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Sudden unexplained death in children with epilepsy
E J Donner1, C R Smith, O C Snead
1Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Sudden unexplained death in epilepsy (SUDEP) risk factors in children differ from adults. Low antiepileptic drug (AED) levels and polytherapy were not significant predictors in this pediatric SUDEP study.
Area of Science:
- Pediatric Neurology
- Epilepsy Research
- Mortality Studies
Background:
- Sudden unexplained death is a major concern in epilepsy patients.
- Identified adult risk factors like male sex, poor medication adherence, and polytherapy may not apply to children.
- Pediatric epilepsy causes and SUDEP risk factors require independent evaluation.
Purpose of the Study:
- To investigate risk factors for SUDEP in children.
- To determine if adult SUDEP risk factors are relevant in the pediatric population.
Main Methods:
- A 10-year retrospective case series of SUDEP in children (<18 years) in Ontario, Canada.
- Review of demographic, clinical, and neuropathology data for 27 cases.
Main Results:
- 27 pediatric SUDEP cases identified; 63% were male, aged 8 months to 15 years.
- Epilepsy types included symptomatic (52%), cryptogenic (18%), and idiopathic (30%).
- Antiepileptic drug (AED) regimens varied, with many patients on monotherapy (46%) or two AEDs (38%); low or therapeutic serum AED levels were observed.
Conclusions:
- This is the largest pediatric SUDEP case series to date.
- Low serum AED levels and polytherapy, known adult SUDEP risk factors, were not significant in this pediatric cohort.
- Further research is needed to identify specific pediatric SUDEP risk factors.
Background:
Sudden unexplained death is a significant cause of mortality in people with epilepsy. Risk factors that have been identified include male sex, poor compliance with medications, and antiepileptic drug (AED) polypharmacy. However, these may not apply to the pediatric population in which the causes of epilepsy differ from the adult population. Therefore, risk factors for sudden unexplained death in epilepsy (SUDEP) in children must be evaluated independently from those in the adult population.
Methods:
Cases of SUDEP in children less than 18 years of age occurring over a 10-year period in the province of Ontario, Canada, were identified. Records were reviewed for demographic and clinical features and neuropathology findings.
Results:
Twenty-seven cases of SUDEP in children were identified. Sixty-three percent were male. Age at death ranged from 8 months to 15 years. Fourteen children had symptomatic epilepsy (52%), five had cryptogenic epilepsy (18%), and eight had idiopathic epilepsy (30%). Twelve children were treated with one AED (46%), 10 were on two AED (38%), and three were on three AED (12%). At the time of death, seven children had one serum AED concentration below the therapeutic range (35%) and 12 children had AED levels within the therapeutic range (60%).
Conclusions:
This case series represents the largest series of sudden unexplained death in children with epilepsy. At least two previously described risk factors for SUDEP in adults, low serum AED levels at time of death and AED polytherapy, do not appear to be significant in children.
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