Adjunctive antiepileptic drug treatment can lower risk of dying from a sudden unexpected death

New research published Online First in The Lancet Neurology, has found that epilepsy patients who receive additional treatment with antiepileptic drugs (AEDs) have about a seven times lower risk of dying from a sudden unexpected death—the most common cause of death in epilepsy patients.

Sudden unexplained death is 20 times more common in people with epilepsy than in the general population. Research has identified some potentially preventable risk factors for sudden unexpected death in epilepsy (SUDEP) including a high number of generalised tonic-clonic seizures (the most common type of generalised seizure that affects the entire brain) and taking a combined regimen of AEDs (polytherapy). But until now, no intervention has been assessed in a controlled study or shown a beneficial effect at preventing SUDEP.

In this study, Philippe Ryvlin, Hôpital Neurologique, Lyon, France, and colleagues pooled data from 112 randomised trials of AED add-on treatment of adults with refractory (treatment-resistant) to compare the incidence of definite and probable SUDEP between patients receiving adjunctive AED therapy at effective doses and those given placebo.

A total of 33 deaths occurred in the trials, of which 18 deaths were deemed probable or definite SUDEP, and two deaths possible SUDEP.

Overall, analyses showed that patients treated with adjunctive AEDs at effective doses were about seven times less likely to die of a SUDEP than patients given placebo.

Rates of definite and probable SUDEP were 0.9 per 1000 person-years in the AED group and 6.9 per 1000 person-years in the placebo group.

The authors suggest that the treatment-related reduction in seizure frequency is the most likely explanation for the very low rate of SUDEP in patients given AEDs at effective doses.

They point out that contrary to research suggesting that polytherapy might increase the risk of SUDEP: "Our data suggest that add-on AEDs at doses effective on seizure frequency reduce the risk of SUDEP despite increasing the drug load, at least during the average 3-month duration of randomised trials."

They conclude: "This finding provides an argument not only for active revision and optimum management of treatment in patients with uncontrolled seizures, but also for further prospective and long-term investigation of this unsettled issue."

In a Comment, Dale Hesdorffer from Columbia University, New York, USA and Torbjorn Tomson from the Karolinska Institute, Stockholm, Sweden, outline three key implications of the findings: "First, the study provides strong evidence for an effective intervention to reduce SUDEP risk…Second, the protective effective of adjunctive therapy suggests that seizure control could be extremely important for SUDEP prevention…Third, polytherapy does not increase risk of SUDEP during the time period of a randomised trial."

More information: Paper online: www.thelancet.com/journals/lan… (11)70193-4/abstract

add to favorites email to friend print save as pdf

Related Stories

Gene identified for sudden unexpected death in epilepsy

Apr 13, 2010

A mutation in a brain protein gene may trigger irregular heart beat and sudden death in people with epilepsy, according to new research in the April 14 issue of The Journal of Neuroscience. People with epilep ...

Heart link discovered in sudden epilepsy deaths

Nov 08, 2010

(PhysOrg.com) -- Sudden unexpected death in epilepsy (SUDEP) is the most common cause of epilepsy-related death and responsible for about 150 Australian deaths each year yet the underlying cause has remained a mystery.

Recommended for you

Surprising new role for calcium in sensing pain

3 hours ago

When you accidentally touch a hot oven, you rapidly pull your hand away. Although scientists know the basic neural circuits involved in sensing and responding to such painful stimuli, they are still sorting ...

Neurons in human skin perform advanced calculations

23 hours ago

Neurons in human skin perform advanced calculations, previously believed that only the brain could perform. This is according to a study from Umeå University in Sweden published in the journal Nature Ne ...

Memory in silent neurons

Aug 31, 2014

When we learn, we associate a sensory experience either with other stimuli or with a certain type of behavior. The neurons in the cerebral cortex that transmit the information modify the synaptic connections ...

User comments