Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Epilepsia. 2018 Aug;59(8):e120-e124. doi: 10.1111/epi.14460. Epub 2018 Jun 15.
Prompted by a recent report on declining incidence of sudden unexpected death in epilepsy (SUDEP) following implantation of a vagus nerve stimulator (VNS), we analyzed SUDEP risk over 6 years in a population-based cohort of 60 952 epilepsy patients in Sweden. All deaths from July 1, 2006 through December 31, 2011, were identified. Those with epilepsy mentioned on the death certificate were adjudicated for SUDEP using medical records and autopsy reports. In all, 292 SUDEP cases were identified. Comparing the first years (2006-2007) with the subsequent 4 years (2008-2011), the crude and standardized (to the US 2000 population) incidence of SUDEP (whether or not possible SUDEP was included) was significantly lower during the second time period; Incidence rate ratios based on standardized rates was estimated at 0.76 (95% confidence interval [CI] 0.60-0.97, P = .027) for SUDEP. The incidence of SUDEP decreased by 7% per year during the 6-year follow-up. Our data thus suggest that, for unknown reasons, incidence of SUDEP decreases with duration of follow-up. This has implications for patient counseling as well as for the design of studies attempting to assess the effectiveness of an intervention against SUDEP, which clearly needs to include a control group.
受最近一篇关于植入迷走神经刺激器 (VNS) 后癫痫猝死 (SUDEP) 发生率下降的报告的启发，我们分析了瑞典一个基于人群的 60952 例癫痫患者队列中 6 年的 SUDEP 风险。确定了 2006 年 7 月 1 日至 2011 年 12 月 31 日期间的所有死亡。在死亡证明中提到癫痫的患者通过病历和尸检报告来判断是否为 SUDEP。总共确定了 292 例 SUDEP 病例。与前几年（2006-2007 年）相比，后 4 年（2008-2011 年）的粗发病率（无论是否包括可能的 SUDEP）明显较低；基于标准化率的发病率比值估计为 0.76（95%置信区间[CI] 0.60-0.97，P=0.027）。在 6 年的随访期间，SUDEP 的发病率每年下降 7%。因此，我们的数据表明，由于未知原因，SUDEP 的发病率随随访时间的延长而降低。这对患者咨询以及试图评估针对 SUDEP 的干预措施的有效性的研究设计具有重要意义，因为显然需要包括对照组。
