scholarly journals A clinical and pathological study in patients with sudden unexpected death in Epilepsy

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Weihua Yu ◽  
Ying Zhu ◽  
Qingshu Li ◽  
Xin Tian ◽  
Peng Zhang ◽  
...  
Keyword(s):  
Pulmonary Edema ◽  
Brain Edema ◽  
Emotional Disturbance ◽  
Clonic Seizure ◽  
Tonic Clonic Seizure ◽  
Sudden Unexpected Death ◽  
Pathological Findings ◽  
Pathological Study ◽  
Unexpected Death ◽  
Definition Of

Abstract Background Sudden unexpected death of epilepsy (SUDEP) is a severe outcome of epilepsy. This study aimed to report the clinical and pathological findings in patients with SUDEP. Methods The record of patients with sudden death was screened. When the reason of death matched with the definition of SUDEP, the clinical and pathological data were analyzed. Eleven patients with SUDEP were included in the study. Results Eight patients died after a generalized tonic-clonic seizure, seizures were induced by emotional changes in five patients, four cases were found dead in bed. Carbamazepine was prescribed in six patients. The autopsy showed brain edema and pulmonary edema in all eleven patients. Loss of neurons and gliosis were presented in some brains of SUDEP subjects. The main pathological changes in SUDEP include brain edema, pulmonary edema, loss of neurons and gliosis. Conclusions Risk factors for SUDEP in the study are generalized tonic-clonic seizure, emotional disturbance and carbamazepine treatment.

scholarly journals Sudden Unexpected Death in Epilepsy: A PersonaliZed Prediction Tool

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011849
Author(s):  
Ashwani Jha ◽  
Cheongeun Oh ◽  
Dale Hesdorffer ◽  
Beate Diehl ◽  
Sasha Devore ◽  
...  
Keyword(s):  
Seizure Frequency ◽  
Clinical Decision Making ◽  
Biomarker Discovery ◽  
Clonic Seizure ◽  
Tonic Clonic Seizure ◽  
Sudden Unexpected Death ◽  
Receiver Operating Curve ◽  
Unexpected Death ◽  
Unseen Data ◽  
Model Predictions

Objective:To develop and validate a tool for individualised prediction of Sudden Unexpected Death in Epilepsy (SUDEP) risk, we re-analysed data from one cohort and three case-control studies undertaken 1980-2005.Methods:We entered 1273 epilepsy cases (287 SUDEP, 986 controls) and 22 clinical predictor variables into a Bayesian logistic regression model.Results:Cross-validated individualized model predictions were superior to baseline models developed from only average population risk or from generalised tonic-clonic seizure frequency (pairwise difference in leave-one-subject-out expected log posterior density = 35.9, SEM +/-12.5, and 22.9, SEM +/-11.0 respectively). The mean cross-validated (95% Credibility Interval) Area Under the Receiver Operating Curve was 0.71 (0.68 to 0.74) for our model versus 0.38 (0.33 to 0.42) and 0.63 (0.59 to 0.67) for the baseline average and generalised tonic-clonic seizure frequency models respectively. Model performance was weaker when applied to non-represented populations. Prognostic factors included generalized tonic-clonic and focal-onset seizure frequency, alcohol excess, younger age of epilepsy onset and family history of epilepsy. Anti-seizure medication adherence was associated with lower risk.Conclusions:Even when generalised to unseen data, model predictions are more accurate than population-based estimates of SUDEP. Our tool can enable risk-based stratification for biomarker discovery and interventional trials. With further validation in unrepresented populations it may be suitable for routine individualized clinical decision-making. Clinicians should consider assessment of multiple risk factors, and not only focus on the frequency of convulsions.

scholarly journals Pulmonary edema following tonic-clonic seizure

2016 ◽  
Vol 4 (2) ◽  
pp. 221-222 ◽  
Author(s):  
Hiroaki Izumida ◽  
Koichiro Homma ◽  
Junichi Sasaki ◽  
Shingo Hori
Keyword(s):  
Pulmonary Edema ◽  
Clonic Seizure ◽  
Tonic Clonic Seizure

scholarly journals Alcohol consumption and sudden unexpected death in epilepsy: experimental approach

2009 ◽  
Vol 67 (4) ◽  
pp. 1003-1006 ◽  
Author(s):  
Carla A. ScorzaI ◽  
Roberta M. Cysneiros ◽  
Ricardo M. Arida ◽  
Vera C. Terra ◽  
Hélio R. Machado ◽  
...  
Keyword(s):  
Alcohol Consumption ◽  
Alcohol Intake ◽  
Experimental Approach ◽  
Clonic Seizure ◽  
Ethanol Solution ◽  
Sudden Unexpected Death ◽  
Unexpected Death ◽  
Alcohol Administration ◽  
Daily Dose ◽  
Pilocarpine Model

Using the pilocarpine model of epilepsy, we investigated the effects of alcohol consumption on the frequency of seizures in animals with epilepsy as well the underlying a possible association between alcohol intake and sudden unexpected death in epilepsy (SUDEP) occurrence. Rats were divided randomly into two groups: (A) rats with epilepsy and (B) rats with epilepsy that received a daily dose of ethanol solution (350 mg kg-1, i.p.) for 30 days. The basal frequency of seizures observed in the A and B groups during the first 30 days were 3.4±1.5 and 3.2±1.9 seizures per week per animal, respectively. In B group, it was observed a significant seizure increase (11.6±5.3) during the first 2 weeks of alcohol administration and quite interesting, one rat died suddenly after a generalized tonic-clonic seizure during this period. We concluded in our experimental study that exist a possible association between alcohol abuse and SUDEP occurrence.

scholarly journals Sudden unexpected death after acute symptomatic seizures in a patient on mechanical ventilation

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Raisa C. Martinez ◽  
Naoum P. Issa ◽  
Shasha Wu ◽  
Xi Liu ◽  
Sandra Rose ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Arrhythmia ◽  
Cause Of Death ◽  
Cerebral Edema ◽  
Vital Signs ◽  
Clonic Seizure ◽  
Sudden Unexpected Death ◽  
Unexpected Death ◽  
Unique Case ◽  
Fatal Cardiac Arrhythmia

Abstract Background The mechanism of sudden unexpected death in epilepsy remains poorly understood. Seizure induced cardiac arrhythmia, central and obstructive apneas have been proposed as possible causes of death. Here we report a unique case of seizure related sudden unexpected death in a patient whose airway was fully protected by intubation and mechanic ventilation in the absence of fatal cardiac arrhythmia. Case presentation A 70-year-old woman was undergoing mechanical ventilation and video-electroencephalography (EEG) monitoring following two convulsive seizures with ictal hypoventilation and hypoxemia. Several hours after intubation, she suffered another generalized tonic clonic seizure lasted for 3 min and developed postictal generalized EEG suppression in the presence of stable vital signs with SpO2 > 90%. EEG suppression persisted throughout the postictal phase. There was a significant fluctuation of systolic blood pressure between 50 and 180 mmHg with several bouts of hypotension < 60 mmHg. She remained unresponsive after the convulsive seizure and died of diffuse cerebral edema 12 h later. Autopsy revealed no clear cause of death, except for possible hypoxic and ischemic injury leading to the diffuse cerebral edema. Conclusion Given the reliable periictal airway protection, neither seizure induced central apnea nor obstructive apnea appeared to be the direct cause of death in this unique case. In the absence of fatal cardiac arrhythmia, diffuse cerebral edema secondary to seizure-induced autonomic dysfunction, hypotension and hypoxemia might be the cause of death, highlighting the etiological heterogeneity of sudden unexpected death in epilepsy.

scholarly journals Sudden unexpected death in epilepsy in a 14-year-old girl: case report and literature review

2018 ◽  
Vol 46 (5) ◽  
pp. 2031-2036 ◽  
Author(s):  
Xinyue Zhang ◽  
Lichao Sun ◽  
Li Cui ◽  
Weihong Lin
Keyword(s):  
Case Report ◽  
Frontal Lobe ◽  
Sleep Stage ◽  
Intractable Epilepsy ◽  
Epileptic Seizures ◽  
Clonic Seizure ◽  
Slow Waves ◽  
Sudden Unexpected Death ◽  
Frontal Lobe Epilepsy ◽  
Unexpected Death

Background Sudden unexpected death in epilepsy (SUDEP) is the most common cause of death in people with epilepsy. The pathogenesis of SUDEP is still unclear. The majority of SUDEP cases occur in intractable epilepsy, especially in the aftermath of a generalized tonic-clonic seizure. We report an atypical SUDEP case with infrequent seizures in frontal lobe epilepsy. Case Report A 14-year-old girl presented with a 13-year history of paroxysmal convulsions. She experienced three episodes within 6–10 months after birth. At 14 years old, she experienced an aggravated seizure, manifesting as unconsciousness, hyperventilation, and urinary incontinence. Electroencephalography showed spike-slow waves and slow waves with mixed asynchronized spike waves originating from the frontal lobe during the sleep stage. Transient outbreaks of spike-slow complex waves (1–2 s) were also noted in all leads. The diagnosis of frontal lobe epilepsy (generalized tonic-clonic seizures secondary to focal impaired awareness seizures and myoclonus) was made. Oral sodium valproate was prescribed. However, she suddenly died on her way to school 2 months later. Conclusion The causes of SUDEP are complicated, and frontal lobe epilepsy may be a potential risk factor. Early diagnosis and appropriate treatment of epileptic seizures, as well as close observation, should be emphasized.

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