Temporal Trends and Autopsy Findings of SUDEP Based on Medico-legal Investigations in the United States

Overview

Journal Neurology

Specialty Neurology

Date 2020 Jul 9

PMID 32636323

Citations 7

Authors

Esma Cihan

Orrin Devinsky

Dale C Hesdorffer

Michael Brandsoy

Ling Li

David R Fowler

Jason K Graham

Michael W Karlovich

Jaclyn E Yang

Anne E Keller

Elizabeth J Donner

Daniel Friedman

Affiliations

Soon will be listed here.

Abstract

Objective: To determine time trends and distinguishing autopsy findings of sudden unexpected death in epilepsy (SUDEP) in the United States.

Methods: We identified decedents where epilepsy/seizure was listed as cause/contributor to death or comorbid condition on the death certificate among all decedents who underwent medico-legal investigation at 3 medical examiner (ME) offices across the country: New York City (2009-2016), San Diego County (2008-2016), and Maryland (2000-2016). After reviewing all available reports, deaths classified as definite/probable/near SUDEP or SUDEP plus were included for analysis. Mann-Kendall trend test was used to analyze temporal trends in SUDEP rate for 2009-2016. Definite SUDEPs were compared to sex- and age ±2 years-matched non-SUDEP deaths with a history of epilepsy regarding autopsy findings, circumstances, and comorbidities.

Results: A total of 1,086 SUDEP cases were identified. There was a decreasing trend in ME-investigated SUDEP incidence between 2009 and 2016 ( = -2.2, S = -42, = 0.028) among 3 regions. There was a 28% reduction in ME-investigated SUDEP incidence from 2009 to 2012 to 2013-2016 (confidence interval, 17%-38%, < 0.0001). We found no correlation between SUDEP rates and the month of year or day of week. There was no difference between SUDEP and non-SUDEP deaths regarding neurodevelopmental abnormalities, pulmonary congestion/edema, and myocardial fibrosis.

Conclusions: There was a decreasing monotonic trend in ME-investigated SUDEP incidence over 8 years, with a 28% reduction in incidence from 2009-2012 to 2013-2016. Unlike SIDS and sudden cardiac death, we found no correlation between SUDEP and the season of year or day of week. No autopsy findings distinguished SUDEP from non-SUDEP deaths.

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References

Sillanpaa M, Shinnar S . Long-term mortality in childhood-onset epilepsy. N Engl J Med. 2010; 363(26):2522-9. DOI: 10.1056/NEJMoa0911610. View

Gallerani M, Pala M, Fedeli U . Circaseptan Periodicity of Cardiovascular Diseases. Heart Fail Clin. 2017; 13(4):703-717. DOI: 10.1016/j.hfc.2017.05.007. View

Kroner B, Wright C, Friedman D, Macher K, Preiss L, Misajon J . Characteristics of epilepsy patients and caregivers who either have or have not heard of SUDEP. Epilepsia. 2014; 55(10):1486-94. DOI: 10.1111/epi.12799. View

Schraeder P, Delin K, McClelland R, So E . Coroner and medical examiner documentation of sudden unexplained deaths in epilepsy. Epilepsy Res. 2006; 68(2):137-43. DOI: 10.1016/j.eplepsyres.2005.10.004. View

Douglas A, Helms P, Jolliffe I . Seasonality of sudden infant death syndrome (SIDS) by age at death. Acta Paediatr. 1998; 87(10):1033-8. DOI: 10.1080/080352598750031338. View

Sveinsson O, Andersson T, Carlsson S, Tomson T . The incidence of SUDEP: A nationwide population-based cohort study. Neurology. 2017; 89(2):170-177. DOI: 10.1212/WNL.0000000000004094. View

Tomson T, Sveinsson O, Carlsson S, Andersson T . Evolution over time of SUDEP incidence: A nationwide population-based cohort study. Epilepsia. 2018; 59(8):e120-e124. DOI: 10.1111/epi.14460. View

Sharma K, Kalakoti P, Henry M, Mishra V, Riel-Romero R, Notarianni C . Revisiting racial disparities in access to surgical management of drug-resistant temporal lobe epilepsy post implementation of Affordable Care Act. Clin Neurol Neurosurg. 2017; 158:82-89. DOI: 10.1016/j.clineuro.2017.05.001. View

Devinsky O, Ryvlin P, Friedman D . Preventing Sudden Unexpected Death in Epilepsy. JAMA Neurol. 2018; 75(5):531-532. DOI: 10.1001/jamaneurol.2018.0400. View

10.

Lash T, Fox M, MacLehose R, Maldonado G, McCandless L, Greenland S . Good practices for quantitative bias analysis. Int J Epidemiol. 2014; 43(6):1969-85. DOI: 10.1093/ije/dyu149. View

11.

Sveinsson O, Andersson T, Carlsson S, Tomson T . Circumstances of SUDEP: A nationwide population-based case series. Epilepsia. 2018; 59(5):1074-1082. DOI: 10.1111/epi.14079. View

12.

Thurman D, Kobau R, Luo Y, Helmers S, Zack M . Health-care access among adults with epilepsy: The U.S. National Health Interview Survey, 2010 and 2013. Epilepsy Behav. 2015; 55:184-8. PMC: 5317396. DOI: 10.1016/j.yebeh.2015.10.028. View

13.

Keller A, Whitney R, Li S, Pollanen M, Donner E . Incidence of sudden unexpected death in epilepsy in children is similar to adults. Neurology. 2018; 91(2):e107-e111. DOI: 10.1212/WNL.0000000000005762. View

14.

Arntz H, Willich S, Schreiber C, Bruggemann T, Stern R, Schultheiss H . Diurnal, weekly and seasonal variation of sudden death. Population-based analysis of 24,061 consecutive cases. Eur Heart J. 2000; 21(4):315-20. DOI: 10.1053/euhj.1999.1739. View

15.

Devinsky O, Friedman D, Cheng J, Moffatt E, Kim A, Tseng Z . Underestimation of sudden deaths among patients with seizures and epilepsy. Neurology. 2017; 89(9):886-892. PMC: 5577966. DOI: 10.1212/WNL.0000000000004292. View

16.

Ryvlin P, So E, Gordon C, Hesdorffer D, Sperling M, Devinsky O . Long-term surveillance of SUDEP in drug-resistant epilepsy patients treated with VNS therapy. Epilepsia. 2018; 59(3):562-572. DOI: 10.1111/epi.14002. View

17.

Devinsky O, Kim A, Friedman D, Bedigian A, Moffatt E, Tseng Z . Incidence of cardiac fibrosis in SUDEP and control cases. Neurology. 2018; 91(1):e55-e61. PMC: 6091880. DOI: 10.1212/WNL.0000000000005740. View

18.

Nashef L, So E, Ryvlin P, Tomson T . Unifying the definitions of sudden unexpected death in epilepsy. Epilepsia. 2011; 53(2):227-33. DOI: 10.1111/j.1528-1167.2011.03358.x. View

19.

Karoly P, Goldenholz D, Freestone D, Moss R, Grayden D, Theodore W . Circadian and circaseptan rhythms in human epilepsy: a retrospective cohort study. Lancet Neurol. 2018; 17(11):977-985. DOI: 10.1016/S1474-4422(18)30274-6. View

20.

Harden C, Tomson T, Gloss D, Buchhalter J, Cross J, Donner E . 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.... Neurology. 2017; 88(17):1674-1680. DOI: 10.1212/WNL.0000000000003685. View