Population-based study of the incidence of sudden unexplained death in epilepsy

Ficker, David M.; So, E. L.; Shen, Weixiao; Annegers, J. F.; O’Brien, Peter C.; Cascino, Gregory D.; Belau, P. O.

doi:10.1212/wnl.51.5.1270

Cited by 422 publications

(292 citation statements)

References 13 publications

(1 reference statement)

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“…Since different definitions of SUDEP have been used, not all patients have a post-mortem examination, and case ascertainment methods and source populations have varied (Tomson et al 2005). The incidence of SUDEP has been estimated to be 3.5/1000 person-years in a lamotrigine clinical trial (Leestma et al 1997), 0.5-1.4/1000 person-years in people with treated epilepsy (Tennis et al 1995), 5.9/1000 person-years in outpatients with epilepsy at a tertiary referral centre (Nashef et al 1995), and 0.35/1000 personyears in a population-based study (Ficker et al 1998). The National General Practice Study of Epilepsy (NG-PSE), a community-based study in the United Kingdom, saw the first case of SUDEP after 11,000 person-years of follow-up (Lhatoo and Sander 2001), 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 (1991).…”

Section: General Aspectsmentioning

confidence: 99%

The pilocarpine model of epilepsy: what have we learned?

Scorza

Arida

Naffah-Mazzacoratti

et al. 2009

An. Acad. Bras. Ciênc.

158

103

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The systemic administration of a potent muscarinic agonist pilocarpine in rats promotes sequential behavioral and electrographic changes that can be divided into 3 distinct periods: (a) an acute period that built up progressively into a limbic status epilepticus and that lasts 24 h, (b) a silent period with a progressive normalization of EEG and behavior which varies from 4 to 44 days, and (c) a chronic period with spontaneous recurrent seizures (SRSs). The main features of the SRSs observed during the long-term period resemble those of human complex partial seizures and recurs 2-3 times per week per animal. Therefore, the pilocarpine model of epilepsy is a valuable tool not only to study the pathogenesis of temporal lobe epilepsy in human condition, but also to evaluate potential antiepileptogenic drugs. This review concentrates on data from pilocarpine model of epilepsy.

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Section: General Aspectsmentioning

confidence: 99%

The pilocarpine model of epilepsy: what have we learned?

Scorza

Arida

Naffah-Mazzacoratti

et al. 2009

An. Acad. Bras. Ciênc.

158

103

View full text Add to dashboard Cite

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“…This finding is consistent with previous observations that only a small proportions (25%) of the deaths were witnessed ¹². In Ficker s study, 8 (88.8%) of the 9 SUDEP patients were found death at home and only 2 (22.2%) had a seizure witnessed before being found dead 14 . Nashef et al reported that among 14 young SUDEP patients, 11 (78.5%) were found dead at home ¹¹.…”

Section: Discussionmentioning

confidence: 96%

“…Ficker et al reported alcohol abuse in 3 patients (42.8%) out of 7 SUDEP cases 14 . Both alcohol excess and medication withdrawal can precipitate seizures, but may also predispose to autonomic instability thus increasing the risk of ictal death 5 .…”

Section: Discussionmentioning

confidence: 97%

Sudden unexpected, unexplained death in epilepsy autopsied patients

Antoniuk

Oliva

Bruck

et al. 2001

Arq. Neuro-Psiquiatr.

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Sudden unexpected, unexplained death in epilepsy (SUDEP) has been reported to be responsible for 2 to 17% of all deaths in patients with epilepsy. This study was conducted to determine the circumstances of SUDEP and the autopsy findings in these patients. Fifty-three individuals whose cause of death was related to epilepsy were identified and in 30 cases relatives or friends were interviewed about the circumstances of death and other information which allowed to classify the patients as SUDEP or not. The death certificates were also reviewed. We found 20 cases of SUDEP. Most of them were found dead lying on the bed with no evidence of seizure event, and most of them had pulmonary and/or cerebral edema as the cause of death. The incidence and the risk of SUDEP can only be fully ascertained if all sudden deaths had postmortem examination. Consensus in certifying SUDEP cases would allow better accuracy in national mortality rate.KEY WORDS: sudden death, epilepsy, circumstances of death, pulmonary edema.Morte súbita, inexplicada e inesperada em epilepsia: pacientes autopsiados RESUMO Morte súbita inexplicada e inesperada em epilepsia (SUDEP) é responsável por 2 a 17% das mortes em pacientes epilépticos. Este estudo visa determinar as circunstâncias de SUDEP e os achados de autópsia destes pacientes. Foram identificados 53 pacientes cuja causa de morte foi associada a crise epiléptica; em 30 destes, parentes ou amigos foram entrevistados quanto às circunstâncias das mortes e outros aspectos. Também foram revisados os certificados de óbito destes pacientes. Foram encontrados 20 casos de SUDEP. A maioria foi encontrada morta na sua cama por parentes, sem evidência de crise convulsiva, e a causa de morte foi edema cerebral e\ou pulmonar. A incidência e o risco relativo de SUDEP só podem ser adequadamente definidos se houver autópsia em todas as pessoas que morrem subitamente. Um consenso sobre SUDEP permitiria maior acurácia aos dados de mortalidade nacional. PALAVRAS-CHAVE: morte súbita, epilepsia, circunstâncias de morte, edema pulmonar.

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“…Comparisons of incidence estimates for SUDEP are difficult, since different definitions of SUDEP have been used, not all patients have a postmortem examination, and case ascertainment methods and source populations have varied 15 . The incidence of SUDEP has been estimated to be 3.5/1000 person-years in a lamotrigine clinical trial 16 , 0.5-1.4/1000 person-years in people with treated epilepsy 17 , 5.9/1000 person-years in outpatients with epilepsy at a tertiary referral centre 18 and 0.35/1000 person-years in a population-based study 19 . 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 .…”

Section: Sudden Unexpected Death In Epilepsymentioning

confidence: 99%

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

Albuquerque

Scorza

Arida

et al. 2009

Arq. Neuro-Psiquiatr.

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-Epilepsy is the most common serious neurological condition and sudden unexpected death in epilepsy (SUDEP) is the most important direct epilepsy-related cause of death. Information concerning risk factors for SUDEP is conflicting, but high seizure frequency is a potential risk factor. Additionally, potential pathomechanisms for SUDEP are unknown, but it is very probable that cardiac arrhythmias during and between seizures or transmission of epileptic activity to the heart via the autonomic nervous system potentially play a role. More than two decades ago, temporal lobe epilepsy was suggested as having been the ''nervous disease'' of Gustave Flaubert, one of the most important French novelists. In these lines, as the circumstances of his death were the subject of fabulous and mysterious speculations, we postulated in this paper that Falubert's death could be due SUDEP phenomenon.KEy worDS: epilepsy, Gustave Flaubert, SUDEP, seizure. O mistério da morte de Gustave Flaubert: pode a morte súbita em epilepsia fazer parte o contexto ?Resumo -A epilepsia é a condição neurológica crônica grave mais comum e a morte súbita em epilepsia (SUDEP) é a mais importante causa de morte diretamente relacionada à epilepsia. Informações sobre fatores de risco para SUDEP são conflitantes, porém, a alta freqüência de crises epilépticas é um fator de risco em potencial. Além disso, os mecanismos causais para SUDEP ainda não estão conhecidos, mas é muito provável que arritmias cardíacas durante e entre as crises epilépticas ou a transmissão da atividade epiléptica para o coração via sistema nervoso autônomo desempenhem um importante papel. Mais de duas décadas atrás, foi proposto que a "doença nervosa" de Gustave Flaubert, um dos mais importantes novelistas franceses, era epilepsia do lobo temporal. Nesse sentido, como a morte de Gustave Flaubert ainda seja motivo de misteriosa especulação, nosso artigo propõe que a mesma poderia estar relacionada ao fenômeno de SUDEP.

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Population-based study of the incidence of sudden unexplained death in epilepsy

Abstract: The incidence of SUDEP in our study was 0.35 per 1,000 person-years. SUDEP was responsible for 1.7% of deaths in our cohort. SUDEP is a rare cause of death in the epilepsy population but exceeds the expected rate of sudden death in the general population by nearly 24 times.

Cited by 422 publications

References 13 publications

The pilocarpine model of epilepsy: what have we learned?

The pilocarpine model of epilepsy: what have we learned?

Sudden unexpected, unexplained death in epilepsy autopsied patients

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

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