Anti-seizure Medication Changes and Risk of Sudden Unexpected Death in Epilepsy
Abstract number :
1.352
Submission category :
4. Clinical Epilepsy / 4D. Prognosis
Year :
2024
Submission ID :
944
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Julian Gal, MD, MA – University of Pennsylvania
Burcu Asma, MD – Thomas Jefferson University
Prahlad Menon, PhD – Thomas Jefferson University
Michael Sperling, MD – Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Maromi Nei, MD – Thomas Jefferson University
Rationale: Sudden unexpected death in epilepsy (SUDEP) affects 1.0 per 1,000 people with epilepsy per year, with much higher risk for some sub-populations. Reported risk factors include convulsive seizures, intellectual disability, and frequent ASM changes. There are inconsistencies in the literature regarding the role of ASM dose/number/type and rate of changes on SUDEP risk. This study evaluates if frequent ASM changes correlate with SUDEP.
Methods: This is a single center retrospective case-control study comparing definite and probable cases of SUDEP with age and sex-matched controls, all with video-EEG confirmation of the epilepsy diagnosis. Data from the 2 years prior to death in SUDEP patients and the last 2 years of follow-up in controls were analyzed. Primary outcome measures include the relationship between SUDEP and ASM initiation, dose increase, decrease and discontinuation. Secondary outcome measures included frequency of convulsive seizures among SUDEP patients. Statistical tests utilized include two-sample T-test, Chi-Squared test, Mann-Whitney U test, Spearman's rank correlation coefficient, and Discriminant Function Analysis.
Results: 45 patients (15 SUDEP (53% female), 30 controls (53% female); mean age 35, standard deviation [SD] 10) were included. Within the last 24-48 months of the study there were more ASMs initiated among SUDEP cases than controls (average 1.08 [SD 0.76] vs 0.4 [SD 0.44], P < 0.05). Additionally, there were more ASMs discontinued in SUDEP cases (average 1.15 [SD 1.07] vs 0.27 [SD 0.58], P < 0.05). Within the last 2 years there were more changes made to ASM regimens in SUDEP patients (average 5.69 [SD 3.88] vs 2.47 [SD 2.70], P < 0.05). There were no significant differences in ASM change frequency when stratified by sex (P = 0.465). There were also no significant differences in the total number of ASMs, dose increases, or decreases between groups. SUDEP patients had more convulsive seizures than controls (P < 0.005). Among SUDEP patients, convulsive seizure frequency significantly correlated with frequency of ASM changes and there was no significant association between ASM changes and SUDEP risk independent of seizure frequency.
Clinical Epilepsy