Age-dependent Profile of Sudden Death Associated with Epilepsy in the General Population
Abstract number :
1.385
Submission category :
6. Cormorbidity (Somatic and Psychiatric)
Year :
2024
Submission ID :
759
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Lisa Bateman, MD, FRCPC – Cedars-Sinai Medical Center
Lauri Holmstrom, MD, PhD – Cedars-Sinai Medical Center
Audrey Uy-Evanado, MD – Cedars-Sinai Medical Center
Arayik Sargsyan, MD – Cedars-Sinai Medical Center
Harpriya Chugh, BS – Cedars-Sinai Medical Center
Habiba Aziz, MS – Cedars-Sinai Medical Center
Angelo Salvucci, MD – Ventura County Health Care Agency
Jonathan Jui, MD – Oregon Health and Science University
Kyndaron Reinier, PhD – Cedars-Sinai Medical Center
Sumeet Chugh, MD – Cedars-Sinai Medical Center
Rationale:
Epilepsy is associated with increased risk of sudden cardiac death (SCD), which can occur at any age. Due to low numbers of SCD events in longitudinal cohort studies of persons with epilepsy (PWE), there has been a relative lack of age-specific clinical information. We performed a detailed evaluation of clinical characteristics of SCD associated with epilepsy in the general population, according to age at the time of SCD.
Methods:
Individuals with a pre-SCD diagnosis of epilepsy were identified from all out-of-hospital SCD cases prospectively ascertained in Portland, OR since 2002 (catchment population ~1 million) and Ventura County, CA since 2015 (catchment population ~850,000). History of pre-arrest epilepsy was identified using multiple sources, including lifetime medical records, medical examiner records, and EMS reports. Lifetime clinical records were evaluated for a detailed assessment of the clinical profile. We stratified SCD cases associated with epilepsy into seven age groups: < 30 years, 30-40 years, 40-50 years, 50-60 years, 60-70 years, 70-80 years, and >80 years.
Results:
From a total of 8,287 SCD cases, we identified 356 (4.3%) with a pre-SCD history of epilepsy. Pre-arrest medical records were available for 346/356 (97%) cases. Assuming a baseline epilepsy prevalence of 1.2% in Multnomah and Ventura Counties, the SCD incidence in PWE was 1.09/1,000 in Ventura County, and 1.15/1,000 in Oregon SUDS. Compared with non-epilepsy SCD cases, PWE with SCD were younger (58.0 [20.4] years vs. 66.9 [18.0] years; p< 0.001). There were no significant sex differences across all SCD cases with and without epilepsy, but the proportion of females was higher in PWE with SCD aged 30-40 years (50.0% vs 24.1%; p=0.005). The proportion of PWE across all SCD cases was highest among younger subjects and progressively decreased with age (from 35.3% at 1-10 years to 2.5% at >80 years; p< 0.001). There was a distinct shift in the clinical profile of SCD in PWE, demarcated by the 50-60 years decade: the proportions of drug-resistant epilepsy and pre-arrest seizures were highest among younger subjects, while the prevalence of comorbid cardiovascular disease and stroke was higher in older subjects (p< 0.001). Young PWE with SCD had a comparable number of ECG abnormalities to older cases, who were often diagnosed with overt cardiac disease.
Conclusions:
Younger PWE with SCD are more likely to have drug-resistant epilepsy and pre-arrest seizures, while SCD in older PWE is more often associated with cardio/cerebrovascular conditions. These findings highlight the importance of age-specific mechanisms of SCD in epilepsy, and have implications for the development of comprehensive strategies directed at prediction and prevention.
Funding: Sigrid Juselius Foundation, The Finnish Cultural Foundation, Instrumentarium Science Foundation, Orion Research Foundation, and Paavo Nurmi Foundation (to LH), and NIH/NHLBI R01HL145675 and R01HL147358 (to SSC).
Cormorbidity (Somatic and Psychiatric)