Sudden unexpected death in epilepsy: people with nocturnal seizures may be at highest risk
Open accessAbstract
PURPOSE: Most people with epilepsy who die suddenly and whose death is attributed to sudden unexpected death in epilepsy (SUDEP) are found in or by the bed for unknown reasons. We assessed whether those with sleep-related SUDEP were more likely to have nocturnal seizures, and whether seizure patterns (diurnal vs. nocturnal) differed from people dying suddenly and living controls with epilepsy. METHODS: Seizure patterns in a cohort of 154 people with epilepsy who died suddenly and after autopsy conformed to the definition of SUDEP and 616 controls living with epilepsy were classified as having "exclusively diurnal" or "nocturnal seizures." Comparisons were made between the groups. SUDEP was classified as sleep-related or non-sleep-related based on eyewitness accounts and the circumstances surrounding death. KEY FINDINGS: SUDEP was primarily a sleep-related (58%) and unwitnessed (86%) event. If sleep-related, SUDEP was more likely to be unwitnessed [odds ratio (OR) 4.4, 95% confidence interval (CI) 1.6-12]. Those with sleep-related SUDEP were more likely to have a history of nocturnal seizures than those who had non-sleep-related SUDEP (OR 3.6, 95% CI 1.4-9.4). Those who died were more likely to have a history of nocturnal seizures than living controls (OR 3.9, 95% CI 2.5-6.0). After correction for previously established SUDEP risk factors (Langan et al., 2005), the presence of nocturnal seizures remained significant (OR 2.6, 95% CI 1.3-5.0). SIGNIFICANCE: Nocturnal seizures seem to be an independent risk factor for SUDEP. These findings underscore the importance of preventive measures, which may include night supervision.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Ictal asystole is probably not involved in sudden death in epilepsy, as this typically occurs in patients after unwitnessed nocturnal generalized tonic-clonic seizures, i.e. another type of epilepsy.
“Ictal asystole is probably not involved in sudden death in epilepsy, as this typically occurs in patients after unwitnessed nocturnal generalized tonic-clonic seizures, i.e. another type of epilepsy.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [419]
The State of wakefulness in SUDEP section (page unavailable) reports that most cases were unwitnessed and sleep-related. The Discussion (page unavailable) suggests SUDEP is a periictal event that probably starts with a convulsive seizure. The paper does not say ictal asystole is probably uninvolved, nor does it establish that the relevant seizures represent a different type of epilepsy. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Impact of Reduced Heart Rate Variability on Risk for Cardiac Events: The Framingham Heart Study
Tsuji, H., Larson, M. G., Venditti, F. J., Manders, E. S., Evans, J. C., Feldman, C. L., & Levy, D. (1996) · Circulation · doi:10.1161/01.cir.94.11.2850 · Cited by 1,762 · see citing works
Incidence and risk factors in sudden unexpected death in epilepsy
Walczak, T. S., Leppik, I. E., D’Amelio, M., Rarick, J. O., So, E. L., Ahman, P., Ruggles, K. H., Cascino, G. D., Annegers, J. F., & Hauser, W. A. (2001) · Neurology · doi:10.1212/wnl.56.4.519 · Cited by 545 · see citing works
The Sudden Infant Death Syndrome
Kinney, H. C., & Thach, B. T. (2009) · New England Journal of Medicine · doi:10.1056/nejmra0803836 · Cited by 527 · see citing works
Combined analysis of risk factors for SUDEP
Hesdorffer, D. C., Tomson, T., Benn, E. K. T., Sander, J. W. A. S., Nilsson, L., Langan, Y. M., Walczak, T. S., Beghi, E., Brodie, M. J., Hauser, A., et al. (2011) · Epilepsia · doi:10.1111/j.1528-1167.2010.02952.x · Cited by 501 · see citing works
Self-citationSudden unexpected death in epilepsy: risk factors and potential pathomechanisms
Surges, R., Thijs, R. D., Tan, H. L., & Sander, J. W. A. S. (2009) · Nature Reviews Neurology · doi:10.1038/nrneurol.2009.118 · Cited by 434 · see citing works
Self-citationLangan, Y. M., Nashef, L. A. M., & Sander, J. W. A. S. (2005) · Neurology · doi:10.1212/01.wnl.0000156352.61328.cb · Cited by 434 · see citing works
Self-citationAn electroclinical case‐control study of sudden unexpected death in epilepsy
Lhatoo, S. D., Faulkner, H. J., Dembny, K., Trippick, K., Johnson, C., & Bird, J. M. (2010) · Annals of Neurology · doi:10.1002/ana.22101 · Cited by 362 · see citing works
Nashef, L. A. M., Fish, D. R., Garner, S., Sander, J. W. A. S., & Shorvon, S. D. (1995) · Epilepsia · doi:10.1111/j.1528-1157.1995.tb01061.x · Cited by 305 · see citing works
Self-citationSudden unexpected death in epilepsy: a series of witnessed deaths
Langan, Y. M. (2000) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.68.2.211 · Cited by 300 · see citing works
Self-citationEEG and ECG in Sudden Unexplained Death in Epilepsy
Nei, M., Ho, R. T., Abou-Khalil, B. W., Drislane, F. W., Liporace, J. D., Romeo, A., & Sperling, M. R. (2004) · Epilepsia · doi:10.1111/j.0013-9580.2004.05503.x · Cited by 225 · see citing works
The serotonin axis: Shared mechanisms in seizures, depression, and SUDEP
Richerson, G. B., & Buchanan, G. F. (2011) · Epilepsia · doi:10.1111/j.1528-1167.2010.02908.x · Cited by 217 · see citing works
Tupal, S., & Faingold, C. L. (2006) · Epilepsia · doi:10.1111/j.1528-1167.2006.00365.x · Cited by 217 · see citing works
Circumstances of death in sudden death in epilepsy: interviews of bereaved relatives
Nashef, L. A. M., Garner, S., Sander, J. W. A. S., Fish, D. R., & Shorvon, S. D. (1998) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.64.3.349 · Cited by 168 · see citing works
Self-citationSudden unexpected death in epilepsy: A search for risk factors
Hitiris, N., Suratman, S., Kelly, K., Stephen, L. J., Sills, G. J., & Brodie, M. J. (2006) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2006.11.010 · Cited by 152 · see citing works
Bateman, L. M., Spitz, M. C., & Seyal, M. (2010) · Epilepsia · doi:10.1111/j.1528-1167.2009.02513.x · Cited by 151 · see citing works
Sudden unexpected death in epilepsy (SUDEP) and sleep
Nobili, L., Proserpio, P., Rubboli, G., Montano, N., Didato, G., & Tassinari, C. A. (2010) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2010.07.006 · Cited by 133 · see citing works
Suppressed circadian heart rate dynamics in temporal lobe epilepsy
Ronkainen, E. (2005) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.2004.053777 · Cited by 105 · see citing works
Sudden Unexplained Death in Epilepsy: An Intracranially Monitored Case
Bird, J. M., Dembny, K., Sandeman, D., et al. (1997) · Epilepsia · doi:10.1111/j.1528-1167.1997.tb06295.x · Cited by 101 · see citing works
Cyclic and circadian variations in cardiovascular events*1
Elliott, W. J. (2001) · American Journal of Hypertension · doi:10.1016/s0895-7061(01)02174-4 · Cited by 99 · see citing works
Sudden death in epilepsy recorded in ambulatory EEG
McLean, B., & Wimalaratna, S. (2007) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.2006.088492 · Cited by 92 · see citing works
Uteshev, V. V., Tupal, S., Mhaskar, Y., & Faingold, C. L. (2009) · Epilepsy Research · doi:10.1016/j.eplepsyres.2009.11.004 · Cited by 88 · see citing works
Circadian Variation in Heart‐Rate Variability in Localization‐related Epilepsy
Persson, H., Kumlien, E., Ericson, M. O., & Tomson, T. (2007) · Epilepsia · doi:10.1111/j.1528-1167.2006.00961.x · Cited by 65 · see citing works
SUDEP, suspected positional airway obstruction, and hypoventilation in postictal coma
Tao, J. X., Qian, S., Baldwin, M., Chen, X., Rose, S., Ebersole, S. M., & Ebersole, J. S. (2010) · Epilepsia · doi:10.1111/j.1528-1167.2010.02719.x · Cited by 63 · see citing works
Daltveit, A. K. N., Irgens, L., Øyen, N., Skjærven, R., Markestad, T., & Wennergren, G. (2003) · Acta Paediatrica · doi:10.1111/j.1651-2227.2003.tb02567.x · Cited by 35 · see citing works
Ye, S., Grunert, M., Thune, J. J., Stephenson, K., Uno, H., Finn, P. V., McMurray, J. J. V., Velazquez, E. J., Califf, R. M., Pfeffer, M. A., et al. (2011) · Circulation · doi:10.1161/circulationaha.110.990655 · Cited by 27 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
2018 ESC Guidelines for the diagnosis and management of syncope
Brignole, M., Moya, A., de Lange, F. J., Deharo, J.-C., Elliott, P. M., Fanciulli, A., Fedorowski, A., Furlan, R., Kenny, R. A., Martín, A., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehy037 · Cited by 1,951 · see citing works
Automated seizure detection systems and their effectiveness for each type of seizure
Ulate-Campos, A., Coughlin, F., Gaínza-Lein, M., Fernández, I. S., Pearl, P. L., & Loddenkemper, T. (2016) · Seizure · doi:10.1016/j.seizure.2016.06.008 · Cited by 233 · see citing works
Multicenter clinical assessment of improved wearable multimodal convulsive seizure detectors
Onorati, F., Regalia, G., Caborni, C., Migliorini, M., Bender, D., Poh, M., Frazier, C., Kovitch Thropp, E., Mynatt, E. D., Bidwell, J., et al. (2017) · Epilepsia · doi:10.1111/epi.13899 · Cited by 212 · see citing works
Dead in the Night: Sleep-Wake and Time-Of-Day Influences on Sudden Unexpected Death in Epilepsy
Purnell, B. S., Thijs, R. D., & Buchanan, G. F. (2018) · Frontiers in Neurology · doi:10.3389/fneur.2018.01079 · Cited by 67 · see citing works
Self-citationIctal asystole: life-threatening vagal storm or a benign seizure self-termination mechanism?
Benditt, D. G., van Dijk, G., & Thijs, R. D. (2015) · Circulation: Arrhythmia and Electrophysiology · doi:10.1161/circep.114.002546 · Cited by 57 · see citing works
Self-citationUsing photoplethysmography in heart rate monitoring of patients with epilepsy
van Andel, J., Ungureanu, C., Aarts, R., Leijten, F., & Arends, J. (2015) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2015.02.018 · Cited by 39 · see citing works
- Authors
- Lamberts, R. J., Thijs, R. D., Laffan, A., Langan, Y., & Sander, J. W.
- Affiliations
- Stichting Epilepsie Instellingen Nederland (NL)
- Leiden University Medical Center (NL)
- St. James's Hospital (IE)
- National Hospital for Neurology and Neurosurgery (GB)
- Corresponding author
- Thijs, Roland D.
- Venue
- Epilepsia
- Publisher
- Wiley
- Published
- 2011-12-22
- Volume
- 53
- Issue
- 2
- Pages
- 253-257
- ISSN
- 0013-9580 (ISSN-L)
- 1528-1167
- OpenAlex
- W1514114524
- Cited by
- 322
- References
- 25
- Citations by year
- 2026: 10 · 2025: 18 · 2024: 15 · 2023: 24 · 2022: 17 · 2021: 27 · 2020: 44 · 2019: 26 · 2018: 34 · 2017: 19 · 2016: 21 · 2015: 22 · 2014: 12 · 2013: 26 · 2012: 6
- FWCI
- 9.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Epilepsia (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- World Health Organization
- Wellcome Trust
- NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust/Institute of Cancer Research
- National Institute for Health and Care Research
- Tuberous Sclerosis Association
- Brain Research Trust
- Eisai
- University College London Hospitals NHS Foundation Trust
- Epilepsy Society
- National Institutes of Health
- Medical Research Council
- National Health and Medical Research Council
- National Medical Research Council
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmacological Effects and Toxicity Studies
- Keywords
- sudden unexpected death in epilepsy, nocturnal seizures, seizure patterns, SUDEP risk factors, epilepsy mortality
- MeSH terms
- Circadian Rhythm, Death, Sudden, Epilepsy, Female, Humans, Male, Risk Factors, Seizures, Sleep, Case-Control Studies
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
