Risk of Sudden Unexplained Death in Epilepsy May Wane Over Time

The following article is part of conference coverage from the American Epilepsy Society’s Annual Meeting in New Orleans, LA. The Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AES 2018.

NEW ORLEANS — Patients at high risk for sudden unexplained death in epilepsy (SUDEP) may shift to a lower risk group over time whereas those already at low risk may stay there, according to new study data presented at the 72nd American Epilepsy Society Annual Meeting, held November 30 to December 4, 2018.

SUDEP has been previously associated with risk factors including the presence of generalized tonic-clonic (GTC) seizures, frequency of GTCs, and absence of seizure freedom (Class  B evidence). However, “these risk factors have not systematically been personalized for an individual’s risk for SUDEP, nor has it been seen if an individual’s risk of SUDEP changes over time,” explained lead author, Neishay Ayub, MD, from Beth Israel Deaconess Medical Center, Boston, MA.

Using SeizureTracker.com, a large patient-reported database of electronic seizure diaries, study authors performed a study to stratify the patient data into low, medium, and high risk for SUDEP based on previously established risk factors and track how this shifts over time.

More than 1.4 million seizure incidences were obtained from 12,402 patients from December 2007 to February 2018. The seizures were categorized into “generalized” (defined as tonic-clonic or secondarily generalized) or “other” seizures.

SUDEP risk levels were grouped as low (0 generalized seizures in a year), medium (1-2 generalized seizures in a year), and high (>3 generalized seizures in a year). The study’s primary endpoint was the length of time within the initial risk group.

“There was a significant global difference between SUDEP risk groups,” the authors noted. Specifically, there were significant differences between the high-risk and low-risk groups (P <.01) and the medium-risk and low-risk groups (P <.01). No significant difference, however, was seen between the medium and high-risk groups (P =.09).

After monitoring seizures for 3 years, the data showed 27% of patients in the high-risk group left their initial category and 32.5% of patients in the Medium risk group left their initial group, compared with 7% of low-risk patients who left their initial risk group to a higher-risk category.

Findings from this study “support the recommendation that for people with epilepsy who have ongoing GTCs, the goal of treatment is to reduce GTCs and thereby, lower SUDEP risk,” concluded Dr. Ayub.

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Ayub N, Chiang S, Moss R, Goldenholz DM. Longitudinal SUDEP risk stratification with electronic diaries. Presentation at: 72nd Annual Meeting of the American Epilepsy Society; November 30-December 4, 2018; New Orleans, LA. Abstract 2.158.