Department of Epidemiology, GH Sergievsky Center, Columbia University, New York, New York 10032, USA.
Epilepsia. 2012 Feb;53(2):249-52. doi: 10.1111/j.1528-1167.2011.03354.x. Epub 2011 Dec 22.
In an analysis of four case-control studies of sudden unexpected death in epilepsy (SUDEP), we found that yearly frequency of generalized tonic-clonic seizures (GTCS) and antiepileptic drug (AED) polytherapy were associated with an increased risk for SUDEP. The prior analysis, however, did not evaluate AEDs and GTCS frequency concurrently.
We combined data from the three case-control studies with information on the frequency of GTCS and AED therapy, that is, carbamazepine, phenytoin, valproic acid, and other AED therapy. Number of AEDs was also considered. Lamotrigine and GTCS frequency were considered separately in two of the case-control studies. Logistic regression analysis was used to evaluate GTCS frequency, each of the AEDs, and number of AEDs. Adjusted analysis of the different AEDs accounted for study, age at death, gender, and GTCS frequency.
In crude analysis, GTCS frequency, AED polytherapy, and number of AEDs were associated with an increased risk for SUDEP. Analysis of individual AEDs and of number of AEDs, adjusting for GTCS frequency, revealed no increased risk associated with AEDs as monotherapy, polytherapy, or total number. GTCS frequency remained strongly associated with an increased risk for SUDEP.
Our findings-that none of the AEDs considered were associated with increased SUDEP risk as monotherapy or as polytherapy when GTCS frequency was taken into account-provide a consistent message that number of GTCS increases SUDEP risk and not AEDs. These results suggest that prevention of SUDEP must involve increased efforts to decrease GTCS frequency in order to avert the occurrence of this devastating epilepsy outcome.
在对四项癫痫猝死（SUDEP）病例对照研究的分析中，我们发现全身性强直阵挛发作（GTCS）的年发作频率和抗癫痫药物（AED）联合治疗与 SUDEP 的风险增加相关。然而，先前的分析并未同时评估 AED 和 GTCS 频率。
我们结合了三项病例对照研究的数据以及 GTCS 和 AED 治疗频率的信息，即卡马西平、苯妥英、丙戊酸和其他 AED 治疗。还考虑了 AED 的数量。在两项病例对照研究中，分别单独考虑了拉莫三嗪和 GTCS 频率。使用逻辑回归分析评估 GTCS 频率、每种 AED 和 AED 的数量。对不同 AED 的调整分析考虑了研究、死亡时的年龄、性别和 GTCS 频率。
在粗分析中，GTCS 频率、AED 联合治疗和 AED 数量与 SUDEP 的风险增加相关。在分析单独的 AED 和 AED 数量时，同时考虑 GTCS 频率，发现 AED 单药治疗、联合治疗或总数量均与增加的 SUDEP 风险无关。GTCS 频率仍然与 SUDEP 的风险增加密切相关。
我们的发现——在考虑 GTCS 频率的情况下，没有一种 AED 被认为与单药治疗或联合治疗时的 SUDEP 风险增加相关——提供了一个一致的信息，即 GTCS 的次数增加会增加 SUDEP 的风险，而不是 AED。这些结果表明，为了避免这种毁灭性的癫痫结局，预防 SUDEP 必须加大努力降低 GTCS 频率。
