Sudden unexpected death: a rare event in a large community based prospective cohort with newly diagnosed epilepsy and high remission rates

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Lhatoo SD, Langan Y, MacDonald BK, Zeidan S, and Sander JW (1999) Sudden unexpected death: A rare event in a large community based prospective cohort with newly diagnosed epilepsy and high remission rates. J Neurol Neurosurg Psychiatry 66:5 692–3.

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First Paragraph: It is now accepted that mortality in epilepsy is significantly increased, with standard mortality ratios raised twofold or threefold. Early deaths are usually attributable to the underlying cause of epilepsy and mortality in chronic cases is commonly due to the epilepsy itself. Of the deaths that are directly related to epilepsy, the commonest category is sudden unexpected death in epilepsy (SUDEP). This is widely defined as a sudden unexpected, non-traumatic and non-drowning death in a person with epilepsy with or without evidence of a seizure and excluding documented status epilepticus in which postmortem examination does not disclose a cause of death. Less common causes are status epilepticus, accidents due to seizures, drowning, and aspiration. The National General Practice Study of Epilepsy (NGPSE) is a prospective, population based, observational study of 792 patients with newly diagnosed epilepsy (564 definite cases and 228 probable cases) followed up for 8000 patient-years and has provided valuable insights into the prognosis and mortality of epilepsy. Fifty per cent of the definite cases were between the ages of 15 and 59 years—encompassing the age band in which the phenomenon of SUDEP is most commonly found. The overall standardised mortality ratio among patients with definite epilepsy in this cohort was 3.0 (95% confidence interval (95% CI) 2.5–3.7).

Context

  • In this letter Nashef et al. report on the first sudden death in the National General Practice Study of Epilepsy Hart et al., a prospective study of 792 patients. Though 8000 patient-years were observed before this first death occurred, the authors emphasize the importance of not underestimating prevalence in symptomatic or refractory patients.

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