Drowning in epilepsy: A population-based case series

Bain, Eva; Keller, Anne; Ho, Jordan; Whitney, Robyn; Pollanen, Michael S.; Williams, Andrew S.; Donner, Elizabeth

doi:10.1016/j.eplepsyres.2018.06.010

Cited by 22 publications

(25 citation statements)

References 11 publications

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“…Therefore, it is important that patients with epilepsy maintain a high adherence rate. Because the most common site of drowning among patients with epilepsy is the bathtub, showering instead of bathing is generally recommended [6]. However, because showering can lead to drowning as described in the present case, it is also unsafe for patients with nonadherence.…”

mentioning

confidence: 89%

Drowning of a patient with epilepsy while showering

Nakagawa¹,

Ishii²,

Hitosugi³

2019

Environ Health Prev Med

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In Japan, because the most common site of drowning among patients with epilepsy is the bathtub, showering is generally recommended as an alternative to bathing. We herein report a case involving a female patient with epilepsy who drowned while showering. She had been diagnosed with epilepsy approximately 25 years previously, and her condition had progressed to refractory epilepsy. Carbamazepine, levetiracetam, lamotrigine, clobazam, and perampanel were prescribed daily. One day while showering, the patient was found lying with her face immersed in water that had accumulated on the floor of the bathtub. A forensic autopsy revealed water in the stomach, trachea, and proximal regions of both lung bronchi as well as white and red foam on the pharynx and larynx. A total of 1.9 μg/mL of lamotrigine, 0.14 μg/mL of carbamazepine, and 0.069 μg/mL of perampanel were detected in the patient’s blood. The patient’s cause of death was determined to be drowning due to an epileptic seizure. Although the patient was prescribed five types of antiepileptic medication, only three were detected in her blood. The current case demonstrates that drowning can occur while showering, suggesting that it is unsafe for patients with medication nonadherence. To prevent unintentional deaths in the bathroom, we recommend that patients with epilepsy maintain high adherence to all prescriptions and are supervised by a family member, even when showering. The current case is the first autopsy report of a patient with epilepsy who drowned while showering.

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mentioning

confidence: 89%

Drowning of a patient with epilepsy while showering

Nakagawa¹,

Ishii²,

Hitosugi³

2019

Environ Health Prev Med

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“…The head and the extremities are the most common locations of the injuries, and falls are by far the most frequent mechanisms for injuries in people with epilepsy 26 . Although far less common, the greatest increase in risk has been reported to be with drowning accidents, the risk being 6-18 times higher in PWE 26,32 .…”

Section: Types Of Injuriesmentioning

confidence: 99%

Dramatic outcomes in epilepsy: depression, suicide, injuries, and mortality

Mesraoua

Deleu

Hassan

et al. 2020

Current Medical Research and Opinion

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In this narrative review, we will discuss some of the significant risks and dramatic consequences that are associated with epilepsy: depression, suicide, seizure-related injuries, and mortality, both in adults and in children. Considering the high prevalence of depression among people with epilepsy (PWE), routine and periodic screening of all PWE for early detection and appropriate management of depression is recommended. PWE should be screened for suicidal ideation regularly and when needed, patients should be referred for a psychiatric evaluation and treatment. When starting an antiepileptic drug (AED) or switching from one to another AED, patients should be advised to report to their treating physician any change in their mood and existence of suicidal ideation. The risk of injuries for the general epilepsy population is increased only moderately. The risk is higher in selected populations attending epilepsy clinics and referral centers. This being said, there are PWE that may suffer frequent, severe, and sometimes even life-threatening seizure-related injuries. The most obvious way to reduce risk is to strive for improved seizure control. Finally, PWE have a 2-3 times higher mortality rate than the general population. Deaths in PWE may relate to the underlying cause of epilepsy, to seizures (including sudden unexpected death in epilepsy [SUDEP] and seizure related injuries) and to status epilepticus, as well as to other conditions that do not appear directly related to epilepsy. Improving seizure control and patient education may be the most important measures to reduce epilepsy related mortality in general and SUDEP in particular.

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“…Epilepsy is associated with fatal drowning at an estimated rate of nearly ten times that of the general population (Bain et al, 2018). Most such fatal drownings occur in the bathtub.…”

Section: Sudden Unexpected Death In Epilepsy (Sudep)mentioning

confidence: 99%

“…Like other SUDEP cases, most occur in young persons in whom the MDR is quite active (Kaijser and Sachs, 1985). By contrast, in the general population, 60% of bathtub drownings occur in persons 65 years of age or older (Bain et al, 2018). A natural assumption is that an inability to coordinate lifesaving movement forms the basis for the increased risk of fatal drowning during a seizure.…”

Section: Sudden Unexpected Death In Epilepsy (Sudep)mentioning

confidence: 99%

Sudden Unexpected Death and the Mammalian Dive Response: Catastrophic Failure of a Complex Tightly Coupled System

Vincenzi

2019

Front. Physiol.

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In tightly coupled complex systems, when two or more factors or events interact in unanticipated ways, catastrophic failures of high-risk technical systems happen rarely, but quickly. Safety features are commonly built into complex systems to avoid disasters but are often part of the problem. The human body may be considered as a complex tightly coupled system at risk of rare catastrophic failure (sudden unexpected death, SUD) when certain factors or events interact. The mammalian dive response (MDR) is a built-in safety feature of the body that normally conserves oxygen during acute hypoxia. Activation of the MDR is the final pathway to sudden cardiac (SCD) in some cases of sudden infant death syndrome (SIDS), sudden unexpected death in epilepsy (SUDEP), and sudden cardiac death in water (SCDIW, fatal drowning). There is no single cause in any of these death scenarios, but an array of, unanticipated, often unknown, factors or events that activate or interact with the mammalian dive reflex. In any particular case, the relevant risk factors or events might include a combination of genetic, developmental, metabolic, disease, environmental, or operational influences. Determination of a single cause in any of these death scenarios is unlikely. The common thread among these seemingly different death scenarios is activation of the mammalian dive response. The human body is a complex tightly coupled system at risk of rare catastrophic failure when that “safety feature” is activated.

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Drowning in epilepsy: A population-based case series

Cited by 22 publications

References 11 publications

Drowning of a patient with epilepsy while showering

Drowning of a patient with epilepsy while showering

Dramatic outcomes in epilepsy: depression, suicide, injuries, and mortality

Sudden Unexpected Death and the Mammalian Dive Response: Catastrophic Failure of a Complex Tightly Coupled System

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