Sudden Unexpected Deaths in Epileptics — A Literature Review

McGugan, Elizabeth

doi:10.1177/003693309904400504

Cited by 22 publications

(10 citation statements)

References 22 publications

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“…In conclusion, the 1993 effort of the FDA subsequently focused attention of practitioners 95,96,[99][100][101][102][103][104][105][106][107][108][109][110][111][112][113] and pharmaceutical manufacturers on the question of whether use of anticonvulsant drugs contributes to or prevents sudden unexpected death in epileptic persons. Consideration of the possibility of sudden unexpected death in epileptic persons when developing new anticonvulsant drugs was emphasized by the FDA-convened panel of scientists assigned to review data on the risk of sudden unexpected death in epileptic persons in patients taking lamotrigine.…”

Section: Discussionmentioning

confidence: 99%

Clinical Pharmacology: Drugs as a Benefit and/or Risk in Sudden Unexpected Death in Epilepsy?

Lathers

Schraeder

2002

The Journal of Clinical Pharma

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Death may be the consequence of natural or unnatural causes, such as accidents, homicide, and suicide, which have no relationship to the disease of epilepsy. Direct causes of death include status epilepticus, and indirect causes may be head trauma or drowning subsequent to a seizure. When death occurs suddenly and without explanation, the term sudden unexpected unexplained death is used. Unexplained is a term that clinicians and research scientists are working to clarify. Numerous preclinical animal studies have been conducted as models for sudden death and have led to clinical studies in persons with epilepsy. These studies show that sympathetic nerve stimulation, ouabain, or coronary occlusion increased temporal dispersion of recovery of ventricular excitability and led to an underlying electrical instability that predisposed the ventricularmyocardium to arrhythmia. Cardiac arrhythmias in an animal model for ouabain-induced toxicity were associated with neural autonomic dysfunction. Neural discharges were characterized by increases, decreases, or no change in the discharge of postganglionic cardiac sympathetic nerves monitored simultaneously, predisposing to cardiac arrhythmia. Stimulation of the sympathetic ventrolateral cardiac nerve produced a shift in the origin of the pacemaker and tachyarrhythmias because the nerve is not uniformly distributed to the various regions of the heart but is localized to the atrioventricular junctional and ventricular regions. Such nonuniform distribution of sympathetic nerves would also contribute to initiation of arrhythmia as a nonuniform neural discharge occurred. Studies examining the physiology and pharmacology of this finding in multiple animal models found that subconvulsant, interictal discharge was associated with autonomic cardiac neural non-uniform discharge and cardiac arrhythmias. As a result of further investigations, Lathers and Schraeder edited a book in 1990 that summarized the clinical problem of sudden unexpected death and epilepsy (SUDEP). The contributors concluded that there was a paucity of clinical data addressing the mechanism of death. Regulatory response resulting from the consequent increased awareness of SUDEP occurred in 1993, when the FDA focused attention of practitioners and pharmaceutical manufacturers on the question of whether use of anticonvulsant drugs contributes to or prevents sudden unexpected death in epileptic persons. The FDA-convened panel of scientists considered the prevalence of sudden unexpected death in patients involved in studies associated with developing new anticonvulsant drugs and reviewed data on the risk of sudden unexpected death in patients taking lamotrigine. The risk of SUDEP was no different from thatfound in the young epilepsy population in general. Estimated SUDEP rates in patients receiving the new anticonvulsant drugs lamotrigine, gabapentin, topiramate, tigabine, and zonisamide were found to be similar to those in patients receiving standard anticonvulsant drugs, suggesting that SUDEP rates reflect population ...

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Section: Discussionmentioning

confidence: 99%

Clinical Pharmacology: Drugs as a Benefit and/or Risk in Sudden Unexpected Death in Epilepsy?

Lathers

Schraeder

2002

The Journal of Clinical Pharma

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“…The mortality rate in patients with epilepsy is twice that of the general population, although the reason for this remains obscure (107). While sudden unexpected death (5–18% of deaths) (104,108–110) and other epilepsy‐related causes can be involved, death directly attributable to epileptic seizures is uncommon (107). Other causes of death include accidents, cardiopulmonary complications, brain tumors, extracranial neoplasma, and other vascular diseases (104,107).…”

Section: Costsmentioning

confidence: 99%

Comprehensive Care of the Epilepsy Patient—Control, Comorbidity, and Cost

Bazil

2004

Epilepsia

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Traditionally, control of seizures in patients with epilepsy is viewed as the most important clinical outcome. Yet, current antiepileptic drugs (AEDs) do not always achieve this. Around 30-40% of patients remain uncontrolled despite pharmacological intervention. Poor tolerability of AEDs is a large part of the problem and contributes as much to the overall effectiveness of therapy as efficacy. Comorbid conditions are present in many patients, and appropriate management of these can further improve seizure control and quality of life. Patients with epilepsy often experience--among other disorders--neuropsychological effects, migraines, and psychological problems (especially anxiety and depression). Sleep disturbances are also common and have been shown to contribute to the intractability of seizures in some patients. Many anticonvulsant treatments have the potential to improve--or in some cases worsen--these concurrent conditions, and these properties should therefore be considered in the total care of the patient. Finally, the costs of uncontrolled epilepsy are measured not only in terms of direct healthcare-related costs, but also in terms of lost productivity and opportunity. The indirect costs of epilepsy are substantial and account for 70-85% of total disease-related costs. Patients with uncontrolled seizures contribute disproportionately to healthcare costs, reinforcing the need for the development of newer AEDs with improved profiles of efficacy and tolerability, but with minimal adverse effects on behavior, cognition, and sleep.

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“…Public 2,16,17,[23][24][25][27][28][29][30]34,36,[39][40][41][42][43]45,47,[50][51][52][53][55][56][57]60,63,67 …”

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Does intellectual disability increase sudden unexpected death in epilepsy (SUDEP) risk?

Young

Shankar

Palmer

et al. 2015

Seizure

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Sudden Unexpected Deaths in Epileptics — A Literature Review

Cited by 22 publications

References 22 publications

Clinical Pharmacology: Drugs as a Benefit and/or Risk in Sudden Unexpected Death in Epilepsy?

Clinical Pharmacology: Drugs as a Benefit and/or Risk in Sudden Unexpected Death in Epilepsy?

Comprehensive Care of the Epilepsy Patient—Control, Comorbidity, and Cost

Does intellectual disability increase sudden unexpected death in epilepsy (SUDEP) risk?

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