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Case-control study of SUDEP

From the Department of Clinical and Experimental Epilepsy (Drs. Langan and Sander), Institute of Neurology, London, UK; and the Department of Neurology (Dr. Nashef), Kings College Hospital, London, UK.

Address correspondence and reprint requests to Dr. Yvonne Langan, North Tyneside General Hospital, Rake Lane, North Shields, NE29 8NH, UK.

Objective: To examine the influence of various factors on the risk of sudden unexpected death in epilepsy (SUDEP).

Methods: The authors investigated 154 cases in which a postmortem examination was performed. Each case had four controls with epilepsy from the community, matched for age and geographic location. Backward stepwise conditional logistic regression analysis was performed and odds ratios for risk and protection were determined.

Results: The risk of SUDEP was increased with a history of generalized tonic-clonic seizures in the previous 3 months (odds ratio [OR]: 13.8, 95% CI: 6.6 to 29.1). The presence of supervision at night was found to be protective (OR: 0.4, 95% CI: 0.2 to 0.8) when a supervising individual shared the same bedroom or when special precautions such as a listening device were employed (OR: 0.1, 95% CI: 0.0 to 0.3).

Conclusion: This work lends support to the view that SUDEP is a seizure-related phenomenon and that control of tonic-clonic seizures is important in its prevention. Nocturnal supervision seems to protect against SUDEP.

Supported by the Epilepsy Research Foundation and Epilepsy Bereaved?

Received July 21, 2004. Accepted in final form December 23, 2004.

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