Incidence and risk factors in sudden unexpected death in epilepsy

Abstract

These results support the idea that tonic-clonic seizures are an important proximate cause of SUDEP. This information creates a risk profile for SUDEP that may help direct preventative efforts.

Cannabinoids and Epilepsy

“…A third of patients remain pharmacoresistant, failing to achieve sustained seizure freedom after 2 or more adequately chosen, tolerated, and appropriately used antiepileptic drugs (AEDs; more accurately termed antiseizure drugs) [2][3][4]. Patients resistant to multiple AEDs have an increased risk for sudden unexpected death in epilepsy and other forms of epilepsy-related mortality [5,6], as well as impairments in psychosocial, behavioral, and cognitive functions [3,[7][8][9]. For many patients, epilepsy is a progressive disorder associated with ongoing loss of brain tissue and function.…”

The mistery of Gustave Flaubert's death: could sudden unexpected death in epilepsy be part of the context?

“…The incidence of SUDEP was 1.21/1,000 patient-years and a progressive risk for SUDEP was found with increasing seizure frequency. The authors support the idea that tonic-clonic seizures are an important proximate cause of SUDEP and concluded that the occurrence of as few as 1-3 such seizures per year was associated with an increased risk factor 23 . From a pathophysiological point of view, SUDEP directly result from the occurrence of seizures, in particular generalized tonic-clonic seizure 30 .…”

“…The relative risk of SUDEP increased with number of seizures per year and the estimated relative risk was 10.16 (95% CI 2.94-35.18) in patients with more than 50 seizures per year, compared with those with up to two seizures per year. In the same way, walczak and co-workers 23 , in a prospective cohort study, determined the incidence of and risk factors for SUDEP. The incidence of SUDEP was 1.21/1,000 patient-years and a progressive risk for SUDEP was found with increasing seizure frequency.…”

“…The National General Practice Study of Epilepsy (NGPSE), a community-based study in the United Kingdom, saw the first case of SUDEP after 11,000 person-years of follow-up 20 , and the results of the Medical research Council Antiepileptic Drug withdrawal Study showed that SUDEP is a rare event among patients with epilepsy in remission 21 . Information concerning risk factors for SUDEP is conflicting, but potential risk factors include: early adulthood 16 , early onset of epilepsy 22 , long duration of epilepsy 23 , uncontrolled seizures (mainly in those with TlE) 23,24 , high seizure frequency [23][24][25] , certain seizure types 23,26 , higher numbers of antiepileptic drug (AED) 22,23,27 and winter temperatures 28 . Additionally, potential pathomechanisms for SUDEP are unknown, but it is very probable that cardiac arrhythmias during and between seizures, electrolyte disturbances, arrhythmogenic drugs or transmission of epileptic activity to the heart via the autonomic nervous system potentially play a role 29,30 .…”

“…Though the respective role of seizure-induced respiratory and cardiac fatal abnormalities remains uncertain, recent studies suggest that high-risk ictal arrhythmias occur in much greater proportion of patients with refractory epilepsy than previously believed, representing the leading cause of SUDEP 15,30 . Quite interesting, as uncontrolled seizures (mainly in those with TlE) and high seizure frequency are the most important risk factors for SUDEP 15,[23][24][25]30 , it is plausible to believe that factors could influence negatively the cardiovascular system of the patient with epilepsy leading to cardiac abnormalities and hence SUDEP.…”