Sudden death in a child with epilepsy: potential cerebellar mechanisms?

Arida, Ricardo Mário; Sakamoto, Américo C; Harper, Ronald M.

doi:10.1590/s0004-282x2011000500024

Cited by 5 publications

(3 citation statements)

References 49 publications

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“…The slower processing likely puts the people at risk of not adapting blood pressure or heart rate sufficiently fast to maintain optimum perfusion for some situations. However, CCHS, HF, and OSA patients also show a subset of structures with phase-leading signals, suggesting higher sensitivity in some regions in those conditions; such timing differences may lead to asymmetric sympathetic outflow, which would enhance the potential for fatal arrhythmias, a major consideration in sudden death in infants and epilepsy (Scorza et al, 2008 , 2011 ; Harper and Kinney, 2010 ). Both the hippocampus and amygdala show neuronal discharge related to the cardiac and respiratory cycle in patients with epilepsy (Frysinger and Harper, 1989 , 1990 ), an issue of concern when structural injury appears in such patients (Staba et al, 2007 ; Ogren et al, 2009a , b ), and sudden death in epilepsy (SUDEP) very likely develops from a failure in breathing or the cardiovascular system (Nashef et al, 2007 ).…”

Section: Types Of Pathology Detectable By Fmri: Findings In Obstructimentioning

confidence: 99%

Functional Imaging of Autonomic Regulation: Methods and Key Findings

et al. 2016

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Central nervous system processing of autonomic function involves a network of regions throughout the brain which can be visualized and measured with neuroimaging techniques, notably functional magnetic resonance imaging (fMRI). The development of fMRI procedures has both confirmed and extended earlier findings from animal models, and human stroke and lesion studies. Assessments with fMRI can elucidate interactions between different central sites in regulating normal autonomic patterning, and demonstrate how disturbed systems can interact to produce aberrant regulation during autonomic challenges. Understanding autonomic dysfunction in various illnesses reveals mechanisms that potentially lead to interventions in the impairments. The objectives here are to: (1) describe the fMRI neuroimaging methodology for assessment of autonomic neural control, (2) outline the widespread, lateralized distribution of function in autonomic sites in the normal brain which includes structures from the neocortex through the medulla and cerebellum, (3) illustrate the importance of the time course of neural changes when coordinating responses, and how those patterns are impacted in conditions of sleep-disordered breathing, and (4) highlight opportunities for future research studies with emerging methodologies. Methodological considerations specific to autonomic testing include timing of challenges relative to the underlying fMRI signal, spatial resolution sufficient to identify autonomic brainstem nuclei, blood pressure, and blood oxygenation influences on the fMRI signal, and the sustained timing, often measured in minutes of challenge periods and recovery. Key findings include the lateralized nature of autonomic organization, which is reminiscent of asymmetric motor, sensory, and language pathways. Testing brain function during autonomic challenges demonstrate closely-integrated timing of responses in connected brain areas during autonomic challenges, and the involvement with brain regions mediating postural and motoric actions, including respiration, and cardiac output. The study of pathological processes associated with autonomic disruption shows susceptibilities of different brain structures to altered timing of neural function, notably in sleep disordered breathing, such as obstructive sleep apnea and congenital central hypoventilation syndrome. The cerebellum, in particular, serves coordination roles for vestibular stimuli and blood pressure changes, and shows both injury and substantially altered timing of responses to pressor challenges in sleep-disordered breathing conditions. The insights into central autonomic processing provided by neuroimaging have assisted understanding of such regulation, and may lead to new treatment options for conditions with disrupted autonomic function.

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Section: Types Of Pathology Detectable By Fmri: Findings In Obstructimentioning

confidence: 99%

Functional Imaging of Autonomic Regulation: Methods and Key Findings

et al. 2016

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“…The fastigial nucleus of the cerebellum in functional imaging studies has roles in normal autonomic regulation of baroreflexes [82]. Cerebellar damage has been implicated in SUDEP [83] but requires more rigorous pathology and molecular assessment in order to identify its role in the pathogenesis of SUDEP.…”

Section: Introductionmentioning

confidence: 99%

Review: The past, present and future challenges in epilepsy‐related and sudden deaths and biobanking

Thom¹,

Boldrini

Bundock

et al. 2018

Neuropathology Appl Neurobio

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The past, present and future challenges in epilepsy-related and sudden deaths and biobanking Awareness and research on epilepsy-related deaths (ERD), in particular Sudden Unexpected Death in Epilepsy (SUDEP), have exponentially increased over the last two decades. Most publications have focused on guidelines that inform clinicians dealing with these deaths, educating patients, potential risk factors and mechanisms. There is a relative paucity of information available for pathologists who conduct these autopsies regarding appropriate post mortem practice and investigations. As we move from recognizing SUDEP as the most common form of ERD toward indepth investigations into its causes and prevention, health professionals involved with these autopsies and post mortem procedure must remain fully informed.Systematizing a more comprehensive and consistent practice of examining these cases will facilitate (i) more precise determination of cause of death, (ii) identification of SUDEP for improved epidemiological surveillance (the first step for an intervention study), and (iii) biobanking and cell-based research. This article reviews how pathologists and healthcare professionals have approached ERD, current practices, logistical problems and areas to improve and harmonize. The main neuropathology, cardiac and genetic findings in SUDEP are outlined, providing a framework for best practices, integration of clinical, pathological and molecular genetic investigations in SUDEP, and ultimately prevention.

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“…The limbic forebrain consists of the hippocampal formation, the amygdaloid complex, the septal region, gyrus fornicatus, the piriform lobe and the caudal orbital frontal cortex. Connections of the limbic system with insula, basal ganglia, thalamus and cerebellum have been shown (Augustine, 1996;Surges et al, 2009a;Burghaus et al, 2011;Scorza et al, 2011). The intracerebral elements of the autonomic nervous system largely consist of connections between the limbic cortex and hypothalamus, pons and medulla oblongata.…”

Section: Pathophysiological Mechanisms Of Sudep Autonomic Structural and Functional Considerationmentioning

confidence: 99%

Sudden Unexpected Death In Epilepsy (SUDEP) - an update

Majkowski¹

2013

Journal of Epileptology

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Introduction. SUDEP is not so rare event, unexplained, underused and underestimated. Its awareness has recently contributed to a number of initiatives for global action and clinical and experimental research. Aim. To undertake a literature review so as to update various aspects of SUDEP: pathophysiological mechanisms, potential markers for autonomic dysfunctions and risk factors, AEDs effects, non-AED management options, forensic/autopsy, patient-physician communications in patients with SUDEP risk. Method. A literature review, up to Nov. 2012, was conducted using PubMed-Medline for SUDEP, no indexed citation and relevant papers. Review. Interactions between the central and peripheral origin of cardiac and respiratory dysfunctions, triggered by epileptiform discharges in the cortical representation of the autonomic functions, may lead to SUDEP during simple partial autonomic seizures -even without other components of a seizure. A number of potential biomarkers of autonomic dysfunctions and risk of SUDEP are identified and proposed to use in its prevention: heart rate variability, long and short QT, arrhythmias, asystole, oxygen desaturation, apneas, hypoxia, postictal EEG suppression, circadian seizure pattern. Conclusions. Risk factors for SUDEP, AEDs effects, non-AED management of preventive options and forensic autopsy in diagnosis of SUDEP are discussed. Periictal long term video EEG, ECG and oxygen saturation monitoring may contribute to better understanding of SUDEP mechanisms and eventually to its prevention. SUDEP occurs as fatal coexistence of several predisposing risk factors. Diagnosis of SUDEP is underestimated and underused. In patient with high risk factors for SUDEP, in particular, with AED noncompliance, prognosis of epilepsy should be discussed with patient. Key words: SUDEP • animal seizure models and autonomic dysfunctions • potential biomarkers of SUDEP risk • risk factors of SUDEP • AEDs • autopsy atives were undertaken to assess the state of knowledge about SUDEP and to work out recommendations, e.g. multidisciplinary workshop to refine current lines of Copyright and photocopying by Foundation of Epileptology, 213

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Sudden death in a child with epilepsy: potential cerebellar mechanisms?

Cited by 5 publications

References 49 publications

Functional Imaging of Autonomic Regulation: Methods and Key Findings

Functional Imaging of Autonomic Regulation: Methods and Key Findings

Review: The past, present and future challenges in epilepsy‐related and sudden deaths and biobanking

Sudden Unexpected Death In Epilepsy (SUDEP) - an update

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