Téllez-Zenteno José F, Ronquillo Lizbeth Hernández, Wiebe Samuel
Department of Clinical Neurological Sciences, London Health Sciences Centre, Canada.
Epilepsy Res. 2005 Jun;65(1-2):101-15. doi: 10.1016/j.eplepsyres.2005.05.004.
To provide an evidence-based analysis of the risk factors and incidence of SUDEP, and to assess methodological aspects and sources of variation in studies dealing with SUDEP.
An expert in library resources and electronic databases comprehensively searched Medline, Index Medicus, and the Cochrane library. We included case-control or cohort studies focusing on SUDEP in children or adults, published in the English language. Two reviewers independently applied study eligibility criteria and extracted data, resolving disagreements through discussion.
Of 404 citations identified, 83 potentially eligible articles were reviewed in full text and 36 studies fulfilled eligibility criteria (29 cohort and 8 case-control studies). In studies using non-SUDEP deaths as controls the most consistent risk factors were a seizure preceding death, and subtherapeutic antiepileptic drug levels. In studies that used persons living with epilepsy as controls the main risk factors for SUDEP were youth, high seizure frequency, high number of antiepileptic drugs and long duration of epilepsy. The annual incidence of SUDEP ranged from 0 to 10:1000. It was highest in studies of candidates for epilepsy surgery and epilepsy referral centers (2.2:1000-10:1000), intermediate in studies including patients with mental retardation (3.4:1000-3.6:1000), and lowest in children (0-0.2:1000). The incidence was similar in autopsy series (0.35:1000-2.5:1000) and in studies of epilepsy patients in the general population (0-1.35:1000). The median proportion of SUDEP in relation to overall mortality in epilepsy was 40 and 4% in high- and low-risk groups, respectively.
Although studies on SUDEP are heterogeneous in methodology, consistent patterns in incidence and risk factors emerge. Low- and high-risk patient groups are identified, which determine the relative contribution of SUDEP to overall mortality in epilepsy. In addition to patient population, risk factors for SUDEP depend on the type of controls used for comparison (dead versus live patients with epilepsy). Risk factors found in different studies are not necessarily contradictory, but are often complementary.
对癫痫性猝死（SUDEP）的危险因素和发病率进行循证分析，并评估研究SUDEP的方法学方面及变异来源。
一位图书馆资源和电子数据库专家全面检索了Medline、医学索引（Index Medicus）和Cochrane图书馆。我们纳入了以英文发表的、聚焦于儿童或成人SUDEP的病例对照研究或队列研究。两名评审员独立应用研究纳入标准并提取数据，通过讨论解决分歧。
在识别出的404条引文中，83篇可能符合条件的文章进行了全文审查，36项研究符合纳入标准（29项队列研究和8项病例对照研究）。在使用非SUDEP死亡作为对照的研究中，最一致的危险因素是死亡前的癫痫发作和抗癫痫药物水平低于治疗剂量。在以癫痫患者作为对照的研究中，SUDEP的主要危险因素是年轻、癫痫发作频率高、抗癫痫药物数量多以及癫痫病程长。SUDEP的年发病率范围为0至10/1000。在癫痫手术候选者和癫痫转诊中心的研究中发病率最高（2.2/1000 - 10/1000），在纳入智力发育迟缓患者的研究中处于中等水平（3.4/1000 - 3.6/1000），在儿童中最低（0 - 0.2/1000）。尸检系列研究中的发病率（0.35/1000 - 2.5/1000）与普通人群中癫痫患者研究的发病率（0 - 1.35/1000）相似。在高风险和低风险组中，SUDEP占癫痫总体死亡率的中位数比例分别为40%和4%。
尽管关于SUDEP的研究在方法学上存在异质性，但发病率和危险因素出现了一致的模式。识别出了低风险和高风险患者群体，这决定了SUDEP对癫痫总体死亡率的相对贡献。除患者群体外，SUDEP的危险因素还取决于用于比较的对照类型（癫痫死亡患者与癫痫存活患者）。不同研究中发现的危险因素不一定相互矛盾，而往往是互补的。
