Sudden unexpected, unexplained death in epilepsy autopsied patients

Antoniuk, Sérgio Antônio; Oliva, Lubomira V.; Bruck, Isac; Malucelli, M.; Yabumoto, Silvia; Castellano, Jeferson Luis

doi:10.1590/s0004-282x2001000100009

Cited by 49 publications

(29 citation statements)

References 24 publications

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“…The literature varies in defining SUDEP, [18][19][20][21] though most definitions require that the death be sudden and nonaccidental, occurring within 1 day of the onset of symptoms, or sometimes within 1 or 2 hours; a history of diagnosed epilepsy; and no anatomic or toxicologic cause of death identified. Some have argued that this last requirement often means an autopsy must be performed to confirm SUDEP, and this precludes such a determination in the present study, in which we have relied on underlying causes of death as indicated in California State mortality files.…”

Section: Discussionmentioning

confidence: 99%

“…6,[15][16][17] As one study noted, "the main causes of death [among persons with epilepsy] are those most common in the population as a whole and those that underlie the epilepsy itself." 2 On the other hand, recent studies have identified sudden unexplained death in epilepsy (SUDEP) as a significant cause of death, [18][19][20] accounting for up to 17% of deaths in persons with epilepsy. 21 The definition of SUDEP varies between studies, however, and it is unclear how these findings can best impact clinical practice and prevention of mortality in epilepsy.…”

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confidence: 99%

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Causes of death in remote symptomatic epilepsy

Day¹,

Wu²,

Strauss³

et al. 2005

Neurology

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Abstract-Objective:To determine the causes of death of individuals with developmental disabilities that occur more frequently among those with remote symptomatic epilepsy (i.e., epilepsy occurring in persons with developmental delay or identified brain lesions) than for those without. Methods: The authors compared causes of mortality in persons with (n ϭ 10,030) and without (n ϭ 96,163) history of epilepsy in a California population of persons with mild developmental disabilities, 1988 to 2002. Subjects had traumatic brain injury, cerebral palsy, Down syndrome, autism, or a developmental disability with other or unknown etiology. There were 721,759 person-years of data, with 2,397 deaths. Underlying causes of death were determined from the State of California's official mortality records. Cause-specific death rates and standardized mortality ratios (SMRs) were computed for those with and without epilepsy relative to subjects in the California general population. Comparisons were then made between SMRs of those with and without epilepsy, and CIs on the ratios of SMRs were determined. Results: Death rates for persons with epilepsy were elevated for several causes. The greatest excess was due to seizures (International Classification of Diseases-9 [ICD-9] 345; SMR 53.1, 95% CI 28.0 to 101.0) and convulsions (ICD-9 780.3; SMR 25.2, 95% CI 11.7 to 54.2). Other causes occurring more frequently in those with epilepsy included brain cancer (SMR 5.2, 95% CI 2.2 to 12.1), respiratory diseases (SMR 1.7, 95% CI 1.2 to 2.5), circulatory diseases (SMR 1.3, 95% CI 1.0 to 1.7), and accidents (SMR 2.7, 95% CI 1.9 to 3.7), especially accidental drowning (SMR 12.8, 95% CI 7.0 to 23.2). Conclusions: Remote symptomatic epilepsy is associated with an increased risk of death. Seizures, aspiration pneumonia, and accidental drowning are among the leading contributors. NEUROLOGY 2005;65:216-222 Persons with epilepsy are at increased risk of death compared with the general population.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Causes of death in remote symptomatic epilepsy

Day¹,

Wu²,

Strauss³

et al. 2005

Neurology

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“…Several autopsy studies in people with SUDEP have reported pulmonary oedema 25 or increased lung weights 14 . The post-mortem data in one study 26 revealed bronchial fluid or pulmonary oedema in four of six cases, suggesting that the increased autonomic stimulation associated with seizures in SUDEP observed in their study may contribute to pulmonary changes that may be important in SUDEP; pre-existing pulmonary diseases could exacerbate this process.…”

Section: Methodsmentioning

confidence: 99%

Quantification of respiratory parameters in patients with temporal lobe epilepsy

Abreu

Albuquerque

Pacheco

et al. 2007

Arq. Neuro-Psiquiatr.

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Sudden unexplained death in epilepsy (SUDEP) is a major cause of mortality in patients with epilepsy 1,2 . The aetiology of SUDEP remains unclear and may be multifactorial. Autonomic dysfunction affecting cardiac or pulmonary systems has been postulated as a major factor in SUDEP. Cardiac rate and rhythm disturbances and respiratory abnormalities have been identified during seizures [3][4][5][6] . Seizures can alter respiratory rate and pattern, producing tachypnoea, hypopnoea or apnoea, and secretions. Apnoea is com- AbSTrACT -Dysfunction affecting cardiac or pulmonary systems has been postulated as a major factor in sudden death in epilepsy (SUDEP). Whilst the majority of studies of cardiorespiratory function have focused on changes during seizures, here we investigate whether epilepsy influences basal respiratory parameters in patients with temporal lobe epilepsy (TLE) during the interictal period. Spirometry was performed in 10 females and 10 males. Measurements of Vital Capacity (VC), Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1) and ratios of FEV1 to FVC (FEV1/FVC) were obtained, and these values were analyzed as percentages of predicted values. None of the patients had chronic obstructive pulmonary disease and no significant alterations in respiratory function tests were found among these patients. No association between seizure frequency, antiepileptic drugs and SUDEP could be found in this study. Although the study did not identify any specific respiratory abnormality in TLE patients during the interictal period, re-evaluation of clinical data on pulmonary disorders in people with epilepsy should be better investigated.KEy WorDS: epilepsy, SUDEP, respiratory parameters. Quantificação de parâmetros respiratórios em pacientes com epilepsia do lobo temporalrESUMo -Alterações cardíacas e pulmonares têm sido propostas como principais fatores de risco no fenô-meno da morte súbita em epilepsia (SUDEP). Enquanto a maioria dos estudos tem verificado as alterações da função cardiorrespiratória durante as crises epilépticas, nosso estudo avaliou a função pulmonar de indivíduos com epilepsia do lobo temporal (ELT) no período interictal. Vinte pacientes com ELT (10 homens e 10 mulheres) participaram de nosso estudo. Nos testes de função pulmonar foram mensurados os seguintes parâmetros: Capacidade Vital Forçada (CVF), Capacidade Vital Lenta (CVL), Volume Expiratório Forçado no primeiro segundo (VEF1) e o Índice VEF1/CVF. os resultados foram comparados aos valores de normalidade preditos na literatura. Nenhum dos pacientes apresentou doença pulmonar obstrutiva ou restritiva e alterações significativas nos testes de função pulmonar. Não foram encontradas associações entre a freqüência de crises, drogas antiepilépticas e SUDEP. Embora nosso estudo não tenha identificado qualquer anormalidade respiratória específica em indivíduos com ELT durante o período interictal, os dados clínicos sobre transtornos pulmonares em indivíduos com epilepsia devem ser melhor avaliados.

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“…Some experiences in the literature are re v i e w e d and related, for example: acute neurogenic pulmon a ry edema in a 28-year-old woman who pre s e n ted ru p t u reof an internal carotid art e ry aneury s m and subarachnoid hemorrh a g e 2 8 ; two patients with n e u rogenic pulmonary edema, one with head inj u ry and another with intracerebral hemorrh a g e 2 9 ; n e u rogenic pulmonary edema after injuries of the c e rvical spine 3 0 ; evidence of lung injury during rec o n s t ructive thoracolumbosacral surg e ry for adult spinal deformities with pulmonary art e ry pre s s u re m o n i t o r i n g 3 1 ; sudden unexpected and unexplained death in autopsied epilepsy patients, most of w h o m had pulmonary and/or cerebral edema as the cause of death 32 .…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic parameters and neurogenic pulmonary edema following spinal cord injury: an experimental model

Filho¹,

Morandin²,

Almeida³

et al. 2005

Arq. Neuro-Psiquiatr.

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-Neurogenic pulmonary edema is a serious and always life-threatening complication following several lesions of the central nervous system. We re p o rt an experiment with 58 Wi s t a r-Hanover adult male rats. Two gro u p s w e re formed: control (n=4) and experimental (n=54). The experimental group sustained acute midthoracic spinal c o rdinjury by Fogart y 's balloon-compression technique containing 20µL of saline for 5, 15, 30 or 60 seconds. The rats w e reanesthetized by intraperitoneal (i.p.) sodium pentobarbital (s.p.) 60 mg/Kg. The quantitative neurological outcome was presented at 4, 24 and 48 hours from compression to characterize the injury graduation in diff e rent gro u p s . Poor outcome occurred with 60 seconds of compression. Six animals died suddenly with pulmonary edema. Using the pro c e d u re to investigate the pulmonary edema during 60 seconds of compression, followed by decompre s s i o n and time-course of 60 seconds, 20 rats were randomly asigned to one of the following groups: control (1, n=4, anesthetized by i.p. s.p., 60 mg/Kg but without compression) and experimental (2, n=7, anesthetized by i.p. xylazine 10 mg/Kg and ketamine 75 mg/Kg) and (3, n=9, anesthetized by i.p. s.p., 60 mg/Kg). The pulmonary index (100 x wet lung weight / body weight) was 0.395 ± 0.018 in control group, rose to 0.499 ± 0.060 in group 2, and was 0.639 ± 0.14 in group 3. Histologic examination of the spinal cord showed parenchymal ru p t u res and acute hemorrh a g e . Comparison of the pulmonary index with morphometric evaluation of edema fluid-filled alveoli by light micro s c o p y showed that relevant intra-alveolar edema occurred only for index values above 0.55. The results suggest that the p u l m o n a ryedema induced by spinal compression is of neurogenic nature and that the type of anesthesia used might be important for the genesis of lung edema.KEY WORDS: spinal cord injury, neurogenic pulmonary edema, central nervous system lesions. P a r â m e t ros hemodinâmicos e edema pulmonar neurogênico após traumatismo raquimedular: modelo experimental RESUMO -Edema pulmonar neurogênico é complicação séria e aumenta o risco de vida em pacientes com várias lesões do sistema nervoso central. Apresentamos uma experiência com 58 ratos Wistar machos e adultos. Foram formados dois grupos: controle (n=4) e experimental (n=54). O grupo experimental sofreu trauma raquimedular torá-cico médio com o cateter-balão de Fogarty contendo 20µL de salina por 5, 15, 30 ou 60 segundos de compressão. Os ratos foram anestesiados com pentobarbital sódico (p.s.), 60 mg/Kg intraperitoneal (i.p.). Foi investigada a re l a ç ã o e n t re a lesão medular e o tempo de compressão. A evolução neurológica foi quantificada e apresentada com 4, 24 e 48 horas da compressão para caracterizar a graduação da lesão nos diferentes grupos. A pior evolução ocorre u com 60 segundos de compressão. Seis animais morreram subitamente com edema pulmonar. Vinte ratos foram randomicamente distribuídos em um dos seguintes grupos: controle (1, n=4, an...

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Sudden unexpected, unexplained death in epilepsy autopsied patients

Cited by 49 publications

References 24 publications

Causes of death in remote symptomatic epilepsy

Causes of death in remote symptomatic epilepsy

Quantification of respiratory parameters in patients with temporal lobe epilepsy

Hemodynamic parameters and neurogenic pulmonary edema following spinal cord injury: an experimental model

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