scholarly journals Delta-gamma phase-amplitude coupling as a biomarker of postictal generalized EEG suppression

2020 ◽  
Vol 2 (2) ◽  
Author(s):  
Vasily Grigorovsky ◽  
Daniel Jacobs ◽  
Vanessa L Breton ◽  
Uilki Tufa ◽  
Christopher Lucasius ◽  
...  
Keyword(s):  
Treatment Phase ◽  
Rhythmic Activity ◽  
Sudden Unexpected Death ◽  
Network Activity ◽  
Unexpected Death ◽  
Baseline Activity ◽  
Increased Risk ◽  
Coupling Dynamics ◽  
Postictal Suppression ◽  
Phase Amplitude

Abstract Postictal generalized EEG suppression is the state of suppression of electrical activity at the end of a seizure. Prolongation of this state has been associated with increased risk of sudden unexpected death in epilepsy, making characterization of underlying electrical rhythmic activity during postictal suppression an important step in improving epilepsy treatment. Phase-amplitude coupling in EEG reflects cognitive coding within brain networks and some of those codes highlight epileptic activity; therefore, we hypothesized that there are distinct phase-amplitude coupling features in the postictal suppression state that can provide an improved estimate of this state in the context of patient risk for sudden unexpected death in epilepsy. We used both intracranial and scalp EEG data from eleven patients (six male, five female; age range 21–41 years) containing 25 seizures, to identify frequency dynamics, both in the ictal and postictal EEG suppression states. Cross-frequency coupling analysis identified that during seizures there was a gradual decrease of phase frequency in the coupling between delta (0.5–4 Hz) and gamma (30+ Hz), which was followed by an increased coupling between the phase of 0.5–1.5 Hz signal and amplitude of 30–50 Hz signal in the postictal state as compared to the pre-seizure baseline. This marker was consistent across patients. Then, using these postictal-specific features, an unsupervised state classifier—a hidden Markov model—was able to reliably classify four distinct states of seizure episodes, including a postictal suppression state. Furthermore, a connectome analysis of the postictal suppression states showed increased information flow within the network during postictal suppression states as compared to the pre-seizure baseline, suggesting enhanced network communication. When the same tools were applied to the EEG of an epilepsy patient who died unexpectedly, ictal coupling dynamics disappeared and postictal phase-amplitude coupling remained constant throughout. Overall, our findings suggest that there are active postictal networks, as defined through coupling dynamics that can be used to objectively classify the postictal suppression state; furthermore, in a case study of sudden unexpected death in epilepsy, the network does not show ictal-like phase-amplitude coupling features despite the presence of convulsive seizures, and instead demonstrates activity similar to postictal. The postictal suppression state is a period of elevated network activity as compared to the baseline activity which can provide key insights into the epileptic pathology.

scholarly journals Fish consumption, contaminants and sudden unexpected death in epilepsy: many more benefits than risks

2010 ◽  
Vol 70 (3) ◽  
pp. 665-670 ◽  
Author(s):  
FA. Scorza ◽  
RM. Cysneiros ◽  
RM. Arida ◽  
VC. Terra ◽  
HR. Machado ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Fish Consumption ◽  
Sudden Unexpected Death ◽  
Omega 3 Fatty Acids ◽  
Omega 3 ◽  
Unexpected Death ◽  
Positive Effects ◽  
Increased Risk ◽  
Fish And Shellfish

People with epilepsy have an increased risk of dying prematurely and the most common epilepsy-related category of death is sudden unexpected death in epilepsy (SUDEP). SUDEP is mainly a problem for patients with chronic uncontrolled epilepsy. The ultimate goal of research in SUDEP is to develop new methods to prevent it and actions other than medical and surgical therapies that could be very useful. Nutritional aspects, i.e., omega-3 fatty acids deficiency, could have an interesting role in this scenario. Some animal and clinical studies have suggested that omega-3 fatty acids could be useful in the prevention and treatment of epilepsy and hence SUDEP. It has been ascertained that the only foods that provide large amounts of omega-3 are seafood (fish and shellfish); however, some fish are contaminated with methylmercury, which may counteract the positive effects of omega-3 fatty acids. Our update review summarises the knowledge of the role of fish consumption on epilepsy research.

scholarly journals Altered A-type potassium channel function in the nucleus tractus solitarii in acquired temporal lobe epilepsy

2019 ◽  
Vol 121 (1) ◽  
pp. 177-187 ◽  
Author(s):  
Isabel D. Derera ◽  
Katalin Cs. Smith ◽  
Bret N. Smith
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Mouse Models ◽  
Temporal Lobe ◽  
Neuronal Excitability ◽  
Gabaergic Neurons ◽  
Nucleus Tractus Solitarii ◽  
Sudden Unexpected Death ◽  
Inactivation Kinetics ◽  
Unexpected Death ◽  
Increased Risk

Sudden unexpected death in epilepsy (SUDEP) is among the leading causes of death in people with epilepsy. Individuals with temporal lobe epilepsy (TLE) have a high risk for SUDEP because the seizures are often medically intractable. Neurons in the nucleus tractus solitarii (NTS) have been implicated in mouse models of SUDEP and play a critical role in modulating cardiorespiratory and autonomic output. Increased neuronal excitability of inhibitory, GABAergic neurons in the NTS develops during epileptogenesis, and NTS dysfunction has been implicated in mouse models of SUDEP. In this study we used the pilocarpine-induced status epilepticus model of TLE (i.e., pilo-SE mice) to investigate the A-type voltage-gated K+ channel as a potential contributor to increased excitability in GABAergic NTS neurons during epileptogenesis. Compared with age-matched control mice, pilo-SE mice displayed an increase in spontaneous action potential frequency and half-width 9–12 wk after treatment. Activity of GABAergic NTS neurons from pilo-SE mice showed less sensitivity to 4-aminopyridine. Correspondingly, reduced A-type K+ current amplitude was detected in these neurons, with no change in activation or inactivation kinetics. No changes were observed in Kv4.1, Kv4.2, Kv4.3, KChIP1, KChIP3, or KChIP4 mRNA expression. These changes contribute to the increased excitability in GABAergic NTS neurons that develops in TLE and may provide insight into potential mechanisms contributing to the increased risk for cardiorespiratory collapse and SUDEP in this model. NEW & NOTEWORTHY Sudden unexpected death in epilepsy (SUDEP) is a leading cause of death in epilepsy, and dysfunction in central autonomic neurons may play a role. In a mouse model of acquired epilepsy, GABAergic neurons in the nucleus tractus solitarii developed a reduced amplitude of the A-type current, which contributes to the increased excitability seen in these neurons during epileptogenesis. Neuronal excitability changes in inhibitory central vagal circuitry may increase the risk for cardiorespiratory collapse and SUDEP.

scholarly journals Probable Sudden Unexpected Death in Dogs With Epilepsy (pSUDED)

2021 ◽  
Vol 8 ◽  
Author(s):  
Enrice Huenerfauth ◽  
Jasmin Nessler ◽  
Johannes Erath ◽  
Andrea Tipold
Keyword(s):  
Status Epilepticus ◽  
Sudden Unexpected Death ◽  
Idiopathic Epilepsy ◽  
Occurrence Rate ◽  
Online Questionnaire ◽  
Unexpected Death ◽  
Validated Questionnaire ◽  
Seizure Event ◽  
Increased Risk ◽  
Cluster Seizures

Sudden unexpected death in human epileptic patients (SUDEP) is defined as death related to recurrent unprovoked seizures, death occurring unexpectedly, and suddenly in a patient with reasonable state of health, without an obvious medical cause of death, trauma, asphyxia, or intractable status epilepticus, and in post mortem examination no obvious reason for death can be found. “Probable SUDEP” (pSUDEP) is defined as SUDEP not confirmed pathologically. The adapted abbreviation for dogs is used in the following: “pSUDED” (probable sudden unexpected death in dogs with epilepsy). The aim of the present monocentric retrospective study using an online questionnaire was to evaluate the occurrence of pSUDED. Data of canine patients presented with seizures between 01/1998 and 05/2018 were retrospectively analyzed and classified according to their etiology (n = 1,503). Owners were contacted by telephone to participate in answering a validated questionnaire. A total of 509 owners were reached, and 373 owners completed the questionnaire. In addition to signalement (e.g., breed), special attention was paid to the frequency and presentation of seizures and seizures in the context of death. Fifty-one percent (191/373) of the dogs were dead at the endpoint of the study. A large proportion of the dogs was euthanized (149/191) because of seizure severity or health problems unrelated to seizures. Idiopathic epilepsy (IE) was diagnosed in 19/34 dogs which died unexpectedly. Of these seven animals had to be excluded for further investigation of pSUDED because of status epilepticus or aspiration pneumonia as a result of the seizures. In 12 dogs with IE the last seizure event occurred between 6 h and ~3 months before death. pSUDED was suspected in these dogs and an occurrence rate of 4.5–10% was calculated. pSUDED appears in a similar occurrence rate as human SUDEP and should be considered as a possible complication in epileptic dogs. The results of this study suggest that dogs with IE but especially those with brachycephalic syndrome and cluster seizures have an increased risk to die of pSUDED. Owners of dogs with seizures should be educated about the risk of sudden death in dogs with epilepsy.

scholarly journals Postictal brainstem hypoperfusion and risk factors for sudden unexpected death in epilepsy

Neurology ◽  
2020 ◽  
Vol 95 (12) ◽  
pp. e1694-e1705
Author(s):  
Jonathan Liu ◽  
Joseph S. Peedicail ◽  
Ismael Gaxiola-Valdez ◽  
Emmy Li ◽  
Victoria Mosher ◽  
...  
Keyword(s):  
Arterial Spin Labeling ◽  
Spin Labeling ◽  
Regions Of Interest ◽  
Sudden Unexpected Death ◽  
Seizure Type ◽  
Unexpected Death ◽  
Increased Risk ◽  
Impaired Awareness ◽  
Clonic Seizures ◽  
Respiratory Centers

ObjectiveSince the strongest risk factor for sudden unexpected death in epilepsy (SUDEP) is frequent bilateral tonic-clonic seizures (BTCS), our aim was to determine whether postictal hypoperfusion in brainstem respiratory centers (BRCs) is more common following tonic-clonic seizures.MethodsWe studied 21 patients with focal epilepsies who underwent perfusion imaging with arterial spin labeling MRI. Subtraction maps of cerebral blood flow were obtained from the postictal and baseline scans. We identified 6 regions of interest in the brainstem that contain key BRCs. Patients were considered to have postictal BRC hypoperfusion if any of the 6 regions of interest were significantly hypoperfused.ResultsAll 6 patients who experienced BTCS during the study had significant clusters of postictal hypoperfusion in BRCs compared to 7 who had focal impaired awareness seizures (7/15). The association between seizure type studied and the presence of BRC hypoperfusion was significant. Duration of epilepsy and frequency of BTCS were not associated with postictal brainstem hypoperfusion despite also being associated with risk for SUDEP.ConclusionPostictal hypoperfusion in brainstem respiratory centers occurs more often following BTCS than other seizure types, providing a possible explanation for the increased risk of SUDEP in patients who regularly experience BTCS.

scholarly journals Sudden unexpected death in genetic epileptic encephalopathies: a role of neurocardiac genes

2018 ◽  
Vol 10 (3) ◽  
pp. 63-70
Author(s):  
E. D. Belousova ◽  
M. A. Shkolnikova
Keyword(s):  
High Risk ◽  
Sudden Unexpected Death ◽  
Dravet Syndrome ◽  
Unexpected Death ◽  
Sodium Potassium ◽  
Epileptic Encephalopathies ◽  
Increased Risk ◽  
Clinical Conditions ◽  
Cultured Cardiomyocytes

It is well known that sudden unexpected death in epilepsy (SUDEP) is one of the most significant factors of mortality in epileptic patients. There is an increased risk of SUDEP in genetic epileptic encephalopathies (EE), partly because those syndromes are associated with mutations in the “neurocardiac” genes, which have been implicated in both epilepsy and cardiac arrhythmias. In these clinical conditions, functions of ion selective channels (sodium, potassium and etc.) are affected; for example, in children with Dravet syndrome, the risk of SUDEP is 40 times higher than that in children with common epilepsy syndromes. In a murine model of SCN1A epilepsy, a prolongation of QT interval coincided with a seizure; in addition, an excessive excitability of cultured cardiomyocytes was demonstrated. A high risk of SUDEP is characteristic for EE caused by mutation in the SCN8A gene. Other prognostic biomarkers of SUDEP may include mutations in sodium channel genes, such as SCN4A, SCN10A, and SCN11A. Our knowledge about SUDEP associated with potassium channel dysfunctions is still very limited. There are likely some mutations in other genes, that can modify (increase or decrease) the risk of SUDEP in EE. If patients with genetic EE are indeed at a high risk for SUDEP, they must be followed up by cardiologists alongside with neurologists. Provided this hypothesis is proved, any newly diagnosed arrhythmia should be carefully monitored and treated (with medications and/or interventions), in order to improve the survival rate in genetic EE.

scholarly journals Interventions to Improve Safer Sleep Practices in Families With Children Considered to Be at Increased Risk for Sudden Unexpected Death in Infancy: A Systematic Review

2022 ◽  
Vol 9 ◽  
Author(s):  
Catherine Ellis ◽  
Anna Pease ◽  
Joanna Garstang ◽  
Debbie Watson ◽  
Peter S. Blair ◽  
...  
Keyword(s):  
Systematic Review ◽  
At Risk ◽  
Health Education ◽  
Mode Of Delivery ◽  
Sudden Unexpected Death ◽  
Quality Data ◽  
Infant Sleep ◽  
Unexpected Death ◽  
Information Giving ◽  
Increased Risk

Background: Advice to families to follow infant care practices known to reduce the risks of Sudden Unexpected Death in Infancy (SUDI) has led to a reduction in deaths across the world. This reduction has slowed in the last decade with most deaths now occurring in families experiencing social and economic deprivation. A systematic review of the literature was commissioned by the National Child Safeguarding Practice Review Panel in England. The review covered three areas: interventions to improve engagement with support services, parental decision-making for the infant sleep environment, and interventions to improve safer sleep practices in families with infants considered to be at risk of SUDI.Aim: To describe the safer sleep interventions tested with families with infants at risk of SUDI and investigate what this literature can tell us about what works to reduce risk and embed safer sleep practices in this group.Methods: Eight online databases were systematically searched in December 2019. Intervention studies that targeted families with infants (0–1 year) at increased risk of SUDI were included. Studies were limited to those from Western Europe, North America or Australasia, published in the last 15 years. The Quality Assessment Tool for Studies with Diverse Designs was applied to assess quality. Data from included studies were extracted for narrative synthesis, including mode of delivery using Michie et al.'s Mode of Delivery Taxonomy.Results: The wider review returned 3,367 papers, with 23 intervention papers. Five types of intervention were identified: (1) infant sleep space and safer sleep education programs, (2) intensive or targeted home visiting services, (3) peer educators/ambassadors, (4) health education/raising awareness interventions, (5) targeted health education messages using digital media.Conclusion: Influencing behavior in families with infants at risk of SUDI has traditionally focused on “getting messages across,” with interventions predominantly using education and awareness raising mechanisms. This review found evidence of interventions moving from “information giving” to “information exchange” models using personalized, longer term relationship-building models. This shift may represent an improvement in how safer sleep advice is implemented in families with infants at risk, but more robust evidence of effectiveness is required.Systematic Review Registration:https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/901091/DfE_Death_in_infancy_review.pdf, identifier: CRD42020165302.

scholarly journals Decision-making for the infant sleep environment among families with children considered to be at risk of sudden unexpected death in infancy: a systematic review and qualitative metasynthesis

2021 ◽  
Vol 5 (1) ◽  
pp. e000983
Author(s):  
Anna Pease ◽  
Joanna J Garstang ◽  
Catherine Ellis ◽  
Debbie Watson ◽  
Jenny Ingram ◽  
...  
Keyword(s):  
Decision Making ◽  
At Risk ◽  
Sudden Unexpected Death ◽  
Infant Sleep ◽  
Unexpected Death ◽  
Parental Decision ◽  
Parental Decision Making ◽  
Increased Risk ◽  
Sleep Environment ◽  
Families With Children

BackgroundAdvice to families to sleep infants on their backs, avoid smoke exposure, reduce excess bedcovering and avoid specific risks associated with cosleeping has greatly reduced sudden unexpected death in infancy (SUDI) rates worldwide. The fall in rates has not been equal across all groups, and this advice has been less effective for more socially deprived families. Understanding decision-making processes of families with infants at risk would support the development of more effective interventions.AimTo synthesise the qualitative evidence on parental decision-making for the infant sleep environment among families with children considered to be at increased risk of SUDI.MethodsThis study was one of three related reviews of the literature for the Child Safeguarding Practice Review Panel’s National Review in England into SUDI in families where the children are considered at risk of harm. A systematic search of eight online databases was carried out in December 2019. Metasynthesis was conducted, with themes extracted from each paper, starting with the earliest publication first.ResultsThe wider review returned 3367 papers, with 16 papers (across 13 studies) specifically referring to parental decision-making. Six overall themes were identified from the synthesis: (1) knowledge as different from action; (2) external advice must be credible; (3) comfort, convenience and disruption to the routine; (4) plausibility and mechanisms of protection; (5) meanings of safety and risk mitigation using alternative strategies; and (6) parents’ own expertise, experience and instincts.ConclusionInterventions that are intended to improve the uptake of safer sleep advice in families with infants at risk of sleep-related SUDI need to be based on credible advice with mechanisms of protection that are understandable, consistent with other sources, widened to all carers of the infant and fit within the complex practice of caring for infants.

Abstract 185: The Association Between Sudden Unexpected Death in Infancy and Neighborhood-Level Disadvantages: A Multi-Dimension Evaluation in the City of Chicago

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Hai Nguyen ◽  
Marina Del Rios ◽  
Oksana Pugach ◽  
Hoang H Nguyen
Keyword(s):  
Composite Index ◽  
Ethnic Disparities ◽  
Admission Rate ◽  
Sudden Unexpected Death ◽  
Unexpected Death ◽  
Hospital Admission Rate ◽  
Increased Risk ◽  
Vulnerable Families ◽  
The City ◽  
Neighborhood Level

Introduction: The association between sudden unexpected death in infancy (SUDI) and low socio-economic status has been well described in the literature. While the rate of SUDI had declined dramatically following successful campaigns that promoted safe sleeping habits, it has remained stable over the past decade and increasingly been confined to the most socially disadvantaged and vulnerable families. Racial and ethnic disparities persist. Despite extensive research associating the multitude of societal level factors associated with social and economic disadvantage and the increased risk of SUDI, their mechanisms on SUDI remain poorly understood. Hypothesis: A novel composite multi-dimensional marker of neighborhood-level disadvantage may be used to evaluate the association between SUDI and neighborhood-level disadvantages in the City of Chicago. Methods: Sudden unexpected death in infancy cases were identified from the Cardiac Arrest Registry to Enhance Survival database. The composite neighborhood-level disadvantage index was derived using an explanatory factor analysis of the social economic factors recorded in the 2015 American Community Survey of the 77 community areas of the City of Chicago. We defined 3 levels of disadvantage: high, medium, and low. A geographic information system, was used to map the community areas’ disadvantage level and individual SUDI cases. Results: Ninety-one SUDI cases were identified. Non-Hispanic Black (64/91(70%)) and Hispanic (16/91 (18%)) comprised the majority of SUDI cases. Sudden unexpected death in infancy cases were highly concentrated in disadvantaged areas. Eighty-six cases (94.5%) occurred in high and medium disadvantaged areas while 5 cases (5.5%) occurred in the low and no disadvantaged areas (P < 0.0001). Finally, SUDI cases from high and medium disadvantaged areas had a lower hospital admission rate when compared to those from the low and no disadvantaged areas (OR 0.04). Conclusions: The study confirms the persistent racial and socio-economic disparities in SUDI in the City of Chicago. The study’s use of a multi-dimensional composite index of neighborhood-level disadvantage and domestic violence would serve as the basis for further analyses and potential social intervention programs.

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