From the Faculty of Medicine (O.S.), University of Iceland, Reykjavik; Department of Neurology (O.S., T.T.), Karolinska University Hospital; Department of Clinical Neuroscience (O.S., T.T.), and Institute of Environmental Medicine (T.A., S.C.), Karolinska Institutet, Stockholm; and Center for Occupational and Environmental Medicine (T.A.), Stockholm County Council, Sweden.
Neurology. 2023 Nov 27;101(22):e2257-e2265. doi: 10.1212/WNL.0000000000207921.
We conducted a nationwide case-control study in Sweden to investigate the risk of sudden unexpected death in epilepsy (SUDEP) in relation to epilepsy duration, epilepsy type, and etiology in combination with occurrence and frequency of tonic-clonic seizures (TCS) and nocturnal TCS.
The study comprised 255 SUDEP cases and 1,148 epilepsy controls. Clinical information was obtained from medical records. The association between SUDEP and risk factors was estimated by odds ratios (ORs) with 95% CIs calculated by conditional logistic regression to account for matching by sex and calendar time.
The risk of SUDEP was elevated in people with focal (OR 1.48, 95% CI 1.00-2.20), generalized and focal (OR 3.51, 95% CI 1.55-7.96), or unknown (OR 2.43, 95% CI 1.29-4.57) vs generalized epilepsy type. Increased risk of SUDEP was also observed in relation to epilepsy with traumatic causes (OR 2.27, 95% CI 1.33-3.89 vs genetic etiology) or short duration (OR 1.71, 95% CI 1.01-2.87 for 0-5 vs 6-15 years duration). Among those with 1-3 TCS during the preceding year, structural epilepsy etiology was associated with a more than 10-fold increase 10.84 (4.85-24.27) in SUDEP risk compared with people with genetic epilepsy without TCS. The risk with ≥4 TCS the preceding year was similar among those with generalized and focal epilepsies. Those with ≥4 TCS had an OR of 210.73 (95% CI 28.40-∞) during years 0-5 compared with those free from TCS and an epilepsy duration of 6-15 years. The combination of short epilepsy duration (0-5 years) and nocturnal TCS conferred an OR of 45.99 (95% CI 12.19-173.61) compared with having longer duration (6-15 years) and being free from nocturnal TCS.
Although certain etiologies, such as post-traumatic epilepsy, seem to entail a higher SUDEP risk, our data indicate that frequent and nocturnal TCS carry a similar level of risk whether focal or generalized from onset. The tonic-clonic part of the seizure seems to be decisive for the fatal outcome. SUDEP risk associated with TCS is highest during the first years after the epilepsy diagnosis which calls for effective TCS treatment and vigilance from the onset of diagnosis.
我们在瑞典进行了一项全国性病例对照研究，旨在探讨癫痫持续时间、癫痫类型和病因与强直-阵挛发作（TCS）的发生和频率以及夜间 TCS 之间的关系，从而确定癫痫相关猝死（SUDEP）的风险。
该研究纳入了 255 例 SUDEP 病例和 1148 例癫痫对照组。临床信息来自病历。通过条件逻辑回归计算比值比（OR）和 95%置信区间（CI）来估计 SUDEP 与危险因素之间的关联，以匹配性别和日历时间。
与全面性癫痫类型相比，局灶性（OR 1.48，95%CI 1.00-2.20）、全面性和局灶性（OR 3.51，95%CI 1.55-7.96）或未知病因（OR 2.43，95%CI 1.29-4.57）的癫痫患者发生 SUDEP 的风险更高。外伤性病因（OR 2.27，95%CI 1.33-3.89 vs 遗传病因）或癫痫持续时间较短（OR 1.71，95%CI 1.01-2.87，0-5 年 vs 6-15 年）也与 SUDEP 风险增加相关。在过去一年中发生 1-3 次 TCS 的患者中，结构性癫痫病因与 SUDEP 风险增加超过 10 倍相关（OR 10.84，4.85-24.27），而无 TCS 的遗传病因癫痫患者风险较低。在过去一年中发生≥4 次 TCS 的患者中，全面性和局灶性癫痫的风险相似。在过去 5 年中，与无 TCS 且癫痫持续时间为 6-15 年的患者相比，那些过去 5 年中发生≥4 次 TCS 的患者 OR 为 210.73（95%CI 28.40-∞）。癫痫持续时间较短（0-5 年）且夜间发生 TCS 的患者 OR 为 45.99（95%CI 12.19-173.61），而持续时间较长（6-15 年）且无夜间 TCS 的患者 OR 为 1.00。
尽管某些病因（如创伤后癫痫）似乎具有更高的 SUDEP 风险，但我们的数据表明，频繁且夜间发生的 TCS 无论首发为局灶性或全面性，其风险水平相似。发作的强直部分似乎对致命结局具有决定性。SUDEP 风险与 TCS 相关，在癫痫诊断后的最初几年最高，这需要从诊断开始就进行有效的 TCS 治疗和监测。
