Practice Guideline Summary: Sudden Unexpected Death in Epilepsy Incidence Rates and Risk Factors: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society

被引:104
作者
Harden, Cynthia [1 ]
Tomson, Torbjorn [2 ]
Gloss, David [3 ]
Buchhalter, Jeffrey [4 ,5 ]
Cross, J. Helen [6 ,7 ]
Donner, Elizabeth [8 ]
French, Jacqueline A. [9 ]
Gil-Nagel, Anthony [10 ]
Hesdorffer, Dale C. [11 ,12 ]
Smithson, W. Henry [13 ]
Spitz, Mark C. [14 ]
Walczak, Thaddeus S. [15 ]
Sander, Josemir W. [16 ,17 ]
Ryvlin, Philippe [18 ]
机构
[1] Mt Sinai Hlth Syst, Dept Neurol, New York, NY USA
[2] Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden
[3] CAMC Phys, Dept Neurol, Charleston, WV USA
[4] Univ Calgary, Dept Pediat, Alberta Childrens Hosp, Calgary, AB, Canada
[5] Univ Calgary, Dept Clin Neurosci, Alberta Childrens Hosp, Calgary, AB, Canada
[6] UCL, Inst Child Hlth, Dept Clin Neurosci, London, England
[7] Great Ormond St Hosp Children NHS Fdn Trust, London, England
[8] Univ Toronto, Hosp Sick Children, Div Neurol, Dept Paediat, Toronto, ON, Canada
[9] NYU, Dept Neurol, Langone Comprehens Epilepsy Ctr, New York, NY 10016 USA
[10] Hosp Ruber Int, Dept Neurol, Madrid, Spain
[11] Columbia Univ, Med Ctr, Gertrude H Sergievsky Ctr, New York, NY USA
[12] Columbia Univ, Med Ctr, Dept Epidemiol, New York, NY USA
[13] Univ Coll Cork, Dept Gen Practice, Cork, Ireland
[14] Univ Colorado Hlth, Anschutz Outpatient Pavil, Aurora, CO USA
[15] Univ Minnesota, Neurol Clin, Minneapolis, MN USA
[16] UCL, Inst Neurol, London, England
[17] SEIN, Heemstede, Netherlands
[18] CHU Vaudois, Dept Clin Neurosci, Lausanne, Switzerland
关键词
CHILDHOOD-ONSET EPILEPSY; UNEXPLAINED DEATH; ANTIEPILEPTIC DRUGS; NERVE-STIMULATION; LONG-TERM; MORTALITY; SUDEP; COHORT; SEIZURES; DEFINITIONS;
D O I
10.5698/1535-7511.17.3.180
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: To determine the incidence rates of sudden unexpected death in epilepsy (SUDEP) in different epilepsy populations and address the question of whether risk factors for SUDEP have been identified. Methods: Systematic review of evidence; modified Grading Recommendations Assessment, Development and Evaluation process for developing conclusions; recommendations developed by consensus. Results: Findings for incidence rates based on 12 Class I studies include the following: SUDEP risk in children with epilepsy (aged 0-17 years) is 0.22/1,000 patient-years (95% CI 0.16-0.31) (high confidence in evidence). SUDEP risk increases in adults to 1.2/1,000 patient-years (95% CI 0.64-2.32) (low confidence in evidence). The major risk factor for SUDEP is the occurrence of generalized tonic-clonic seizures (GTCS); the SUDEP risk increases in association with increasing frequency of GTCS occurrence (high confidence in evidence). Recommendations: Level B: Clinicians caring for young children with epilepsy should inform parents/guardians that in 1 year, SUDEP typically affects 1 in 4,500 children; therefore, 4,499 of 4,500 children will not be affected. Clinicians should inform adult patients with epilepsy that SUDEP typically affects 1 in 1,000 adults with epilepsy per year; therefore, annually 999 of 1,000 adults will not be affected. For persons with epilepsy who continue to experience GTCS, clinicians should continue to actively manage epilepsy therapies to reduce seizures and SUDEP risk while incorporating patient preferences and weighing the risks and benefits of any new approach. Clinicians should inform persons with epilepsy that seizure freedom, particularly freedom from GTCS, is strongly associated with decreased SUDEP risk.
引用
收藏
页码:180 / 187
页数:8
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