Sudden unexpected death in epilepsy: Identifying risk and preventing mortality

Lhatoo, Samden D.; Noebels, Jeffrey L.; Whittemore, Vicky

doi:10.1111/epi.13134

Cited by 89 publications

(52 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…8 In each case, good quality video EEG (VEEG) and single channel EKG were recorded during the terminal event. In Case 2, the patient was out of camera view for much of the event.…”

Section: Methodsmentioning

confidence: 99%

Nonseizure SUDEP: Sudden unexpected death in epilepsy without preceding epileptic seizures

et al. 2016

View full text Add to dashboard Cite

Summary Objective To describe the phenomenology of monitored Sudden Unexpected Death in Epilepsy (SUDEP) occurring in the inter-ictal period where death occurs without a seizure preceding it. Methods We report a case series of monitored definite and probable SUDEP where no electroclinical evidence of underlying seizures was found preceding death. Results Three patients (2 definite and 1 probable) suffered SUDEP. They had a typical high SUDEP-risk profile with longstanding intractable epilepsy and frequent generalized tonic-clonic seizures (GTCS). All patients had varying patterns of respiratory and bradyarrhythmic cardiac dysfunction with profound EEG suppression. In two patients, patterns of cardio-respiratory failure were similar to those seen in some patients in the Mortality in Epilepsy Monitoring Units Study (MORTEMUS). Significance Sudden Unexpected Deaths in Epilepsy (SUDEP) almost always occur postictally, after GTCS and less commonly after a partial seizure. Monitored SUDEP or near-SUDEP cases without a seizure have not yet been reported in literature. When non-monitored SUDEP occurs in an ambulatory setting without an overt seizure, the absence of EEG information prevents the exclusion of a subtle seizure. These cases confirm the existence of non-seizure SUDEP; such deaths may not be prevented by seizure detection based devices. SUDEP risk in epilepsy patients may constitute a spectrum of susceptibility wherein some are relatively immune, death occurs in others with frequent GTCS with one ultimately proving fatal, while in others still, death may occur even in the absence of a seizure. We emphasize the heterogeneity of SUDEP phenomena.

show abstract

“…8 In each case, good quality video EEG (VEEG) and single channel EKG were recorded during the terminal event. In Case 2, the patient was out of camera view for much of the event.…”

Section: Methodsmentioning

confidence: 99%

Nonseizure SUDEP: Sudden unexpected death in epilepsy without preceding epileptic seizures

et al. 2016

View full text Add to dashboard Cite

show abstract

“…The closure of this critical gap in understanding has been suggested by researchers (Kothare and Singh 2014) as essential to obtaining a complete picture of autonomic regulation in epilepsy. This, in turn, would better inform us on the physiological mechanisms of sudden unexpected death in epilepsy (SUDEP) (Bozorgi and Lhatoo 2013;Lhatoo et al 2015;Moghimi and Lhatoo 2013) and improve the efficacy of risk factors used to provide clinical prognoses for both epilepsy and SUDEP (Lhatoo et al 2015;Varon et al 2015b).…”

mentioning

confidence: 99%

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

Sivakumar

Namath

Tuxhorn

et al. 2016

Journal of Neurophysiology

View full text Add to dashboard Cite

Sivakumar SS, Namath AG, Tuxhorn IE, Lewis SJ, Galán RF. Decreased heart rate and enhanced sinus arrhythmia during interictal sleep demonstrate autonomic imbalance in generalized epilepsy. J Neurophysiol 115: 1988 -1999. First published February 17, 2016 doi:10.1152/jn.01120.2015.-We hypothesized that epilepsy affects the activity of the autonomic nervous system even in the absence of seizures, which should manifest as differences in heart rate variability (HRV) and cardiac cycle. To test this hypothesis, we investigated ECG traces of 91 children and adolescents with generalized epilepsy and 25 neurologically normal controls during 30 min of stage 2 sleep with interictal or normal EEG. Mean heart rate (HR) and high-frequency HRV corresponding to respiratory sinus arrhythmia (RSA) were quantified and compared. Blood pressure (BP) measurements from physical exams of all subjects were also collected and analyzed. RSA was on average significantly stronger in patients with epilepsy, whereas their mean HR was significantly lower after adjusting for age, body mass index, and sex, consistent with increased parasympathetic tone in these patients. In contrast, diastolic (and systolic) BP at rest was not significantly different, indicating that the sympathetic tone is similar. Remarkably, five additional subjects, initially diagnosed as neurologically normal but with enhanced RSA and lower HR, eventually developed epilepsy, suggesting that increased parasympathetic tone precedes the onset of epilepsy in children. ECG waveforms in epilepsy also displayed significantly longer TP intervals (ventricular diastole) relative to the RR interval. The relative TP interval correlated positively with RSA and negatively with HR, suggesting that these parameters are linked through a common mechanism, which we discuss. Altogether, our results provide evidence for imbalanced autonomic function in generalized epilepsy, which may be a key contributing factor to sudden unexpected death in epilepsy.SUDEP; heart rate variability; cardiac cycle; parasympathetic tone; children EPILEPTIC SEIZURES ARE KNOWN to have profound effects on autonomic function (Wyllie 2015). To quantify these effects, many studies have focused on heart rate (HR) (Behbahani et al.

show abstract

“…There has been a renewed interest in investigating the impact of seizures and epilepsy on cardiovascular and autonomic function in preclinical models in order to try to better understand the pathophysiologic mechanisms of SUDEP . Studies in transgenic mouse models have identified genetic defects that lead to seizures, cardiac arrhythmias, and sudden death .…”

Section: Resultsmentioning

confidence: 99%

A companion to the preclinical common data elements for physiologic data in rodent epilepsy models. A report of the TASK3 Physiology Working Group of the ILAE/AES Joint Translational Task Force

et al. 2018

View full text Add to dashboard Cite

SummaryThe International League Against Epilepsy/American Epilepsy Society (ILAE/AES) Joint Translational Task Force created the TASK3 working groups to create common data elements (CDEs) for various aspects of preclinical epilepsy research studies, which could help improve standardization of experimental designs. This article concerns the parameters that can be measured to assess the physiologic condition of the animals that are used to study rodent models of epilepsy. Here we discuss CDEs for physiologic parameters measured in adult rats and mice such as general health status, temperature, cardiac and respiratory function, and blood constituents. We provide detailed CDE tables and case report forms (CRFs), and with this companion manuscript we discuss the monitoring of different aspects of physiology of the animals. The CDEs, CRFs, and companion paper are available to all researchers, and their use will benefit the harmonization and comparability of translational preclinical epilepsy research. The ultimate hope is to facilitate the development of biomarkers and new treatments for epilepsy.

show abstract

Sudden unexpected death in epilepsy: Identifying risk and preventing mortality

Cited by 89 publications

References 46 publications

Nonseizure SUDEP: Sudden unexpected death in epilepsy without preceding epileptic seizures

Nonseizure SUDEP: Sudden unexpected death in epilepsy without preceding epileptic seizures

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

A companion to the preclinical common data elements for physiologic data in rodent epilepsy models. A report of the TASK3 Physiology Working Group of the ILAE/AES Joint Translational Task Force

Contact Info

Product

Resources

About