Incidence of SUDEP in a cohort of patients with refractory epilepsy: the role of surgery and lesion localization

Almeida, Alexandre Oliveira; Nunes, Magda Lahorgue; Palmini, André; Costa, Jaderson Costa da

doi:10.1590/s0004-282x2010000600013

Cited by 19 publications

(30 citation statements)

References 30 publications

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“…Confirming this finding our group demonstrated that patients with refractory epilepsy that became seizure free after epilepsy surgery had a lower SUDEP rate 22 . Other authors demonstrated a higher risk of SUDEP in patients with extratemporal epilepsy 23 . Although a higher mortality in boys had been reported 4,6 , we could not confirm that finding.…”

Section: Discussionmentioning

confidence: 90%

Mortality in children with severe epilepsy: 10 years of follow-up

Arida

Fernandes

Wichert‐Ana

et al. 2011

Arq. Neuro-Psiquiatr.

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Epilepsy is the main neurological condition in children and adolescents. Unfortunately patients with medical refractory epilepsy are more susceptible for clinical complications and death. We report a prospectively evaluated cohort of children followed for approximately 10 years. Fifty-three of 1012 patients died. Forty-two patients died due to epilepsy or its clinical complications and the main causes of death were pneumonia (in 16 cases), sepses (in 9 patients), status epilepticus (in 8 patients). In 11 patients cause of death was sudden unexpected death in epilepsy (SUDEP). Mental retardation was significantly more frequent in patients who did not die from SUDEP. SUDEP may be a significant condition associated with mortality in children and adolescents with epilepsy. Key words: epilepsy, mortality, sudden death, children.Mortalidade em crianças com epilepsia severa: 10 anos de seguimento RESUMO Epilepsia é uma das condições neurológicas mais comuns em crianças e adolescentes. Infelizmente, pacientes com epilepsias refratárias ao tratamento medicamentoso estão mais susceptíveis a complicações clínicas e óbito. Neste trabalho reportamos, em uma análise prospectiva, um cohort de crianças acompanhadas por aproximadamente dez anos. Cinquenta e três de 1012 pacientes foram a óbito. Quarenta e dois pacientes morreram em decorrência da epilepsia ou de suas complicações clínicas; as principais causas foram pneumonia (16 casos), sepse (9 casos) e estado de mal epiléptico (8 casos). Em 11 pacientes a causa da morte foi SUDEP. A presença de retardo mental foi significantemente associada a mortalidade em crianças e adolescentes com epilepsia.

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Section: Discussionmentioning

confidence: 90%

Mortality in children with severe epilepsy: 10 years of follow-up

Arida

Fernandes

Wichert‐Ana

et al. 2011

Arq. Neuro-Psiquiatr.

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“…and two articles reported separate findings from the same cohort . Thus, the articles contained 12 reports of findings from population‐based cohorts and eight reports from clinical cohorts . South America provided eight studies, Asia six studies, and Africa six studies .…”

Section: Resultsmentioning

confidence: 99%

“…Thus, the articles contained 12 reports of findings from population‐based cohorts and eight reports from clinical cohorts . South America provided eight studies, Asia six studies, and Africa six studies . Nine studies were conducted in rural populations only, six in urban only, and five in both urban and rural populations …”

Section: Resultsmentioning

confidence: 99%

Premature mortality of epilepsy in low‐ and middle‐income countries: A systematic review from the Mortality Task Force of the International League Against Epilepsy

et al. 2016

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SUMMARYTo determine the magnitude of risk factors and causes of premature mortality associated with epilepsy in low-and middle-income countries (LMICs). We conducted a systematic search of the literature reporting mortality and epilepsy in the World Bank-defined LMICs. We assessed the quality of the studies based on representativeness; ascertainment of cases, diagnosis, and mortality; and extracted data on standardized mortality ratios (SMRs) and mortality rates in people with epilepsy. We examined risk factors and causes of death. The annual mortality rate was estimated at 19.8 (range 9.7-45.1) deaths per 1,000 people with epilepsy with a weighted median SMR of 2.6 (range 1.3-7.2) among higherquality population-based studies. Clinical cohort studies yielded 7.1 (range 1.6-25.1) deaths per 1,000 people. The weighted median SMRs were 5.0 in male and 4.5 in female patients; relatively higher SMRs within studies were measured in children and adolescents, those with symptomatic epilepsies, and those reporting less adherence to treatment. The main causes of death in people with epilepsy living in LMICs include those directly attributable to epilepsy, which yield a mean proportional mortality ratio (PMR) of 27.3% (range 5-75.5%) derived from population-based studies. These direct causes comprise status epilepticus, with reported PMRs ranging from 5 to 56.6%, and sudden unexpected death in epilepsy (SUDEP), with reported PMRs ranging from 1 to 18.9%. Important causes of mortality indirectly related to epilepsy include drowning, head injury, and burns. Epilepsy in LMICs has a significantly greater premature mortality, as in high-income countries, but in LMICs the excess mortality is more likely to be associated with causes attributable to lack of access to medical facilities such as status epilepticus, and preventable causes such as drowning, head injuries, and burns. This excess premature mortality could be substantially reduced with education about the risk of death and improved access to treatments, including AEDs. Key Points • Mortality in people with epilepsy in low-and middleincome countries (LMICs) is estimated to be 2.6-fold higher (range 1.3-7.2) than in general populations of LMICs• The main causes of death in people with epilepsy in LMICs are epilepsy-related complications, that is, status epilepticus, SUDEP, and injuries• Estimates of the public health burden of epilepsyrelated mortality are higher in LMICs than estimates from high-income countries• Insufficient studies of good quality, high heterogeneity, and underrepresentation of diverse LMIC economies and culture were the main limitations of this systematic review• Improving access to medical facilities and antiepileptic drugs, and preventing injuries may substantially reduce premature mortality in epilepsy in LMICs Standardized mortality in people with epilepsy in highincome countries (HICs) is estimated to be up to 4-15 times higher than in the general population in community-based studies and selected high-risk populations, respectively.

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“…The SUDEP risk is closely related to the frequency of major convulsive seizures [1,39], but the literature on the relationship between meningioma and SUDEP is scarce. However, AEDs can also have adverse effects so the decision to treat, with what, and for how long needs to be based on a careful risk benefit analysis.…”

Section: Not Availablementioning

confidence: 99%