Incidence of sudden unexpected death in nocturnal frontal lobe epilepsy: a cohort study

Abstract

HighlightsWe assessed sudden unexpected death in epilepsy in nocturnal frontal lobe epilepsy.The incidence of SUDEP in NFLE was no higher than that of other epilepsy populations.The lower than expected risk of SUDEP might reflect a low occurrence of GTCS in NFLE.

Decreased heart rate and enhanced sinus arrhythmia during interictal sleep demonstrate autonomic imbalance in generalized epilepsy

“…According to Mostacci et al (2015), "Most cases of SUDEPь ь ьoccur while people are in bed, presumably sleeping." In a clinical study, 58% of all reported SUDEP cases were found to have occurred during sleep; of these, 86% were unwitnessed but confirmed through autopsies (Lamberts et al 2012).…”

New avenues to prevent sudden unexpected death in nocturnal frontal lobe epilepsy: follow the route established by omega-3 polyunsaturated fatty acids

“…The very elegant article by Mostacci and colleagues [1], which assessed the incidence of sudden unexpected death in epilepsy (SUDEP) retrospectively in a cohort of patients with nocturnal frontal lobe epilepsy (NFLE), encouraged us to write this commentary.…”

“…Currently, the main risk factors associated with SUDEP include the presence and number of generalized tonic-clonic seizures (GTCS), young age at epilepsy onset, longer duration of epilepsy, dementia, absence of cerebrovascular disease, asthma, male gender, symptomatic etiology of epilepsy, alcohol abuse, and nocturnal seizure [15,16]. Considering this last mentioned risk factor and associating it with nocturnal frontal lobe epilepsy (NFLE), it is relevant to note that NFLE is a syndrome in which seizures occur mostly or exclusively during sleep and tend to be very frequent, occurring up to dozens of times per night [1,17]. In addition, if these patients concomitantly present with obstructive sleep apnea (OSA), a common form of sleep-disordered breathing [18], the story may be more alarming due to a possible occurrence of a fatal event.…”

“…The excellent study delineated by Mostacci and collaborators [1] made it clear that people with NFLE do not have a high risk of SUDEP which is a reflection of the low occurrence of generalized tonicclonic seizures in this population [1]. The authors rightly point out in their discussion that OSA could be considered an independent risk factor for sudden death in people with NFLE (especially at night time), since several studies report high prevalence of OSA in patients with epilepsy, particularly in refractory cases [1,[26][27][28].…”

“…The authors rightly point out in their discussion that OSA could be considered an independent risk factor for sudden death in people with NFLE (especially at night time), since several studies report high prevalence of OSA in patients with epilepsy, particularly in refractory cases [1,[26][27][28]. In fact, the authors report in the study that eight people (7.8%) had OSA, which was considered moderate-to-severe and four of them required continued positive airway pressure (CPAP) treatment [1]. Furthermore, in the remaining four, OSA was considered to be mild and a weight-loss program was undertaken [1].…”