Shankar Rohit, Walker Matthew, McLean Brendan, Laugharne Richard, Ferrand Fucundo, Hanna Jane, Newman Craig
Cornwall Partnership NHS Foundation Trust, Chygovenck Threemilestone Industrial Estate Highertown, Truro, Cornwall, TR4 9LD, UK.
Exeter Medical School, Exeter, England.
J Neurol. 2016 Sep;263(9):1840-6. doi: 10.1007/s00415-016-8203-3. Epub 2016 Jun 22.
Our objectives were to compare people with epilepsy (PWE) who died of sudden unexpected death in epilepsy (SUDEP) with live controls using the risk factor items of the SUDEP and Seizure Safety Checklist. All 48 SUDEPs of 93 epilepsy deaths which occurred in Cornwall UK 2004-2012 were compared to 220 live controls using the SUDEP and Seizure Safety Checklist, an evidenced based tool used to communicate person centered risk of SUDEP to PWE. The odds ratio for having a specific factor in those who died was compared to controls and ranked according to P value using a sequential Bonferroni correction for multiple comparisons. Of the 17 modifiable and non-modifiable risk factors analyzed 9 were statistically significant of which 7 are potentially modifiable. Well known modifiable factors such as nocturnal monitoring, compliance and sleeping position featured prominently in the risk association. This is the first case control study exploring the risk factors for SUDEP since 2009. The findings are compared to the current considered risk factors as identified in a major recent review. The study further validates certain SUDEP risk factors. It highlights that the majority of risk factors strongly associated with SUDEP are potentially modifiable. There is an emerging profile to rank the risk factors. It furthers the evidence to use structured risk assessment and communication tools such as the SUDEP and Seizure Safety Checklist in daily clinical practice. It highlights key areas for a person centered discussion to empower PWE to mitigate risk.
我们的目标是使用癫痫猝死（SUDEP）和癫痫发作安全检查表的风险因素项目，将死于癫痫猝死（SUDEP）的癫痫患者（PWE）与存活对照者进行比较。使用SUDEP和癫痫发作安全检查表（一种用于向癫痫患者传达以患者为中心的SUDEP风险的循证工具），将2004年至2012年在英国康沃尔郡发生的93例癫痫死亡中的所有48例SUDEP与220例存活对照者进行比较。将死亡者中具有特定因素的比值比与对照组进行比较，并使用序贯Bonferroni校正进行多重比较，根据P值进行排序。在分析的17个可改变和不可改变的风险因素中，有9个具有统计学意义，其中7个可能是可改变的。夜间监测、依从性和睡眠姿势等众所周知的可改变因素在风险关联中显著突出。这是自2009年以来探索SUDEP风险因素的首例病例对照研究。研究结果与近期一项主要综述中确定的当前公认风险因素进行了比较。该研究进一步验证了某些SUDEP风险因素。它强调与SUDEP密切相关的大多数风险因素可能是可改变的。有一个新兴的风险因素排名概况。它进一步证明了在日常临床实践中使用结构化风险评估和沟通工具（如SUDEP和癫痫发作安全检查表）的证据。它突出了以患者为中心进行讨论的关键领域，以使癫痫患者能够降低风险。
