Abstracts

Rationale: Sudden unexpected death in epilepsy (SUDEP) is a common cause of epilepsy mortality. In the past decade, there has been a significant effort to educate patients, families and clinicians about the risks of SUDEP and potential risk mitigation strategies. At the same time, the Affordable Care Act has also improved access to care for previously under- and uninsured patients. It is not known if these recent efforts have been associated with a decline in SUDEP rates. Methods: We performed a retrospective study of all decedents who underwent medico-legal investigation at three medical examiner’s offices across the country: New York City (1/1/2009-12/31/2016), San Diego County (1/1/2008-12/31/2016), and Maryland (1/1/2000-12/31/2016). We identified all decedents where epilepsy/seizure was listed as cause/contributor to death, or comorbid condition on death certificate. We then reviewed all available reports including investigator notes, autopsy reports, and medical records. Deaths classified as definite/probable/near SUDEP or SUDEP plus were included for analysis. The annual SUDEP rate was calculated as proportion of the general population estimated from annual U.S. Census and American Community Survey. Mann-Kendall trend test was used to analyze the trends in SUDEP rate over time. Trend in the overall SUDEP rate was calculated for the overlapping years for three regions (2009-2015). Results: Among 1466 deaths in people with epilepsy, 1124 SUDEP (definite, probable, and near SUDEPs including SUDEP Plus) cases were identified. 63.1 % (N=709) of SUDEP cases were male and 45 % (N=506) were African-American. The mean age at death was 38 ± 14.3 years. There was a decreasing monotonic trend in the overall SUDEP incidence in total population for the period of 2009-2015 (tau= -0.47, p=0.02). When regions were analyzed separately, a decreasing trend was found in New York City and Maryland (tau =-0.52, p=0.01 and tau=-0.33, p=0.03 respectively), but no monotonic trend was observed in San Diego County. There was no difference in SUDEP rates regarding the season of year and the day of week. Conclusions: The decreasing trend in SUDEP incidence in total population over 7 years is promising for the efficiency of organizations and studies related to the awareness and prevention of SUDEP and/or efforts to improve access to medical care. In addition, unlike SIDS and sudden cardiac death, we found no correlation between SUDEP and the season of year and the day of week. Funding: FACES (Finding a Cure for Epilepsy and Seizures)