Abstracts

Rationale: Mortality among epilepsy patients may be as high as 1 in 300 patients per year¹. We evaluated factors associated with death in epilepsy and specific risk factors for sudden unexplained death in epilepsy (SUDEP). Methods: We retrospectively reviewed patients diagnosed with seizures and epilepsy who deceased at a tertiary pediatric hospital between 2003 and 2013. We excluded patients whose report did not correspond to clinical seizures (63) and were incomplete (22). We evaluated clinical and demographic factors correlated with death as the outcome. Results: Among 30,262 patients with seizures and epilepsy, 250 (0.83%) were deceased and 165 met our inclusion critera. Median age of death was 8 yrs (IQR: 3-14), epilepsy duration was 0.92 yrs (IQR: 0.08-4), age of epilepsy onset was 3 yrs (IQR: 0.42-10) and 96 (58.2%) patients were males. Two patients (1.2%) met criteria for probable SUDEP, 10 (6.1%) had possible SUDEP and 118 (71.5%) deceased due to other causes. Circumstances around death in 35 (21.2%) patients could not be retrieved. Epilepsy etiology was genetic in 34 (20.6%), structural/metabolic in 100 (60.6%), and unknown in 31 (18.8%). 55 patients (33.3%) had generalized tonic-clonic seizures, while 92 (55.8%) had focal. 32 (19.4%) patients had 1 or more episodes of status epilepticus with generalized seizures in 12. Neoplasia was the most common specific seizure etiology in 39 (23.6%) patients, while etiology was viral, bacterial or parasitic infection in 15 (9,1%). 109 patients (66.1%) had neurological or motor deficits, 64 (38.8%) had global weakness, 57 (34.5%) were non-ambulatory and 58 (35.2%) non-verbal. 19 patients (11.5%) had apnea during seizures and 8 (4.8%) had cardiac arrhythmia with seizures. 61 patients (37%) were medically refractory to anti-epileptic drugs (AEDs). Number of continuous AEDs ranged from 0-12 in their lifetime with median of 2 AEDs (IQR: 1-4) and mean of 3 AEDs (SD: 2.6). Most recent EEG was abnormal in 90/127 available reports, presenting slowing and background abnormalities in 90 of these patients, interictal epileptiform activity in 62 and ictal abnormalities in 31. The MRI was abnormal in 117/129 available reports with neoplasia observed in 23 of these patients, malformation of cortical development in 21 and cerebral atrophy in 19. Seizure was witnessed around death in 8 (4.8%) patients, while 7 (4.2%) had evidence of recent seizure. Infection, illness or fever were present in 33 (20%) patients at least 2 weeks before death. Neuropathological findings were available in 21 (12.7%) patients with 11 cases of malignant neoplasia. Conclusions: Deaths may be related to neurological and non-neurological/systemic underlying causes, including sudden unexpected and unexplained causes as our results show in 7.3% of patients. This occurance of SUDEP requires detailed counseling of family members, as well as further descriptions of its physiopathology. Identifying clinical risk factors and future biomarkers is essential to determine patients at a high risk of death, enabling preventative strategies. 1. Sillanpää M, Shinnar S. Long-term mortality in childhood-onset epilepsy. N Engl J Med 2010.