sudep amer aboukasm, md, facp. s udden u nexpected d eath in e pilepsy p atients
TRANSCRIPT
![Page 1: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/1.jpg)
SUDEPAmer Aboukasm, MD, FACP
![Page 2: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/2.jpg)
SUDDEN Unexpected Deathin
Epilepsy Patients
![Page 3: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/3.jpg)
Increased Mortality in Epilepsy(2-3 fold greater than general population)
• Direct– SUDEP– Accidents– Status Epilepticus
• Indirect– Underlying brain disease/co-morbidities– Suicide – Complication of treatment (AEDs, surgery…)
![Page 4: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/4.jpg)
SUDEP Definition(FDA/Burrouhgs-Wellcome 1993)
• Patient has epilepsy (recurrent unprovoked Sz)• Unexpected death while in good health• Death occurred suddenly (minutes)• Death occurred during benign circumstances• No obvious medical cause of death on autopsy• Death not due to seizure or status epilepticus
![Page 5: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/5.jpg)
SUDEP Definition(FDA/Burrouhgs-Wellcome 1993)
• Definite SUDEP: meet all 5 criteria
• Probable SUDEP: meet criteria except no autopsy
• Possible SUDEP: insufficient evidence , no autopsy
• Not SUDEP: other cause of death established
![Page 6: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/6.jpg)
![Page 7: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/7.jpg)
![Page 8: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/8.jpg)
![Page 9: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/9.jpg)
SUDEP• Increased recognition• Unanticipated death• Traumatic to families and care givers• “Unknown” incidence • “Unknown” burden on public health
![Page 10: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/10.jpg)
US Institute of Medicine• Recent report on public health on epilepsy• Emphasis on SUDEP• Recognizes deficiencies in measuring its
occurrence (Med Records, coroner offices and medical examiners)
![Page 11: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/11.jpg)
SUDEP (Incidence)
• Incidence vary widely• Small Communities-based studies– Methods varies substantially
• Population-based studies– Challenges in obtaining data (Underestimate)
![Page 12: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/12.jpg)
SUDEP (Incidence)
• A better Understanding Incidence of SUDEP – Helps measure the “Public Health Burden”– Helps prioritize medical research & prevention– Helps inform people (pts and caregivers) on risks
![Page 13: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/13.jpg)
SUDEP (Incidence)Thurman et al. Epilepsia 2014
• Literature search Jan 2014– 199 references– 17 relevant population-based studies– 7 studies used for the meta-analysis– 3 level 2– 4 level 3
![Page 14: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/14.jpg)
SUDEP (incidence) • Crude annual rate per 100.000 population
0.81
• Crude annual rate per 1000 PWE
1.16
![Page 15: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/15.jpg)
SUDEP• Higher incidence in – Medically refractory epilepsy– Mentally challenged with epilepsy – Recent generalized tonic-clonic seizure
![Page 16: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/16.jpg)
![Page 17: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/17.jpg)
![Page 18: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/18.jpg)
SUDEP (incidence)• Incidence is Underestimated (Undercounting)• Extent of underestimation is “unknown” • Low incidence in over 50 of age – Undercounting due to other co-morbidities
• Low incidence in young children– Adults supervision/assistance during seizures– Misclassifying SIDS
![Page 19: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/19.jpg)
![Page 20: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/20.jpg)
SUDEP• Implication for further research & studies– Prospective, Medical examiners, coroner offices
• Identify modifiable risk factors• Development of preventive strategies.
![Page 21: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/21.jpg)
SUDEP CONTROVERSIES• UK N.I.C.E. Recommends:
“All individual with epilepsy should be informed about SUDEP”• 5% of neurologists discuss SUDEP with all pts• 66% “ “ “ “ few or none
• US AES and Epilepsy foundation have similar recommendations
• 7% of neurologists discuss SUDEP with all pts• 66% “ “ “ “ few or none
![Page 22: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/22.jpg)
SUDEP physicians concerns -Creating fear anxiety and distress-Uncertainty about the magnitude of risks in
individual patient-Inability to prevent it-Adverse effects on the Dr-patient relationship
![Page 23: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/23.jpg)
SUDEP controversies
Should we & when to
educate
Some or All patients and/or Caregivers
![Page 24: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/24.jpg)
SUDEP controversies• Research and surveys strongly confirm that
the patients and their caregivers desire is to learn about SUDEP and early.
• Patients and caregivers believe that the discussion about SUDEP should follow how parents learn about SIDS. Reducing its rate to 1/3 after the 80s campaign of “Back-to-sleep”
![Page 25: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/25.jpg)
Sudden Unexpected Death in Epilepsy:Assessing the Public Health Burden*
• Estimated annual incidence rate of 1.2 cases SUDEP per 1,000 patients with epilepsy
• Lower risk in young children; higher risk in later adolescence and younger adulthood
• Risk varies greatly among individuals, types of epilepsy, and severity of seizures
• In U.S. population, among common neurological disorders, overall years of potential life lost due to SUDEP rank second only to stroke.
Thurman et al, 2014, DOI: 10.1111/epi.12666
![Page 26: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/26.jpg)
![Page 27: SUDEP Amer Aboukasm, MD, FACP. S UDDEN U nexpected D eath in E pilepsy P atients](https://reader036.vdocuments.us/reader036/viewer/2022062519/5697bfc41a28abf838ca60c5/html5/thumbnails/27.jpg)