Sudden unexpected death in patients with epilepsy receiving renal replacement therapy with dialysis: A 17‐year experience at a single institution

Abstract

Epilepsy is the most common acquired chronic neurological disorder; each year about 1 in a 1000 patients with chronic epilepsy die suddenly, unexpectedly, and without explanation, even with postmortem examination (SUDEP). Seizure incidence is approximately 10% in patients with chronic renal failure and hemodialysis-associated seizure has been considered to be a common complication of people on hemodialysis treatment. Considering this, we evaluated the incidence of seizures in 189 patients under dialytic treatment.

Near-sudden unexpected death in a patient with epilepsy undergoing hemodialysis: a case report

“…SUDEP is considered the primary but rare cause of deaths in patients with epilepsy [ 7 ]. The incidence of SUDEP has been reported to be 1.20/1000 person-years [ 8 , 9 ], with only a few cases of SUDEP being reported in HD patients till date [ 10 ].…”

Omega-3 intake in people with epilepsy under regular hemodialysis program: here to stay

“…It provided evidence that fish oil may reduce the risk of SUDEP in epilepsy 27 , which was also confirmed experimentally [28][29][30] . In dialysis, omega-3 FAs have been clinically and experimentally assessed due to their proven benefits in advanced chronic kidney disease (CKD), such as renoprotection in IgA nephropathy, cardioprotection via a variety of mechanisms including triglyceride levels and blood pressure reduction, maintenance of dialysis access patency, sparing of inflammation-associated muscle loss, and reduced mortality 17,31,32 . In these lines, we fully agree with this and have recently confirmed it in a trial (Rui Alberto Gomes, PhD Thesis -unpublished data).…”

“…This data has to be cautiously interpreted as the numbers examined are small, but our conclusion is that the flame of translational science among health professionals directly involved with these people must be permanently lit. For these new considerations, experimental, epidemiological, and clinical studies should be carried out to establish the association between epilepsy, cardiovascular abnormalities, and sudden death in people on dialysis 13,17 . Currently, the ultimate goal in neurology and nephrology research in regards to cardiovascular changes that may lead to sudden death is to develop new methods to prevent it and to establish actions other than medical that may be effective.…”

“…It also calls the attention for clinical trials designed to evaluate the effects of omega-3 FAs supplementation on cardiovascular risk and outcomes 17,[31][32][33] . It is important to note that sudden cardiac death is the most common cause of death in ESRD individuals under regular dialysis program usually caused by ventricular arrhythmias, such as ventricular tachycardia and fibrillation 34 .…”

Multiple Factors Including Infections and Antibiotics Affecting New‐Onset Epilepsy in Hemodialysis Patients

“…Although its exact pathogenesis remains unclear, uremic encephalopathy is one of the most serious neurological complications of chronic renal failure , and tonic–clonic seizures are the most serious of the complications that can arise from it. Acute onset, critical illness, and a high mortality rate are all typically associated with patients with sustained epilepsy arising from uremic encephalopathy . Timely treatment can however improve patient prognosis and reduce the mortality rate.…”