Pharmacologic treatment and SUDEP risk
Open Access
- 3 November 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurology
- Vol. 95 (18), e2509-e2518
- https://doi.org/10.1212/wnl.0000000000010874
Abstract
Objective We conducted a nationwide case–control study in Sweden to test the hypothesis that antiepileptic drugs (AEDs) mono- or polytherapy, adherence, antidepressants, neuroleptics, β-blockers, and statins are associated with sudden unexpected death in epilepsy (SUDEP) risk. Methods Included were 255 SUDEP cases and 1,148 matched controls. Information on clinical factors and medications came from medical records and the National Patient and Prescription Registers. The association between SUDEP and medications was assessed by odds ratios (ORs) with 95% confidence intervals (CIs) adjusted for potential risk factors including type of epilepsy, living conditions, comorbidity, and frequency of generalized tonic-clonic seizures (GTCS). Results Polytherapy, especially taking 3 or more AEDs, was associated with a substantially reduced risk of SUDEP (OR 0.31, 95% CI 0.14–0.67). Combinations including lamotrigine (OR 0.55, 95% CI 0.31–0.97), valproic acid (OR 0.53, 95% CI 0.29–0.98), and levetiracetam (OR 0.49, 95% CI 0.27–0.90) were associated with reduced risk. No specific AED was associated with increased risk. Regarding monotherapy, although numbers were limited, the lowest SUDEP risk was seen in users of levetiracetam (0.10, 95% CI 0.02–0.61). Having nonadherence mentioned in the medical record was associated with an OR of 2.75 (95% CI 1.58–4.78). Statin use was associated with a reduced SUDEP risk (OR 0.34, 95% CI 0.11–0.99) but selective serotonin reuptake inhibitor use was not. Conclusion These results provide support for the importance of medication adherence and intensified AED treatment for patients with poorly controlled GTCS in the effort to reduce SUDEP risk and suggest that comedication with statins may reduce risk.Keywords
This publication has 32 references indexed in Scilit:
- SUDEP in the North American SUDEP RegistryNeurology, 2019
- Serotonin reuptake inhibitors and mortality in epilepsy: A linked primary‐care cohort studyEpilepsia, 2017
- ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and TerminologyEpilepsia, 2017
- Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and TerminologyEpilepsia, 2017
- Risk of sudden unexpected death in epilepsy in patients given adjunctive antiepileptic treatment for refractory seizures: a meta-analysis of placebo-controlled randomised trialsThe Lancet Neurology, 2011
- Unexplained differences between hospital and mortality data indicated mistakes in death certification: an investigation of 1,094 deaths in Sweden during 1995Journal of Clinical Epidemiology, 2009
- Nonadherence to antiepileptic drugs and increased mortalityNeurology, 2008
- Sudden Cardiac Death and the Role of Medical TherapyProgress in Cardiovascular Diseases, 2008
- Risk factors for sudden unexpected death in epilepsy: a case control studyThe Lancet, 1999
- Sudden unexpected death in epilepsy: a local auditSeizure, 1993