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Stratifying Sudden Death Risk in Adults with Drug-Resistant Focal Epilepsy: The SUDEP-CARE Score.

Chris Serrand 1, 2 Sylvain Rheims 3 Marie Faucanié 1 Arielle Crespel 4 Vera Dinkelacker 5, 6 William Szurhaj 7, 8 Arnaud Biraben 9 Fabrice Bartolomei 10 Nathalie De Grissac Elizabeth Landré 11 Marie Denuelle 12, 13 Laurent Vercueil 14 Cécile Marchal 15 Louis Maillard 16, 17 Philippe Derambure 7 Sophie Dupont 18 Vincent Navarro 18, 19 Thibault Mura 2 Audrey Jaussent 1 Valérie Macioce 1, 20 Ryvlin Philippe 21 Marie-Christine Picot 1, 22 
Abstract : BACKGROUND: A clinical risk score for Sudden Unexpected Death in EPilepsy (SUDEP) in patients with drug-resistant focal epilepsy could help improve prevention. METHODS: We conducted a case-control study, including (i) definite or probable SUDEP cases collected by the French National Sentinel Mortality Epilepsy Network, and (ii) control patients from the French national research database of the epilepsy monitoring units. Patients with drug-resistant focal epilepsy were eligible. Multiple logistic regressions were performed. After sensitivity analysis and internal validation, a simplified risk score was developed from the selected variables. RESULTS: We included 62 SUDEP cases and 620 controls. Of 21 potential predictors explored, 7 were ultimately selected, including (adjusted odds ratio, 95% confidence intervals (CI)): generalised seizure frequency (>\,1/month vs <1/year: 2.6, 95%CI: 1.25-5.41), nocturnal or sleep-related seizures (4.49, 95%CI: 2.68-7.53), current or past depression (2.0, 95%CI: 1.19-3.34), or the ability to alert someone of an oncoming seizure (0.57, 95%CI: 0.33-0.98). After internal validation, a clinically usable score ranging from -1 to 8 was developed, with high discrimination capabilities (AUROC=0.85, 95%CI: 0.80-0.90). The threshold of 3 has good sensitivity (Se=82.3%, 95%CI: 72.7-91.8), while keeping a good specificity (Sp=82.7%, 95%CI: 79.8-85.7). CONCLUSIONS: These results outline the importance of generalised and nocturnal seizures on the occurrence of SUDEP, and show a protective role in the ability to alert someone of an oncoming seizure. The SUDEP-CARE score is promising and will need external validation. Further work, including paraclinical explorations, could improve this risk score.
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https://hal-u-picardie.archives-ouvertes.fr/hal-03779213
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Soumis le : vendredi 16 septembre 2022 - 15:04:13
Dernière modification le : samedi 24 septembre 2022 - 15:04:06

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Chris Serrand, Sylvain Rheims, Marie Faucanié, Arielle Crespel, Vera Dinkelacker, et al.. Stratifying Sudden Death Risk in Adults with Drug-Resistant Focal Epilepsy: The SUDEP-CARE Score.. European Journal of Neurology, Wiley, 2022, ⟨10.1111/ene.15566⟩. ⟨hal-03779213⟩

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