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. 2020 Jan 28;94(4):e419-e429.
doi: 10.1212/WNL.0000000000008741. Epub 2019 Dec 12.

Clinical risk factors in SUDEP: A nationwide population-based case-control study

Olafur Sveinsson  1 , Tomas Andersson  2 , Peter Mattsson  2 , Sofia Carlsson  2 , Torbjörn Tomson  2
Affiliations

Clinical risk factors in SUDEP: A nationwide population-based case-control study

Olafur Sveinsson et al. Neurology. .

Erratum in

Abstract

Objective: We conducted a nationwide case-control study in Sweden to test the hypothesis that specific clinical characteristics are associated with increased risk of sudden unexpected death in epilepsy (SUDEP).

Methods: The study included 255 SUDEP cases (definite and probable) and 1,148 matched controls. Clinical information was obtained from medical records and the National Patient Register. The association between SUDEP and potential risk factors was assessed by odds ratios (ORs) and 95% confidence intervals (CIs) and interaction assessed by attributable proportion due to interaction (AP).

Results: Experiencing generalized tonic-clonic seizures (GTCS) during the preceding year was associated with a 27-fold increased risk (OR 26.81, 95% CI 14.86-48.38), whereas no excess risk was seen in those with exclusively non-GTCS seizures (OR 1.15, 95% CI 0.54-48.38). The presence of nocturnal GTCS during the last year of observation was associated with a 15-fold risk (OR 15.31, 95% CI 9.57-24.47). Living alone was associated with a 5-fold increased risk of SUDEP (OR 5.01, 95% CI 2.93-8.57) and interaction analysis showed that the combination of not sharing a bedroom and having GTCS conferred an OR of 67.10 (95% CI 29.66-151.88), with AP estimated at 0.69 (CI 0.53-0.85). Among comorbid diseases, a previous diagnosis of substance abuse or alcohol dependence was associated with excess risk of SUDEP.

Conclusions: Individuals with GTCS who sleep alone have a dramatically increased SUDEP risk. Our results indicate that 69% of SUDEP cases in patients who have GTCS and live alone could be prevented if the patients were not unattended at night or were free from GTCS.

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Figures

Figure 1
Figure 1. Flow chart describing the selection process
SUDEP = sudden unexpected death in epilepsy.
Figure 2
Figure 2. Odds ratio (OR) (95% confidence interval [CI]) of sudden unexpected death in epilepsy by combinations of generalized tonic-clonic seizures (GTCS) and living conditions
AP = attributable proportion due to interaction.
See this image and copyright information in PMC

Comment in

References

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