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

AdultPediatric

Mar 31

Ryvlin P, So EL, Gordon CM, Hesdorffer DC, Sperling MR, Devinsky O, Bunker MT, Olin B, Friedman D.

Epilepsia. 2018 Mar;59(3):562-572.
https://doi.org/10.1111/epi.14002

Sudden Unexpected Death in Epilepsy (#SUDEP) refers to the death of a patient with epilepsy that is not related to drowning, trauma, status epilepticus, or any other known causes[1,2]. Every October the SUDEP Action Month Campaign that aims to raise awareness of SUDEP takes place[3].

Therefore, we would like to share an article by Ryvlin et al. (Dec. 2018) examining SUDEP rates during vagus nerve stimulation (#VNS) postimplantation follow-up periods in drug-resistant epilepsy (#DRE) patients.

The study included 40 443 #epilepsy patients, receiving VNS treatment in the U.S., from the VNS Device Tracking Database (Cyberonics, Inc./LivaNova, Houston, TX, USA). The accumulating follow-up time was 277 661 person-year (PY). The total death number was 3689, including 632 SUDEP cases.

The results showed that the age-adjusted SUDEP rate was significantly reduced from 2.47/1000 PY for 1-2 years of follow-up to 1.68/1000 PY for 3-10 years of follow-up (p=0.008) for the patients using VNS Therapy.

The best way to lower SUDEP risk is to achieve seizure control. Hence, VNS Therapy might prevent SUDEP by (1) achieving better control of generalized tonic-clonic seizures (the main SUDEP risk factor)[4, 5], (2) reducing the duration and severity of ictal and postictal phases[6], and (3) its increasing efficiency with the long-term follow-up[7].

For future studies, the effect of attrition, age, medication change, medical practices, and VNS parameter settings on the SUDEP rate should be considered to confirm these results.

Ref.

[1]https://onlinelibrary.wiley.com/doi/epdf/10.1111/epi.14195

[2]https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1528-1157.1997.tb06137.x

[3]https://www.daysoftheyear.com/days/sudep-action-month/

[4]https://thejns.org/pediatrics/view/journals/j-neurosurg-pediatr/10/3/article-p200.xml

[5]https://reader.elsevier.com/reader/sd/pii/S1059131103002279?token=C2B6F7ACA1E975B3D875586F742589BF9912519F6C47A695123C0EAB8EF4D23876D8D418A6A64994ADA608B8DF252075&originRegion=eu-west-1&originCreation=20221003090734

[6]https://onlinelibrary.wiley.com/doi/epdf/10.1111/ane.12288

[7]https://n.neurology.org/content/53/8/1731.long