Clinical Significance of Postmortem AED Level Determination in SUDEP Patients
Abstract number :
3.303
Submission category :
7. Anti-seizure Medications / 7E. Other
Year :
2021
Submission ID :
1825695
Source :
www.aesnet.org
Presentation date :
12/9/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:50 AM
Authors :
Nitin Sethi, MD, MBBS, FAAN - New York-Presbyterian Hospital, Weill Cornell Medical Center; bhavan Shah, MD – New York-Presbyterian Hospital, Weill Cornell Medical Center
Rationale: Clinically definite SUDEP (CDS) is defined as sudden unexpected non-traumatic non-drowning death of a person with epilepsy, without toxicological or anatomical cause of death detected at postmortem (PM) examination. We present one case and reviewed the existing clinical literature to determine the clinical significance of PM antiepileptic drug (AED) level determination in SUDEP patients.
Methods: A-38-year-old male with idiopathic left temporal lobe epilepsy on oxcarbazepine was found unresponsive on 07/22/2020. Medical autopsy performed on 07/24/2020 was unrevealing apart from bite mark on tongue, hepatic steatosis and concentric left ventricular wall thickening. Femoral blood and urine samples were submitted for toxicological evaluation. Positive findings included 10-hydroxycarbazepine at 6.6 mcg/ml (antemortem level 9) confirming CDS. Literature search of multiple bibliographic databases was conducted.
Results: Opeskin et al. compared PM AED levels in SUDEP patients with a control group of epilepsy patients. Compared with controls, SUDEP group showed no difference in number with no detectable AED, the number with subtherapeutic and with therapeutic AED levels. No AED was associated with a higher risk for SUDEP. 1 Lathers et al. found in 7 SUDEP patients (5 definite 2 possible), 4 had subtherapeutic, 2 had therapeutic and 1 supratherapeutic AED levels concluding subtherapeutic AED level a risk factor for SUDEP. 2 Zhuo et al. reviewed 74 cases of SUDEP. Out of 50 subjects reported as being on AEDs, PM toxicological analysis revealed only 26 subjects (35.1%) with detectable AEDs. 3 Sveinsson et al. compared AED data of 255 SUDEP cases against 1148 matched controls. Polytherapy was associated with reduced SUDEP risk. No AED was associated with a higher risk for SUDEP. Lowest risk was noted in patients taking levetiracetam. 4
Conclusions: Based on literature review, we conclude limited clinical significance of PM AED level determination in SUDEP patients. The level of AED detected postmortem is dependent on many variables including the time when the drug was last taken antemortem, the time when sample is drawn PM and the individual pharmacokinetics of a particular AED pre and post death. Detection of AED level PM gives no clinically significant information about AED compliance, whether SUDEP can be attributed to AED noncompliance or to any particular AED.
Funding: Please list any funding that was received in support of this abstract.: None.
Anti-seizure Medications