title: Incidence of sudden unexpected death in nocturnal frontal lobe epilepsy: a cohort study.
abstract: OBJECTIVE
  Most cases of sudden unexpected death in epilepsy (SUDEP) follow a seizure, and most deaths occur while people are in bed, presumably sleeping. Nocturnal seizures are reported to be a risk factor for SUDEP. People with nocturnal frontal lobe epilepsy (NFLE) have seizures predominantly or exclusively during sleep, often many times per night. The present study aimed to assess whether NFLE represents a high-risk condition for SUDEP.
  
  
  METHODS
  The present study retrospectively assessed the incidence of SUDEP in a cohort reconstructed from a dedicated database of consecutive patients referred to the Epilepsy and Sleep Centres of the Institute of Neurological Sciences of Bologna from 1980 to 2012 with: (1) a diagnosis of NFLE, (2) at least 90% of seizures during sleep, and (3) at least one-year of follow-up.
  
  
  RESULTS
  One hundred and three people were included. The median time from seizure onset to last observation was 26 years, equal to a follow-up of 2789 person-years. One person died of SUDEP during the follow-up period. The incidence rate of SUDEP was 0.36 per 1000 person-years (95% CI 0.01 to 2.0).
  
  
  CONCLUSIONS
  The incidence of SUDEP in the participant population was not higher than the rates previously reported in prevalent epilepsy populations (0.4 to 2.3 per 1000 person-years). The low prevalence of SUDEP might reflect the low occurrence of generalised tonic-clonic seizures in people with NFLE.
authors.affiliation: IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy. Electronic address: bmostacci@gmail.com.
authors.forename: Barbara
authors.initials: B
authors.lastname: Mostacci
authors.affiliation: IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Bisulli
authors.affiliation: Department of Primary Health Care, Bologna Health Trust, Bologna, Italy; Regional Health and Social Agency, Emilia-Romagna Region, Bologna, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Vignatelli
authors.affiliation: IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Licchetta
authors.affiliation: Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.
authors.forename: Lidia
authors.initials: L
authors.lastname: Di Vito
authors.affiliation: Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Rinaldi
authors.affiliation: Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Trippi
authors.affiliation: Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Ferri
authors.affiliation: IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Plazzi
authors.affiliation: IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Provini
authors.affiliation: IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Tinuper
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003645:Death, Sudden / Q000453:epidemiology / Q000209:etiology*; D017034:Epilepsy, Frontal Lobe / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000453:epidemiology / Q000401:mortality; D012893:Sleep Wake Disorders / Q000401:mortality*; D055815:Young Adult
keywords: Generalised tonic-clonic seizures; Insular seizures; Nocturnal seizures; Obstructive sleep apnoea; Sleep