Adjunctive Anti-epileptic Drug Therapy and Prevention of SUDEP

Saturday, October 15, 2011

In the in-press electronic version of Lancet Neurology, Professor Ryvlin and colleagues from the Claude Bernard Universite in Lyon, France, presents a meta-analysis of the impact of anti-epileptic drugs on the prevention of sudden unexplained death in epilepsy ( SUDEP).  The investigators searched MEDLINE and the Cochrane Library for randomized trials investigating any anti-epileptic drug in the add-on treatment of drug-resistant epilepsy in adults.  They specifically looked at the causes of death in patients who had been randomized to taking medications at doses that were more effective than placebo (a sugar pill).  They then compared the occurrence of definite or probable SUDEP between patients given therapeutic or effective doses of anti-epileptic drugs versus those given placebo.

They found 33 deaths, including 20 which were deemed as SUDEP.  These were extracted for 112 possible randomized trials.  The investigators found that the definite or probable SUDEP in all causes of death for the most part were significantly less common in the group that had been given a seizure drug versus a placebo.  The authors concluded that treatment with anti-epileptic drugs at therapeutic doses can reduce the incidence of definite or probable SUDEP by more than seven times compared to a placebo. 

The study is an important one because it highlights once again the fact that seizures are the cause of SUDEP, and therefore preventing seizures by effective treatment that reduces the cause of seizures (such as anti seizure drugs) would be helpful.  Although this is a retrospective study and needs to be verified in other research, this is an important paper because it once again helps underscore the importance of SUDEP counseling and the importance of pursuing therapies for seizures.

Authored by: Joseph I Sirven, MD on 10/2011

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