Figure 4. Individualized Model Predictions of Sudden Unexpected Death In Epilepsy (SUDEP).

To demonstrate the potential research and clinical utility of this tool, the individualized risk predictions of 10 individuals with epilepsy are shown. These individuals are not known to the model, were drawn from recent practice, and were selected as their SUDEP risk was of clinical interest. The risk is presented on the y axis as a summary measure of a probability distribution (black circle = mean, red line 80% credibility interval, black line 95% credibility interval) for individuals A–J specified on the x axis and ordered by mean predicted risk. Note the y axis is a log scale with risk quantified as a ratio for ease of interpretation. The dotted horizontal line represents the average population risk of 1–2/1,000 patient-years. The predictions are probabilistic, intuitive, and help focus discussions in a time-limited setting such as a clinical consultation. Important prognostic factors vary between the individuals and so multiple factors need to be considered together. For example, in those 5 with the highest risk, focal seizure frequency is particularly important in F, H, and J, generalized tonic-clonic seizures (GTCS) frequency in G, and poor adherence in I. Two of the individuals with highest risk (marked with a red circle next to their names) have died of SUDEP. ASM = antiseizure medications. *The influence of levetiracetam was not modeled.