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Review
. 2017 Sep 21:8:473.
doi: 10.3389/fneur.2017.00473. eCollection 2017.

Ranking the Leading Risk Factors for Sudden Unexpected Death in Epilepsy

Christopher M DeGiorgio  1   2   3 , Daniela Markovic  2 , Rajarshi Mazumder  1   2 , Brian D Moseley  4
Affiliations
Review

Ranking the Leading Risk Factors for Sudden Unexpected Death in Epilepsy

Christopher M DeGiorgio et al. Front Neurol. .

Abstract

Background: Sudden unexpected death in epilepsy (SUDEP) is rare in well-controlled epilepsy. However, SUDEP is a common cause of death in drug-resistant epilepsy. Over the last 30 years, multiple cohort and population studies have identified clinical risk factors associated with an increased risk for SUDEP.

Objective: To identify and rank the leading SUDEP risk factors from major cohort and population-based studies. The incidence of SUDEP is also evaluated in special clinical situations, including antiepileptic drug treatment, epilepsy surgery, devices, and assignment to placebo in clinical trials.

Methods: A PubMed search for English language human cohort studies for the terms Sudden, Death, and Epilepsy was performed for the years 1987-2017. Risk factors for SUDEP were identified and ranked by the weighted log adjusted odds ratio (OR)/relative risk ratio (RR).

Findings: The top 10 leading risk factors ranked from highest to lowest log adjusted OR/RR are the following: ≥3 GTC seizures per year; ≥13 seizures in the last year; No Antiepileptic Drug (AED) treatment; ≥3 AEDs; ≥3 GTCs in the past year; 11-20 GTC seizures in the last 3 months; age of onset 0-15 years old; IQ < 70; 3-5 AED changes in the last year; ≥3 AEDs. Two risk factors from separate sources (≥3 GTC seizures and ≥3 AEDs) occur twice in the top 10 risk factors.

Conclusion: The top 10 risk factors for SUDEP are identified and ranked. A ranking of the top risk factors could help clinicians identify patients at highest risk for SUDEP.

Keywords: epilepsy; mortality; odds ratio; seizures; sudden death; sudden unexpected death in epilepsy.

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Figures

Figure 1
Figure 1
Forest plot of the 10 leading risk factors by adjusted odds ratios (ORs) with corresponding 95% confidence intervals (CI).
See this image and copyright information in PMC

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