Sudden unexplained death in children with epilepsy
Donner EJ, Smith CR, and Snead r OC (2001) Sudden unexplained death in children with epilepsy. Neurology 57:3 430–4
Abstract: BACKGROUND: Sudden unexplained death is a significant cause of mortality in people with epilepsy. Risk factors that have been identified include male sex, poor compliance with medications, and antiepileptic drug (AED) polypharmacy. However, these may not apply to the pediatric population in which the causes of epilepsy differ from the adult population. Therefore, risk factors for sudden unexplained death in epilepsy (SUDEP) in children must be evaluated independently from those in the adult population. METHODS: Cases of SUDEP in children less than 18 years of age occurring over a 10-year period in the province of Ontario, Canada, were identified. Records were reviewed for demographic and clinical features and neuropathology findings. RESULTS: Twenty-seven cases of SUDEP in children were identified. Sixty-three percent were male. Age at death ranged from 8 months to 15 years. Fourteen children had symptomatic epilepsy (52%), five had cryptogenic epilepsy (18%), and eight had idiopathic epilepsy (30%). Twelve children were treated with one AED (46%), 10 were on two AED (38%), and three were on three AED (12%). At the time of death, seven children had one serum AED concentration below the therapeutic range (35%) and 12 children had AED levels within the therapeutic range (60%). CONCLUSIONS: This case series represents the largest series of sudden unexplained death in children with epilepsy. At least two previously described risk factors for SUDEP in adults, low serum AED levels at time of death and AED polytherapy, do not appear to be significant in children.
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Context
- Retrospective study of SUDEP risks in children specifically, using data from Ontario over 10 year period. Of 27 cases of SUDEP there was a roughly 2:1 male predominance, and approximately one-third of patients had low serum AED levels at the time of death. As two-thirds of the cases did not have low AED levels, the authors conclude that low levels are not a risk factor, but they do not provide comparison data on the appropriateness of levels in healthy controls. Another potential control group is epilepsy patients who died of non-SUDEP causes George and Davis. Similarly, with 12% of SUDEP cases in their series occurring in patients on 3 AEDs, while 46% were on a single AED and 38% on 2, the authors indicate that polytherapy is not a risk, but data from living controls needs to be considered to reach this comparison. 5 children had witnessed cardiorespiratory arrrest without evidence of seizure. Hypoxia was seen on tissue examination in 7 cases.