Abstracts

Rationale: Sudden Unexpected Death in Epilepsy (SUDEP) is an important cause of death in patients (pts) with epilepsy. Many modifiable disease factors, including tonic-clonic (TC) seizure frequency, have been associated with elevated risk of SUDEP. The SUDEP-7 inventory (DeGiorgio et al., 2010) is a widely used clinical tool to evaluate risk for SUDEP, both in practice and clinical research. However, this inventory has never been validated in a SUDEP population. In this study, we evaluated whether pts with epilepsy who subsequently died due to SUDEP have higher SUDEP-7 scores than in a control refractory epilepsy population.  Methods: We included all definite or probable SUDEP pts identified at Jefferson University Hospital and two age- and sex-matched epilepsy control pts per SUDEP case. All pts underwent video EEG monitoring at Jefferson. Any pts with insufficient data to complete the SUDEP-7 inventory were excluded. We compared SUDEP-7 scores between SUDEP pts at last clinical follow-up (f/u) vs. control pts at 1) time of EEG monitoring and 2) last follow-up. We also compared TC frequencies and duration of epilepsy between groups. Results: Twenty-eight SUDEP (54% men; mean age 32 years, range 14-54) and 56 control (54% men; mean age 32 years, range 15-56) pts were included. Mean SUDEP-7 score was 3.6 (0-8) in SUDEP pts at last f/u. Mean SUDEP-7 scores were 3.08 (1-8) and 2.33 (0-8) in control pts at time of EEG monitoring and at last f/u, respectively. 89% of SUDEP and 86% of control pts had a history of TC seizures. Mean duration of epilepsy was 19.3 years (range 4-42) and 15.08 years (1-40) in SUDEP and control pts at the time of monitoring (p = 0.08), respectively. At the time of monitoring, SUDEP-7 scores and TC frequency were not significantly different in SUDEP vs. control pts, However, SUDEP-7 scores in control pts declined significantly at last clinical f/u (p=0.02). Additionally, SUDEP-7 scores were significantly higher in SUDEP than control pts at last f/u (p=0.01).  Conclusions: Similar SUDEP-7 scores in both control and SUDEP pts at the time of video-EEG monitoring suggest that both populations were at similar risk for SUDEP at that time. However, SUDEP-7 scores subsequently declined significantly in the control population, which is consistent with their observed survival. The reduction in SUDEP-7 scores over time in the control pts may be related to successful treatment of epilepsy in this population, which contributed to improved survival. Our findings suggest that the SUDEP-7 inventory may be a valid assessment tool for SUDEP risk, the risk of SUDEP in individuals with epilepsy can be modified over time, and that the SUDEP-7 could help to assess changes in SUDEP risk in individuals with epilepsy. Funding: No funding