scholarly journals Reducing Sudden Unexpected Death in Epilepsy: Considering Risk Factors, Pathophysiology and Strategies

2021 ◽  
Vol 23 (11) ◽  
Author(s):  
Nathan A. Shlobin ◽  
Josemir W. Sander
Keyword(s):  
Risk Factors ◽  
Significant Proportion ◽  
Premature Mortality ◽  
Sudden Unexpected Death ◽  
Unexpected Death ◽  
Cardiorespiratory Function ◽  
Younger Age ◽  
History Of ◽  
Symptomatic Epilepsy ◽  
Convulsive Seizures

Abstract Purpose of Review Sudden Unexpected Death in Epilepsy (SUDEP) is the commonest cause of epilepsy-related premature mortality in people with chronic epilepsy. It is the most devastating epilepsy outcome. We describe and discuss risk factors and possible pathophysiological mechanisms to elucidate possible preventative strategies to avert SUDEP. Recent Findings Sudden death accounts for a significant proportion of premature mortality in people with epilepsy compared to the general population. Unmodifiable risk factors include a history of neurologic insult, younger age of seizure-onset, longer epilepsy duration, a history of convulsions, symptomatic epilepsy, intellectual disability, and non-ambulatory status. Modifiable risk factors include the presence of convulsive seizures, increased seizure frequency, timely and appropriate use of antiseizure medications, polytherapy, alcoholism, and supervision while sleeping. Pathophysiology is unclear, but several possible mechanisms such as direct alteration of cardiorespiratory function, pulmonary impairment, electrocerebral shutdown, adenosine dysfunction, and genetic susceptibility suggested. Summary Methods to prevent SUDEP include increasing awareness of SUDEP, augmenting knowledge of unmodifiable risk factors, obtaining full seizure remission, addressing lifestyle factors such as supervision and prone positioning, and enacting protocols to increase the detection of and intervention for SUDEP. Further studies are required to characterize precisely and comprehensively SUDEP risk factors and pathophysiological drivers and develop evidence-based algorithms to minimize SUDEP in people with epilepsy.

scholarly journals Is there something special about cardiovascular abnormalities and sudden unexpected death in epilepsy among patients with chronic renal insufficiency in regular hemodialysis program?

2009 ◽  
Vol 67 (2a) ◽  
pp. 209-213 ◽  
Author(s):  
Rui A. Gomes ◽  
Silvana Kesrouani ◽  
Jenner Cruz ◽  
Alexandre L. Silva ◽  
Tânia M.G. Henriques ◽  
...  
Keyword(s):  
Renal Insufficiency ◽  
Chronic Renal Insufficiency ◽  
Sudden Unexpected Death ◽  
Unexpected Death ◽  
Cardiovascular Abnormalities ◽  
History Of ◽  
Clonic Seizures ◽  
Convulsive Seizures ◽  
The Many ◽  
Regular Hemodialysis

Of the many risk factors suggested for sudden unexpected death in epilepsy (SUDEP), higher frequency of seizures is a very consistent issue. Following this reasoning, it has been established that hemodialysis-associated seizure is a complication of dialysis procedure. Based on these facts, this study investigated a possible association between cardiovascular abnormalities and SUDEP among patients with chronic renal insufficiency in regular hemodialysis program. For that, a retrospective medical history of 209 patients was reviewed to investigate the occurrence of convulsive seizures and EKG abnormalities during dialytic program. Three patients presented generalized tonic-clonic seizures, one had partial seizure with secondary generalization, and one presented unclassified seizure. Any EKG abnormalities and SUDEP event were found in all patients evaluated. In conclusion, the present findings demonstrated uncommon the occurrence of seizures and also SUDEP. Probably, the main justification to not allow us to demonstrated a direct relation between SUDEP and cardiovascular diseases in hemodialysis are the reduced number of cases examined.

Seizures and Epilepsy (DRAFT)

2018 ◽  
Author(s):  
Tamara Kaplan ◽  
Tracey Milligan
Keyword(s):  
Risk Factors ◽  
Brain Injury ◽  
Family History ◽  
Cognitive Disorders ◽  
Febrile Seizures ◽  
Sudden Unexpected Death ◽  
Unexpected Death ◽  
Generalized Seizures ◽  
History Of

The video in this chapter explores seizures and epilepsy, including definitions or focal or generalized seizures and epilepsy, as well as the differences between the two. It discusses risk factors for epilepsy (family history, history of febrile seizures, brain injury) and its diagnosis (by history and EEG), as well as comorbidities of epilepsy (mood and cognitive disorders, accidents, and sudden unexpected death).

Incidence of postural headache after lumbar puncture requiring epidural blood patch: Effects of needle caliber; 2-year experience

2021 ◽  
pp. 197140092110006
Author(s):  
Warren Chang ◽  
Ajla Kadribegic ◽  
Kate Denham ◽  
Matthew Kulzer ◽  
Tyson Tragon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lumbar Puncture ◽  
Conservative Management ◽  
Epidural Blood Patch ◽  
Female Gender ◽  
Regional Hospital ◽  
Younger Age ◽  
Blood Patch ◽  
History Of ◽  
The Difference

Purpose A common complication of lumbar puncture (LP) is postural headaches. Epidural blood patches are recommended if patients fail conservative management. Owing to a perceived increase in the number of post-lumbar puncture headaches (PLPHs) requiring epidural blood patches at a regional hospital in our network, the decision was made to switch from 20 to 22 gauge needles for routine diagnostic LPs. Materials and methods Patients presenting for LP and myelography at one network regional hospital were included in the study. The patients were contacted by nursing staff 3 days post-procedure; those patients who still had postural headaches after conservative management and received epidural blood patches were considered positive cases. In total, 292 patients were included; 134 underwent LP with 20-gauge needles (53 male, 81 female, average age 57.7) and 158 underwent LP with 22-gauge needles (79 male, 79 female, average age 54.6). Results Of 134 patients undergoing LP with 20-gauge needles, 15 (11%) had PLPH requiring epidural blood patch (11 female, 3 male, average age 38). Of 158 patients undergoing LP with 22-gauge needles, only 5 (3%) required epidural blood patches (all female, average age 43). The difference was statistically significant ( p < 0.01). Risk factors for PLPH included female gender, younger age, lower body mass index, history of prior PLPH and history of headaches. Conclusion Switching from 20-gauge to 22-gauge needles significantly decreased the incidence of PLPH requiring epidural blood patch. Narrower gauge or non-cutting needles should be considered in patients with risk factors for PLPH, allowing for CSF requirements.

Sudden unexpected death in epilepsy: A search for risk factors

2007 ◽  
Vol 10 (1) ◽  
pp. 138-141 ◽  
Author(s):  
Nikolas Hitiris ◽  
Suraya Suratman ◽  
Kevin Kelly ◽  
Linda J. Stephen ◽  
Graeme J. Sills ◽  
...  
Keyword(s):  
Risk Factors ◽  
Sudden Unexpected Death ◽  
Unexpected Death

Dynamic networks of psychotic symptoms in adults living in precarious housing or homelessness

2021 ◽  
pp. 1-11
Author(s):  
Andrea A. Jones ◽  
Kristina M. Gicas ◽  
Sara Mostafavi ◽  
Melissa L. Woodward ◽  
Olga Leonova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Psychotic Disorder ◽  
Psychotic Disorders ◽  
Community Sample ◽  
Dynamic Networks ◽  
Premature Mortality ◽  
Psychotic Symptoms ◽  
Network Measures ◽  
History Of ◽  
Precarious Housing

Abstract Background People living in precarious housing or homelessness have higher than expected rates of psychotic disorders, persistent psychotic symptoms, and premature mortality. Psychotic symptoms can be modeled as a complex dynamic system, allowing assessment of roles for risk factors in symptom development, persistence, and contribution to premature mortality. Method The severity of delusions, conceptual disorganization, hallucinations, suspiciousness, and unusual thought content was rated monthly over 5 years in a community sample of precariously housed/homeless adults (n = 375) in Vancouver, Canada. Multilevel vector auto-regression analysis was used to construct temporal, contemporaneous, and between-person symptom networks. Network measures were compared between participants with (n = 219) or without (n = 156) history of psychotic disorder using bootstrap and permutation analyses. Relationships between network connectivity and risk factors including homelessness, trauma, and substance dependence were estimated by multiple linear regression. The contribution of network measures to premature mortality was estimated by Cox proportional hazard models. Results Delusions and unusual thought content were central symptoms in the multilevel network. Each psychotic symptom was positively reinforcing over time, an effect most pronounced in participants with a history of psychotic disorder. Global connectivity was similar between those with and without such a history. Greater connectivity between symptoms was associated with methamphetamine dependence and past trauma exposure. Auto-regressive connectivity was associated with premature mortality in participants under age 55. Conclusions Past and current experiences contribute to the severity and dynamic relationships between psychotic symptoms. Interrupting the self-perpetuating severity of psychotic symptoms in a vulnerable group of people could contribute to reducing premature mortality.

Pattern of Congenital Heart Diseases and Associated Risk Factors among Children at a Tertiary Care Hospital

2021 ◽  
Vol 15 (9) ◽  
pp. 2451-2453
Author(s):  
Shahid Iqbal ◽  
Muhammad Fareed Khan ◽  
Raja Imtiaz Ahmed ◽  
Shahab Saidullah ◽  
Nisar Ahmed ◽  
...  
Keyword(s):  
Risk Factors ◽  
Folic Acid ◽  
Congenital Heart ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Febrile Illness ◽  
Care Hospital ◽  
Younger Age ◽  
History Of ◽  
Associated Risk Factors

Objective: To find out the pattern of CHD and associated risk factors among children presenting at a tertiary care hospital. Study Design: A case-control study. Place and Duration of the Study: The Department of Pediatrics and Department of Cardiology, Sheikh Khalifa Bin Zayed Al Nahyan Hospital, Rawlakot from July 2020 to June 2021. Material and Methods: A total of 207 children of both genders, screened by ECG along with chest x-ray and further confirmed with the diagnosis of CHD through echocardiography were enrolled as cases. Same number of healthy controls (n=207) were recruited from immunization center of the study institution. Among cases, types of CHD were noted. For cases and controls, demographic, antenatal and maternal risk factors including maternal age, gender of the child, history of consanguinity, history of febrile illness in pregnancy, use or multi-vitamin or folic acid in pregnancy, bad obstetrical history and maternal diabetes mellitus were noted. Results: In a total of 414 children (207 cases and 207 controls), there were 219 (53.8%) male. In terms of CHD types among cases, VSD was the most noted in 62 (30.0%), ASD 35 (16.9%), TOF 33 (15.9%) and PDA in 30 (14.5%). Cases were found to have significant association with younger age (78.3% cases below 1 year of age vs. 64.7% in controls, p=0.0085), bad obstetrical history (p=0.0002), history of febrile illness in 1st trimester of pregnancy (p=0.0229) and lack of multivitamins and folic acid in the 1st trimester of pregnancy (p=0.0147). Conclusion: Majority of the children with CHDs were male and aged below 1 year. VSD, ASD, TOF and PDA were the most frequent types of CHD. Younger age, bad obstetrical history, history of febrile illness in 1st trimester of pregnancy and lack of multivitamins and folic acid in the 1st trimester of pregnancy were found to have significant association with CHDs among children. Keywords: Congenital heart disease, echocardiography, ventricular septal defect.

scholarly journals Practice Guideline Summary: Sudden Unexpected Death in Epilepsy Incidence Rates and Risk Factors: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society

2017 ◽  
Vol 17 (3) ◽  
pp. 180-187 ◽  
Author(s):  
Cynthia Harden ◽  
Torbjörn Tomson ◽  
David Gloss ◽  
Jeffrey Buchhalter ◽  
J. Helen Cross ◽  
...  
Keyword(s):  
Risk Factors ◽  
Guideline Development ◽  
Evaluation Process ◽  
Incidence Rates ◽  
Sudden Unexpected Death ◽  
Dissemination And Implementation ◽  
Seizure Freedom ◽  
High Confidence ◽  
Unexpected Death ◽  
Assessment Development

Objective: To determine the incidence rates of sudden unexpected death in epilepsy (SUDEP) in different epilepsy populations and address the question of whether risk factors for SUDEP have been identified. Methods: Systematic review of evidence; modified Grading Recommendations Assessment, Development and Evaluation process for developing conclusions; recommendations developed by consensus. Results: Findings for incidence rates based on 12 Class I studies include the following: SUDEP risk in children with epilepsy (aged 0–17 years) is 0.22/1,000 patient-years (95% CI 0.16–0.31) (high confidence in evidence). SUDEP risk increases in adults to 1.2/1,000 patient-years (95% CI 0.64–2.32) (low confidence in evidence). The major risk factor for SUDEP is the occurrence of generalized tonic-clonic seizures (GTCS); the SUDEP risk increases in association with increasing frequency of GTCS occurrence (high confidence in evidence). Recommendations: Level B: Clinicians caring for young children with epilepsy should inform parents/guardians that in 1 year, SUDEP typically affects 1 in 4,500 children; therefore, 4,499 of 4,500 children will not be affected. Clinicians should inform adult patients with epilepsy that SUDEP typically affects 1 in 1,000 adults with epilepsy per year; therefore, annually 999 of 1,000 adults will not be affected. For persons with epilepsy who continue to experience GTCS, clinicians should continue to actively manage epilepsy therapies to reduce seizures and SUDEP risk while incorporating patient preferences and weighing the risks and benefits of any new approach. Clinicians should inform persons with epilepsy that seizure freedom, particularly freedom from GTCS, is strongly associated with decreased SUDEP risk.

Sudden Unexpected Death of Two Infants in Baby Carriers

2021 ◽  
Author(s):  
Dennis Storz ◽  
Christof Dame ◽  
Anke Wendt ◽  
Alexander Gratopp ◽  
Christoph Bührer
Keyword(s):  
Risk Factors ◽  
Infant Development ◽  
Sudden Infant Death ◽  
Developed Countries ◽  
Bottle Feeding ◽  
Sudden Unexpected Death ◽  
Sudden Infant ◽  
Unexpected Death ◽  
Sleeping Position ◽  
Prone Sleeping Position

Sudden unexpected death in infancy (SUDI), previously termed sudden infant death syndrome (SIDS), is the second leading cause of death in infants beyond the neonatal period in Germany, and a major cause of infant mortality in economically well developed countries (OECD Health Statistics, 2019). The risk of SUDI peaks at the age of 2–4 months and then decreases continuously till the end of the first year. A complex multifactorial cause, rather than a single characteristic factor, may cause SUDI within a critical period of infant development (Guntheroth WG et al., Pediatrics 2002; 110: e64–e64). Risk factors include prematurity, male gender, bottle-feeding, prone sleeping position, overheating, as well as exposure to smoke amongst others (Carpenter RG et al., Lancet 2004; 363: 185–191). Thus, health professionals consistently advise and educate parents about avoidable risk factors of SUDI at routine well-baby examinations. Since the advent of SUDI prevention strategies in the 1980s, the incidence has decreased 10fold, from 1,55/1.000 live births in 1991 to 0,15/1000 in 2015. This number seems to have reached a steady state (Statistisches Bundesamt Germany, 2015).

Prevalence And Risk Factors Of Internet Addiction Among Hungarian High School Teachers

2020 ◽  
Author(s):  
Gabor Toth ◽  
Krisztian Kapus ◽  
David Hesszenberger ◽  
Marietta Pohl ◽  
Gabor Kosa ◽  
...  
Keyword(s):  
Risk Factors ◽  
High School ◽  
High School Teachers ◽  
Internet Addiction ◽  
Demographic Data ◽  
Significant Proportion ◽  
Family Status ◽  
School Teachers ◽  
Younger Age ◽  
Secondary Employment

Abstract The extensive availability of internet has led to the the recognition of problematic internet use (so called internet addiction, IA) mostly involving adolescents. There is insufficient data about the prevalence of IA in adults. Here we present a study focusing on the prevalence and risk factors of internet addiction among high school teachers.Overall 2500 paper-based questionnaires were successfully delivered and 1817 responses received (response rate of 72.7%). 1194 females (65.7%) and 623 males (34.3%) participated in our study.In a multivariate analysis including of all factors (demographic data, internet habits, comorbidity etc) age < 35 years (OR: 6.098, CI: 5.09-7.08, p<0.001), male gender (OR=5.413, CI: 4.39-6.18, p=0.002), surfing on the internet > 5 hours daily (OR 2.568, CI: 2.03-3.39, p<0.001), having no children (OR: 1.353, CI: 1.13-1.99, p=0.0248), and having secondary employment (OR=11.377, CI: 8.67-13.07, p=0.001) were significantly associated with internet addiction.This is the first study from Hungary showing the prevalence and risk factors of internet addiction among high school teachers. A small, but significant proportion suffered from IA. Our study also draws attention to the risk factors of IA such as younger age, family status and working type.

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