incidence rate in epilepsy populations and for prognostic factors

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confidence: 99%

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

et al. 2017

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“…Surprisingly, bradycardia has not been reported as a side effect of ACTH treatment, although Hamano et al (2005) have described two patients who suddenly died during ACTH treatment. Nevertheless, cardiac vagal activation and resultant bradycardia represent a plausible potential cause of death among patients with epilepsy (Hirsch and Martin 1971;Tennis et al 1995;Tomson et al 1998;Nei et al 2004). Although the administration of antiepileptic drugs except for ACTH was not changed and HR and HRV parameters did not significantly differ between before and after ACTH, the HR and HRV parameters were altered during ACTH treatment.…”

Section: Discussionmentioning

confidence: 87%

Cardiac Vagal Activation by Adrenocorticotropic Hormone Treatment in Infants with West Syndrome

Hattori

Hayano

Fujimoto

et al. 2007

Tohoku J. Exp. Med.

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West syndrome (WS) is a generalized epileptic syndrome of infancy and early childhood with various etiologies, and consists of a triad of infantile spasm, arrest or regress of psychomotor development and specific electroencephalogram (EEG) pattern of hypsarrhythmia. WS had been believed to be refractory, but recent evidence supports effectiveness of adrenocorticotropic hormone (ACTH) treatment. The ACTH treatment, however, has a problem that it is often accompanied by adverse autonomic symptoms. We therefore examined heart rate variability (HRV) for assessing cardiac autonomic functions in WS and prospectively observed the changes during ACTH treatment. We studied 15 patients with WS and 9 age-matched controls during sleep (EEG stage 2). Compared with controls, the patients with WS were greater in the low-frequency component (LF) of HRV, an index reflecting sympatho-vagal interaction ( p = 0.02), but were comparable for high-frequency component (HF) and LF-to-HF ratio (LF/HF), indices reflecting cardiac vagal activity and sympathetic predominance, respectively. During ACTH treatment, heart rate decreased ( p < 0.01), LF and HF increased ( p < 0.01), and LF/HF did not differ significantly. These results indicate that West syndrome might be accompanied by autonomic changes and that ACTH treatment enhances parasympathetic function and causes bradycardia. West syndrome; ACTH; heart rate variability; bradycardia; autonomic function

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“…SUDEP in community-based epilepsy cohorts was reported to occur at a rate of 0.09-2.3/1,000 py, 11,[26][27][28][29][30][31][32][33] with a steady increase of SUDEP rates in more severe study populations to up to 9.3/1,000 py in epilepsy surgery referrals. 34 In our cohort, the rate of 3.3/1,000 py (3.6/1,000 py for the active device), is similar to that among other intractable cohorts.…”

Section: Sudepmentioning

confidence: 99%

Mortality and SUDEP in epilepsy patients treated with vagus nerve stimulation

et al. 2015

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SUMMARYObjective: The risk of premature death is increased in patients with intractable epilepsy. The effect of vagus nerve stimulation (VNS) on mortality remains unclear. In a previous study by Annegers et al., mortality was raised, comparable to similar intractable cohorts. Our aim was to calculate standardized mortality ratios (SMRs), identify epilepsy-related deaths, and estimate sudden unexpected death in epilepsy (SUDEP) rates in patients treated with VNS for epilepsy. Methods: All United Kingdom patients undergoing VNS between January 1, 1995 and December 31, 2010 at King's College Hospital, London were flagged through the national Medical Research Information Service. Analysis was performed in relation to all deaths occurring by December 31, 2010. Deceased patients were identified from the national death register, and additional information on cause and circumstances of death sought where appropriate to allow for classification of deaths. Results: The cohort consisted of 466 patients, with 2993.83 person-years of follow-up and a median observation period of 5.9 years. Twenty-nine deaths occurred, 27 with the device active. SMR was 7.1 (95% confidence interval [CI] 4.8-10.3) for the active device; 12 deaths were considered epilepsy related, including 10 definite or probable SUDEP and one fatal near SUDEP. Definite/probable and fatal near SUDEP occurred at a rate of 3.7/1,000 person-years. SMRs decreased from 10.5 (5.6-19.5) in the first 2 years after implantation to 5.9 (3.7-9.5) thereafter, although CIs overlapped. SU-DEP rates did not alter over time. Significance: SMRs and SUDEP rate in this study are comparable to other cohorts with intractable epilepsy, with SUDEP an important cause of death. VNS does not appear to lower the risk of premature death overall. There was a clear trend with lower SMR after 2 years of implantation, although CIs overlapped. SUDEP rates, however, did not change.

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Cohort Study of Incidence of Sudden Unexplained Death in Persons with Seizure Disorder Treated with Antiepileptic Drugs in Saskatchewan, Canada

Cited by 177 publications

References 13 publications

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

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

Cardiac Vagal Activation by Adrenocorticotropic Hormone Treatment in Infants with West Syndrome

Mortality and SUDEP in epilepsy patients treated with vagus nerve stimulation

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