Sudden unexpected death in epilepsy: experience from a tertiary epilepsy centre in Cyprus with review of the literature.
BACKGROUND
Sudden unexpected death in epilepsy (SUDEP) affects 0.09-9.3 per 1,000 person-years depending on the population studied and constitutes the most common cause of death in people with epilepsy. The purpose of this study was to analyze epidemiological data of patients with SUDEP, identify possible risk factors in the population of a tertiary referral center and provide a review of the literature aiming to raise awareness of this phenomenon.


METHODS
Data for this study originate from the records of the Cyprus Institute of Neurology and Genetics in Nicosia Cyprus. We performed a systematic review of patients with epilepsy who had died between 1997 and 2012 and identified those whose death circumstances met the definition of SUDEP. Information was collected regarding sex, age, type of seizures, anti-epileptic therapies, and circumstances of death. Ethical approval was obtained from the institutional medical ethics committee.


RESULTS
Four hundred and forty four new patients were diagnosed with epilepsy among referrals to the epilepsy clinic and were followed to the end of the study period. Seven patients, six males, were identified who met criteria for SUDEP. The average age was 30 years. All patients had had either primary or secondary tonic-clonic seizures. Most were on polypharmacy, and two had Vagus Nerve Stimulation implanted. Most deaths were unwitnessed and nocturnal. The overall incidence rate for SUDEP in this population was 2.13 deaths/1000 person-years. Overall Cumulative Incidence (or lifetime risk) was calculated at 15.76 SUDEP deaths/1,000 patients.


CONCLUSIONS
In our series, SUDEP was primarily a nocturnal and unwitnessed event that affected primarily young males. Among both males and females patients, 36.8% of all deaths were due to SUDEP. The major risk factor identified was the occurrence of generalized tonic-clonic seizures signifying that every effort should be made to control this type of seizures. Hippokratia 2015; 19 (4): 338-343.
The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.
S S
SS
Papacostas
SUDEP; case series; epidemiology; epilepsy; risk factors
Epilepsia. 2008 Feb;49(2):360-5
18251839
Epilepsy Res. 2009 Dec;87(2-3):277-80
19747799
Ann Neurol. 2001 Mar;49(3):336-44
11261508
Epilepsia. 2000 Nov;41(11):1494-7
11077466
Seizure. 1993 Dec;2(4):287-90
8162397
Epilepsia. 2004 Aug;45(8):993-6
15270769
Epilepsia. 1996 May;37(5):428-32
8617170
Epilepsia. 2014 Oct;55(10):1486-94
25323807
Epilepsia. 1997 Nov;38(11 Suppl):S6-8
19909329
Epilepsia. 2002 Feb;43(2):170-4
11903464
Lancet Neurol. 2011 Nov;10(11):961-8
21937278
Epilepsia. 2003 Apr;44(4):575-81
12681008
Epilepsia. 2000 May;41(5):549-53
10802760
Epilepsia. 1999 Dec;40(12 ):1828-31
10612352
Lancet Neurol. 2013 Oct;12(10):966-77
24012372
Ann Neurol. 2010 Dec;68(6):787-96
20882604
Neurology. 2005 Oct 11;65(7):1021-5
16217053
Clin Neurol Neurosurg. 2007 Dec;109(10):849-52
17825483
Cleve Clin J Med. 2010 Jul;77 Suppl 3:S51-5
20622077
Am J Ment Retard. 2000 Jul;105(4):229-35
10934565
Neurology. 1999 Oct 12;53(6):1276-83
10522885
J Neurosci. 2010 Apr 14;30(15):5167-75
20392939
Ann Neurol. 1999 Jul;46(1):45-50
10401779
Epilepsia. 2010 May;51(5):916-20
20132291
Neurology. 1984 Feb;34(2):255-7
6538024
Ann Neurol. 1997 Oct;42(4):588-94
9382470
Neurology. 2007 Jul 31;69(5):434-41
17664402
Neurology. 1998 Nov;51(5):1270-4
9818844
Brain Pathol. 2011 Mar;21(2):201-8
20875080
Neurology. 2001 Feb 27;56(4):519-25
11222798
Arch Neurol. 1986 Feb;43(2):194-6
3947265
Trends Mol Med. 2003 Dec;9(12):542-8
14659469
Neurology. 2000 Nov 28;55(10):1450-4
11094096
Neurology. 1992 Sep;42(9):1727-32
1513461
J Neurol Neurosurg Psychiatry. 1999 Oct;67(4):439-44
10486388
Arch Neurol. 1998 Jun;55(6):857-60
9626779
Lancet Neurol. 2006 Jun;5(6):481-7
16713919
Seizure. 2007 Mar;16(2):153-9
17178458
Clin Auton Res. 2006 Feb;16(1):6-11
16477489
J Neurol Neurosurg Psychiatry. 2007 Dec;78(12):1395-7
17389715
Epilepsy Res. 2003 Nov;57(1):69-75
14706734
J Neurol Neurosurg Psychiatry. 2010 Jul;81(7):716-8
20478848
Epilepsia. 2010 May;51(5):738-44
20384763
Epilepsia. 2003 Feb;44(2):179-85
12558571
Epilepsia. 2012 Feb;53(2):267-71
22126418
Epilepsia. 2006 Jan;47(1):21-6
16417527
Epilepsia. 2005;46 Suppl 11:49-53
16393181
Epilepsia. 2012 Feb;53(2):253-7
22192074
J Neurol Neurosurg Psychiatry. 1996 Mar;60(3):297-300
8609507
Neurology. 2005 Apr 12;64(7):1131-3
15824334
Epilepsy Res. 2000 Jun;40(1):17-24
10771254
Epilepsia. 2012 Feb;53(2):249-52
22191685
Seizure. 2004 Oct;13(7):523-8
15324833
J Neurol Neurosurg Psychiatry. 2005 Jun;76(6):885-7
15897520
Acta Neurol Scand. 2005 Feb;111(2):126-33
15644073
Epilepsy Res. 1998 Mar;30(1):77-83
9551847
Electromyogr Clin Neurophysiol. 2007 Jan-Feb;47(1):61-3
17375884
Neurology. 1995 Oct;45(10):1926-7
7477995
Seizure. 2009 Mar;18(2):158-60
18752973
J Neurol Neurosurg Psychiatry. 2005 Oct;76(10):1382-6
16170081
Epilepsia. 2012 Feb;53(2):227-33
22191982
Ann Neurol. 1995 Apr;37(4):531-7
7717690
Sci Transl Med. 2009 Oct 14;1(2):2ra6
20368164
Lancet. 2011 Dec 10;378(9808):2028-38
21737136
Neurology. 2009 May 12;72(19):1702-3
19433745
Lancet. 1999 Mar 13;353(9156):888-93
10093982