Peri-ictal Prone Position Is Associated With Independent Risk Factors For Sudden Unexpected Death In Epilepsy: A Controlled Video-EEG Monitoring Unit Study

Postictal atrial fibrillation (PIAF) has rarely been captured during video-EEG monitoring (VEM), with the longest duration being <5 minutes.1, 2 Some cases have later died of sudden unexpected death in epilepsy (SUDEP),1 suggesting that PIAF may be implicated in the pathophysiology of SUDEP. Here, we report a case with drug-resistant epilepsy who experienced remarkably prolonged PIAF (>12 hours) during VEM, and subsequently died of probable SUDEP.

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Risk factors of sudden unexpected death in patients with advanced cancer near the end of life

Palliative & Supportive Care ◽

10.1017/s1478951521001632 ◽

2021 ◽

pp. 1-5

Author(s):

Tomohiko Taniyama ◽

Rie Tokutani ◽

Shuji Hiramoto

Keyword(s):

Risk Factors ◽

End Of Life ◽

Advanced Cancer ◽

Group Performance ◽

Eastern Cooperative Oncology Group ◽

Sudden Unexpected Death ◽

Unexpected Death ◽

Number Of Patients ◽

Independent Risk Factors ◽

Cardiac Comorbidity

Abstract Background The definition of sudden unexpected death (SUD) in patients with advanced cancer near the end of life (EOL) was unclear. Methods This study was conducted as a single-center retrospective analysis. We analyzed 1,282 patients who died of advanced cancer from August 2011 to August 2019 retrospectively. We divided into patients who died within 24 h after the acute change of general condition or others and analyzed risk factors by a multiple logistics method. The reason for SUD was found, the reason is detected by using an electronic medical record retrospectively. The risk factors in SUD were analyzed using age, sex, EOL symptom and treatment, the primary site of cancer, metastatic site of cancer, comorbidly, chemotherapy, and Eastern Cooperative Oncology Group Performance Status. The primary endpoint was to identify the frequency and risk factors of SUD in patients with advanced cancer near the EOL. Results As a background, the median age is 73 years old, 690 males, 592 females, 227 gastroesophageal cancers, 250 biliary pancreatic cancers, 54 hepatocellular carcinomas, 189 colorectal cancer, 251 lung cancers, 71 breast cancers, 58 urological malignancies, 60 gynecological malignancies, 47 head and neck cancer, 31 hematological malignancies, and 22 sarcomas. The number of patients who died suddenly was 93 (7.2%) at EOL. In a multivariate analysis, Age (ORs 0.619), sex (ORs 1.700), patients with EOL delirium (ORs 0.483), nausea and vomiting (ORs 2.263), 1L or more infusion (ORs 3.479), EOL opioids (ORs 0.465), EOL sedations (ORs 0.339), and with cardiac comorbidity (ORs 0.345) were independent risk factors. Conclusions The frequency of patients who died suddenly was 7.2% (n = 93) at EOL. Age, sex, EOL symptom, EOL treatment, and cardiac comorbidity were independent risk factors in patients with advanced cancer near the EOL. Information on these risk factors is useful to explaining their EOL in advance.

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Sudden unexpected death in epilepsy: A search for risk factors

Epilepsy & Behavior ◽

10.1016/j.yebeh.2006.11.010 ◽

2007 ◽

Vol 10 (1) ◽

pp. 138-141 ◽

Cited By ~ 96

Author(s):

Nikolas Hitiris ◽

Suraya Suratman ◽

Kevin Kelly ◽

Linda J. Stephen ◽

Graeme J. Sills ◽

...

Keyword(s):

Risk Factors ◽

Sudden Unexpected Death ◽

Unexpected Death

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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

Epilepsy Currents ◽

10.5698/1535-7511.17.3.180 ◽

2017 ◽

Vol 17 (3) ◽

pp. 180-187 ◽

Cited By ~ 25

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.

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Sudden Unexpected Death of Two Infants in Baby Carriers

Klinische Pädiatrie ◽

10.1055/a-1545-4590 ◽

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).

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