Abstract 972: Anti-Epileptic Drugs Are Associated With Sudden Death
Introduction: Epilepsy is associated with an increased mortality rate. Cardiac arrhythmias are proposed as a mechanism for sudden death in epilepsy. Anti-Epileptic Drugs (AEDs) may influence cardiac conduction directly by blocking cardiac sodium current, while blockade of cardiac sodium channels may evoke lethal arrhythmias. Therefore, we performed a case-control study on the association between the use of AEDs and sudden death in a community-based database.
Methods: A population-based case-control study was performed in the Integrated Primary Care Information (IPCI) project, a longitudinal observational database with complete medical records from more than 800,000 persons. All deaths between 1 January 1995 and 1 May 2007 were reviewed. Sudden death was classified based on the time between onset of symptoms and death. For each case, up to 20 random controls were matched for age, gender, date of sudden death, and general practice. The exposure of interest was the use of AEDs. The AEDs were divided into two groups: those with documented ability to block (neural and/or cardiac) sodium channels, and those without such ability.
Results: The study population comprised 926 cases of sudden death and 9832 matched controls. Current use of any AED was associated with a significantly increased risk for sudden death (adjusted odds ratio [OR]: 2.5; 95% confidence interval [CI]: 1.5– 4.2). The highest risk was observed among users of AEDs with sodium channel blocking ability (adjusted OR: 2.9; 95% CI: 1.5– 4.2). The risk among users of non-sodium channel blocking AEDs was lower and not significant. Subanalysis of individual AEDs showed an increased and significant risk for sudden death for carbamazepine (adjusted OR: 3.4 (1.5–7.7). Past use of AEDs was not associated with sudden death.
Conclusion: Current use of AEDs is associated with an increased risk for sudden death in the general population. The risk for sudden death seems to be higher among users of carbamazepine and other AEDs with sodium channel blocking properties.