Abstracts

There is a known increased mortality rate in patients with epilepsy.
Sudden unexpected death is the most important epilepsy related cause of death. Experimental and clinical data support that early age at onset of seizures, mental retardation, frequent tonic-clonic seizures as well as intractability are significant risk factors for sudden unexpected death in epilepsy (SUDEP). The main autopsy finding, pulmonar oedema, is still not enough to understand the cause of death of the affected patients.
Depending on the cohort studied, SUDEP is responsible for 2 to 18% of all deaths, although the incidence may be up to 40 times higher among young adults with epilepsy. However, (up to our knowledge) incidence of SUDEP in South America has not been reported.
The aim of our study is to communicate the frequency of SUDEP in our population. Clinical records of patients evaluated in our Section from 1999 to December 2004 were reviewed. History of their disease, personal data, treatment given, circumstances of death and autopsy reports were analyzed. Patients with epilepsy who died suddenly and unexpectedly, fulfilling established SUDEP criteria were included. Total of clinical records evaluated: 1000 (from 1999 to Dec. 2004). Educational program about SUDEP was started in 2003.
Seven cases fulfill SUDEP criteria, 5 were females and 2 males. Six died between December 2002 and 2004 and one in 1999 (this particular death was read in newspaper and relatives were contacted).
The average age at seizure onset was 10,71 [underline]+[/underline] 4,46 years (range: 3-16 years old). The mean age of death was 33,85 [underline]+[/underline] 6,7 (28 to 45 years old), resulting in mean duration of seizures of 23,14 [underline]+[/underline] 7,24 years.
Two cases had primarily generalized epilepsies and five suffered from focal seizures with secondary generalization. Three patients were mentally retarded and one had a vascular sequelae in temporal lobe. Except for this patient, all the others had normal MRIs.
Seizure frequency median was 4/month (range: 2-150/month). All patients were intractable but one. All of them were on politherapy.
No patients had any other potential cause of death and were, aside from epilepsy, healthy at the moment of death.
Five patients underwent necropsy, and were classified as definitive SUDEP. The autopsy reported: pulmonary oedema in 3 cases and no remarkable findings in the others. The clinical features described in our study group are similar to those previously reported in the literature.
Although the number of SUDEP cases is small, 5 of them were reported after 2003 which might reflect the influence of the educational program implemented at our Department.
We believe education is necessary in order to identify SUDEP cases. Patients and family members need to be aware that SUDEP is the most important cause of death related to epilepsy. Its recognition is essential and the first step to determine the incidence of SUDEP in South America.