Lower Sudden Death Risk With Add-On Antiepileptic Therapy

Treatment tied to reduction of sudden death incidence in patients with refractory epilepsy

TUESDAY, Sept. 20 (HealthDay News) -- Patients with refractory epilepsy who are treated with adjunctive antiepileptic drugs (AEDs) at efficacious doses may have lower incidence of sudden unexpected death in epilepsy (SUDEP) compared with those receiving a placebo, according to a meta-analysis published online Sept. 20 in The Lancet Neurology.

Philippe Ryvlin, M.D., from the Hospices Civils de Lyon in France, and colleagues conducted a meta-analysis of 112 randomized trials to investigate the relative risk of SUDEP in patients with refractory epilepsy who received either AEDs or placebo. Data were collected on the number and causes of deaths in patients receiving AEDs at efficacious doses, those receiving AEDs at non-efficacious doses, and those receiving placebo. The incidence of definite or probable SUDEP was compared.

The investigators found that, of a total of 33 deaths, 20 were determined to be SUDEP (18 probable or definite and two possible). The likelihood of definite or probable SUDEP, all SUDEP, and all causes of death was significantly less frequent in patients treated with AEDs at efficacious doses (odds ratio, 0.17, 0.17, and 0.37, respectively) compared to patients given a placebo. The rates of definite or probable SUDEP per 1,000 person-years were 0.9 and 6.9 in patients who received AEDs at efficacious doses and those who received placebo, respectively.

"Treatment with adjunctive AEDs at efficacious doses may have reduced the incidence of definite or probable SUDEP by more than seven times compared with placebo in patients with previously uncontrolled seizures," the authors write.

Two of the study authors disclosed financial ties to the pharmaceutical industry.

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