Meta-analysis Of Risk Factors For Sudden Unexpected Death In Epilepsy

Objectives:Sudden unexpected death in epilepsy(SUDEP)is a leading cause of death in patients with epilepsy.Recently,the pathogenesis and a number of risk factors of SUDEP have been gradually recognized based on a large number of survey,case-control and cohort studies in the world.The results,because of the design,sample size,statistical methods were different in the studies,remains contradictory even opposite,and need to be further elucidated,to get a more precise result.The present study stresses the risk factors for sudden unexpected death in epilepsy,in an attempt to gain an improved understanding and to provide a potential effective therapeutic target for SUDEP.Methods:Four words including sudden unexpected death in epilepsy 、 risk factors 、 case-control studies as well as cohort studies were strictly selected as subject headings and keywords retrieval in Pub Med,MEDLINE,Cochrane library,GOOGLE,CBM,CNKI,VIP,Wanfang from January 1997 to January 2017,and combined with manual retrieval.Formulating the inclusion and exclusion criteria,then according to the standards by two reviewers were retrieved from the literature screeningqualified literature.If there were any disagreement,was solved through consultation.If the disagreement still coundn’t be solved,the third party was needed to arbitrate.Then,A quality evaluation of the included references was made with the Newcastle-Ottawa Scale.We extracted the base case,research characteristics and research results of the references which met the inclusion criteria and quality requirements..Finally,Meta analysis was carried out by the Review Manager 5.3.We calculated the odds ratio(OR value)and 95% confidence interval(95% CI),test for Z.P<0.05 is statistically significant in this research.Results:According to the retrieval strategy and strict screening,this study corparate 8 references,all of which were English references.According to the cause of death,the total sample size of 956 cases was divided into two groups,325 cases of SUDEP group and 631 cases of the control group(non-SUDEP group),and 11 risk factors sex,age in years at epilepsy onset,epilepsy type,seizure frequency during last year,antiepileptic drug levels,multi-drug combination therapy,carbamazepine monotherapy,a history of heart disease,a history of psychiatric disease,mental retardation,alcohol abuse,were selected as the main risk factors in the study.Age in years at epilepsy onset ≤15 years old is 4.72 times of the age in years at epilepsy onset >15 years old group,the difference was statistically significant(P<0.00001).The GTCS group the incidence ofSUDEP was 1.97 times higer tan the non-GTCS group,and the difference was statistically significant(P=0.002).The incidence rate of SUEDP in the seizure frequency during last year≥50 times/ year group was 3.62 times than that of the control group,the difference was statistically significant(P=0.001).SUDEP in multi-drug combination therapy group is 2.36 times of the incidence of monotherapy group,and the difference is statistically significant(P<0.00001).The incidence rate in male group and female group was no significant difference,the difference was not statistically significant(P = 0.36).The incidence of the non-therapeutic AEDs and therapeutic AEDs groups was very similar,and the difference was not statistically significant(P = 0.67).There was no significant difference between the two groups in the carbamazepine monotherapy group and other AEDs therapy group,and the difference was not statistically significant(P=0.98).The result of a history of heart disease and no history of heart disease groups was very similar,the difference was not statistically significant(P = 0.17).There was no significant difference between a history of psychiatric disease group and no history of psychiatric disease group,and the difference was not statistically significant(P=0.28).There was a 2.39 fold difference in the incidence of SUDEP in the mental retardation group,but the difference was not statistically significant(P = 0.26).There was not significant difference between the alcohol abuse group and no alcohol abuse group,and thedifference was not statistically significant(P=0.48).Conclusion:Four factors including age in years at epilepsy onset ≤15 years old,generalised tonic–clonic seizure,seizure frequency during last year≥50time per year as well as multi-drug combination therapy is closely related to SUDEP,while the correlation of sex,antiepileptic drug levels,catbamazapine monotherapy,a history of heart disease,a history of psychiatric disease,mental retardation and alcohol abuse with SUDEP is uncertain.In addition this study included sample size was small,and did not include all the risk factors for SUDEP.So the analysis of this paper still needed to be confirmed.