PT  - JOURNAL ARTICLE
AU  - Olafur Sveinsson
AU  - Tomas Andersson
AU  - Peter Mattsson
AU  - Sofia Carlsson
AU  - Torbjörn Tomson
TI  - Clinical risk factors in SUDEP
AID  - 10.1212/WNL.0000000000008741
DP  - 2020 Jan 28
TA  - Neurology
PG  - e419--e429
VI  - 94
IP  - 4
4099  - http://n.neurology.org/content/94/4/e419.short
4100  - http://n.neurology.org/content/94/4/e419.full
SO  - Neurology2020 Jan 28; 94
AB  - Objective We conducted a nationwide case-control study in Sweden to test the hypothesis that specific clinical characteristics are associated with increased risk of sudden unexpected death in epilepsy (SUDEP).Methods The study included 255 SUDEP cases (definite and probable) and 1,148 matched controls. Clinical information was obtained from medical records and the National Patient Register. The association between SUDEP and potential risk factors was assessed by odds ratios (ORs) and 95% confidence intervals (CIs) and interaction assessed by attributable proportion due to interaction (AP).Results Experiencing generalized tonic-clonic seizures (GTCS) during the preceding year was associated with a 27-fold increased risk (OR 26.81, 95% CI 14.86–48.38), whereas no excess risk was seen in those with exclusively non-GTCS seizures (OR 1.15, 95% CI 0.54–48.38). The presence of nocturnal GTCS during the last year of observation was associated with a 15-fold risk (OR 15.31, 95% CI 9.57–24.47). Living alone was associated with a 5-fold increased risk of SUDEP (OR 5.01, 95% CI 2.93–8.57) and interaction analysis showed that the combination of not sharing a bedroom and having GTCS conferred an OR of 67.10 (95% CI 29.66–151.88), with AP estimated at 0.69 (CI 0.53–0.85). Among comorbid diseases, a previous diagnosis of substance abuse or alcohol dependence was associated with excess risk of SUDEP.Conclusions Individuals with GTCS who sleep alone have a dramatically increased SUDEP risk. Our results indicate that 69% of SUDEP cases in patients who have GTCS and live alone could be prevented if the patients were not unattended at night or were free from GTCS.AED=antiepileptic drug; AP=proportion attributable to interaction; CI=confidence interval; GTCS=generalized tonic-clonic seizures; ICD=International Classification of Diseases; LISA=longitudinal integration database for health insurance and labor market studies; OR=odds ratio; SNPR=Swedish National Patient Register; SUDEP=sudden unexpected death in epilepsy; VNS=vagus nerve stimulation