Neurologist Andrew Wilner, MD, succinctly summarizes 5 key things from the AAN’s newly released guidelines on sudden unexpected death in epilepsy (SUDEP). Dr. Wilner's latest book, Bullets and Brains, is a collection of over 100 essays that focus on the intersection of neurology and society. You can follow him on Twitter: @drwilner.
Welcome to Neurology Times. I’m Dr. Andrew Wilner, and today on Neurology Update I’d like to discuss five important facts about SUDEP.
SUDEP is defined as: Sudden, unexpected, witnessed or unwitnessed, nontraumatic, and non-drowning death in patients with epilepsy, with or without evidence for a seizure and excluding documented status epilepticus where necropsy examination does not reveal a toxicological or anatomical cause for death.”1
In other words, death is ascribed to SUDEP when there is cardio/respiratory failure without an identifiable cause other than a history of epilepsy.
SUDEP is the leading cause of epilepsy-related mortality.2
The American Academy of Neurology and the American Epilepsy Society recently published a Practice Guideline summarizing what we know about SUDEP.3
Based on a literature review, the practice guideline estimated the incidence of SUDEP in children with epilepsy as 0.22/1,000 patient-years. The risk increases in adults to 1.2/1,000 patient years. This translates to the occurrence of SUDEP in one child with epilepsy out of 4,500, and one adult with epilepsy out of 1,000, per year.
Although rare, SUDEP is a sudden fatal event in a person with epilepsy who may be otherwise healthy. Consequently, research efforts are focused on finding the underlying etiologies for SUDEP and preventive strategies for this catastrophic event.
Physicians are encouraged to discuss the possibility of SUDEP with their patients, particularly those whose seizures are uncontrolled.
Many risk factors for SUDEP have been proposed in the past, such as polytherapy, male sex, and long duration of seizure disorder. However, the only definite risk factor according to the new practice guideline is generalized tonic clonic seizures.
To summarize, here are 5 facts about SUDEP:
1. SUDEP is the leading cause of epilepsy-related mortality.
2. The etiology of SUDEP is unknown.
3. SUDEP is rare; 1 child with epilepsy out of 4,500 per year and 1 adult with epilepsy out of 1,000 per year.
4. The only known risk factor is recurrent generalized tonic clonic seizures.
5. The only known SUDEP prevention is seizure control.
The risk of SUDEP is one more reason to encourage patients to adhere to their antiepileptic medications and consider other seizure treatments such as epilepsy surgery to achieve seizure freedom.
Thank you for listening to today’s Neurology Update on Sudden Unexpected Death in Epilepsy. I’m Dr. Andrew Wilner, reporting for Neurology Times.
Related content: How Common Is Sudden Unexpected Death in Epilepsy?
1. Nashef L, Brown S. Epilepsy and sudden death. The Lancet 1996;348;1324-5.
2. Glasscock E. Genomic biomarkers of SUDEP in brain and heart. Epilepsy and Behavior 2014;38:172-9.
3. Harden C, Tomson T, Gloss D et al. Practice guideline summary: Sudden unexpected death in epilepsy incidence rates and risk factors. Neurology 2017;88:1674-1680.