[Research] Additional Drug Lowers Risk of SUDEP

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Additional Anti-Epileptic Drug Treatment Lowers Risk of Death

Epilepsy patients receiving additional treatment with anti-epileptic drugs (anti-epileptic drugs) have an approximately seven times lower risk of dying from a sudden unexpected death according to new research published online first in The Lancet Neurology.
In comparison with the general population, sudden unexplained death is 20 times more common in people suffering from epilepsy. Researchers have found some potentially preventable risk factors for sudden unexpected death in epilepsy (Sudden Unexplained Death in Epilepsy), such as large numbers of generalized tonic-clonic seizures (the most common type of generalized seizure affecting the entire brain) and taking a combined regimen of anti-epileptic drugs (polytherapy). Until recently, no research has examined or developed a beneficial effect at preventing Sudden Unexplained Death in Epilepsy in a controlled study.
Philippe Ryvlin from the Hôpital Neurologique in Lyon, France, and his team collated data from 112 randomized trials of anti-epileptic drug adjunctive treatment of adults with treatment-resistant (refractory) epilepsy to evaluate comparisons of definite and probable Sudden Unexplained Death in Epilepsy incidences between patients receiving add-on anti-epileptic drug therapy at effective doses and those given placebo.
During the trials a total of 33 patients died, with 18 deaths being caused by probable or definite Sudden Unexplained Death in Epilepsy, and two deaths due to possible Sudden Unexplained Death in Epilepsy.
Analyses revealed in general that patients treated with adjunctive anti-epileptic drugs at effective doses had a seven times reduced risk of dying a Sudden Unexplained Death in Epilepsy compared with those given placebo with rates of definite and probable Sudden Unexplained Death in Epilepsy being 0.9 per 1000 person-years in the anti-epileptic drug group and 6.9 per 1000 person-years in the placebo group.
According to the authors, treatment-related reduction in the frequency of seizures seems the most likely explanation for significantly low rate of Sudden Unexplained Death in Epilepsy in patients administered with anti-epileptic drugs at effective doses. Opposing research's suggestion that polytherapy might increase the risk of Sudden Unexplained Death in Epilepsy, the authors point out, stating: "Our data suggest that add-on anti-epileptic drugs at doses effective on seizure frequency reduce the risk of Sudden Unexplained Death in Epilepsy despite increasing the drug load, at least during the average 3-month duration of randomized trials," concluding that, "This finding provides an argument not only for active revision and optimum management of treatment in patients with uncontrolled seizures, but also for further prospective and long-term investigation of this unsettled issue."
Dale Hesdorffer from Columbia University in New York, USA and Torbjorn Tomson from the Karolinska Institute in Stockholm, Sweden, outline three key implications of the findings in a comment:

"First, the study provides strong evidence for an effective intervention to reduce Sudden Unexplained Death in Epilepsy risk. Second, the protective effective of adjunctive therapy suggests that seizure control could be extremely important for Sudden Unexplained Death in Epilepsy prevention. Third, polytherapy does not increase risk of Sudden Unexplained Death in Epilepsy during the time period of a randomized trial."

http://www.medicalnewstoday.com/articles/234740.php