Advances in sudden unexpected death in epilepsy

Abstract

Sudden unexpected death in epilepsy (SUDEP) is the major cause of premature death in epilepsy patients, particularly those with refractory epilepsy. Sudden unexpected death in epilepsy is thought to be related to peri‐ictal cardiac dysfunction, respiratory depression, and autonomic dysfunction, albeit the exact etiology is unknown. Sudden unexpected death in epilepsy prevention remains a huge challenge. The sole presence and frequency of generalized tonic–clonic seizures (GTCS) are the most important risk factors for SUDEP, and nocturnal monitoring may lower the risk with the use of remote listening devices. In addition, studies in animal models of SUDEP have discovered that multiple neurotransmitters, including serotonin (5‐HT) and adenosine, may be involved in the pathophysiological mechanisms of SUDEP and that these neurotransmitters could be the targets of future pharmacological intervention for SUDEP. The latest research findings on the epidemiology, clinical risk factors, and probable causes of SUDEP are presented in this review.

Pharmacovigilance on cannabidiol as an antiepileptic agent

“…Death, particularly Sudden unexpected death in epilepsy (SUDEP), seems to be the leading cause of premature death in people affected by epilepsy, especially in those patients with refractory epilepsy, and its exact etiology is not known. However, research in animal models revealed that multiple neurotransmitters, including serotonin (5-HT) and adenosine, both of which are targets of CBD biological activity, may be involved in the pathophysiological mechanisms of SUDEP (Zhao et al, 2022).…”

The mechanism of sudden unexpected death in epilepsy: A mini review

“…The frequency of generalized tonic-clonic seizures (GTCS) is considered the most important clinical risk factor for SUDEP ( 3 , 6 – 8 ): the higher the GTCS frequency, the higher the risk of SUDEP. Data from a pooled analysis of SUDEP risk factors indicate that patients who have one to two GTCS per year are nearly three times as likely to experience SUDEP than patients who do not have GTCS; patients who have more than 50 GTCS per year are more than 14 times as likely to experience SUDEP ( 8 ).…”

“…In a large Chinese community cohort of 1,562 epileptic patients, 15 experienced suspected SUDEP during the 5-year follow-up period; SUDEP incidence was 2.34 per 1,000 person-years (2). Sudden epileptic death is believed to be related to cardiac dysfunction, respiratory depression, autonomic nervous dysfunction, and brain dysfunction during seizure; however, the exact mechanism is unclear (3)(4)(5). The purpose of this review is to summarize the current knowledge regarding mechanisms of SUDEP.…”

SUDEP counseling: Where do we stand?

“…The incidence of sudden death in individuals with epilepsy is 20 times higher than in the general population 1 . Sudden unexpected death in epilepsy (SUDEP) is the most common epilepsy‐related cause of death in persons with epilepsy (PWEs) 2 . The overall risk is around 1 per 1000 person‐years, although this risk substantially increases in PWEs with frequent generalized or focal to bilateral tonic–clonic seizures (TCS) 2 .…”

“…Sudden unexpected death in epilepsy (SUDEP) is the most common epilepsy‐related cause of death in persons with epilepsy (PWEs) 2 . The overall risk is around 1 per 1000 person‐years, although this risk substantially increases in PWEs with frequent generalized or focal to bilateral tonic–clonic seizures (TCS) 2 . Compared to other neurological conditions, SUDEP is the second leading cause of total years of potential life loss after stroke 3 …”