Risk factors for sudden unexpected death in epilepsy: a case-control study
Risk factors for sudden unexpected death in epilepsy: a case-control study
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DOI：
10.1016/s0140-6736(98)05114-9
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发表时间：
1999-03-13
期刊：
影响因子：
168.9
通讯作者：
Tomson, T
中科院分区：
文献类型：
--
作者：
Nilsson, L;Farahmand, BY;Tomson, T
背景 癫痫患者中突然意外死亡比普通人群更为常见。我们的目的是调查一些临床变量与癫痫猝死 (SUDEP) 之间的关联，以确定危险因素。 方法 这项巢式病例对照研究以年龄在 15 岁至 70 岁之间的队列为基础，这些人在 1980-89 年间曾在斯德哥尔摩县的任何一家医院因癫痫诊断入院并出院。研究人群通过国家死因登记册进行随访，直至 1991 年 12 月 31 日。病例是指已死亡、死亡证明上登记为癫痫诊断的个体，以及在审查医疗和尸检记录后发现符合我们的 SUDEP 标准的个体。每个病例从同一队列中选择了三名对照参与者，他们是年龄和性别相匹配的活着的癫痫患者。所有医疗记录均经过检查。根据预先设计的方案收集和分析临床数据。结果纳入了 57 例 SUDEP 病例，其中 91% 接受了尸检。 SUDEP 的相对风险随着每年癫痫发作次数的增加而增加。与每年癫痫发作最多两次的患者相比，每年癫痫发作超过 50 次的患者的估计相对风险为 10.16 (95% CI 2.94-35.18)，SUDEP 的风险随着同时服用的抗癫痫药物数量的增加而增加，与单一治疗相比，三种抗癫痫药物的相对风险为 9.89 (3.20-30.60)。其他主要危险因素是早发性癫痫与晚发性癫痫（7.72 [2.13-27.96]），以及抗癫痫药物剂量与不变剂量相比频繁变化（6.08 [1.99-18.56]）。女性患者的 SUDEP 风险与早发、SUDEP 风险与癫痫发作频率之间的关联较男性患者弱，而频繁的剂量变化在女性患者中显示出更强的关联。 解释 我们的数据表明，SUDEP 是一种癫痫相关事件，尽管使个体易患 SUDEP 的病理生理学基础可能在早期就已建立，并且可能存在一些性别差异。改善癫痫发作控制以及可能避免多重治疗可能是降低 SUDEP 风险的方法。
Background Sudden unexpected death is substantially more common in people with epilepsy than in the general population. Our objective was to investigate the association between some clinical variables and sudden unexpected death in epilepsy (SUDEP) to identify risk factors.Methods This nested case-control study was based on a Cohort of people aged between 15 and 70 years, who, during 1980-89, had been admitted to and discharged with a diagnosis of epilepsy from any hospital in the county of Stockholm. The study population was followed up through the National Cause of Death Register until Dec 31, 1991. Cases were individuals who had died, with a diagnosis of epilepsy registered on the death certificate, and who after review of medical and necropsy records were found to meet our SUDEP criteria. Three control participants, who were living epilepsy patients matched for age and sex, were selected from the same cohort for each case. All medical records were examined. Clinical data were collected and analysed on a predesigned protocol.Findings 57 SUDEP cases were included, of whom 91% had undergone necropsy. The relative risk of SUDEP increased with number of seizures per year. The estimated relative risk was 10.16 (95% CI 2.94-35.18) in patients with more than 50 seizures per year, compared with those with up to two seizures per year, The risk of SUDEP increased with increasing number of antiepileptic drugs takenconcomitantly-9.89 (3.20-30.60) for three antiepileptic drugs compared with monotherapy. Other major risk factors were early-onset versus late-onset epilepsy (7.72 [2.13-27.96]), and frequent changes of antiepileptic drug dosage compared with unchanged dosage (6.08 [1.99-18.56]). The association between SUDEP risk and early onset, and SUDEP risk and seizure frequency, was weaker for female than for male patients, whereas frequent dose changes showed a stronger association in female patients.Interpretation Our data suggest that SUDEP is a seizure-related event, although the pathophysiological substrate that predisposes individuals to SUDEP may be established at an early age, and there may be some sex differences. Improvement of seizure control and possibly the avoidance of polytherapy may be ways to reduce the risk of SUDEP.