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Abstract
Objective To determine time trends and distinguishing autopsy findings of sudden unexpected death in epilepsy (SUDEP) in the United States.
Methods We identified decedents where epilepsy/seizure was listed as cause/contributor to death or comorbid condition on the death certificate among all decedents who underwent medico-legal investigation at 3 medical examiner (ME) offices across the country: New York City (2009–2016), San Diego County (2008–2016), and Maryland (2000–2016). After reviewing all available reports, deaths classified as definite/probable/near SUDEP or SUDEP plus were included for analysis. Mann-Kendall trend test was used to analyze temporal trends in SUDEP rate for 2009–2016. Definite SUDEPs were compared to sex- and age ±2 years–matched non-SUDEP deaths with a history of epilepsy regarding autopsy findings, circumstances, and comorbidities.
Results A total of 1,086 SUDEP cases were identified. There was a decreasing trend in ME-investigated SUDEP incidence between 2009 and 2016 (z = −2.2, S = −42, p = 0.028) among 3 regions. There was a 28% reduction in ME-investigated SUDEP incidence from 2009 to 2012 to 2013–2016 (confidence interval, 17%–38%, p < 0.0001). We found no correlation between SUDEP rates and the month of year or day of week. There was no difference between SUDEP and non-SUDEP deaths regarding neurodevelopmental abnormalities, pulmonary congestion/edema, and myocardial fibrosis.
Conclusions There was a decreasing monotonic trend in ME-investigated SUDEP incidence over 8 years, with a 28% reduction in incidence from 2009–2012 to 2013–2016. Unlike SIDS and sudden cardiac death, we found no correlation between SUDEP and the season of year or day of week. No autopsy findings distinguished SUDEP from non-SUDEP deaths.
Glossary
- CI=
- confidence interval;
- MD=
- Maryland;
- ME=
- medical examiner;
- MLI=
- medico-legal investigation;
- NYC=
- New York City;
- OCME=
- Office of Chief Medical Examiner;
- PWE=
- people with epilepsy;
- SDC=
- San Diego County;
- SUDEP=
- sudden unexpected death in epilepsy
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received June 10, 2019.
- Accepted in final form January 28, 2020.
- © 2020 American Academy of Neurology
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- Temporal trends and autopsy findings of SUDEP based on medico-legal investigations in the US
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