Document Detail


An electroclinical case-control study of sudden unexpected death in epilepsy.
MedLine Citation:
PMID:  20882604     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Sudden unexpected death in epilepsy (SUDEP) accounts for approximately 1 in 5 deaths in patients with epilepsy, but its cause remains unexplained. A recorded seizure resulting in death in our center appeared to suggest that postictal generalized electroencephalographic (EEG) suppression (PGES) and apnea are implicated in SUDEP. Our objective was to determine the association between PGES, as a possible identifiable EEG marker of profound postictal cerebral dysfunction, and SUDEP.
METHODS: We studied 10 adult patients from our video-telemetry database who had 30 documented epileptic seizures during video-EEG recording and who later died of SUDEP. They were compared with 30 matching live controls with 92 epileptic seizures taken from the same database. Clinical and EEG findings were analyzed.
RESULTS: PGES was seen in 15/30 (50%) case and 35/92 (38%) control seizures. A Mann-Whitney U test showed that PGES was significantly longer in the generalized motor seizures of the SUDEP group (p < 0.001). After adjustment for variables, odds ratio analysis of all seizures indicated significantly elevated odds of SUDEP with PGES durations of >50 seconds (p < 0.05). Beyond 80 seconds, the odds were quadrupled (p < 0.005). After adjustment for variables, for each 1-second increase in duration of PGES, the odds of SUDEP increased by a factor of 1.7%(p < 0.005).
INTERPRETATION: Prolonged PGES (>50 seconds) appears to identify refractory epilepsy patients who are at risk of SUDEP. Risk of SUDEP may be increased in direct proportion to duration of PGES. Profound postictal cerebral dysfunction, possibly leading to central apnea, may be a pathogenetic mechanism for SUDEP.
Authors:
Samden D Lhatoo; Howard J Faulkner; Krystina Dembny; Kathy Trippick; Claire Johnson; Jonathan M Bird
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of neurology     Volume:  68     ISSN:  1531-8249     ISO Abbreviation:  Ann. Neurol.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2011-01-03     Completed Date:  2011-01-31     Revised Date:  2011-08-22    
Medline Journal Info:
Nlm Unique ID:  7707449     Medline TA:  Ann Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  787-96     Citation Subset:  IM    
Affiliation:
Department of Neurology, University Hospitals, Case Medical Center, Cleveland, OH 44106-5040, USA. slhatoo@aol.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Brain / physiopathology
Case-Control Studies
Death, Sudden / epidemiology,  etiology*
Electroencephalography
Epilepsy / complications*,  epidemiology,  pathology
Female
Humans
Longitudinal Studies
Male
Middle Aged
Odds Ratio
Statistics, Nonparametric
Telemetry / methods*
Time Factors
Video Recording / methods
Young Adult
Comments/Corrections
Comment In:
Curr Neurol Neurosci Rep. 2011 Aug;11(4):349-50   [PMID:  21519886 ]
Ann Neurol. 2010 Dec;68(6):773-5   [PMID:  21194146 ]

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