Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034063 (pulmonary edema)
 10,665 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report two cases with complex partial and secondarily generalized seizures, both on oxcarbazepine and vigabatrin, with additional lamotrigine in one case. Both died in a manner resembling SUDEP, i.e. suddenly, unexpectedly, probably following a seizure with pulmonary oedema at autopsy. Both had SIADH. A number of drugs may cause SIADH, among them carbamazepine and oxcarbazepine. A search for SIADH in patients on carbamazepine and oxcarbazepine, and in cases of sudden death in epilepsy, is recommended.
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PMID:Sudden death in two patients with epilepsy and the syndrome of inappropriate antidiuretic hormone secretion (SIADH). 980 22

In summary, SUDEP accounts for death in approximately 8% of the young epileptic population. It is commoner in young male epileptics with a long history of generalised seizures, who have a history of head trauma and alcohol excess, and who are taking more than one antiepileptic drug. Most deaths are unwitnessed and occur at home, usually in bed and presumably overnight. Subtherapeutic AED levels do not necessarily imply non compliance, and may simply reflect drug degradation in the plasma after death. Many victims have pulmonary oedema on postmortem examination, and some show ischaemic damage of the heart despite normal coronary arteries. This possibly arises as a result of repeated episodes of vasoconstriction from seizure related catecholamine bursts. Animal studies have demonstrated the occurrence of central apnoea and also support the theory of acute fatal cardiac failure. Possible association with the daily level of geomagnetic activity is reported. The precise reason for a particular seizure being fatal in an otherwise healthy individual is as yet undetermined.
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PMID:Sudden unexpected deaths in epileptics--a literature review. 1062 8

Sudden unexplained death in epilepsy (SUDEP) is an important unresolved problem affecting many patients with recurrent seizures. Amongst the mechanisms postulated are ictal or postictal cardiac arrhythmias, central hypoventilation or apnea, and neurogenic pulmonary edema. Across these categories, a common element appears to be some form of autonomic dysregulation. Accordingly, the search for biomarkers of SUDEP risk has focused increasingly on autonomic findings. Emerging models implicate attenuated cardiac vagal modulation coupled with surging cardiac sympathetic activity, neuronal dropout in the nucleus tractus solitarii, and in some cases genetic factors affecting ion channel behavior. Explicating the crucial links between brain and heart in epilepsy benefits from collaboration amongst neurologists, cardiologists, physiologists, and other specialists with an interest in the autonomic nervous system.
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PMID:Highlights in clinical autonomic neurosciences: sudden unexpected death in epilepsy. 2390 Feb 58

Epilepsy is a common neurological disorder associated with increased morbidity and mortality, including premature death from different causes. Sudden unexpected death in epilepsy, or SUDEP, is one of the most common causes of death in people with epilepsy and originally brought to light by medical examiners. It accounts for 5% to 30% of all deaths in individuals with epilepsy and up to 50% in individuals with medically refractory epilepsy. It is commonly associated with a history of generalized tonic-clonic seizures and may be mitigated by other electroclinical risk factors, such as postictal electroencephalographic suppression, prone position, altered heart rate variability, conduction abnormalities, gender, or antiepileptic medications, to name a few. More recently, potential neuroimaging biomarkers have also been identified. Still, despite the increased mortality risk in people with epilepsy due to SUDEP, little is known about its underlying pathophysiology. The pathogenesis is likely to be multifactorial, resulting in neurogenic pulmonary edema or, in some cases, fatal cardiac arrhythmias. Medical examiners can provide an important role in our understanding of the magnitude of the problem and ongoing research into the underlying mechanisms. In this review, we discuss diagnostic criteria, incidence, risk factors, and current theories regarding the pathophysiology of SUDEP.
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PMID:Sudden Unexpected Death in Epilepsy: Incidence, Risk Factors, and Proposed Mechanisms. 2959 66