Sudden unexpected death in epilepsy: A bibliometric overview

Tong, Fang; Jiang, Lin; Zeng, Zixuan; Wang, Qi; Yang, Zhaohui; Lv, Yubao

doi:10.3389/fneur.2023.1139521

Cited by 4 publications

(3 citation statements)

References 29 publications

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“…SUDEP is the most common cause of death in epileptic patients. In forensic field making, a diagnosis of SUDEP is difficult (14,41). As the diagnosis of SUDEP is also made by the exclusion of other causes of death, forensic pathologists must collect informations about the death scene, the circumstance of the death, and the victim's medical history.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, a lot of studies and scientific literature come from retrospective postmortem studies carried out by schools of Legal Medicine (12). Luo Zhuo and his colleagues highlighted autopsy cases of SUDEP in the Office of Chief Medical Examiner, in the State of Maryland (41). From 2007 to 2009, they analyzed 104 cases of sudden unexpected deaths directly or indirectly caused by epilepsy or seizures.…”

Section: Discussionmentioning

confidence: 99%

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The analysis of SUDEP forensic autopsies leading to preventable events

et al. 2023

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IntroductionThe diagnosis of unexpected death by excluding non-natural causes, particularly in subjects with epilepsy, is a topic of interest and it is difficult to identify in the forensic field. Health professionals sometimes are faced with cases of sudden death, generally in young adults with a long history of epilepsy that require, for judicial purposes, an explanation in terms of cause and means to determine the death. SUDEP is an entity diagnosed by the exclusion of other causes that may have led to death, and then for forensic purposes, it requires particular attention and knowledge, and there is difficulty in identifying it. Our contribution aims to illustrate the scientific community pathological findings, medical history, and circumstantial evidence of four cases of sudden death in epileptic subjects.MethodWe illustrated four cases of judicial autopsies from the Institute of Forensic Medicine of Palermo, Italy; the purpose was to exclude the criminal intervention in determining the death as non-natural. The study of victims’ medical history, the toxicological investigations, and the autopsy findings analyzed both from macroscopic and microscopic aspects have made it possible to highlight some findings that can be traced back to SUDEP despite the small sample of subjects studied.ResultsThese presented findings of four SUDEP cases could help forensic pathologists in recognizing this entity, by highlighting its characteristics, and allowing for a pathological classification, also in relation to the use of drugs for epilepsy treatment and circumstances of death.DiscussionTo obtain a definite diagnosis of SUDEP, a complex investigation process is required in a multidisciplinary approach. Considering the literature review with criticism, it could allow health professionals to select the characteristics of epileptic patients at risk of sudden death. Processing human behaviors, molecular and histopathological findings of the autopsies, but also the physiological, and pathological human body system functions thanks to Artificial Intelligence, could be the key to explaining SUDEP mechanisms and the future results to prevent it.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The analysis of SUDEP forensic autopsies leading to preventable events

et al. 2023

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“…A cause of death not discussed in the report is sudden unexpected death in epilepsy (SUDEP). SUDEP has been repeatedly reported as a complication of witnessed and unwitnessed seizures [2]. Because the patient died suddenly and unexpectedly during a status epilepticus on the ICU, it cannot be ruled out that SUDEP was responsible.…”

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confidence: 97%

SUDEP as Endpoint of SARS-CoV-2 Associated Encephalitis with Status Epilepticus

Finsterer,

Alexandre Scorza,

George-Opuda

2023

J. Appl. Health Sci. Med.

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With interest we read the article by Farias et al. on a 31 year-old, previously healthy male with SARS-CoV-2 related meningo-encephalitis who died suddenly and unexpectedly during a status epilepticus on the intensive care unit (ICU) [1]. Because the patient was co-infected with influenza-A, it was suspected that meningoencephalitis was due to infection with both viruses [1]. No autopsy was performed. The study is excellent, but has limitations that are cause of concerns and should be discussed. The main limitation of the study is that the patient did not undergo autopsy. To clarify whether SARS-CoV-2 or influenza-A was truly present inside neurons and glial cells, it is critical to have the results of histological, immune-histological, and electron microscopy examinations of the brain. Autopsy is also critical to assess whether the lung was affected or not since no CT of the lungs had been done intra vitam. Another limitation of the study is that no cerebral MRI with contrast medium had been done intra vitam to document the extension and localisation of encephalitis. It would have been also interesting to know whether the patient had developed cerebral edema or brainstem herniation with progression of encephalitis. Another limitation is that RT-PCR for SARS-CoV-2 and influenza-A in the CSF was not repeated and the initial test results were not confirmed by using a different kit to rule out a false positive result on the first test. It is speculative to assume that the patient had both, SARS-CoV-2 encephalitis and influenza-A encephalitis. Since presence of the influenza-A virus was not documented in the CSF, it is rather unlikely that the patient also had influenza-A encephalitis. A cause of death not discussed in the report is sudden unexpected death in epilepsy (SUDEP). SUDEP has been repeatedly reported as a complication of witnessed and unwitnessed seizures [2]. Because the patient died suddenly and unexpectedly during a status epilepticus on the ICU, it cannot be ruled out that SUDEP was responsible. SUDEP is assumed due to neurogenic pulmonary edema, autonomic dysreflexia, or acute cardiac disease, such as Takotsubo syndrome (TTS), acute heart failure, or ventricular arrhythmias. Therefore, we should know whether the ECG shortly before or during resuscitation on the ICU was abnormal or not and whether a bedside echocardiography was done during CPR. We disagree with the statement that the patient had only neurological symptoms [1]. Figure 1 clearly shows that the patient also had coughing, fever, and running nose, which are all non-neurological. Meningo-encephalitis, myelitis, and ADEM are neither neurological symptoms nor neurological syndromes, as stated in the introduction [1]. All of them are simply central nervous system (CNS) diseases. At the beginning of 2022 anti-SARS-CoV-2 vaccinations were already available. We therefore should know if the patient was vaccinated and had a breakthrough SARSCoV-2 infection or if she was unvaccinated. There is no mention of the anti-seizure drugs the patient received for the initial tonic clonic seizure and for status epilepticus. There is also no mention of the reference limits of the blood and CSF values reported. Overall, the interesting study has limitations that call the results and their interpretation into question. Addressing these issues would strengthen the conclusions and could improve the status of the study. Before claiming that encephalitis was due to SARS-CoV-2 and influenza-A, repeated documentation of the presence of both viruses is warranted. This can be achieved by autopsy, or repeated CSF investigations, both of which were not carried out in the index patient.

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