Abstracts

Rationale:
Sudden unexpected death in epilepsy is well-recognized in epilepsy yet poorly understood. We aimed to look at the antiepileptics (AED) which were being used and the adherence to them in reported SUDEP cases.




Methods:
A comprehensive search of PubMed and Google Scholar using the term "sudden unexpected death in epilepsy case report" was conducted by two independent researchers. A total of 99 cases were collected, comprising case reports and case series. We classified the cases based on the Nashef et al(2012) SUDEP classification. From these cases, data on demographics, AED usage, seizure types, and EEG findings were extracted.









Results:
The data consists of 56(56.57%) definite SUDEP and definite SUDEP plus cases, 17(17.17%) probable SUDEP and probable SUDEP plus cases, 14 (14.14%) possible SUDEP and possible SUDEP plus cases, and 12 near SUDEP cases. The mean age of SUDEP occurrence was 28.06 ± 18.08, and the mean age of onset of epilepsy was 17.13 years (SD: 18.25. 64 (64.65%) cases of SUDEP were males and 35 were females (35.35%). Among the cases with documented AED usage, 64.47% of cases were using more than one AED at the time of SUDEP. The most common drugs used were sodium ion channel blockers [Phenytoin (28.95%), Carbamazepine (14.47%), Oxcarbazepine (14.47%), Lamotrigine (18.42%)] followed by Levetiracetam (17.11%) and phenobarbital (17.11%). Non-adherence to AED was noticed in 25 (32.89%) patients. Generalized tonic-clonic seizure (GTCS) was the most predominant seizure type (62.77%). EEG findings were available for 50 cases, with temporal lobe involvement being the most common (38%).




Conclusions:
This comprehensive review points out the increased risk for SUDEP in epilepsy requiring multiple drug therapy. The study reveals sodium ion channel blockers as the most common medication among SUDEP cases. A clinical trial after elimination of cofounders will be useful in the future to look into the AED selection. Non-adherence in one-third of the cases on AED highlights the necessity for early patient counseling on the risk of SUDEP and AED adherence. Generalized tonic-clonic seizures (GTCS) were the most common seizure type seen in cases of SUDEP, signifying increased risk. Additionally, EEG findings indicated a substantial involvement of the temporal lobe in SUDEP cases, which may point to specific epilepsy types being at higher risk for SUDEP.




These results emphasize the importance of timely follow-ups, optimizing AED therapy, and enhancing monitoring for high-risk seizure types to mitigate the risk of SUDEP in epilepsy patients. Further studies are required to establish causality and develop robust preventive strategies to reduce SUDEP incidence.




Funding: No funding to disclose