Perinatal risk factors for SUDEP: A population‐based case‐control study

Abstract

Sudden unexpected death in epilepsy (SUDEP) is a leading epilepsy-related cause of death. Researchers have highlighted the similarities between SUDEP and sudden infant death syndrome (SIDS), but perinatal risk factors such as those identified for SIDS have not been assessed previously for SUDEP. We conducted a population-based case-control study of 58 SUDEP individuals and 384 living epilepsy controls born after 1982, utilizing the Swedish Medical Birth Register together with other national health registers and individual medical records to examine if prenatal and perinatal factors are associated with SUDEP risk. We observed a 3-fold SUDEP risk increase for infants who were small for gestational age (SGA) (odds ratio [OR] 3.13; 95% confidence interval [CI] 1.05-9.30) and for those with an Apgar score of 0-6 compared to 9-10 at 10 min (OR 3.22; 95% CI 1.05-9.87). After adjusting for a number of known SUDEP risk factors, we observed that the Apgar score between 0 and 6 after 10 min had a 10-fold increased risk for SUDEP OR 10.37 (95% CI 1.49-72.01) and over a 2-fold risk for those born after the 40th gestational week (OR 2.42; 95% CI 1.03-5.65). The potential mechanisms linking low Apgar score, gestational age, and SGA to SUDEP risk remain to be explored.

The clinical, economic, and humanistic burden of Dravet syndrome – A systematic literature review

“…Daily seizure diaries are burdensome and certain seizure types -myoclonic or absence seizures, or seizures during sleep -may go unnoticed or may not be recorded accurately. Given the contribution of generalized TC seizures and SE to increased mortality through infancy, childhood, and adulthood [97,98], longitudinal data are needed to characterize the occurrence and frequency over the course of the disease.…”

Multimodal nocturnal seizure detection: Do we need to adapt algorithms for children?

“…Getting help fast during a seizure is one of the concerns of living with epilepsy. Especially, nocturnal seizures are easily missed and have a higher risk of sudden unexpected death in epilepsy (SUDEP), [1][2][3] particularly in the case of nocturnal tonic clonic seizures. [3][4][5] Automated seizure detection can improve the quality of care, 6,7 reassure patients and caregivers, improve their sleep and possibly prevent SUDEP.…”

“…Especially, nocturnal seizures are easily missed and have a higher risk of sudden unexpected death in epilepsy (SUDEP), [1][2][3] particularly in the case of nocturnal tonic clonic seizures. [3][4][5] Automated seizure detection can improve the quality of care, 6,7 reassure patients and caregivers, improve their sleep and possibly prevent SUDEP. 5,8,9 Various devices have entered the market over the last decade, usually based on non-EEG sensors that are worn on the body.…”

Automated detection of nocturnal motor seizures using an audio‐video system

“…Nocturnal generalized tonic‐clonic seizures (TCSs), including focal‐to‐bilateral TCSs (formerly known as secondarily generalized TCSs), represent the major risk factor for sudden unexpected death in epilepsy (SUDEP) patients (Devinsky et al., 2016 ). Patients without nocturnal surveillance, not sharing a bedroom and experiencing TCS, have a 67‐fold increase in the risk of SUDEP (Sveinsson et al., 2020 ). Postictal interventions, such as stimulation, repositioning, or clearing the airways of the patient, may be protective against SUDEP (Surges et al., 2009 ).…”