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Circumstances of SUDEP: A nationwide population‐based case series
Author(s) -
Sveinsson Olafur,
Andersson Tomas,
Carlsson Sofia,
Tomson Torbjörn
Publication year - 2018
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.14079
Subject(s) - death certificate , medicine , cause of death , epilepsy , pediatrics , autopsy , coroner , incidence (geometry) , population , emergency medicine , injury prevention , poison control , psychiatry , disease , environmental health , optics , physics
Summary Objective Given the increasing attention being paid to potential strategies for sudden unexpected death in epilepsy (SUDEP) prevention, we analyzed the circumstances of SUDEP and its incidence in relation to time of year, week, and day. Methods Prospective case‐series based on persons with an International Classification of Diseases (ICD‐10) code for epilepsy in the Swedish Patient Registry 1998‐2005, who were alive on June 30, 2006 (n = 60 952). Linkage to the National Cause‐of‐Death Registry identified all deaths from July 2006 through December 2011, with epilepsy mentioned on death certificate, together with all deaths during 2008 (n = 3166). Death certificates, medical charts, autopsy, and police reports were reviewed to identify SUDEP cases and related circumstances. Autopsied non‐ SUDEP deaths (n = 60) from the study population served as a reference. Results There were 329 SUDEP s (63% men) of which 167 were definite, 89 probable, and 73 possible. SUDEP cases were younger at death (50.8 years) than non‐ SUDEP deaths (73.3 years) ( P < .001) and more likely to be male (63% vs 55%, P = .0079). Most SUDEP cases died at night (58%), at home (91%), and 65% were found dead in bed. When documented, 70% were found in prone position. In 17%, death was witnessed and in 88% of these, a seizure was observed. Of the 329 SUDEP cases, 71% were living alone and 14% shared a bedroom. Compared to an autopsied non‐ SUDEP reference group, definite SUDEP s were more likely to die at home, during the night, unwitnessed, in the prone position, to live alone, and more often with a preceding seizure. Significance SUDEP cases live alone, die unwitnessed at home at night, with indication of a preceding seizure, supporting the critical role of lack of supervision. These facts need to be considered in the development of preventive strategies.