Long-term surveillance of SUDEP in drug-resistant epilepsy patients treated with VNS therapy

Philippe Ryvlin, Elson L. So, Charles M. Gordon, Dale C. Hesdorffer, Michael R. Sperling, Orrin Devinsky, Mark T. Bunker, Bryan Olin, Daniel Friedman

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Objective: Limited data are available regarding the evolution over time of the rate of sudden unexpected death in epilepsy patients (SUDEP) in drug-resistant epilepsy. The objective is to analyze a database of 40 443 patients with epilepsy implanted with vagus nerve stimulation (VNS) therapy in the United States (from 1988 to 2012) and assess whether SUDEP rates decrease during the postimplantation follow-up period. Methods: Patient vital status was ascertained using the Centers for Disease Control and Prevention's National Death Index (NDI). An expert panel adjudicated classification of cause of deaths as SUDEP based on NDI data and available narrative descriptions of deaths. We tested the hypothesis that SUDEP rates decrease with time using the Mann-Kendall nonparametric trend test and by comparing SUDEP rates of the first 2 years of follow-up (years 1-2) to longer follow-up (years 3-10). Results: Our cohort included 277 661 person-years of follow-up and 3689 deaths, including 632 SUDEP. Primary analysis demonstrated a significant decrease in age-adjusted SUDEP rate during follow-up (S = -27 P = .008), with rates of 2.47/1000 for years 1-2 and 1.68/1000 for years 3-10 (rate ratio 0.68; 95% confidence interval [CI] 0.53-0.87; P = .002). Sensitivity analyses confirm these findings. Significance: Our data suggest that SUDEP risk significantly decreases during long-term follow-up of patients with refractory epilepsy receiving VNS Therapy. This finding might reflect several factors, including the natural long-term dynamic of SUDEP rate, attrition, and the impact of VNS Therapy. The role of each of these factors cannot be confirmed due to the limitations of the study.

Original languageEnglish (US)
JournalEpilepsia
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Vagus Nerve Stimulation
Sudden Death
Epilepsy
Therapeutics
Drug Resistant Epilepsy
Centers for Disease Control and Prevention (U.S.)
Cause of Death

Keywords

  • Epilepsy
  • Mortality
  • Sudden unexpected death in epilepsy patients
  • Vagus nerve stimulation

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Ryvlin, P., So, E. L., Gordon, C. M., Hesdorffer, D. C., Sperling, M. R., Devinsky, O., ... Friedman, D. (Accepted/In press). Long-term surveillance of SUDEP in drug-resistant epilepsy patients treated with VNS therapy. Epilepsia. https://doi.org/10.1111/epi.14002

Long-term surveillance of SUDEP in drug-resistant epilepsy patients treated with VNS therapy. / Ryvlin, Philippe; So, Elson L.; Gordon, Charles M.; Hesdorffer, Dale C.; Sperling, Michael R.; Devinsky, Orrin; Bunker, Mark T.; Olin, Bryan; Friedman, Daniel.

In: Epilepsia, 01.01.2018.

Research output: Contribution to journalArticle

Ryvlin, P, So, EL, Gordon, CM, Hesdorffer, DC, Sperling, MR, Devinsky, O, Bunker, MT, Olin, B & Friedman, D 2018, 'Long-term surveillance of SUDEP in drug-resistant epilepsy patients treated with VNS therapy', Epilepsia. https://doi.org/10.1111/epi.14002
Ryvlin P, So EL, Gordon CM, Hesdorffer DC, Sperling MR, Devinsky O et al. Long-term surveillance of SUDEP in drug-resistant epilepsy patients treated with VNS therapy. Epilepsia. 2018 Jan 1. https://doi.org/10.1111/epi.14002
Ryvlin, Philippe ; So, Elson L. ; Gordon, Charles M. ; Hesdorffer, Dale C. ; Sperling, Michael R. ; Devinsky, Orrin ; Bunker, Mark T. ; Olin, Bryan ; Friedman, Daniel. / Long-term surveillance of SUDEP in drug-resistant epilepsy patients treated with VNS therapy. In: Epilepsia. 2018.
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