Status Epilepticus a risk factor for Sudden Unexpected Death in Epilepsy (SUDEP): A scoping review and narrative synthesis

Rohit Shankar, Zygimantas Puras, Saffron Richardson, Lance Watkins

Research output: Contribution to journalReview articlepeer-review

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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 tonicclonic 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.
Original languageEnglish
Article number110085
JournalEpilepsy and Behavior
Volume160
DOIs
Publication statusPublished - 9 Oct 2024

ASJC Scopus subject areas

  • Neurology
  • Neurology (clinical)
  • Behavioral Neuroscience

Keywords

  • Status Epilepticus
  • SUDEP
  • Epilepsy
  • Risk factor
  • Mortality

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