Can sudden unexpected death in epilepsy be prevented?

Presenter:  Adam Dickey, MD, PhD, PGY2 Neurology

Link to Presentation:  Journal Club June 2016

Clinical Question:

Do patients with refractory epilepsy show a lower incidence of SUDEP when receiving anti-epileptic drugs (AEDs) at efficacious doses than in those receiving placebo?

Journal Club Article:

Rivlin P, et al.  Risk of sudden unexpected death in epilepsy in patients given adjunctive antiepileptic treatment for refractory seizures: a meta-analysis of placebo-controlled randomised trials. Lancet Neurol. 2011 Nov;10(11):961-8.  PDF attached:  Rivlin et al

Methodology:

Searched Medline and the Cochrane Library for randomised trials investigating any AED in the add-on treatment of drug-resistant epilepsy in adults. Extracted the number and causes of death in patients allocated to AEDs at doses that were more efficacious than placebo against seizures, AEDs at non-efficacious doses, and placebo. In the study’s primary analysis, investigators compared the occurrence of definite or probable SUDEP between patients given efficacious AED doses and those given placebo using the Mantel-Haenszel method, with exclusion of trials with no event.

Study Conclusions:

Treatment with adjunctive AEDs at efficacious doses may have reduced the incidence of definite or probable SUDEP by more than seven times compared with placebo in patients with previously uncontrolled seizures. This result provides evidence in favor of active treatment revision for patients with refractory epilepsy.

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