Nocturnal seizures with convulsions were found to be associated with an increased risk for sudden unexpected death in epilepsy (SUDEP) in patients with intellectual disabilities who reside in care facilities, according to study results in Neurology.

In a nested case-control study, investigators reviewed medical records of patients with SUDEP from 2 different residential care settings over a 25-year period (1987-2012). A total of 60 cases of SUDEP and 198 age- and residential-matched controls were identified. The researchers correlated the degree of nocturnal supervision (eg, no supervision; a listening device, roommate, or physical checks at 15-minute intervals; or 2 of the following: a listening device, roommate, additional device, or physical checks at 15-minute intervals) with outcomes.

The total incidence of SUDEP was 3.53/1000 patient-years (95% CI, 2.73-4.53), with a difference in variance observed in SUDEP incidence among centers of 2.21/1000 (95% CI, 1.49-3.27) patient-years vs 6.12/1000 (95% CI, 4.40-8.52) patient-years. Cases of SUDEP from the first center had higher grade of nocturnal supervision than SUDEP cases from the second center (P <.001). A greater percentage of patients with SUDEP were more likely to have nocturnal convulsive seizures compared with control participants (77% vs 32%, respectively; P <.001). Patients with SUDEP were also more likely to have a higher frequency of nocturnal convulsive seizures (P =.001) and a higher IQ (P =.005). 

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Limitations of the analysis include its retrospective design and the inclusion of data from patients aged < 60.years.

Considering SUDEP may be associated with sleeping position and nocturnal seizures, the researchers wrote that their study “underlines the importance of nocturnal supervision and reliable seizure detection systems for different populations.”

Reference

van der Lende M, Hesdorffer DC, Sander JW, Thijs RD. Nocturnal supervision and SUDEP risk at different epilepsy care settings. Neurology. 2018;91(16):e1508-e1518.