Post-mortem findings of cardiac lesions in epileptics: A preliminary report

Falconer, Bertil; Rajs, Jovan

doi:10.1016/0300-9432(76)90048-0

Cited by 76 publications

(31 citation statements)

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“…The incidence of sudden, unexpected, death among people with epilepsy has been a subject of considerable attention in recent years (7,8). A high incidence of SUDEP was first suggested by autopsy series of causes of death among patients with epilepsy (9)(10)(11)(12)(13)(14)(15)(16). In these studies, the proportion of sudden deaths among patients with epilepsy, particularly at younger ages, appeared to be excessive.…”

Section: Sudden Unexpected Unexplained Death In Epilepsy (Sudep)mentioning

confidence: 99%

Epilepsy, Vagal Nerve Stimulation by the NCP System, Mortality, and Sudden, Unexpected, Unexplained Death

et al. 1998

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Summary:Purpose: To determine rates of all-cause mortality and of sudden, unexpected, unexplained deaths in epilepsy (SUDEP) in a cohort of individuals treated with the Neuro Cybernetic Prosthesis (NCP) System for intractable epilepsy, and; to contrast the NCP experience with other epilepsy cohorts.Methods: A cohort of 791 individuals were followed for 1,335 person-years from implantation. Of the total cohort, 120 individuals had their NCP System devices deactivated. The 15 deaths which occurred during NCP System activation were reviewed for SUDEP by a panel. There were three additional deaths and 242.5 person-years of monitoring after deactivation.Results: The standardized mortality ratios for NCP System were 5.3, 95% confidence interval (CI) 3.0-8.7; and for the time period after device deactivation, 4.4,95% CI 0.9-12.8. Six of the deaths during stimulation were considered definite or probable SUDEP and two as possible SUDEP. Seven were not considered to be SUDEP. The incidence of definite/probable SUDEP was 4.5 per 1,000 person-years and 6.0 per 1,000 person-years for definite/probable/possible SUDEP.Conclusions: The mortality rates and standardized mortality ratios are comparable with studies of young adults with intractable epilepsy who were not treated with NCP System. These SUDEP rates are not significantly different from those reported in the recent studies of lamotrigine (LTG), gabapentin (GBP), and tiagabine (TGB). The higher rates of SUDEP in the NCP System cohort, as compared with recent drug trials, presumably is explained by the selection of relatively higher-risk patients for the NCP System device. Key Words: EpilepsyMortality-SUDEP-Vagal nerve.Individuals with epilepsy have long been known to have increased mortality rates. A number of factors account for these higher rates, including (a) accidents during seizures, especially drowning; (b) the causes of epilepsy, such as brain tumors and cerebrovascular disease; and (c) an increase in unexplained deaths (1). An apparent high incidence of unexpected death has been observed in recent clinical trials of adjunctive drugs for epilepsy (2-4). Cases of SUDEP were found in the early experiences of clinical trials and open-label use of lamotrigine (LTG), gabapentin (GBP), tiagabine (TGB), and the Neuro-Cybernetic Prosthesis (NCP) System. These deaths tended to occur in relatively young (1 5-44 years of age) individuals who were otherwise in reasonable states of health. The deaths usually occurred in benign circumstances; most often the individual was found dead in bed. Many of the deaths were accompanied by

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Section: Sudden Unexpected Unexplained Death In Epilepsy (Sudep)mentioning

confidence: 99%

Epilepsy, Vagal Nerve Stimulation by the NCP System, Mortality, and Sudden, Unexpected, Unexplained Death

et al. 1998

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“…Following this reasoning, postmortem examinations in people dying of SUDEP have found hearts that are dilated and heavier than expected 16,29,31,32 and pulmonary edema in approximately 50-86% of cases 16,26,29,32,33 . Furthermore, others have described pathological changes in the hearts of those dying with SUDEP, including fibrosis of the walls of small coronary arteries, atrophy of cardiomyocytes, myofibrillar degeneration, edema of the conductive tissue and morphological abnormalities of the cardiac conduction system 26,29,31,34,35 .…”

Section: Sudden Unexpected Death In Epilepsymentioning

confidence: 97%

“…Furthermore, others have described pathological changes in the hearts of those dying with SUDEP, including fibrosis of the walls of small coronary arteries, atrophy of cardiomyocytes, myofibrillar degeneration, edema of the conductive tissue and morphological abnormalities of the cardiac conduction system 26,29,31,34,35 . These abnormalities may be the consequence of repeated hypoxemia and/or may be associated with the increase of catecholamines during an ictal sympathetic storm 29,31,34 .…”

Section: Sudden Unexpected Death In Epilepsymentioning

confidence: 99%

The mistery of Gustave Flaubert's death: could sudden unexpected death in epilepsy be part of the context?

Albuquerque

Scorza

Arida

et al. 2009

Arq. Neuro-Psiquiatr.

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-Epilepsy is the most common serious neurological condition and sudden unexpected death in epilepsy (SUDEP) is the most important direct epilepsy-related cause of death. Information concerning risk factors for SUDEP is conflicting, but high seizure frequency is a potential risk factor. Additionally, potential pathomechanisms for SUDEP are unknown, but it is very probable that cardiac arrhythmias during and between seizures or transmission of epileptic activity to the heart via the autonomic nervous system potentially play a role. More than two decades ago, temporal lobe epilepsy was suggested as having been the ''nervous disease'' of Gustave Flaubert, one of the most important French novelists. In these lines, as the circumstances of his death were the subject of fabulous and mysterious speculations, we postulated in this paper that Falubert's death could be due SUDEP phenomenon.KEy worDS: epilepsy, Gustave Flaubert, SUDEP, seizure. O mistério da morte de Gustave Flaubert: pode a morte súbita em epilepsia fazer parte o contexto ?Resumo -A epilepsia é a condição neurológica crônica grave mais comum e a morte súbita em epilepsia (SUDEP) é a mais importante causa de morte diretamente relacionada à epilepsia. Informações sobre fatores de risco para SUDEP são conflitantes, porém, a alta freqüência de crises epilépticas é um fator de risco em potencial. Além disso, os mecanismos causais para SUDEP ainda não estão conhecidos, mas é muito provável que arritmias cardíacas durante e entre as crises epilépticas ou a transmissão da atividade epiléptica para o coração via sistema nervoso autônomo desempenhem um importante papel. Mais de duas décadas atrás, foi proposto que a "doença nervosa" de Gustave Flaubert, um dos mais importantes novelistas franceses, era epilepsia do lobo temporal. Nesse sentido, como a morte de Gustave Flaubert ainda seja motivo de misteriosa especulação, nosso artigo propõe que a mesma poderia estar relacionada ao fenômeno de SUDEP.

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“…(Tomson et al, 2008) By definition, the cause of death in SUDEP is currently unknown, but it is very probable that cardiac arrhythmia during and between seizures plays a potential role. It has been suggested on postmortem studies and interictal cardiac abnormalities observed (Falconer & Rajs, 1976;Leestma, 1989;Ryvlin et al, 2006;Stollberger & Finsterer, 2004). Several suggestions have been made concerning the mechanisms behind SUDEP, most involving speculations on the possible role of autonomic effects such as cardiorespiratory disturbances.…”

Section: Sudden Unexpected Death In Epilepsy Secondary To Neurocysticmentioning

confidence: 99%

Clinical Features of Epilepsy Secondary to Neurocysticercosis at the Insular Lobe

Foyaca-Sibat¹,

Valdés²

2011

Novel Aspects on Epilepsy

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Post-mortem findings of cardiac lesions in epileptics: A preliminary report

Cited by 76 publications

References 4 publications

Epilepsy, Vagal Nerve Stimulation by the NCP System, Mortality, and Sudden, Unexpected, Unexplained Death

Epilepsy, Vagal Nerve Stimulation by the NCP System, Mortality, and Sudden, Unexpected, Unexplained Death

The mistery of Gustave Flaubert's death: could sudden unexpected death in epilepsy be part of the context?

Clinical Features of Epilepsy Secondary to Neurocysticercosis at the Insular Lobe

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