Preventing Tomorrow’s Sudden Cardiac Death in Epilepsy Today: What Should Physicians Know about This?

Scorza, Fúlvio Alexandre; Colugnati, Diego Basile; Pansani, Aline Priscila; Sonoda, Eliza Yumi de Freitas; Arida, Ricardo Mário; Cavalheiro, Ésper A.

doi:10.1590/s1807-59322008000300017

Cited by 48 publications

(41 citation statements)

References 63 publications

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“…Improved seizure control by treatment (pharmacological or surgical) seems to be one of the most important measures to prevent SUDEP. In the mean time, other actions than medical and surgical therapies may help to prevent SUDEP, such as altered sleeping arrangements, seizure alarms, omega-3 supplementation and physical activity 1,5,6 . …”

Section: Discussionmentioning

confidence: 99%

Does sudden unexpected death in children with epilepsy occur more frequently in those with high seizure frequency?

Terra

Scorza

Sakamoto

et al. 2009

Arq. Neuro-Psiquiatr.

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-People with epilepsy are more likely to die prematurely and the most common epilepsy-related category of death is sudden unexpected death in epilepsy (SUDEP). Several studies have reported a moderate or high seizure frequency among SUDEP cases and SUDEP is considered rare in patients in remission. Method: We reviewed the occurrence of SUDEP in our epilepsy unit over an 8-year period to identify a potential association between seizure frequency and SUDEP occurrence in children with epilepsy. Results: From 835 patients evaluated, 12 had suffered SUDEP and nearly all of the SUDEP cases in our children are related to chronic uncontrolled epilepsy (daily -50.0%, two to four/week -41.7%, monthly -8.3%). Conclusion: SUDEP is not a rare event in children and increased mortality was recorded in those individuals who had not responded to pharmacologic treatment. Improved seizure control seems to be one of the most important measures to prevent SUDEP.KEy WorDS: epilepsy, children, sudden death, seizure frequency. Morte súbita em crianças com epilepsia ocorre naquelas que apresentam maior frequência de crises?Resumo -Pessoas com epilepsia têm maior chance de morrer prematuramente e a principal causa de morte relacionada à epilepsia é a morte súbita em epilepsia (SUDEP). Vários estudos têm relatado uma freqüência de crises moderada ou elevada em pacientes com SUDEP e SUDEP é considerada rara em pacientes em remissão. Método: revisamos a ocorrência de SUDEP em nossa unidade de epilepsia por um período de oito anos com o objetivo de identificar uma possível associação entre freqüência de crises e a ocorrência de SUDEP em crianças com epilepsia. Resultados: De 835 pacientes avaliados, 12 evoluíram com SUDEP e a maioria das crianças apresentava epilepsia crônica não controlada (50% com crises diárias; 41,7% com duas a quatro crises/ semana; 8,3% com crises mensais). Conclusão: SUDEP não é um evento raro em crianças e maior mortalidade foi observada em indivíduos que não responderam ao tratamento medicamentoso. Melhor controle de crises parece ser uma das principais medidas na prevenção de SUDEP.PAlAVrAS-chAVE: epilepsia, crianças, morte súbita, frequência de crises. People with epilepsy are more likely to die prematurely than those without epilepsy and the most common epilepsy-related category of death is sudden unexpected death in epilepsy (SUDEP) 1,2 . A number of associated factors for SUDEP have been reported but the results are not wholly consistent between studies. These include presence of generalized tonic-clonic seizures, polytherapy with antiepileptic drugs, young age, duration of the seizure disorder ranging from 15 to 20 years, early onset of epilepsy and more-frequent seizures 1,2 . In line with the latter risk factors, the impact of high seizure frequency on the risk of SUDEP has been evaluated from different angles: most studies including information on seizure control have reported a moderate or high sei-

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Section: Discussionmentioning

confidence: 99%

Does sudden unexpected death in children with epilepsy occur more frequently in those with high seizure frequency?

Terra

Scorza

Sakamoto

et al. 2009

Arq. Neuro-Psiquiatr.

Self Cite

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“…It is clear that SUDEP is mainly, yet not exclusively, a problem for people with uncontrolled epilepsy 9 , but our understanding of the best way to prevent it is still incomplete. Strict evidence for their effectiveness is still lacking, but epidemiological and observational data seem to suggest some measures to minimize the risk of SUDEP, including good seizure control, stress reduction, participation in physical activity and sports (with appropriate professional supervision), dietary management (omega-three supplementation), night supervision, family members' knowledge of cardiopulmonary resuscitation techniques, and the basics of defibrillator use 9,11,12 . Despite the great scientific advances of SUDEP over the past two decades, the discussion of potential death related to seizures is still a topic under discussion between epileptologists.…”

Section: Fulvio Alexandre Scorzamentioning

confidence: 99%

Epilepsy kills

Scorza

2012

Arq. Neuro-Psiquiatr.

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Epilepsy is one of the most common serious brain disorders; it knows no age, racial, social class, geographic, or national boundaries 1 . Often epilepsy is still seen as a benign condition in which individuals only have seizures. Unfortunately, the story is not as simple as it seems. Epilepsy is a malignant condition, which has a high rate of premature death compared to the general population [2][3][4] . Most of the excess death is due to the underlying disease causing epilepsy, and some is epilepsy-related, including trauma, suicide, aspiration pneumonia, status epilepticus, but mostly due to sudden unexpected death in epilepsy (SUDEP) that is a leading cause of mortality in epileptics [2][3][4] . The lack of findings in autopsy and the fact that most cases of SUDEP are not witnessed cause difficulties with regard to the definitions of SUDEP. It is generally defined as a sudden, unexpected, witnessed or not witnessed, nontraumatic and non-drowning death in patients with epilepsy, with or without evidence of a seizure and excluding documented status epilepticus, in which postmortem examination does not reveal a toxicological or anatomical cause of death 5 . The reported incidence of SUDEP is quite variable, and this is largely due to differences in patient populations, study design, and the criteria for defining SUDEP 4 . In fact, results from a US population-based study indicate that the risk of sudden death in people with epilepsy is estimated to be at least 20 times higher than the one of the general population 6 . In general terms, SUDEP is responsible for 7.5 to 17% of all deaths in people with epilepsy and it has an incidence among adults between 1:500 and 1:1,000 patient-years 7 . Concerning risk factors, several studies have tried for more than ten years to find factors predisposing to SUDEP in order to identify individuals with particularly high risks. To date, several risk factors have been identified such as refractoriness of the epileptic condition, presence of convulsive seizures, early onset of epilepsy, antiepileptic medication (polytherapy with antiepileptic drugs), young age, and duration of the seizure disorder 4,8,9 . The cause(s) of SUDEP is(are) still unknown, however research consistently suggests that the main mechanism for SUDEP is autonomic deregulation, i.e., cardiac and respiratory abnormalities during and after seizures 4,[8][9][10] . It is clear that SUDEP is mainly, yet not exclusively, a problem for people with uncontrolled epilepsy 9 , but our understanding of the best way to prevent it is still incomplete. Strict evidence for their effectiveness is still lacking, but epidemiological and observational data seem to suggest some measures to minimize the risk of SUDEP, including good seizure control, stress reduction, participation in physical activity and sports (with appropriate professional supervision), dietary management (omega-three supplementation), night supervision, family members' knowledge of cardiopulmonary resuscitation techniques, and the basics of defibrillator use 9,1...

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“…Therefore,to achieve precisely. Epidemiological studies suggest that 70-80% of people developing epilepsy will go into remission, while the remaining patients continue to have seizures 4 . The most common risk factors for epilepsy are cerebrovascular disease, brain tumour, alcoholic, traumatic head injuries, malformations of cortical development, genetic inheritance, and infections of the central nervous system 5 .…”

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confidence: 99%

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Preventing Tomorrow’s Sudden Cardiac Death in Epilepsy Today: What Should Physicians Know about This?

Cited by 48 publications

References 63 publications

Does sudden unexpected death in children with epilepsy occur more frequently in those with high seizure frequency?

Does sudden unexpected death in children with epilepsy occur more frequently in those with high seizure frequency?

Epilepsy kills

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