Risk markers for sudden unexpected death in epilepsy: an observational, prospective, multicentre cohort study
Abstract
Background Sudden Unexpected Death in Epilepsy (SUDEP) is the leading category of epilepsy-related mortality. Generalized, particularly nocturnal, convulsive seizures, longstanding epilepsy, and solitary living are retrospectively identified risk factors. No definite electroclinical biomarkers have been prospectively ascertained. This study aimed to identify SUDEP risk markers using multimodality data with long-term follow-up. Methods A prospective, multicenter observational cohort study enrolled 2632 children and adults with epilepsy undergoing prolonged videoelectroencephalographic monitoring from 2011 to 2021. Demographic, electroclinical, and cardiorespiratory data were collected at baseline. Patients were followed up long-term for mortality. Primary study endpoint was time to SUDEP. Cox proportional hazards models assessed significant risk factors. Findings Incident SUDEP mortality rate was 0.85 (95% confidence interval [CI]: 0.6—1.16) cases per 1000 person-years, from a cohort of 44,803 person-years. Among 2468 patients, 38 succumbed to SUDEP (12 definite SUDEP, 18 probable, 8 possible) and two experienced near-SUDEP. Living alone (hazard ratio [HR] 7.62 [95% CI: 3.94—14.71), experiencing >3 generalized convulsive seizures in the prior year (HR 3.1 [95% CI: 1.64—5.87]), longer ictal central apnea (HR 1.11 [95% CI: 1.05—1.18]), and longer postictal central apnea (HR 1.32 [95% CI: 1.14—1.54]) were significant predictors of increased SUDEP risk. In sub-analysis excluding…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 2,632 participants or records.
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