OBJECTIVE Sudden unexpected death in epilepsy (SUDEP) is a diagnosis of exclusion; the definition includes individuals with epilepsy who die suddenly without an identifiable toxicological or anatomical cause of death. Limited data suggest underidentification of SUDEP as the cause of death on death certificates. Here, we evaluate the autopsy-reported cause of death in a population-based cohort of SUDEP cases. METHODS Case summaries of forensic autopsies conducted in Ontario, Canada between January 2014 and June 2016 were retrospectively screened using a language processing script for decedents with a history of epilepsy or seizures. After manual review for potential SUDEP cases, two neurologists independently examined the autopsy reports and classified deaths by Nashef criteria. Demographic characteristics and consideration by the forensic pathologist of the role of epilepsy, seizure, and SUDEP in death were summarized. RESULTS One hundred and eight Definite, 34 Definite Plus, and 22 Possible SUDEP cases were identified. Seventy-five percent of Definite/Definite Plus SUDEP cases identified by the neurologists were attributed to SUDEP, epilepsy, or seizure disorder in the autopsy report. There was a significant association between the proportion of cases listed in the autopsy report as SUDEP, epilepsy, or seizure disorder and neurologists' SUDEP classification (86% of Definite, 38% of Definite Plus, 0% of Possible). Age was significantly associated with SUDEP classification; Definite cases were younger than Definite Plus, which were younger than Possible SUDEP cases. SIGNIFICANCE Most SUDEP cases identified by neurologists were classified concordantly by forensic pathologists in Ontario, Canada; however, concordance decreased with increased case complexity. Although the role of epilepsy/seizures was considered in most Definite/Definite Plus cases, this study highlights the need for autopsy report review of potential SUDEP cases in research studies and assessments of the public health burden of SUDEP. The relationship between age and SUDEP classification has important public health implications; SUDEP incidence may be underappreciated in older adults.

中文翻译：

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以人群为基础的癫痫猝死人群中尸检报告的死因

目的 癫痫中的突然意外死亡 (SUDEP) 是一种排除性诊断；该定义包括突然死亡但没有可识别的毒理学或解剖学原因的癫痫患者。有限的数据表明 SUDEP 作为死亡证明上的死因的认定不足。在这里，我们评估了基于人群的 SUDEP 病例队列中尸检报告的死因。方法 使用语言处理脚本对 2014 年 1 月至 2016 年 6 月在加拿大安大略省进行的法医尸检案例摘要进行回顾性筛选，以查找有癫痫或癫痫病史的死者。在对潜在的 SUDEP 病例进行人工审查后，两名神经科医生独立检查了尸检报告并根据 Nashef 标准对死亡进行分类。总结了人口统计学特征和法医病理学家对癫痫、癫痫发作和 SUDEP 在死亡中的作用的考虑。结果 确定了 108 个 Definite、34 个 Definite Plus 和 22 个可能的 SUDEP 案例。在尸检报告中，神经科医生确定的 Definite/Definite Plus SUDEP 病例中有 75% 归因于 SUDEP、癫痫或癫痫发作。尸检报告中列为 SUDEP、癫痫或癫痫症的病例比例与神经科医生的 SUDEP 分类之间存在显着关联（86% 的 Definite，38% 的 Definite Plus，0% 的可能）。年龄与 SUDEP 分类显着相关；确定病例比确定加更年轻，确定加比可能的 SUDEP 病例更年轻。意义 加拿大安大略省的法医病理学家对神经科医师确定的大多数 SUDEP 病例进行了统一分类；然而，一致性随着案件复杂性的增加而下降。尽管在大多数 Definite/Definite Plus 病例中考虑了癫痫/癫痫的作用，但本研究强调了在研究和 SUDEP 公共卫生负担评估中对潜在 SUDEP 病例进行尸检报告审查的必要性。年龄与 SUDEP 分类之间的关系具有重要的公共卫生意义；老年人的 SUDEP 发生率可能被低估。这项研究强调了在研究和评估 SUDEP 的公共卫生负担时对潜在 SUDEP 病例进行尸检报告审查的必要性。年龄与 SUDEP 分类之间的关系具有重要的公共卫生意义；老年人的 SUDEP 发生率可能被低估。这项研究强调了在研究和评估 SUDEP 的公共卫生负担时对潜在 SUDEP 病例进行尸检报告审查的必要性。年龄与 SUDEP 分类之间的关系具有重要的公共卫生意义；老年人的 SUDEP 发生率可能被低估。