Presence of Nighttime Seizures May Increase Risk of Death in Patients With Epilepsy
Researchers have found that having nighttime seizures, especially generalized seizures at night, increases the risk of sudden unexpected death in epilepsy (SUDEP).(Neurology:September 21, 2018) In a study of SUDEP at 2 residential centers for adults with severe epilepsy and intellectually disability, those who died of SUDEP were more likely to have nocturnal convulsive seizures (77%) compared with controls (33%, P < .001) and to have a higher frequency of nighttime convulsive seizures. The total incidence of SUDEP was 3.53/1,000 patient-years (95% CI, 2.73–4.53). Incidence of SUDEP differed between the 2 centers. The center with a lower level of nighttime supervision had almost a 3-fold higher incidence of SUDEP. Even at the center with higher monitoring, the rate of SUDEP was more than double that of the general population with epilepsy.
In this nested, case-controlled study, all records of patients who died at either of 2 residential settings were reviewed for age, residential unit, and level of nocturnal supervision. For each occurrence of a patient who died of SUDEP (n = 60), multiple control subjects, matched by age within 5 years of patient dying of SUDEP, assignment to the same residential unit, and having the same level of nighttime supervision were selected (n = 198).
Nighttime supervision was graded as having no supervision; having a listening device, roommate, or checks every 15 minutes; or having 2 of the following: a listening device, roommate, bed sensor or video monitor, and physical checks every 15 minutes. Presence and type of nocturnal seizures and other outcome measures for patients who died of SUDEP were compared with the matched control subjects using Mann-Whitney U tests and Fisher exact tests.
In an accompanying editorial it is suggested that certain patient populations with epilepsy would benefit from nighttime seizure monitoring. The study authors also noted that the higher rate of SUDEP in the populations they studied can be partly accounted for by lower levels of nighttime monitoring.