scholarly journals SUDEP in adults and children

2022 ◽  
Vol 7 (4) ◽  
pp. 259-265
Author(s):  
Ajith Cherian ◽  
Divya K P
Keyword(s):  
Premature Death ◽  
Drug Level ◽  
Dravet Syndrome ◽  
Therapeutic Drug ◽  
Neurogenic Pulmonary Edema ◽  
Unexpected Death ◽  
Temporal Lobe Resection ◽  
Antiepileptic Medications ◽  
Drug Resistant Epilepsy ◽  
Patients With Epilepsy

Sudden unexpected death in epilepsy (SUDEP) represents an important cause of death in patients with epilepsy and it exceeds the expected rate of sudden death in the general population by nearly 24 times. We searched the electronic databases (Cochrane, EMBASE, Scopus, Medline, Pubmed) for studies related to etiology and risk stratification of SUDEP including data on Takotsubo cardiomyopathy (TKC) following seizures resulting in death or near death.: SUDEP is more common among males in the fourth decade of life. Risk for SUDEP is increased by early onset of seizures, low IQ, generalised tonic clonic seizures, nocturnal seizures and seizure frequency. Nonadherance to antiepileptic medications, absence of therapeutic drug level monitoring, presence of neuropathological lesions on imaging and certain subgroups like Dravet syndrome increase its risk. The risk for premature death in patients undergoing temporal lobe resection for drug resistant epilepsy decreased over time but remained above the standard population. Prolonged postictal electroencephalographic suppression was a risk factor for SUDEP in patients with generalised seizures which may indicate a cerebral electrical shutdown. Documented ictal/postictal hypoventilation, laryngeal spasm and cardiac rhythm abnormalities prior to SUDEP may suggest central apnea, neurogenic pulmonary edema, cardiac arrhythmia, or a combination of the above as a cause. Seizure triggered TKC does not seem to play a major role in the pathogenesis of SUDEP.

scholarly journals Epilepsy and cannabidiol - a new perspective for seizures treatment

2021 ◽  
Vol 11 (8) ◽  
pp. 226-235
Author(s):  
Ilona Kozioł ◽  
Julia Budzyńska ◽  
Magdalena Leśniewska ◽  
Joanna Milanowska
Keyword(s):  
Seizure Control ◽  
Cannabis Sativa ◽  
Refractory Epilepsy ◽  
Adult Population ◽  
Dravet Syndrome ◽  
Therapeutic Effects ◽  
Cannabis Indica ◽  
New Perspective ◽  
Drug Resistant Epilepsy ◽  
Patients With Epilepsy

BACKGROUND: Despite the fact that the number of antiepileptic drugs is constantly increasing, epilepsy can still be a therapeutic challenge. Approximately one-third of patients with epilepsy have persistent seizures refractory to treatment. The limited number of effective alternatives motivates researchers to seek new solutions. There is some hope for cannabidiol (CBD) preparations.AIM OF THE STUDY: The purpose of this study was to review the most recent available literature on the use of cannabidiol in the treatment of refractory epilepsy in children and adults. For this purpose, the PubMed and Google Scholar databases were reviewed. The phrase "cannabidiol and epilepsy"  was used to search the database. After Screening titles and abstracts a total of 19 papers and articles cited in them were received and analyzed in detail. RESULTS:  Nowadays there are many CBD related products available in the market, Cannabis sativa and Cannabis indica are the plants used due to their strong therapeutic effects and also seizure control. Regulations regarding the use of raw marijuana, cannabis extracts, and cannabinoid-based drugs vary from place to place. Many studies have been generated on the efficacy of cannabinoid therapy in the treatment of epilepsy. This therapy in patients with Dravet syndrome and Lennox-Gaust syndrome results in a reduction in the frequency of motor and total seizures. The most commonly reported side effects of CBD are drowsiness, seizures and diarrhea, but the therapy is generally well tolerated.SUMMARY AND CONCLUSIONS: Many available studies support the efficacy of CBD as a treatment option to reduce seizure frequency in children with drug-resistant epilepsy, particularly in patients with Dravet and Lennox-Gastaut syndrome. However, there is a lack of reports on the use of CBD in the adult population, which may be an area for further research.

scholarly journals Sudep: risk factors, protective factors and pathophysiological mechanisms

2021 ◽  
Vol 32 (2) ◽  
pp. 157-171
Author(s):  
Louise Ferreira Krol ◽  
Beatriz Chiquito Sacchi ◽  
Paulo Henrique Pires de Aguiar
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Protective Factors ◽  
Premature Death ◽  
Case Control ◽  
Adherence To Treatment ◽  
Unexpected Death ◽  
Pathophysiological Mechanisms ◽  
Pubmed Database ◽  
Patients With Epilepsy

Introduction: Sudden Unexpected Death In Epilepsy (SUDEP) is the main cause of premature death in patients with epilepsy. The pathophysiology is not clear, however there are risks and protective factors described in the literature. Objective: To gather the data of these variables and elucidate the pathophysiological mechanisms. Methods: Literature review of free full articles from PubMed database from 2000 to 2019, in English, with an impact factor higher than 1, carried out in humans. As keywords were used “SUDEP”; “Epilepsy”; “Sudden Death”; “Seizure” resulting in 130 articles, and 44 reflecting the objectives. Results: A total of 11 case control and 10 cohort studies was analyzed and the risks and protective factors were presented. Among the risks were found: nocturnal seizure, frequencies, young adults, generalized tonic-clonic (GTCS) type and others. Some of protective factors were adherence to treatment, night supervision and having pets. Discussion: There are evidences that cardiorespiratory and autonomic systems interfere on the phisiopatology. Conclusion: More studies are necessary to elucidate all the involved mechanisms.

scholarly journals Update on the Genetic Basis of Sudden Unexpected Death in Epilepsy

2019 ◽  
Vol 20 (8) ◽  
pp. 1979 ◽  
Author(s):  
Monica Coll ◽  
Antonio Oliva ◽  
Simone Grassi ◽  
Ramon Brugada ◽  
Oscar Campuzano
Keyword(s):  
Sudden Unexpected Death ◽  
Close Monitoring ◽  
Unexpected Death ◽  
Effective Prevention ◽  
Sleeping Position ◽  
Prone Sleeping Position ◽  
Incidence Risk ◽  
History Of ◽  
Antiepileptic Medications ◽  
Patients With Epilepsy

Epilepsy is a common neurological disorder associated with increased morbidity and mortality. Sudden unexpected death in epilepsy, also known as SUDEP, is the main cause of death in patients with epilepsy. SUDEP has an incidence of 1.2 per 1000 person-years in adults and 0.2 per 1000 person-years in children. SUDEP accounts for 8–17% of deaths in patients with epilepsy. It is commonly associated with a history of generalized tonic-clonic seizures, and its risk may be increased by other factors such as postictal electroencephalographic suppression, prone sleeping position, altered heart rate variability, conduction abnormalities, gender, or antiepileptic medications. Recently, electrocardiograms, electroencephalograms, and imaging markers have helped clinicians stratify SUDEP risk and identify patients in need of close monitoring. However, the pathophysiology of SUDEP is likely multifactorial and still unknown. Improving the knowledge of SUDEP incidence, risk factors, and biomarkers can help design and implement effective prevention strategies.

scholarly journals Automated detection of activity onset after postictal generalized EEG suppression

2020 ◽  
Vol 20 (S12) ◽  
Author(s):  
Bishal Lamichhane ◽  
Yejin Kim ◽  
Santiago Segarra ◽  
Guoqiang Zhang ◽  
Samden Lhatoo ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Time Series ◽  
Area Under The Curve ◽  
Premature Death ◽  
Classification Problem ◽  
Classification Model ◽  
Correct Identification ◽  
Unexpected Death ◽  
Eeg Recordings ◽  
Patients With Epilepsy

Abstract Background Sudden unexpected death in epilepsy (SUDEP) is a leading cause of premature death in patients with epilepsy. If timely assessment of SUDEP risk can be made, early interventions for optimized treatments might be provided. One of the biomarkers being investigated for SUDEP risk assessment is postictal generalized EEG suppression [postictal generalized EEG suppression (PGES)]. For example, prolonged PGES has been found to be associated with a higher risk for SUDEP. Accurate characterization of PGES requires correct identification of the end of PGES, which is often complicated due to signal noise and artifacts, and has been reported to be a difficult task even for trained clinical professionals. In this work we present a method for automatic detection of the end of PGES using multi-channel EEG recordings, thus enabling the downstream task of SUDEP risk assessment by PGES characterization. Methods We address the detection of the end of PGES as a classification problem. Given a short EEG snippet, a trained model classifies whether it consists of the end of PGES or not. Scalp EEG recordings from a total of 134 patients with epilepsy are used for training a random forest based classification model. Various time-series based features are used to characterize the EEG signal for the classification task. The features that we have used are computationally inexpensive, making it suitable for real-time implementations and low-power solutions. The reference labels for classification are based on annotations by trained clinicians identifying the end of PGES in an EEG recording. Results We evaluated our classification model on an independent test dataset from 34 epileptic patients and obtained an AUreceiver operating characteristic (ROC) (area under the curve) of 0.84. We found that inclusion of multiple EEG channels is important for better classification results, possibly owing to the generalized nature of PGES. Of among the channels included in our analysis, the central EEG channels were found to provide the best discriminative representation for the detection of the end of PGES. Conclusion Accurate detection of the end of PGES is important for PGES characterization and SUDEP risk assessment. In this work, we showed that it is feasible to automatically detect the end of PGES—otherwise difficult to detect due to EEG noise and artifacts—using time-series features derived from multi-channel EEG recordings. In future work, we will explore deep learning based models for improved detection and investigate the downstream task of PGES characterization for SUDEP risk assessment.

scholarly journals Mechanisms of Drug Resistance in the Pathogenesis of Epilepsy: Role of Neuroinflammation. A Literature Review

2021 ◽  
Vol 11 (5) ◽  
pp. 663
Author(s):  
Elena D. Bazhanova ◽  
Alexander A. Kozlov ◽  
Anastasia V. Litovchenko
Keyword(s):  
Drug Resistance ◽  
Premature Death ◽  
Resistance Mechanisms ◽  
Biomedical Literature ◽  
Drug Resistant ◽  
Psychological Consequences ◽  
Text Documents ◽  
Neural Connections ◽  
Inflammatory Processes ◽  
Drug Resistant Epilepsy

Epilepsy is a chronic neurological disorder characterized by recurring spontaneous seizures. Drug resistance appears in 30% of patients and it can lead to premature death, brain damage or a reduced quality of life. The purpose of the study was to analyze the drug resistance mechanisms, especially neuroinflammation, in the epileptogenesis. The information bases of biomedical literature Scopus, PubMed, Google Scholar and SciVerse were used. To obtain full-text documents, electronic resources of PubMed Central and Research Gate were used. The article examines the recent research of the mechanisms of drug resistance in epilepsy and discusses the hypotheses of drug resistance development (genetic, epigenetic, target hypothesis, etc.). Drug-resistant epilepsy is associated with neuroinflammatory, autoimmune and neurodegenerative processes. Neuroinflammation causes immune, pathophysiological, biochemical and psychological consequences. Focal or systemic unregulated inflammatory processes lead to the formation of aberrant neural connections and hyperexcitable neural networks. Inflammatory mediators affect the endothelium of cerebral vessels, destroy contacts between endothelial cells and induce abnormal angiogenesis (the formation of “leaky” vessels), thereby affecting the blood–brain barrier permeability. Thus, the analysis of pro-inflammatory and other components of epileptogenesis can contribute to the further development of the therapeutic treatment of drug-resistant epilepsy.

scholarly journals Effect and Safety of Shihogyejitang for Drug Resistant Childhood Epilepsy

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Jinsoo Lee ◽  
Kwanghyun Son ◽  
Gwiseo Hwang ◽  
Moonju Kim
Keyword(s):  
Adverse Events ◽  
Antiepileptic Drugs ◽  
Retention Rate ◽  
Seizure Type ◽  
Drug Resistant ◽  
Exact Test ◽  
Alternative Treatment Option ◽  
Drug Resistant Epilepsy ◽  
Intent To Treat ◽  
Patients With Epilepsy

Objective. Herbal medicine has been widely used to treat drug resistant epilepsy. Shihogyejitang (SGT) has been commonly used to treat epilepsy. We investigated the effect and safety of SGT in children with drug resistant epilepsy.Design. We reviewed medical records of 54 patients with epilepsy, who failed to respond to at least two antiepileptic drugs and have been treated with SGT between April 2006 and June 2014 at the Department of Pediatric Neurology, I-Tomato Hospital, Korea. Effect was measured by the response rate, seizure-free rate, and retention rate at six months. We also checked adverse events, change in antiepileptic drugs use, and the variables related to the outcome.Results. Intent-to-treat analysis showed that, after six months, 44.4% showed a >50% seizure reduction, 24.1% including seizure-free, respectively, and 53.7% remained on SGT. Two adverse events were reported, mild skin rash and fever. Focal seizure type presented significantly more positive responses when compared with other seizure types at six months (p=0.0284, Fisher’s exact test).Conclusion. SGT is an effective treatment with excellent tolerability for drug resistant epilepsy patients. Our data provide evidence that SGT may be used as alternative treatment option when antiepileptic drug does not work in epilepsy children.

scholarly journals Temporo-Frontal Coherences and High-Frequency iEEG Responses during Spatial Navigation in Patients with Drug-Resistant Epilepsy

2021 ◽  
Vol 11 (2) ◽  
pp. 162
Author(s):  
Aljoscha Thomschewski ◽  
Eugen Trinka ◽  
Julia Jacobs
Keyword(s):  
Cognitive Processes ◽  
Spatial Navigation ◽  
General Effect ◽  
Permutation Testing ◽  
Intracranial Eeg ◽  
Epileptic Spikes ◽  
Drug Resistant Epilepsy ◽  
Task Conditions ◽  
Hippocampal Theta ◽  
Patients With Epilepsy

The prefrontal cortex and hippocampus function in tight coordination during multiple cognitive processes. During spatial navigation, prefrontal neurons are linked to hippocampal theta oscillations, presumably in order to enhance communication. Hippocampal ripples have been suggested to reflect spatial memory processes. Whether prefrontal-hippocampal-interaction also takes place within the ripple band is unknown. This intracranial EEG study aimed to investigate whether ripple band coherences can also be used to show this communication. Twelve patients with epilepsy and intracranial EEG evaluation completed a virtual spatial navigation task. We calculated ordinary coherence between prefrontal and temporal electrodes during retrieval, re-encoding, and pre-task rest. Coherences were compared between the conditions via permutation testing. Additionally, ripples events were automatically detected and changes in occurrence rates were investigated excluding ripples on epileptic spikes. Ripple-band coherences yielded no general effect of the task on coherences across all patients. Furthermore, we did not find significant effects of task conditions on ripple rates. Subsequent analyses pointed to rather short periods of synchrony as opposed to general task-related changes in ripple-band coherence. Specifically designed tasks and adopted measures might be necessary in order to map these interactions in future studies.

Circulating miRNAs expression profiling in drug-resistant epilepsy: Up-regulation of miR-301a-3p in a case of sudden unexpected death

2018 ◽  
Vol 33 ◽  
pp. 5 ◽  
Author(s):  
Maria De Matteis ◽  
Giovanni Cecchetto ◽  
Giada Munari ◽  
Laura Balsamo ◽  
Marina Paola Gardiman ◽  
...  
Keyword(s):  
Expression Profiling ◽  
Sudden Unexpected Death ◽  
Drug Resistant ◽  
Circulating Mirnas ◽  
Unexpected Death ◽  
Mirnas Expression ◽  
Drug Resistant Epilepsy

Drug level monitoring in palliative patients

2021 ◽  
pp. bmjspcare-2020-002613
Author(s):  
Joanne Bartlett ◽  
Elizabeth Freshwater
Keyword(s):  
Brain Tumour ◽  
Palliative Medicine ◽  
Drug Level ◽  
Therapeutic Drug ◽  
Primary Brain Tumour ◽  
Drug Level Monitoring ◽  
Symptoms And Signs ◽  
Level Monitoring ◽  
Palliative Patients

Palliative medicine is always patient centred and promotes the principle that no unnecessary investigations are performed. The case is reported of a patient with suspected carbamazepine toxicity presenting as progression of symptoms of primary brain tumour. A comparison is made of the symptoms and signs of toxicity versus tumour, and an aid for deciding when to perform therapeutic drug level monitoring for some common drugs.

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