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Antiseizure Medications and Sudden Unexpected Death in Epilepsy: An Updated Review

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CNS Drugs

Published in:

Open Access 07-08-2024 | Epilepsy | Review Article

Antiseizure Medications and Sudden Unexpected Death in Epilepsy: An Updated Review

Authors: Anemoon T. Bosch, Josemir W. Sander, Roland D. Thijs

Published in: CNS Drugs | Issue 10/2024

Abstract

Sudden unexpected death in epilepsy (SUDEP) is responsible for most epilepsy-related deaths. It is mainly related to unwitnessed nocturnal convulsions, either focal to bilateral or generalised tonic–clonic seizures (TCS). Targeted preventive strategies are currently lacking as underlying mechanisms are largely unknown. Antiseizure medications (ASMs) modulate SUDEP risk through seizure reduction, but it is yet undetermined whether individual ASMs or other medications could also influence the internal SUDEP cascade. Seizure detection devices (SDD) may offer an alternative strategy by preventing TCS from being unwitnessed. Here, we critically evaluated the current evidence on the influence of ASMs, non-epilepsy concomitant drugs and SDD on SUDEP occurrence. We found no robust evidence for the effect of starting ASMs on SUDEP beyond TCS control, but we found some indications of a protective effect for polytherapy. We found no signs that specific ASMs exert a risk for SUDEP. One study suggested a possible protective effect of levetiracetam requiring further investigation. Only a few small studies addressed the association between non-epilepsy concomitant drugs and SUDEP, with no consistent effect for psychotropic medications and one more extensive study suggesting a lower risk among statin users. We only found indirect evidence indicating a protective effect for enhancing nocturnal supervision without explicitly addressing the impact of SDD on SUDEP occurrence. Further work is needed to explore the potential of ASMs and other interventions to modulate SUDEP risk, and they should accurately account for TCS frequency, polypharmacy and markers of non-adherence.

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Title: Antiseizure Medications and Sudden Unexpected Death in Epilepsy: An Updated Review
Authors: Anemoon T. Bosch
Josemir W. Sander
Roland D. Thijs
Publication date: 07-08-2024
Publisher: Springer International Publishing
Keywords: Epilepsy
Antiepileptic Drugs
Epileptic Seizure
Neurologic Therapy
Antiepileptic Drugs
Published in: CNS Drugs / Issue 10/2024
Print ISSN: 1172-7047
Electronic ISSN: 1179-1934
DOI: https://doi.org/10.1007/s40263-024-01112-0

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