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 Risk factors for suicidal tendency in people with epilepsy in China: a case–control study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mintao Lin ◽  
Jiani Chen ◽  
Sisi Li ◽  
Yingjie Qin ◽  
Xuruan Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Low Income ◽  
Case Control Study ◽  
Univariate Analysis ◽  
Case Control ◽  
Conditional Inference ◽  
Suicidal Tendency ◽  
Patients With Epilepsy ◽  
Nested Case Control ◽  
Control Study

AbstractPeople with epilepsy (PWE) have an increased suicide prevalence. This study aimed to identify the risk factors for suicidal tendency among PWE in West China. A nested case–control study was designed in a cohort of patients with epilepsy (n = 2087). In total, 28 variates were calculated. In the univariate analysis, unemployment, low income, seizure frequency, seizure-free time, infectious or structural etiology, levetiracetam or phenobarbital use, anxiety, depression, and stigma were associated with suicidal tendency. A multivariate analysis indicated that unemployment (odds ratio [OR] 5.74, 95% confidence interval [CI] 2.13–15.48), levetiracetam use (OR 2.80, 95%CI 1.11–7.05), depression (C-NDDI-E score ≥ 13; OR 3.21, 95%CI 1.26–8.21), and stigma (SSCI score ≥ 16; OR 6.67, 95%CI 1.80–24.69) were independently associated with suicidal tendency. Conditional inference tree analysis indicated that SSCI and C-NDDI-E scores could effectively identify patients with suicidal tendency. Thus, this study suggests that unemployment, levetiracetam use, depression, and stigma are independent risk factors for suicidal tendency in PWE in China.

scholarly journals Cerebrovascular risk factors associated with ischemic stroke in a young non-diabetic and non-hypertensive population: a retrospective case-control study

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Nan Zhang ◽  
Lin Zhang ◽  
Qiu Wang ◽  
Jingwei Zhao ◽  
Jia Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Young Adults ◽  
Ischemic Stroke ◽  
Case Control Study ◽  
Conditional Logistic Regression ◽  
Case Control ◽  
Retrospective Case ◽  
Factors Associated ◽  
Control Study

Abstract Background Globally, rates of ischemic stroke (IS) have been rising among young adults. This study was designed to identify risk factors associated with IS incidence in young adults unaffected by hypertension or diabetes. Methods This was a retrospective case-control study of early-onset IS patients without diabetes and hypertension. Control patients were matched with healthy individuals based upon sex, age (±2 years), and BMI (±3 kg/m2) at a 1:3 ratio. Sociodemographic, clinical, and risk factor-related data pertaining to these patients was collected. The association between these risk factors and IS incidence was then assessed using conditional logistic regression models. Results We recruited 60 IS patients and 180 controls with mean ages of 44.37 ± 4.68 and 44.31 ± 4.71 years, respectively, for this study. Relative to controls, IS patients had significantly higher total cholesterol (TG), homocysteine (HCY), white blood cell (WBC), absolute neutrophil count (ANC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels, and significantly lower high-density lipoprotein cholesterol (HDL-C) and triglyceride cholesterol (TC), free triiodothyronine (FT3), and free thyroxine (FT4) levels (all P < 0.05). After controlling for potential confounding factors, HCY and ANC were found to be significantly positively associated with IS incidence (OR 1.518, 95%CI 1.165–1.977, P = 0.002 and OR 2.418, 95%CI 1.061–5.511, P = 0.036, respectively), whereas HDL-C and FT3 levels were negatively correlated with IS incidence (OR 0.001, 95%CI 0.000–0.083, P = 0.003 and OR 0.053, 95%CI 0.008–0.326, P = 0.002, respectively). Conclusions In young non-diabetic and non-hypertensive patients, lower HDL-C and FT3 levels and higher HCY and ANC levels may be associated with an elevated risk of IS. Additional prospective studies of large patient cohorts will be essential to validate these findings.

scholarly journals 346. Factors Associated with Hypertension in Young Adults with Perinatally-Acquired HIV Infection: a Case–Control Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S184-S184
Author(s):  
Patrick O’Neil ◽  
Patrick Ryscavage ◽  
Kristen A Stafford
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Family History ◽  
Case Control Study ◽  
Case Control ◽  
Systemic Hypertension ◽  
Early Management ◽  
Factors Associated ◽  
History Of ◽  
Control Study

Abstract Background The incidence of systemic hypertension (HTN) among perinatally-HIV-infected (PHIV) patients appears to increase as they enter adulthood. Among non-perinatally HIV-infected adults both traditional and HIV-associated risk factors have been found to contribute to HTN. Whether these same factors contribute to HTN in PHIV is unknown. The purpose of this study was to determine the socio-demographic, clinical, virologic, and immunologic factors associated with HTN among a cohort of PHIV adolescents and young adults, aged ≥18 years. Methods We conducted a case–control study among a population of 160 PHIV adults with and without HTN who were receiving care at the University of Maryland and aged 18–35 years as of December 31, 2017. Covariates assessed included traditional risk factors such as age, family history of HTN, and smoking, as well as HIV- and antiretroviral-associated covariates. Results We identified 49 HTN cases (30.6%) and 111 (69.4%) controls. There were no significant differences in the odds of most traditional (age, gender, race, family history of HTN, tobacco, alcohol, and/or other drug use) or HIV-associated (CD4 nadir <100 cells/mm3, individual ART exposure, ART interruption) risk factors among PHIV adults with HTN compared with those with no diagnosis of HTN. Cases had lower odds of a history of treatment with lopinavir/ritonavir (LPV/r). Cases had 3.7 (95% CI 1.11, 12.56) times the odds of a prior diagnosis of chronic kidney disease (CKD) compared with controls after controlling for CD4 nadir and ARV treatment history. Conclusion The results of this study suggest that most traditional and HIV-related risk factors do not appear to increase the odds of having HTN in this PHIV cohort. However, HTN among PHIV may be driven in part by CKD, and a focus on the prevention and early management of CKD in this group may be necessary to prevent the development of HTN. Additionally, there may be as yet unidentified risk factors for HTN among PHIV which require further exploration. Given the large and growing population of PHIV entering adulthood worldwide, it is imperative to explore risk factors for and effects of HTN in large, diverse PHIV populations. Disclosures All authors: No reported disclosures.

scholarly journals Disease History and Medication Use as Risk Factors for the Clinical Manifestation of Type 1 Diabetes in Children and Young Adults: An Explorative Case Control Study

PLoS ONE ◽  
2014 ◽  
Vol 9 (2) ◽  
pp. e87408 ◽  
Author(s):  
Soulmaz Fazeli Farsani ◽  
Patrick C. Souverein ◽  
Marja M. J. van der Vorst ◽  
Aukje K. Mantel-Teeuwisse ◽  
Catherijne A. J. Knibbe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Young Adults ◽  
Clinical Manifestation ◽  
Case Control Study ◽  
Medication Use ◽  
Case Control ◽  
Children And Young Adults ◽  
Control Study

Defining Youth Suicide

2017 ◽  
pp. 483-496
Author(s):  
Herbert Hendin ◽  
Ann P. Haas ◽  
Jill Harkavy-Friedman ◽  
Maggie Mortali
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Environmental Factors ◽  
Protective Factors ◽  
Suicide Prevention ◽  
Risk And Protective Factors ◽  
Research Needs ◽  
Youth Suicide ◽  
Prevention Strategies ◽  
What Works

This chapter looks at suicide among adolescents and young adults. Although true suicide causation is difficult to empirically establish, an accumulated body of research points to a number of individual and environmental factors that have been closely and fairly consistently associated with youth suicidal behaviors. These risk factors are identified and briefly discussed here. The chapter looks the behavioral and environmental factors for suicide. The main aim of this chapter is to examine current youth suicide prevention strategies and interventions with an eye towards identifying what works, what does not appear to work, and what research needs to be undertaken to move the field forward. Given the multiplicity of risk and protective factors that have been related to youth suicide, it is understandable that many different approaches have been taken in the attempt to prevent this behaviour.

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.

Risk Factors and Protective Factors for Lower-Extremity Running Injuries

2015 ◽  
Vol 105 (6) ◽  
pp. 532-540 ◽  
Author(s):  
Gabriel Gijon-Nogueron ◽  
Marina Fernandez-Villarejo
Keyword(s):  
Risk Factors ◽  
Protective Factors ◽  
Cochrane Library ◽  
Impact Peak ◽  
Pubmed Database ◽  
Running Injuries ◽  
Foot Arch ◽  
Foot Strike ◽  
Critical Appraisal Skills ◽  
And Control

A review of the scientific literature was performed 1) to identify studies describing the most common running injuries and their relation to the risk factors that produce them and 2) to search for potential and specific protective factors. Spanish and English biomedical search engines and databases (MEDLINE/PubMed, Database Enfermería Fisioterapia Podología [ENFISPO], Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature) were queried (February 1 to November 30, 2013). A critical reading and assessment was then performed by the Critical Appraisal Skills Programme Spanish tool. In total, 276 abstracts that contained the selected key words were found. Of those, 25 identified and analyzed articles were included in the results. Injuries result from inadequate interaction between the runner's biomechanics and external factors. This leads to an excessive accumulation of impact peak forces in certain structures that tends to cause overuse injuries. The main reasons are inadequate muscle stabilization and pronation. These vary depending on the runner's foot strike pattern, foot arch morphology, and sex. Specific measures of modification and control through running footwear are proposed.

scholarly journals Dietary and lifestyle behavior in adults with epilepsy needs improvement: a case-control study from northeastern Poland

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Kamila Szałwińska ◽  
Monika Cyuńczyk ◽  
Jan Kochanowicz ◽  
Anna M. Witkowska
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Vitamin C ◽  
Case Control Study ◽  
Case Control ◽  
Alcoholic Beverages ◽  
Cottage Cheese ◽  
Control Group ◽  
Patients With Epilepsy ◽  
Control Study

Abstract Background Several factors predispose individuals with epilepsy to chronic diseases. Among them, nutrition and lifestyle factors have not been sufficiently studied. Therefore, the aim of this study was to evaluate patients with epilepsy in terms of diet, body composition and physical activity compared to healthy sex- and age-matched subjects to investigate whether there are risk factors for nutritional deficiencies and risk factors for the development of metabolic diseases. Methods The case-control study involved 60 epileptic male and female volunteers and 70 healthy controls matched according to age and sex. Medical information was collected during the study, and a detailed questionnaire regarding eating and lifestyle habits was conducted. Physical activity was evaluated using the International Physical Activity Questionnaire (IPAQ). Nutritional status was assessed by bioelectric impedance. Venous blood samples were taken for lipid and 25-hydroxyvitamin D3 (25(OH)D3) analyses. Results A tendency toward an increase in LDL cholesterol was found in the individuals with epilepsy. Significantly higher body fat and insignificantly higher visceral fat were found in epileptic men than in healthy men. In epileptic women, a tendency toward a lower lean body mass was found. Patients with epilepsy were more sedentary, consumed less cottage cheese, fruit, pulses, nuts and seeds, vitamin C and potassium, and consumed more sugar-sweetened soda, fat and sodium than healthy people. On a positive note, individuals with epilepsy consumed less coffee and alcoholic beverages. More than 80% of the epileptic volunteers had diets that were low in folic acid, vitamin D and calcium, but a similar tendency was observed in the healthy volunteers. A higher percentage of the patients with epilepsy had diets that were low in niacin, vitamin C and potassium than the control group (25% vs. 7, 50% vs. 31% and 73 vs. 56%, respectively). A significantly lower serum concentration of 25(OH)D3 was observed in epileptic individuals and was found to be positively modulated by physical activity. Conclusions The results indicate that several behavior-related habits, which may predispose epileptic people to cardiovascular disease, need to be improved. For this reason, patients with epilepsy should be provided with more comprehensive medical care, including advice on nutrition and physical activity.

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.

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