Sudden Unexpected Death in Epilepsy - An Overview of Current Understanding and Future Perspectives

2012 ◽  
Vol 7 (1) ◽  
pp. 67 ◽  
Author(s):  
Daniel Friedman ◽  
Lawrence J Hirsch ◽  
◽  
Keyword(s):  
Seizure Control ◽  
Healthy Person ◽  
Sudden Unexpected Death ◽  
Future Perspectives ◽  
Prevention Strategies ◽  
Treatment Resistant ◽  
Unexpected Death ◽  
Cerebral Dysfunction ◽  
Clonic Seizures ◽  
Related Mortality

Sudden unexpected death in epilepsy (SUDEP) is likely to be the most common cause of disease-related mortality in people with epilepsy. The most commonly encountered scenario is that a previously healthy person is found dead in bed by family. Patients with frequent generalised tonic-clonic seizures are at highest risk but SUDEP can occur in patients who have never had convulsions. The mechanisms of SUDEP are poorly understood but seem to be related to seizure-related cardiac, respiratory or cerebral dysfunction. Seizure control is the only clear strategy to prevent SUDEP but that is not possible in the 30 % of patients with treatment-resistant epilepsy. Understanding the pathophysiology of SUDEP may lead to prevention strategies for patients who continue to have seizures despite maximal therapy.

Sudden Unexpected Death in Epilepsy—An Overview of Current Understanding and Future Perspectives

US Neurology ◽  
2012 ◽  
Vol 08 (01) ◽  
pp. 42
Author(s):  
Daniel Friedman ◽  
Lawrence J Hirsch ◽  
◽  
Keyword(s):  
Seizure Control ◽  
Healthy Person ◽  
Sudden Unexpected Death ◽  
Future Perspectives ◽  
Prevention Strategies ◽  
Treatment Resistant ◽  
Unexpected Death ◽  
Cerebral Dysfunction ◽  
Clonic Seizures ◽  
Related Mortality

Sudden unexpected death in epilepsy (SUDEP) is likely to be the most common cause of disease-related mortality in people with epilepsy. The most commonly encountered scenario is that a previously healthy person is found dead in bed by family. Patients with frequent generalized tonic-clonic seizures are at highest risk but SUDEP can occur in patients who have never had convulsions. The mechanisms of SUDEP are poorly understood but seem to be related to seizure-related cardiac, respiratory or cerebral dysfunction. Seizure control is the only clear strategy to prevent SUDEP but that is not possible in the 30 % of patients with treatment-resistant epilepsy. Understanding the pathophysiology of SUDEP may lead to prevention strategies for patients who continue to have seizures despite maximal therapy.

scholarly journals Prevention of Sudden Unexpected Death in Epilepsy

2018 ◽  
Vol 13 (2) ◽  
pp. 72
Author(s):  
Philippe Ryvlin ◽  
Torbjörn Tomson ◽  
Orrin Devinsky ◽  
◽  
◽  
...  
Keyword(s):  
Risk Factors ◽  
Seizure Control ◽  
Predictive Biomarkers ◽  
Treatment Resistance ◽  
Sudden Unexpected Death ◽  
Preventive Strategies ◽  
Preventive Interventions ◽  
Unexpected Death ◽  
Clonic Seizures ◽  
Underlying Mechanisms

Sudden unexpected death in epilepsy (SUDEP) is the most common cause of death related to epilepsy and is associated with treatment resistance and the presence of generalised tonic-clonic seizures (GTCS, of either focal or generalised onset). While the causative mechanisms of SUDEP are yet to be fully elucidated, it is thought that seizure-induced brainstem suppression, and respiratory and cardiac dysfunction may be involved. Research into SUDEP has identified several risk factors (including frequency of GTCS and male gender) but has also indicated proven or potential preventive strategies, including more effective seizure control. Despite increasing awareness and research into SUDEP, its underlying mechanisms and preventive strategies remain poorly defined. More research is needed into the pathophysiology of SUDEP and to identify predictive biomarkers. Furthermore, clinical trials are warranted to assess outcomes with preventive interventions. We review SUDEP epidemiology and risk factors, and discuss potential measures to reduce SUDEP risk.

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 Is cold the new hot in sudden unexpected death in epilepsy? Effect of low temperature on heart rate of rats with epilepsy

2008 ◽  
Vol 66 (4) ◽  
pp. 848-852 ◽  
Author(s):  
Eliza Y.F. Sonoda ◽  
Diego B. Colugnati ◽  
Carla A. Scorza ◽  
Ricardo M. Arida ◽  
Aline P. Pansani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Rate ◽  
Low Temperature ◽  
Low Temperatures ◽  
Refractory Epilepsy ◽  
Sudden Unexpected Death ◽  
Unexpected Death ◽  
Temperature Exposure ◽  
Low Temperature Exposure ◽  
Related Mortality

Sudden unexpected death in epilepsy (SUDEP) is the commonest cause of seizure-related mortality in people with refractory epilepsy. Several risk factors for SUDEP are described; however, the importance of including low temperatures as risk factor for SUDEP was never explored. Based on this, the aim of this study was to evaluate the heart rate of rats with epilepsy during low temperature exposure. Our results showed that low temperature clearly increased the heart rate of rats with epilepsy. Taken together, we concluded that exposure to low temperatures could be considered important risk factors from cardiovascular abnormalities and hence sudden cardiac death in epilepsy.

scholarly journals Practice guideline summary: Sudden unexpected death in epilepsy incidence rates and risk factors

Neurology ◽  
2017 ◽  
Vol 88 (17) ◽  
pp. 1674-1680 ◽  
Author(s):  
Cynthia Harden ◽  
Torbjörn Tomson ◽  
David Gloss ◽  
Jeffrey Buchhalter ◽  
J. Helen Cross ◽  
...  
Keyword(s):  
Risk Factors ◽  
Evaluation Process ◽  
Incidence Rates ◽  
Sudden Unexpected Death ◽  
Seizure Freedom ◽  
Unexpected Death ◽  
New Approach ◽  
Assessment Development ◽  
Clonic Seizures ◽  
Patients With Epilepsy

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% confidence interval [CI] 0.16–0.31) (moderate 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.

scholarly journals Ictal Cardiac Ryhthym Abnormalities

2016 ◽  
Vol 10 (1) ◽  
pp. 105-109 ◽  
Author(s):  
Rushna Ali
Keyword(s):  
Risk Factor ◽  
Autonomic Function ◽  
Seizure Control ◽  
Preventive Strategy ◽  
Cardiac Autonomic Function ◽  
Seizure Onset ◽  
Unexpected Death ◽  
Prolonged Duration ◽  
Clonic Seizures ◽  
Generalized Epilepsy

Cardiac rhythm abnormalities in the context of epilepsy are a well-known phenomenon. However, they are under-recognized and often missed. The pathophysiology of these events is unclear. Bradycardia and asystole are preceded by seizure onset suggesting ictal propagation into the cortex impacting cardiac autonomic function, and the insula and amygdala being possible culprits. Sudden unexpected death in epilepsy (SUDEP) refers to the unanticipated death of a patient with epilepsy not related to status epilepticus, trauma, drowning, or suicide. Frequent refractory generalized tonic-clonic seizures, anti-epileptic polytherapy, and prolonged duration of epilepsy are some of the commonly identified risk factors for SUDEP. However, the most consistent risk factor out of these is an increased frequency of generalized tonic–clonic seizures (GTC). Prevention of SUDEP is extremely important in patients with chronic, generalized epilepsy. Since increased frequency of GTCS is the most consistently reported risk factor for SUDEP, effective seizure control is the most important preventive strategy.

scholarly journals Does sudden unexpected death in children with epilepsy occur more frequently in those with high seizure frequency?

2009 ◽  
Vol 67 (4) ◽  
pp. 1001-1002 ◽  
Author(s):  
Vera C. Terra ◽  
Fulvio A. Scorza ◽  
Américo C. Sakamoto ◽  
Kylvia G.F.D. Pinto ◽  
Regina M.F. Fernandes ◽  
...  
Keyword(s):  
Seizure Frequency ◽  
Seizure Control ◽  
Rare Event ◽  
Sudden Unexpected Death ◽  
Pharmacologic Treatment ◽  
Unexpected Death ◽  
Potential Association ◽  
Related Category

People with epilepsy are more likely to die prematurely and the most common epilepsy-related category of death is sudden unexpected death in epilepsy (SUDEP). Several studies have reported a moderate or high seizure frequency among SUDEP cases and SUDEP is considered rare in patients in remission. METHOD: We reviewed the occurrence of SUDEP in our epilepsy unit over an 8-year period to identify a potential association between seizure frequency and SUDEP occurrence in children with epilepsy. RESULTS: From 835 patients evaluated, 12 had suffered SUDEP and nearly all of the SUDEP cases in our children are related to chronic uncontrolled epilepsy (daily - 50.0%, two to four/week - 41.7%, monthly - 8.3%). CONCLUSION: SUDEP is not a rare event in children and increased mortality was recorded in those individuals who had not responded to pharmacologic treatment. Improved seizure control seems to be one of the most important measures to prevent SUDEP.

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.

scholarly journals Sudden cardiac death in epilepsy disappoints, but epileptologists keep faith

2016 ◽  
Vol 74 (7) ◽  
pp. 570-573 ◽  
Author(s):  
Fulvio A. Scorza ◽  
Esper A. Cavalheiro ◽  
Jaderson Costa da Costa
Keyword(s):  
Risk Factors ◽  
Sudden Cardiac Death ◽  
Cause Of Death ◽  
Cardiac Death ◽  
Seizure Control ◽  
Intractable Epilepsy ◽  
Sudden Unexpected Death ◽  
Unexpected Death ◽  
Common Cause ◽  
Preventative Measures

ABSTRACT Sudden unexpected death in epilepsy (SUDEP) is the most common cause of death in people with intractable epilepsy. Probably, optimization of seizure control will prevent some of these deaths. Briefly, we integrated in this paper some data about the epidemiology, risk factors, etiology, and preventative measures in the management of SUDEP.

scholarly journals Preferences of Patients for Discussing Sudden Unexpected Death in Epilepsy

2017 ◽  
Vol 71 (4) ◽  
pp. 280-285
Author(s):  
Normunds Sūna ◽  
Evija Gūtmane ◽  
Madara Lazdāne ◽  
Guntis Karelis ◽  
Valdis Folkmanis
Keyword(s):  
Seizure Control ◽  
Mortality Rates ◽  
Negative Influence ◽  
Sudden Unexpected Death ◽  
Considerable Proportion ◽  
Epilepsy Syndrome ◽  
Unexpected Death ◽  
Risk Factor Management ◽  
To Receive

Abstract People with epilepsy have increased mortality rates, which is partially attributed to sudden unexpected death in epilepsy syndrome (SUDEP). Poor seizure control appears to be the strongest SUDEP risk factor. Management of epilepsy and adherence to therapy is critical to seizure control. The belief by caregivers of negative influence caused by being informed about the syndrome is the main reason SUDEP is not disclosed. There are no clear recommendations when to disclose the risk of SUDEP and how much information should be provided. We addressed the preferences of Latvian epilepsy patients for discussing SUDEP as well as awareness of the syndrome. Our study involved 55 epilepsy patients. We found that, as in other studies, our patients were relatively well informed about SUDEP. We found that a considerable proportion of patients preferred to receive information about SUDEP from a general practitioner. We note the belief of patients that the disclosure of SUDEP would either improve or have no effect on the quality of life. We were able to identify groups of patients with a self-reported belief of more frequent expected anxiety and poor adherence to medical treatment. Our data improves the understanding of preferences of patient for discussing the negative aspects of epilepsy.

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