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Query: UMLS:C0036572 (seizures)
 80,221 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.
Seizure 1998 Oct
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

Seizures may be associated with risk of injury or death. Injuries are common in patients with epilepsy, with up to 30% of patients reporting injuries, most commonly blunt trauma and lacerations. Seizures associated with falls increase the risk of injury, but any seizure that is associated with alteration in consciousness may cause injury. Patients with seizures may injure others, especially by causing motor vehicle accidents. Each state has restrictions on driving, requiring seizure-free intervals that range from 3 to 18 months. Mortality is increased in patients with epilepsy. The standardized mortality ratio is increased two to three times in epilepsy cohorts. Sudden unexplained death in epilepsy (SUDEP) is responsible for 2% to 17% of all deaths in patients with epilepsy, depending on the cohort studied. Population-based studies of SUDEP show a lower overall SUDEP rate compared with clinical trials or epilepsy referral center cohorts. Overall, the risk of sudden death is increased in the epilepsy population by 24 times compared with the general population. Risk factors for SUDEP may include poorly controlled seizures, early onset of epilepsy, and generalized tonic-clonic seizures. The pathophysiology of SUDEP is unknown, but animal data suggest apnea may be the initial factor that results in sudden death.
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PMID:Sudden unexplained death and injury in epilepsy. 1088 35

Sudden unexplained death in epilepsy occurs when epilepsy patients die suddenly and unexpectedly in the absence of recent tonic-clonic seizure activity. There is currently no known reliable indicator of acutely lethal seizure activity. Clinical studies record a relationship between recent (within 10-40 minutes) seizure activity and elevated serum prolactin levels, and postictal elevation of prolactin within peripheral vessels has proved clinically useful in determining recent seizure activity. The authors hypothesized that elevated prolactin could be detected in cerebral vessels by immunohistochemical stains, serving as a marker for sudden unexplained death in epilepsy. They conducted a retrospective study of individuals who died in their jurisdiction during the 14 years from 1986 through 1999. The study contained one group of individuals who died of sudden unexplained death in epilepsy, a group with epilepsy who died of some other cause, and a control group whose members died rapidly of a gunshot wound of the torso. Sections of hippocampus and neocortex were obtained and stained with a polyclonal prolactin antibody. No significant difference in the level of immunostaining for prolactin in cerebral vessels was found between the experimental and control groups. A review of the protocols used indicates that revision of certain aspects may provide better immunostaining and more conclusive results.
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PMID:Diagnosis of sudden unexplained death in epilepsy by immunohistochemical staining for prolactin in cerebral vessels. 1260 94

Bite marks of the tongue are often associated with epileptic seizures, although information about the real frequency of bite marks of the tongue is hard to find. This is also true for their presence in deaths of epileptics or in deaths in general. The purpose of this investigation was to analyze the frequency of bite marks of the tongue in deaths of epileptics in comparison to a control group. Further points of interest were the spectrum of the causes of death recorded, toxicological data as well as the presence and localization of external head injuries. The study group consisted of 105 individuals with a known history of epilepsy, the control group of 107 individuals with sudden cardiac death. Autopsy reports were analyzed retrospectively. In the first group bite marks of the tongue were seen in 21% (in the subgroup "observed death during seizure" even in 64%) and were thus significantly more frequent than in the control group (2%). In 35 cases of the study material an unnatural manner of death was found (trauma, especially craniocerebral trauma, drowning, asphyxia, intoxication) and in 70 cases a natural death was assumed. However, in 41 of these the exact cause of death was not ascertainable. According to the SUDEP criteria (Ficker 2000, Nilsson 1999) 29 of these cases could be categorized as possible or probable SUDEP (sudden unexpected death in epilepsy) with 17 showing bite marks of the tongue. The fact that half of the remaining 12 cases showed bite marks of the tongue suggests at least for these cases that death occurred during the seizure. Head injuries were reported in 41% of the epilepsy group--in the subgroup "observed death during seizure" in 73%. Our investigation did not produce evidence for a higher frequency of bite marks of the tongue in cases in which resuscitation had been attempted. In our experience the presence of fresh bite marks of the tongue--according to histological findings--is a useful signs for the assignment of death to an epileptic seizure and especially for death during acute convulsion.
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PMID:[Tongue bite injuries--a diagnostic criterium for death in epileptic seizure?]. 1295 21

Patsy Custis, George Washington's stepdaughter, died suddenly during a brief seizure in 1773. Accounts of Patsy's illness and unexpected death were abstracted from George Washington's papers available via the Library of Congress. Patsy's epilepsy, the treatments she received, and his descriptions of her death were studied. Sudden unexplained death in epilepsy (SUDEP) criteria are applied and discussed. George Washington's description of Patsy's epilepsy and subsequent death meet criteria for SUDEP.
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PMID:The sudden death of Patsy Custis, or George Washington on sudden unexplained death in epilepsy. 1525 1

Sudden unexplained death in epilepsy (SUDEP) accounts for 7-17% of deaths among people with epilepsy. Both cardiac and pulmonary derangement have been postulated as proximate causes. Patients with uncontrolled seizures are at greatest risk for SUDEP, and experiencing tonic-clonic seizures, taking multiple antiepileptic drugs and having coexisting neurologic disease further increase the risk.
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PMID:Sudden Unexplained Death in Epilepsy. 1530 34

Sudden unexplained death in epilepsy (SUDEP) is the commonest cause of epilepsy-related death and most of the presumed risks factors associated with it are probably avoidable. In Nigeria most deaths in individuals with epilepsy occurred at home and so were never reported. Therefore, autopsies are usually not carried to determine the cause of death. This article hopes to reawaken the attention of clinicians to this important, yet not so well known phenomenon, with a view towards addressing problems highlighted Literatures and research publications on SUDEP were systematically reviewed. Case definition, criteria for diagnosis, risk factors, pathophysiology and treatment options for SUDEP and possible methods towards decreasing its incidence was discussed. Incidence of SUDEP increases with the severity of seizure, early onset epilepsy, poor seizure control, generalised tonic-clonic seizure, multiple antiepileptic medications and frequent adjustment of antiepileptic drugs (AEDs). The pathophysiology of SUDEP is not yet clearly elucidated, but it seems to involve interplay of several factors. At the centre of this, is the impaired cardio-respiratory reflexes leading to central apnoea, hypoxia and oedema along with cardiac arrhythmias. Education of patients, relatives and caregivers is crucial to reducing the incidence of SUDEP. Optimal seizure management with an effective monotherapy where possible, should be the goal of the managing physician. In cases of intractable epilepsy, vagal nerve stimulation and neurosurgery should be considered early.
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PMID:Increasing awareness about sudden unexplained death in epilepsy--a review. 1675 59

Sudden unexplained death in epilepsy (SUDEP) has been proposed to result from seizure-induced changes in respiratory and cardiac function. Our purpose was to characterize changes in respiration during seizures. We used a preparation of the anaesthetized, perfused in situ rat. This preparation has the advantage over in vivo preparations in that delivery of oxygen to the brain does not depend upon the lungs or cardiovascular system. Electroencephalographic activity was recorded as were activities of the hypoglossal, vagus and phrenic nerves. The hypoglossal and vagus nerves innervate muscles of the upper airway and larynx while the phrenic nerve innervates the diaphragm. Fictive seizures were elicited by injections of penicillin into the parietal cortex or the carotid artery. Following elicitation of the fictive seizures, activities of the hypoglossal and vagal nerves declined greatly while phrenic activity was little altered. Such a differential depression of activities of nerves to the upper airway and larynx, compared to that to the diaphragm, would predispose to obstructive apnea in intact preparations. With more time, activity of the phrenic nerve also declined or ceased. These changes characterize central apnea. The major conclusion is that seizures may result in recurrent periods of obstructive and central apnea. Thus, seizures can adversely alter respiratory function in a profound manner.
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PMID:Changes in respiratory-modulated neural activities, consistent with obstructive and central apnea, during fictive seizures in an in situ anaesthetized rat preparation. 1676 66

Sudden unexplained death in epilepsy is rare in children, and few studies report risk factors. We reviewed our experience with 17 cases of sudden unexplained death in epilepsy to determine risk factors in children. The charts of all patients with onset of epilepsy at less than age 18 years who suffered sudden unexplained death in epilepsy between August 1992 and April 2004 at our epilepsy center were retrospectively reviewed. Deaths were classified as possible, probable, or definite sudden unexplained death in epilepsy. There were seven cases of definite, nine cases of probable, and one case of possible sudden unexplained death in epilepsy. Generalized tonic-clonic seizures and prone position during sleep were found to be major risk factors. Sudden unexplained death in epilepsy in children and adolescents is associated with convulsive seizures, and aggressive treatment of nocturnal generalized tonic-clonic seizures might help lower the occurrence.
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PMID:Pediatric experience with sudden unexplained death in epilepsy at a tertiary epilepsy center. 1697 Aug 86


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