Practice guideline summary: Sudden unexpected death in epilepsy incidence rates and risk factors: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society
- PMID: 28438841
- DOI: 10.1212/WNL.0000000000003685
Practice guideline summary: Sudden unexpected death in epilepsy incidence rates and risk factors: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society
Erratum in
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Practice guideline summary: Sudden unexpected death in epilepsy incidence rates and risk factors.Neurology. 2019 Nov 26;93(22):982. doi: 10.1212/WNL.0000000000008565. Neurology. 2019. PMID: 31767666 No abstract available.
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Neuroanatomy of pediatric postoperative cerebellar cognitive affective syndrome and mutism.Neurology. 2020 Mar 3;94(9):414. doi: 10.1212/WNL.0000000000008668. Epub 2020 Feb 7. Neurology. 2020. PMID: 32033987 No abstract available.
Abstract
Objective: To determine the incidence rates of sudden unexpected death in epilepsy (SUDEP) in different epilepsy populations and address the question of whether risk factors for SUDEP have been identified.
Methods: Systematic review of evidence; modified Grading Recommendations Assessment, Development, and Evaluation process for developing conclusions; recommendations developed by consensus.
Results: Findings for incidence rates based on 12 Class I studies include the following: SUDEP risk in children with epilepsy (aged 0-17 years) is 0.22/1,000 patient-years (95% confidence interval [CI] 0.16-0.31) (moderate confidence in evidence). SUDEP risk increases in adults to 1.2/1,000 patient-years (95% CI 0.64-2.32) (low confidence in evidence). The major risk factor for SUDEP is the occurrence of generalized tonic-clonic seizures (GTCS); the SUDEP risk increases in association with increasing frequency of GTCS occurrence (high confidence in evidence).
Recommendations: Level B: Clinicians caring for young children with epilepsy should inform parents/guardians that in 1 year, SUDEP typically affects 1 in 4,500 children; therefore, 4,499 of 4,500 children will not be affected. Clinicians should inform adult patients with epilepsy that SUDEP typically affects 1 in 1,000 adults with epilepsy per year; therefore, annually 999 of 1,000 adults will not be affected. For persons with epilepsy who continue to experience GTCS, clinicians should continue to actively manage epilepsy therapies to reduce seizures and SUDEP risk while incorporating patient preferences and weighing the risks and benefits of any new approach. Clinicians should inform persons with epilepsy that seizure freedom, particularly freedom from GTCS, is strongly associated with decreased SUDEP risk.
© 2017 American Academy of Neurology.
Comment in
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Gaining perspective on SUDEP: The new guideline.Neurology. 2017 Apr 25;88(17):1598-1599. doi: 10.1212/WNL.0000000000003698. Neurology. 2017. PMID: 28438840 No abstract available.
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Letter re: Practice guideline summary: Sudden unexpected death in epilepsy incidence rates and risk factors: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society.Neurology. 2017 Nov 21;89(21):2213-2214. doi: 10.1212/WNL.0000000000004660. Neurology. 2017. PMID: 29158298 No abstract available.
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Author response: Practice guideline summary: Sudden unexpected death in epilepsy incidence rates and risk factors: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society.Neurology. 2017 Nov 21;89(21):2214. doi: 10.1212/WNL.0000000000004663. Neurology. 2017. PMID: 29158299 No abstract available.
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