AAN SUDEP Guidelines: A Quiz

Question 1:

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The correct answer is A.  1 in 4500 children; 1 in 1000 adults

Discussion:

According to 2017 practice guidelines on Sudden Unexpected Death in Epilepsy (SUDEP) by the American Academy of Neurology (AAN) and American Epilepsy Association (AEA), the annual incidence of SUDEP is lower for children (for whom the risk is rare) than for adults (for whom the risk is small).  Typically, 1 in 4500 children with epilepsy experience SUDEP each year, while 1 in 1000 adults with epilepsy experience SUDEP each year.  To lessen patient anxiety, another way of saying it is that each year 4,499 of 4,500 children with epilepsy will not experience SUDEP, and each year 999 of 1000 adults with epilepsy will not experience SUDEP.¹ [link to Reference 1]

Question 2:

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The correct answer is B. Presence of atonic seizures

Discussion:

Risk factors for SUDEP include the presence of generalized tonic clonic seizures (GTCS), increased frequency of GTCS, failure to attain seizure control for 1-5 years, and not adding an antiepileptic drug (AED) when indicated in medically refractory patients.¹ Factors for risk reduction include nocturnal supervision and use of a nocturnal remote listening device.¹ [link to Reference 1]

Question 3:

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The correct answer is D. All of the above

Discussion:

Risk for SUDEP is greatly increased in people with GTCS, especially in those with increased seizure frequency.¹ Research suggests that people with 3 or more GTCS per year have 15 times increased risk of SUDEP, and that GTCS may be in the causal pathway for SUDEP. Less severe seizure types, like myoclonic seizures, have not been proven to be linked to increased risk for SUDEP. However, patients who do not achieve seizure freedom from less severe types of seizures may be at risk for GTCS, especially if they are nonadherent to medication.  Exploring reasons why this patient forgets to take his medication, and steps he can take to help himself or seek support may improve adherence.¹ [link to Reference 1] For more on this topic, see A Quiz on SUDEP.

References:

1. Harden C, Tomson T, Gloss D, et al. Practice guideline summary: Sudden unexpected death in epilepsy incidence rates and risk factors: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2017 Apr 25;88(17):1674-1680. doi: 10.1212/WNL.0000000000003685.