Long-term surveillance of SUDEP in drug-resistant epilepsy patients treated with VNS therapy.

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Version: Final published version
Serval ID
serval:BIB_577D68C4A0A3
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Long-term surveillance of SUDEP in drug-resistant epilepsy patients treated with VNS therapy.
Journal
Epilepsia
Author(s)
Ryvlin P., So E.L., Gordon C.M., Hesdorffer D.C., Sperling M.R., Devinsky O., Bunker M.T., Olin B., Friedman D.
ISSN
1528-1167 (Electronic)
ISSN-L
0013-9580
Publication state
Published
Issued date
03/2018
Peer-reviewed
Oui
Volume
59
Number
3
Pages
562-572
Language
english
Notes
Publication types: Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
Limited data are available regarding the evolution over time of the rate of sudden unexpected death in epilepsy patients (SUDEP) in drug-resistant epilepsy. The objective is to analyze a database of 40 443 patients with epilepsy implanted with vagus nerve stimulation (VNS) therapy in the United States (from 1988 to 2012) and assess whether SUDEP rates decrease during the postimplantation follow-up period.
Patient vital status was ascertained using the Centers for Disease Control and Prevention's National Death Index (NDI). An expert panel adjudicated classification of cause of deaths as SUDEP based on NDI data and available narrative descriptions of deaths. We tested the hypothesis that SUDEP rates decrease with time using the Mann-Kendall nonparametric trend test and by comparing SUDEP rates of the first 2 years of follow-up (years 1-2) to longer follow-up (years 3-10).
Our cohort included 277 661 person-years of follow-up and 3689 deaths, including 632 SUDEP. Primary analysis demonstrated a significant decrease in age-adjusted SUDEP rate during follow-up (S = -27 P = .008), with rates of 2.47/1000 for years 1-2 and 1.68/1000 for years 3-10 (rate ratio 0.68; 95% confidence interval [CI] 0.53-0.87; P = .002). Sensitivity analyses confirm these findings.
Our data suggest that SUDEP risk significantly decreases during long-term follow-up of patients with refractory epilepsy receiving VNS Therapy. This finding might reflect several factors, including the natural long-term dynamic of SUDEP rate, attrition, and the impact of VNS Therapy. The role of each of these factors cannot be confirmed due to the limitations of the study.
Keywords
Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Death, Sudden/epidemiology, Death, Sudden/prevention & control, Drug Resistant Epilepsy/diagnosis, Drug Resistant Epilepsy/mortality, Drug Resistant Epilepsy/therapy, Female, Follow-Up Studies, Humans, Infant, Infant, Newborn, Male, Middle Aged, Population Surveillance, Time Factors, Treatment Outcome, United States/epidemiology, Vagus Nerve Stimulation/trends, Young Adult, epilepsy, mortality, sudden unexpected death in epilepsy patients, vagus nerve stimulation
Pubmed
Web of science
Open Access
Yes
Create date
25/01/2018 22:01
Last modification date
20/08/2019 15:11
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