Walczak T S, Leppik I E, D'Amelio M, Rarick J, So E, Ahman P, Ruggles K, Cascino G D, Annegers J F, Hauser W A
MINCEP Epilepsy Care and the Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, USA.
Neurology. 2001 Feb 27;56(4):519-25. doi: 10.1212/wnl.56.4.519.
To determine incidence of and risk factors for sudden unexpected death in epilepsy (SUDEP).
Three epilepsy centers enrolled 4,578 patients and prospectively followed these patients for 16,463 patient-years. The cohort was screened for death annually. Deaths were investigated to determine whether SUDEP occurred. Potential risk factors were compared in SUDEP cases and in controls enrolled contemporaneously at the same center.
Incidence of SUDEP was 1.21/1,000 patient-years and was higher among women (1.45/1,000) than men (0.98/1,000). SUDEP accounted for 18% of all deaths. Occurrence of tonic-clonic seizures, treatment with more than two anticonvulsant medications, and full-scale IQ less than 70 were independent risk factors for SUDEP. The number of tonic-clonic seizures was a risk factor only in women. The presence of cerebral structural lesions and use of psychotropic drugs at the last visit were not risk factors for SUDEP in this cohort. Subtherapeutic anticonvulsant levels at the last visit were equally common in the two groups. No particular anticonvulsant appeared to be associated with SUDEP.
These results support the idea that tonic-clonic seizures are an important proximate cause of SUDEP. This information creates a risk profile for SUDEP that may help direct preventative efforts.
确定癫痫性猝死（SUDEP）的发病率及危险因素。
三个癫痫中心招募了4578名患者，并对这些患者进行了为期16463患者年的前瞻性随访。每年对该队列进行死亡筛查。对死亡病例进行调查以确定是否发生了SUDEP。对SUDEP病例和同一中心同期纳入的对照组的潜在危险因素进行了比较。
SUDEP的发病率为1.21/1000患者年，女性（1.45/1000）高于男性（0.98/1000）。SUDEP占所有死亡病例的18%。强直阵挛发作的发生、使用两种以上抗惊厥药物治疗以及全量表智商低于70是SUDEP的独立危险因素。强直阵挛发作的次数仅在女性中是危险因素。在该队列中，脑结构性病变的存在以及末次就诊时使用精神药物不是SUDEP的危险因素。两组末次就诊时抗惊厥药物水平低于治疗剂量的情况同样常见。没有特定的抗惊厥药物似乎与SUDEP有关。
这些结果支持强直阵挛发作是SUDEP重要的直接原因这一观点。这些信息为SUDEP创建了一个风险概况，可能有助于指导预防工作。
