Long‐term surveillance of SUDEP in drug‐resistant epilepsy patients treated with VNS therapy

Ryvlin, Philippe; So, Elson L.; Gordon, Christopher P.; Hesdorffer, Dale C.; Sperling, Michael R.; Devinsky, Orrin; Bunker, Mark; Olin, Bryan; Friedman, Daniel

doi:10.1111/epi.14002

Cited by 116 publications

(89 citation statements)

References 29 publications

(28 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Using an analysis similar to the one in the recent VNS study, we found a SUDEP rate approximately 25% lower during the last 4 years of follow‐up compared with the first 2 years (Table ). This decrease is on par with the decline reported in the 10‐year follow‐up of epilepsy patients with VNS therapy …”

Section: Discussionmentioning

confidence: 55%

“…This is reflected in the fact that 80.2% of our cases were either definite or probable and only 19.8% possible SUDEP. In contrast, 84% of the SUDEP cases in the VNS study were classified as possible …”

Section: Discussionmentioning

confidence: 95%

“…Incidence rates were standardized by the direct method to the US 2000 population, with the age ranges 0‐4, 5‐9, 10‐14, 15‐19, 20‐24, 25‐34, 35‐44, 45‐ 54, 55‐64, 65‐74, and 75+ years, similar to Ryvlin and collaborators . Also following the method used in the VNS study, we contrasted incidence during the last 4 years of follow‐up against the 2 first years and calculated incidence rate ratios (IRRs), 95% confidence intervals (CIs), and two‐tailed P ‐values. Mann‐Kendall nonparametric trend tests were used on the crude and standardized incidence rates .…”

Section: Methodsmentioning

confidence: 99%

“…To facilitate comparison, our primary statistical analyses were chosen to mimic closely the methods used in the recent VNS study. 4 Crude annual incidence rates were calculated as number of deceased individuals divided by person-years accumulated until date of death or end of year. This was done separately for all-cause mortality, all SUDEPs, and for definite and probable SUDEP.…”

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Evolution over time of SUDEP incidence: A nationwide population‐based cohort study

et al. 2018

View full text Add to dashboard Cite

Prompted by a recent report on declining incidence of sudden unexpected death in epilepsy (SUDEP) following implantation of a vagus nerve stimulator (VNS), we analyzed SUDEP risk over 6 years in a population-based cohort of 60 952 epilepsy patients in Sweden. All deaths from July 1, 2006 through December 31, 2011, were identified. Those with epilepsy mentioned on the death certificate were adjudicated for SUDEP using medical records and autopsy reports. In all, 292 SUDEP cases were identified. Comparing the first years (2006-2007) with the subsequent 4 years (2008-2011), the crude and standardized (to the US 2000 population) incidence of SUDEP (whether or not possible SUDEP was included) was significantly lower during the second time period; Incidence rate ratios based on standardized rates was estimated at 0.76 (95% confidence interval [CI] 0.60-0.97, P = .027) for SUDEP. The incidence of SUDEP decreased by 7% per year during the 6-year follow-up. Our data thus suggest that, for unknown reasons, incidence of SUDEP decreases with duration of follow-up. This has implications for patient counseling as well as for the design of studies attempting to assess the effectiveness of an intervention against SUDEP, which clearly needs to include a control group.

show abstract

Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 95%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Evolution over time of SUDEP incidence: A nationwide population‐based cohort study

et al. 2018

View full text Add to dashboard Cite

show abstract

“…[1][2][3] The incidence of SUDEP ranges from three to nine per 1000 per year in patients with refractory epilepsy 4 and may be underestimated in current literature. 6 Some of the best available prevention techniques for SUDEP include risk reduction through seizure control [7][8][9] and possibly nocturnal supervision. 6 Some of the best available prevention techniques for SUDEP include risk reduction through seizure control [7][8][9] and possibly nocturnal supervision.…”

Section: Introductionmentioning

confidence: 99%

Automated detection of sudden unexpected death in epilepsy risk factors in electronic medical records using natural language processing

et al. 2019

Self Cite

View full text Add to dashboard Cite

Objective Sudden unexpected death in epilepsy (SUDEP) is an important cause of mortality in epilepsy. However, there is a gap in how often providers counsel patients about SUDEP. One potential solution is to electronically prompt clinicians to provide counseling via automated detection of risk factors in electronic medical records (EMRs). We evaluated (1) the feasibility and generalizability of using regular expressions to identify risk factors in EMRs and (2) barriers to generalizability. Methods Data included physician notes for 3000 patients from one medical center (home) and 1000 from five additional centers (away). Through chart review, we identified three SUDEP risk factors: (1) generalized tonic–clonic seizures, (2) refractory epilepsy, and (3) epilepsy surgery candidacy. Regular expressions of risk factors were manually created with home training data, and performance was evaluated with home test and away test data. Performance was evaluated by sensitivity, positive predictive value, and F‐measure. Generalizability was defined as an absolute decrease in performance by <0.10 for away versus home test data. To evaluate underlying barriers to generalizability, we identified causes of errors seen more often in away data than home data. To demonstrate how small revisions can improve generalizability, we removed three “boilerplate” standard text phrases from away notes and repeated performance. Results We observed high performance in home test data (F‐measure range = 0.86‐0.90), and low to high performance in away test data (F‐measure range = 0.53‐0.81). After removing three boilerplate phrases, away performance improved (F‐measure range = 0.79‐0.89) and generalizability was achieved for nearly all measures. The only significant barrier to generalizability was use of boilerplate phrases, causing 104 of 171 errors (61%) in away data. Significance Regular expressions are a feasible and probably a generalizable method to identify variables related to SUDEP risk. Our methods may be implemented to create large patient cohorts for research and to generate electronic prompts for SUDEP counseling.

show abstract

Association Between Standardized Mortality Ratio and Utilization of Care in US Veterans With Drug-Resistant Epilepsy Compared With All US Veterans and the US General Population

2022

View full text Add to dashboard Cite

ImportanceDrug-resistant epilepsy (DRE) is thought to be associated with increased mortality, but larger population-based studies are lacking. Additionally, the benefit of effective management in DRE lacks evidence.ObjectiveTo examine the association of utilization of care with mortality in US veterans with DRE.Design, Setting, and ParticipantsObservational cohort study conducted between October 1, 2013, and March 31, 2020. Mortality statistics in US veterans with DRE were compared to the US general population and all veterans within the Veterans Health Administration. Epilepsy was defined as use of 1 or more antiseizure medications (ASMs) for 30 days or longer with a seizure diagnosis or 1 inpatient or 2 outpatient encounters with an epilepsy diagnosis. DRE was defined as the use of 2 or more ASMs. Among 9.6 million US veterans, 164 435 (1.7%) had epilepsy, of whom 55 571 (33.8%) had DRE. Epilepsy and DRE were administratively identified based on criteria noted in design. Identified participants were included for analysis.ExposuresVeterans with DRE.Main Outcomes and MeasuresStandardized mortality ratio (SMR).ResultsAmong US veterans with DRE, the mean (SD) age was 58.3 (15.4) years, and 49 430 individuals (88.9%) were male. Of ethnicity data gathered, 3170 individuals (5.7%) were Hispanic or Latino, 50 599 (91.1%) were not Hispanic or Latino, 842 (1.5%) declined to answer, and 960 (1.7%) were recorded as unknown. Of race data gathered, 516 individuals (0.9%) were American Indian or Alaskan Native, 270 (0.5%) were Asian, 11 316 (20.4%) were Black or African American, 587 (1.1%) were of multiple races, 453 (0.8%) were Native Hawaiian or Pacific Islander, 39 543 (71.2%) were White, 1697 (3.1%) declined to answer, and 1189 (2.1%) were recorded as unknown. SMR was 1.50 (95% CI, 1.47-1.53) compared with the US general population and 1.56 (95% CI, 1.53-1.59) compared with all veterans. Utilization rates were 81.1% (n = 45 057) for neurology clinic evaluation, 66.4% (n = 36 905) for magnetic resonance imaging (MRI), and 49.6% (n = 27 546) for electroencephalography (EEG) testing. Only 8350 individuals (15.0%) had comprehensive epilepsy evaluations and 3357 (6.0%) had epilepsy monitoring. Multivariable analysis revealed an association between lower mortality and neurology clinic evaluation, EEG, MRI, epilepsy monitoring, and the use of more than 2 ASMs after adjusting for age and comorbidities.Conclusions and RelevanceMortality rates were significantly higher in US veterans with DRE compared to the general population. Better utilization of comprehensive epilepsy care, diagnostic services, and medications were each associated with reduced mortality. These findings indicate that appropriate management of DRE is critical in this population.

show abstract

Long‐term surveillance of SUDEP in drug‐resistant epilepsy patients treated with VNS therapy

Cited by 116 publications

References 29 publications

Evolution over time of SUDEP incidence: A nationwide population‐based cohort study

Evolution over time of SUDEP incidence: A nationwide population‐based cohort study

Automated detection of sudden unexpected death in epilepsy risk factors in electronic medical records using natural language processing

Association Between Standardized Mortality Ratio and Utilization of Care in US Veterans With Drug-Resistant Epilepsy Compared With All US Veterans and the US General Population

Contact Info

Product

Resources

About