Definite SUDEP population in Bexar County, Texas: A 36-year data registry.

Area of Science:

• Neurology
• Epileptology
• Forensic Pathology

Background:

• Sudden unexplained death in epilepsy (SUDEP) is a primary cause of mortality among individuals with epilepsy.
• Understanding SUDEP's risk factors is crucial for improving patient outcomes and reducing mortality rates.

Purpose of the Study:

• To investigate the incidence and characteristics of definite SUDEP cases in Bexar County over a 36-year period.
• To identify potential risk factors associated with SUDEP, including anti-seizure medication (ASM) levels and body mass index (BMI).

Main Methods:

• Review of death reports from the Bexar County Medical Examiner (BCME) between 1983 and 2018.
• Analysis of medical history, medication lists, sleep position, time of death, pathology reports, BMI, and organ weights.
• Comparison of SUDEP victims with therapeutic versus subtherapeutic ASM levels.

Main Results:

• 286 definite SUDEP cases were identified, with an incidence of 0.51 ± 0.26 per 1000 person-years in people with epilepsy.
• The majority of SUDEP victims (83.6%) had subtherapeutic ASM levels, indicating potential nonadherence.
• Elevated BMI was significantly associated with subtherapeutic ASM levels, suggesting a potential role for obesity in SUDEP.

Conclusions:

• Subtherapeutic ASM levels are a significant finding in autopsy-based SUDEP cases, highlighting nonadherence as a critical risk factor.
• Obesity, indicated by elevated BMI, may also contribute to SUDEP risk, particularly when associated with nonadherence to ASM therapy.
• Further case-controlled studies are recommended to confirm the specific roles of obesity and related comorbidities in SUDEP.