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Puras Z, Richardson S, Vincent Watkins L, Shankar R. Status Epilepticus a risk factor for Sudden Unexpected Death in Epilepsy (SUDEP): A scoping review and narrative synthesis. Epilepsy Behav 2024; 160:110085. [PMID: 39388974 DOI: 10.1016/j.yebeh.2024.110085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 09/07/2024] [Accepted: 10/03/2024] [Indexed: 10/12/2024]
Abstract
BACKGROUND Sudden Unexpected Death in Epilepsy (SUDEP) is a leading cause of mortality among people with epilepsy (PWE). Risk factors such as increased seizure frequency, drug-resistant epilepsy, and early epilepsy onset are well recognised. However, little evidence of the role of seizure severity, specifically Status Epilepticus (SE) on SUDEP risk exists. OBJECTIVE To identify mechanisms, risk factors and clinical characteristics overlap between SE and SUDEP. METHODS A scoping review using the PRISMA-ScR model was performed by two reviewers using suitable search terms. The PubMed Advanced Search tool along with the ancestry method was utilised to identify suitable articles published between 06/1992 and 05/2023. Quantitative, qualitative and mixed method studies were included. A narrative synthesis was undertaken and is presented as themes and subthemes. RESULTS Of 5453 papers identified in the preliminary search, 50 studies were suitable for final analysis. Key themes include overlap between SE complications and SUDEP risk factors (pharmaco-resistant generalised tonic-clonic epilepsy, intellectual disability), overlap of shared risk factors (alcohol abuse, developmental epileptic encephalopathies) and clinical characteristics (cardiac and respiratory). SE's role in development of drug-resistant epilepsy was the strongest potential mechanism for SE's contribution to SUDEP risk. SE's contribution to recurrent ictal hypoxaemia episodes and lowered heart rate variability suggests a relationship with SUDEP needing further study. CONCLUSIONS This review identifies research areas of influence of SE on SUDEP risk. Such research could inform counselling for patients concerned about seizure severity in relation to their SUDEP risk and optimise surveillance and subsequent management of post-SE epileptogenic outcomes.
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Affiliation(s)
- Zygimantas Puras
- University of Plymouth, Peninsula Schools of Medicine and Dentistry, Plymouth, Devon, United Kingdom
| | - Saffron Richardson
- University of Plymouth, Peninsula Schools of Medicine and Dentistry, Plymouth, Devon, United Kingdom
| | - Lance Vincent Watkins
- University of Plymouth, Peninsula Schools of Medicine and Dentistry, Plymouth, Devon, United Kingdom; Swansea University, Swansea Bay University Health Board, Swansea, Wales, United Kingdom; University of South Wales, United Kingdom
| | - Rohit Shankar
- University of Plymouth, Peninsula Schools of Medicine and Dentistry, Plymouth, Devon, United Kingdom.
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Watkins L, Henning O, Bassett P, Ashby S, Tromans S, Shankar R. Epilepsy professionals' views on sudden unexpected death in epilepsy counselling: A tale of two countries. Eur J Neurol 2024; 31:e16375. [PMID: 38837829 PMCID: PMC11295158 DOI: 10.1111/ene.16375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/30/2024] [Accepted: 05/16/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND AND PURPOSE Sudden unexpected death in epilepsy (SUDEP) is a leading cause of epilepsy mortality. All international guidance strongly advocates for clinicians working with people with epilepsy (PWE) to discuss SUDEP. Clinician views working with PWE in the UK and Norway on SUDEP counselling are compared. METHODS A cross-sectional online mixed methodology survey of 17 Likert and free-text response questions using validated themes was circulated via International League against Epilepsy/Epilepsy Specialist Nurses Association in the UK and International League against Epilepsy/Epilepsinet in Norway using a non-discriminatory exponential snowballing technique leading to non-probability sampling. Quantitative data were analysed using descriptive statistics and Mann-Whitney, Kruskal-Wallis, chi-squared and Fisher's exact tests. Significance was accepted at p < 0.05. Thematic analysis was conducted on free-text responses. RESULTS Of 309 (UK 197, Norway 112) responses, UK clinicians were more likely to have experienced an SUDEP (p < 0.001), put greater importance on SUDEP communication (p < 0.001), discuss SUDEP with all PWE particularly new patients (p < 0.001), have access and refer to bereavement support (p < 0.001) and were less likely to never discuss SUDEP (p < 0.001). Significant differences existed between both countries' neurologists and nurses in SUDEP counselling with UK clinicians generally being more supportive. UK responders were more likely to be able to identify bereavement support (p < 0.001). Thematic analysis highlighted four shared themes and two specific to Norwegians. DISCUSSION Despite all international guidelines stating the need/importance to discuss SUDEP with all PWE there remain hesitation, avoidance and subjectivity in clinicians having SUDEP-related conversations, more so in Norway than the UK. Training and education are required to improve communication, engagement and decision making.
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Affiliation(s)
- Lance Watkins
- University of South WalesPontypriddUK
- Swansea Bay University Health BoardPort TalbotUK
- Cornwall Intellectual Disability Equitable Research (CIDER)University of Plymouth Peninsula School of MedicineTruroUK
| | - Oliver Henning
- National Epilepsy CenterOslo University HospitalOsloNorway
| | | | | | - Samuel Tromans
- SAPPHIRE Group, Department of Population Health SciencesUniversity of LeicesterLeicesterUK
- Adult Learning Disability ServiceLeicestershire Partnership NHS TrustLeicesterUK
| | - Rohit Shankar
- Cornwall Intellectual Disability Equitable Research (CIDER)University of Plymouth Peninsula School of MedicineTruroUK
- Cornwall Intellectual Disability Equitable Research (CIDER)Cornwall Partnership NHS Foundation TrustTruroUK
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Chatterjee S, Singh S, Kumar Kar S, Shankar R. Knowledge, attitudes and practices of psychiatrists in India regarding sudden unexpected death in epilepsy (SUDEP) and seizure-related harm. Epilepsy Behav Rep 2024; 27:100686. [PMID: 39114442 PMCID: PMC11305211 DOI: 10.1016/j.ebr.2024.100686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 05/31/2024] [Accepted: 06/18/2024] [Indexed: 08/10/2024] Open
Abstract
Sudden unexpected death in Epilepsy (SUDEP) is one of the leading causes of death in people with epilepsy (PWE). Awareness and taking adequate preventive measures are pivotal to reducing SUDEP. Nearly 80% of PWE live in lower-middle-income countries (LMICs) such as India where for many, epilepsy management is by psychiatrists. To evaluate the knowledge, attitude and practices of Indian psychiatrists on SUDEP and seizure risk. A cross-sectional online survey of 12 Likert response questions using validated themes, was circulated among Indian Psychiatric Society members. Non-discriminatory exponential snowballing technique leading to convenience non-probability sampling was used. The inquiry involved SUDEP-related topics including the need for and importance of counselling. Descriptive statistics and the chi-square test were used for analysis. The psychiatrists responding (n = 134) were likely to be males (72.4 %), urban (94 %) and affiliated to academic institutions (76.1 %). Nearly all saw PWE monthly with over half (54 %) seeing more than 10. Nearly two-third (64.17 %) did not counsel PWE regarding SUDEP, due to fear of raising concerns in caregivers/family (33.3 %), patients (38.9 %) or lack of time (35.6 %), though 37 % had lost patients due to SUDEP. Over two-third (66.7 %) agreed risk counselling was important. Barriers included fear of raising concerns, limited time, and training. A strong need for national SUDEP guidelines (89 %) and suitable training (75.4 %) was expressed. Though epilepsy care is provided by a considerable number of psychiatrists, there is a poor understanding of SUDEP. Enhancing the awareness and understanding of SUDEP is likely to enhance epilepsy care.
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Affiliation(s)
- Surobhi Chatterjee
- Department of Psychiatry, King George’s Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Shivangini Singh
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK
| | - Sujita Kumar Kar
- Department of Psychiatry, King George’s Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Rohit Shankar
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK
- Cornwall Intellectual Disability Equitable Research (CIDER) Cornwall Partnership NHS Foundation Trust, Truro, UK
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Zhou SM, McLean B, Roberts E, Baines R, Hannon P, Ashby S, Newman C, Sen A, Wilkinson E, Laugharne R, Shankar R. Analysing patient-generated data to understand behaviours and characteristics of women with epilepsy of childbearing years: A prospective cohort study. Seizure 2023; 108:24-32. [PMID: 37060628 DOI: 10.1016/j.seizure.2023.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/02/2023] [Accepted: 04/06/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Women with epilepsy (WWE) are vulnerable in pregnancy, with increased risks to mother and baby including teratogenic risks, especially from valproate. The free EpSMon mobile-phone app allows self-monitoring to afford patient-centred feedback on seizure related risks, such as sudden death in epilepsy (SUDEP) to its users. We sought to generate insights into various seizure related risks and its treatments in WWE of childbearing age (16 to 60 years ) using EpSMon. METHODS The study utilizes a prospective real-world cohort of 5.5 years. Patient reported data on demographics, medication taken, diagnoses, seizure types and recognised biological, psychological, and social factors of seizure related harm were extracted. Data was stratified according to frequent and infrequent users and those scoring lower and higher risk scores. Multivariate logistic regression and different statistical tests were conducted. FINDINGS Data from 2158 WWE of childbearing age encompassing 4016 self-assessments were analysed. Overall risk awareness was 25.3% for pregnancy and 54.1% for SUDEP. Frequent users were more aware of pregnancy risks but not of SUDEP. Repeated EpSMon use increased SUDEP awareness but not pregnancy risks. Valproate was used by 11% of WWE, ranging from 6.5% of younger to 31.5% of older women. CONCLUSIONS The awareness to risks to pregnancy, SUDEP and valproate is low. Valproate is being used by a significant minority. It is imperative risk communication continues for WWE based on their individual situation and need. This is unlikely to be delivered by current clinical models. Digital solutions hold promise but require work done to raise implementation and acceptability.
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Affiliation(s)
- Shang-Ming Zhou
- Centre for Health Technology, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
| | - Brendan McLean
- Cornwall Intellectual Disability Equitable Research (CIDER), Peninsula School of Medicine, University of Plymouth, Truro, TR4 9LD, UK; Royal Cornwall Hospital NHS Trust, Truro TR1 3LJ, UK
| | - Elis Roberts
- School of Engineering, Computing and Mathematics, University of Plymouth, Plymouth PL4 8AA, UK
| | - Rebecca Baines
- Cornwall Intellectual Disability Equitable Research (CIDER), Peninsula School of Medicine, University of Plymouth, Truro, TR4 9LD, UK
| | | | | | | | - Arjune Sen
- Nuffield Department of Clinical Neurosciences, University of Oxford, OX39DU, UK
| | | | - Richard Laugharne
- Cornwall Intellectual Disability Equitable Research (CIDER), Peninsula School of Medicine, University of Plymouth, Truro, TR4 9LD, UK; Psychoanalytica St Germans, UK; Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust Truro TR4 9LD UK
| | - Rohit Shankar
- Cornwall Intellectual Disability Equitable Research (CIDER), Peninsula School of Medicine, University of Plymouth, Truro, TR4 9LD, UK; Psychoanalytica St Germans, UK; Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust Truro TR4 9LD UK.
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Watkins LV, Ashby S, Hanna J, Henley W, Laugharne R, Shankar R. An evidence-based approach to provide essential and desirable components to develop surveys on Sudden Unexpected Death in Epilepsy (SUDEP) for doctors: A focused review. Seizure 2023; 106:14-21. [PMID: 36706666 DOI: 10.1016/j.seizure.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/30/2022] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
Sudden Unexpected Death in Epilepsy (SUDEP) is a major concern for people with epilepsy, their families, their care givers, and medical professionals. There is inconsistency in the SUDEP counselling doctors provide, compared to what is recommended in clinical guidelines. Numerous national and international surveys have highlighted how epilepsy professionals, usually doctors, deliver SUDEP risk counselling, particularly, when they deliver it and to whom. These surveys help understand the unmet need, develop suitable strategies, and raise awareness among clinicians with the eventual goal to reduce SUDEPs. However, there is no standardised survey or essential set of questions identified that can be used to evaluate SUDEP counselling practice globally. This focused review analyses the content of all published SUDEP counselling surveys for medical professionals (n=16) to date covering over 4000 doctors across over 30 countries and five continents. It identifies 36 question themes across three topics. The questions are then reviewed by an expert focus group of SUDEP communication experts including three doctors, an expert statistician and SUDEP Action, an UK based charity specialising in epilepsy deaths with a pre-set criterion. The review and focus group provide ten essential questions that should be included in all future surveys inquiring on SUDEP counselling. They could be used to evaluate current practice and compare findings over time, between services, across countries and between professional groups. They are provided as a template to download and use. The review also explores if there is a continued need in future for similar surveys to justify this activity.
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Affiliation(s)
- L V Watkins
- University of South Wales, Pontypridd, UK; Swansea Bay University Health Board, Port Talbot, UK
| | | | - J Hanna
- University of South Wales, Pontypridd, UK; Swansea Bay University Health Board, Port Talbot, UK; SUDEP Action, Wantage, UK; University of Exeter Medical School, Exeter, UK; Cornwall Partnership NHS Foundation Trust, Highertown, Cornwall, UK; University of Plymouth Peninsula School of Medicine, Plymouth, UK; Cornwall Intellectual Disability Equitable Research (CIDER), Truro, UK
| | - W Henley
- University of Exeter Medical School, Exeter, UK
| | - R Laugharne
- Cornwall Partnership NHS Foundation Trust, Highertown, Cornwall, UK; University of Plymouth Peninsula School of Medicine, Plymouth, UK; Cornwall Intellectual Disability Equitable Research (CIDER), Truro, UK
| | - R Shankar
- Cornwall Partnership NHS Foundation Trust, Highertown, Cornwall, UK; University of Plymouth Peninsula School of Medicine, Plymouth, UK; Cornwall Intellectual Disability Equitable Research (CIDER), Truro, UK.
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Serrand C, Rheims S, Faucanié M, Crespel A, Dinkelacker V, Szurhaj W, Biraben A, Bartolomei F, de Grissac N, Landré E, Denuelle M, Vercueil L, Marchal C, Maillard L, Derambure P, Dupont S, Navarro V, Mura T, Jaussent A, Macioce V, Ryvlin P, Picot MC. Stratifying sudden death risk in adults with drug-resistant focal epilepsy: The SUDEP-CARE score. Eur J Neurol 2023; 30:22-31. [PMID: 36094672 PMCID: PMC10087018 DOI: 10.1111/ene.15566] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/22/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE A clinical risk score for sudden unexpected death in epilepsy (SUDEP) in patients with drug-resistant focal epilepsy could help improve prevention. METHODS A case-control study was conducted including (i) definite or probable SUDEP cases collected by the French National Sentinel Mortality Epilepsy Network and (ii) control patients from the French national research database of epilepsy monitoring units. Patients with drug-resistant focal epilepsy were eligible. Multiple logistic regressions were performed. After sensitivity analysis and internal validation, a simplified risk score was developed from the selected variables. RESULTS Sixty-two SUDEP cases and 620 controls were included. Of 21 potential predictors explored, seven were ultimately selected, including generalized seizure frequency (>1/month vs. <1/year: adjusted odds ratio [AOR] 2.6, 95% confidence interval [CI] 1.25-5.41), nocturnal or sleep-related seizures (AOR 4.49, 95% CI 2.68-7.53), current or past depression (AOR 2.0, 95% CI 1.19-3.34) or the ability to alert someone of an oncoming seizure (AOR 0.57, 95% CI 0.33-0.98). After internal validation, a clinically usable score ranging from -1 to 8 was developed, with high discrimination capabilities (area under the receiver operating curve 0.85, 95% CI 0.80-0.90). The threshold of 3 has good sensitivity (82.3%, 95% CI 72.7-91.8), whilst keeping a good specificity (82.7%, 95% CI 79.8-85.7). CONCLUSIONS These results outline the importance of generalized and nocturnal seizures on the occurrence of SUDEP, and show a protective role in the ability to alert someone of an oncoming seizure. The SUDEP-CARE score is promising and will need external validation. Further work, including paraclinical explorations, could improve this risk score.
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Affiliation(s)
- Chris Serrand
- University Hospital of Montpellier, Montpellier, France
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and University of Lyon, Lyon, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sophie Dupont
- AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Vincent Navarro
- AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, Paris, France.,Paris Brain Institute, ICM, INSERM, CNRS, Paris, France
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On epilepsy perception: Unravelling gaps and issues. Epilepsy Behav 2022; 137:108952. [PMID: 36306590 DOI: 10.1016/j.yebeh.2022.108952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 10/09/2022] [Accepted: 10/10/2022] [Indexed: 01/05/2023]
Abstract
Epilepsy is one of the most common neurological diseases, but it can sometimes be under-reported or have a time delay in diagnosis. This data is not surprising if we consider that a person often seeks medical attention only after presenting a generalized tonic-clonic seizure. Epilepsy diagnostic delay is caused by several factors: under-reporting by patients, under-diagnosed epileptic manifestations by inexperienced clinicians, and lack of time in the emergency setting. The consequences of this delay are increased accidents, a high rate of premature mortality, and economic expanses for the healthcare system. Moreover, people with epilepsy have a higher probability of comorbidities than the general population, such as mood disorders or cognitive problems. Along with recurrent seizures, these comorbid diseases promote isolation and stigmatization of people with epilepsy, who suffer from discrimination at school, in the workplace, and even in social relationships. Public awareness of epilepsy and its comorbidities is necessary to prevent diagnostic delays and overcome social and professional iniquities for people with epilepsy.
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McCabe J, McLean B, Henley W, Harris C, Cheatle K, Ashby S, Shankar R. Sudden Unexpected Death in Epilepsy (SUDEP) and seizure safety: Modifiable and non-modifiable risk factors differences between primary and secondary care. Epilepsy Behav 2021; 115:107637. [PMID: 33317940 DOI: 10.1016/j.yebeh.2020.107637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/08/2020] [Accepted: 11/16/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The SUDEP and Seizure Safety Checklist ("Checklist") is a risk factors Checklist based around a person with epilepsy (PWE) demographics, seizure, physical, psychological, and lifestyle issues. The Checklist provides a cumulative picture of current risk when applied to a PWE. This study compares and contrasts risk factors of PWE in primary versus secondary care. METHODS The Checklist was applied to all PWE registered in four primary care practices in central Cornwall UK (pop: 120,000). Individual, modifiable, non-modifiable, and total risk factors and scores were compared between PWE open to secondary care and those not. Statistical tests were used to calculate significance of individual risk factors in primary or secondary care, to compare the total risk scores between care settings and to find the frequency differences of each risk factor between primary practices. RESULTS People with total and non-modifiable risk scores were higher in secondary care (both p < 0.001). However, modifiable risk scores were higher in primary care (p < 0.001). Psychiatric concerns were the most prevalent modifiable risk factor in primary care. There were significant differences in the risk profiles between all four primary care practices. CONCLUSION This study highlights that there is a lack of clarity on who is referred to secondary care and when. There needs to be an evidence-based system to allow for a bidirectional flow of PWE considering their fluctuating risk. The Checklist can be a decision support tool to enable this.
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Affiliation(s)
- Joanne McCabe
- University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, UK
| | - Brendan McLean
- Royal Cornwall Hospitals NHS Trust, Treliske, Truro, Cornwall, UK
| | - William Henley
- Health Statistics Group, Institute of Health Research, Royal Devon and Exeter Hospital, University of Exeter Medical School, Exeter, UK
| | - Craig Harris
- Royal Cornwall Hospitals NHS Trust, Treliske, Truro, Cornwall, UK
| | - Katie Cheatle
- Cornwall Partnership NHS Foundation Trust, Threemilestone Industrial Estate, Truro, UK
| | - Samantha Ashby
- SUDEP Action, 18 Newbury Street, Wantage, Oxfordshire, UK
| | - Rohit Shankar
- University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, UK; Cornwall Partnership NHS Foundation Trust, Threemilestone Industrial Estate, Truro, UK.
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Morrish P, Duncan S, Cock H. Epilepsy deaths: Learning from health service delivery and trying to reduce risk. Epilepsy Behav 2020; 103:106473. [PMID: 31668578 DOI: 10.1016/j.yebeh.2019.106473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 11/25/2022]
Abstract
Two recent UK reports have highlighted data of concern in relation to potentially preventable epilepsy deaths. Public Health England, an executive agency of the Government Department of Health, using National Health Service data from 2001 to 2014 reported a rise in direct age-standardised mortality for epilepsy-associated deaths, in contrast to a reduction in all-cause deaths over the same period. Premature death was seen in people aged below 50 years, especially in men, and where epilepsy was a contributory cause rather than an association. The Scottish Epilepsy Deaths Study, analysing deaths between 2009 and 2016, similarly found death in those with epilepsy was significantly higher than the matched population below the age of 54, especially between the ages of 16 and 24 (6 times higher). Sudden unexpected death in epilepsy accounted for 38% of epilepsy-related deaths under the age of 45. Both studies found a strong relationship between risk of death and deprivation; we discuss the implications of these and other data for planning service delivery and improving epilepsy care. This paper is for the Special Issue: Prevent 21: SUDEP Summit - Time to Listen.
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Affiliation(s)
| | - Susan Duncan
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh EH4 2XU, UK; Muir Maxwell Epilepsy Centre, University of Edinburgh EH9 1UW, UK
| | - Hannah Cock
- St George's, University of London SW17 0RE, UK; Atkinson Morley Regional Epilepsy Network, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK.
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Shankar R, Ashby S, McLean B, Newman C. Bridging the gap of risk communication and management using the SUDEP and Seizure Safety Checklist. Epilepsy Behav 2020; 103:106419. [PMID: 31648927 DOI: 10.1016/j.yebeh.2019.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 07/05/2019] [Indexed: 01/17/2023]
Abstract
Sudden unexpected death in epilepsy (SUDEP) is a tragic condition and, despite varied risk levels among the population with epilepsy, is the cause of significant premature mortality. In the last 20 years, though awareness of SUDEP has increased among epilepsy professionals, little has changed with regard to the death rates per se, in rates of informing people with epilepsy (PWE) of their person-centered SUDEP risks, or in the awareness levels of nonepilepsy clinicians, such as, primary care practitioners and hospital doctors. The challenges to make aware and inform PWE have been multifold, in particular, 'when', 'what', and 'how' to tell about SUDEP. Current guidance recognizes that to improve SUDEP rates, it is important to engage proactively with PWE. There is a need to bring shared responsibility between clinicians and PWE to help mitigate the risk of SUDEP. To enable this, a meaningful evidence-based person-centered conversation is essential. The SUDEP and Seizure Safety Checklist ("Checklist") was created to facilitate this. This paper showcases the background, concept, development, implementation, feasibility and validity studies undertaken, challenges, barriers, and limitations of the eight-year Checklist project, which has moved from a single clinic to an international presence. It outlines the need to further reform SUDEP risk communication recognizing the differences between a basic risk message at time of diagnosis as advocated by current good practice guidance and the need for a more person-centered discussion on a regular basis for which the Checklist can be a key catalyst. This article is part of the Special Issue "Prevent 21: SUDEP Summit - Time to Listen".
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Affiliation(s)
- Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Threemilestone Industrial Estate, Truro TR4 9LD, UK; Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro TR1 3HD, UK.
| | | | | | - Craig Newman
- Plymouth University, Peninsula Schools of Medicine and Dentistry, Plymouth PL4 8AA, UK
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Elmali AD, Bebek N, Baykan B. Let's talk SUDEP. ACTA ACUST UNITED AC 2019; 56:292-301. [PMID: 31903040 DOI: 10.29399/npa.23663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/21/2019] [Indexed: 01/17/2023]
Abstract
Sudden unexplained death in epilepsy (SUDEP) is a devastating complication of epilepsy which was under-recognized in the recent past despite its clear importance. In this review, we examine the definition of SUDEP, revise current pathophysiological theories, discuss risk factors and preventative measures, disclose tools for appraising the SUDEP risk, and last but not least dwell upon announcing and explaining the SUDEP risk to the patients and their caretakers. We aim to aid the clinicians in their responsibility of knowing SUDEP, explaining the SUDEP risk to their patients in a reasonable and sensible way and whenever possible, preventing SUDEP. Future studies are definitely needed to increase scientific knowledge and awareness related to this prioritized topic with malign consequences.
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Affiliation(s)
- Ayşe Deniz Elmali
- İstanbul University, İstanbul Faculty of Medicine, Department of Neurology, İstanbul, Turkey
| | - Nerses Bebek
- İstanbul University, İstanbul Faculty of Medicine, Department of Neurology, İstanbul, Turkey
| | - Betül Baykan
- İstanbul University, İstanbul Faculty of Medicine, Department of Neurology, İstanbul, Turkey
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12
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Watkins L, Shankar R. Reducing the Risk of Sudden Unexpected Death in Epilepsy (SUDEP). Curr Treat Options Neurol 2018; 20:40. [DOI: 10.1007/s11940-018-0527-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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