SUDEP in Spain: An Epilepsy Monitoring Unit based case series

Abstract

SUDEP is the first cause of mortality related to epilepsy. However, in Spain there are no published cases or series from Epilepsy Monitoring Units that could expose the characteristics of SUDEP in our population. Method: We reviewed all patients treated at our Spanish Epilepsy Reference Centre who died between 2010-2018. SUDEP cases were classified as definite, probable, possible or near-SUDEP. Epilepsy type, demographics and case detection issues were described. Results: From 1250 evaluated patients, 102 died during the study period. Seven patients were diagnosed with SUDEP or near-SUDEP: two definite SUDEP, one definite SUDEP plus, two probable SUDEP and two near-SUDEP. Specific problems for detection and registration of SUDEP inherent to the Spanish healthcare system and the legal framework were defined. Only 43% of cases were known by the referral neurologist. SUDEP incidence was 1.3 per 1000 patient/year, comprising 0.56% of all deaths in our cohort. Two cases were female, the average age was 36 years (18-61). All patients had focal epilepsy and suffered from generalized tonic-clonic seizures. All witnessed cases occurred after a focal to bilateral tonic-clonic seizure. Four cases occurred during sleep and all non-witnessed cases were found in prone position. One case occurred during video-EEG monitoring. Conclusions: Our casuistic represents the first Epilepsy Monitoring Unit based case series of SUDEP conducted in Spain. The incidence in our population agrees with the reported in other countries. However, in our population, SUDEP is probably underdiagnosed due to administrative and legal issues.

Characterization of the Insular Role in Cardiac Function through Intracranial Electrical Stimulation of the Human Insula

“…10,45,46 Sudden unexpected death in epilepsy can occur after a seizure and is the most common epilepsy-related cause of death, with an incidence ranging from 1 to 6 cases per 1000 patients/ year in patients with drug-refractory epilepsy. 47,48 Sudden death is more frequent in patients with epilepsy than in the general population and, as in other forms of sudden unexpected death, the final pathophysiological mechanism of death in sudden unexpected death in epilepsy has not yet been elucidated. It is possible that insular involvement in a seizure or its functional impairment in postictal generalized electroencephalographic suppression might lead to cardiac arrhythmias or acute heart failure that could explain some of these cases.…”

“…Neurocardiac damage might be the main cause of many forms of sudden unexpected death 10,45,46 . Sudden unexpected death in epilepsy can occur after a seizure and is the most common epilepsy‐related cause of death, with an incidence ranging from 1 to 6 cases per 1000 patients/year in patients with drug‐refractory epilepsy 47,48 . Sudden death is more frequent in patients with epilepsy than in the general population and, as in other forms of sudden unexpected death, the final pathophysiological mechanism of death in sudden unexpected death in epilepsy has not yet been elucidated.…”

Sudden unexpected death in epilepsy: A critical view of the literature

“…More variable, mostly higher SUDEP rates can be found in selected populations represented by patients seen in secondary or tertiary referral centers, individuals with drug‐refractory epilepsy, or patients included in drug trials or surgery registers (Table 2). 32–52 Nineteen studies have been included. Only one‐fourth of the studies have been done prospectively.…”

Can We Prevent Sudden Unexpected Death in Epilepsy (SUDEP)?

“…SUDEP and near-SUDEP have been reported from EMUs. 12,48 Special attention should be given to all patients admitted to the EMU for elective VEEG monitoring. Apart from providing basic care, systematic monitoring for ictal/postictal cardiorespiratory compromise is a crucial part of their management.…”