Abstracts

Rationale: Sudden Unexpected Death in Epilepsy (SUDEP) is one of the most common causes of death in people with epilepsy. This is a retrospective evaluation definite SUDEP cases identified in the only medical examiner’s office in San Antonio, Texas. Demographics and clinical information were examined. Methods: This retrospective case review identified 50 people succumbing to SUDEP between 2011 and 2016. The mean age was 37 (range 14 to 67 years old). A comprehensive database maintained by the Medical Examiner, which included death certificates, police, medical information and autopsy reports, including antiepileptic drug (AED) levels and toxicology, were reviewed. Results: By review of the Medical Examiner’s database, 68% had idiopathic or cryptogenic epilepsy, while the remainder had a suspected structural etiology of their epilepsy.  SUDEP could be identified as occurring nocturnally in 40% of the patients, during the daytime in 38%, and in the remainder, the time of day was unknown.  However, only 22% of the SUDEP cases were witnessed.  Documentation of body position was available in 64%, and over half of the people were found in the prone position, more than twice in a supine position. AEDs were prescribed in 60% of the cases, lack of compliance was revealed in 28% by toxicology report. Cardiovascular, psychiatric, and neurological comorbidities, as well as drug or alcohol abuse were identified in 58%, and 14% were smokers. Pathological examination identified cerebral edema in 16%, 38% had pulmonary edema, and 26% had a cardiovascular abnormality, including interstitial or perivascular fibrosis, cardiomegaly, coronary artery disease, ventricular dilation or hypertrophy. However, lungs were not routinely weighed by all examiners. 78% of SUDEP cases had no known cause of death other than seizures (definite SUDEP), while other contributing factors were identified in the remainder, such as underlying cardiomegaly, cerebral edema or alcohol abuse (definite SUDEP Plus).   Conclusions: This study provides a preliminary insight into the demographics and clinical findings underlying SUDEP in the ethnically heterogenous population of Bexar County.  Lack of AED therapy, and poor AED compliance in those treated, may be the main contributing factors underlying SUDEP in this cohort. We propose to expand our sample and evaluate the significance of the co-morbidities in a control group of people succumbing to sudden unexpected death without a history of epilepsy.  Funding: None