Sudden death in epilepsy: A wake-up call for management
Pedley TA and Hauser WA (2002) Sudden death in epilepsy: A wake-up call for management. Lancet 359:9320 1790–1.
Abstract: First Paragraph: Sudden unexplained death in epilepsy (SUDEP) is the most common cause of seizure-related mortality in people with chronic epilepsy. Depending on the cohort studied, SUDEP is responsible for 2% to 18% of all deaths in patients with epilepsy, and the incidence may be up to 40 times higher in young adults with epilepsy than among persons without seizures. Several studies have emphasised early age of onset of epilepsy, frequent generalised tonic-clonic seizures, and intractability as significant risk factors for SUDEP. Polytherapy may be an additional independent risk-factor in adults, but not in children. Although most cases of SUDEP are not observed, the few witnessed cases, as well as circumstantial clinical data and autopsy findings, suggest that SUDEP is a direct consequence of the seizure itself. Although the pathophysiological mechanisms leading to death are not fully understood, experimental and clinical evidence implicate seizure-related pulmonary effects such as central apnoea and oedema as well as secondary cardiac dysfunction from ischaemia or arrhythmias.
- Comment on Hanna et al. Summarizes the report and emphasizes the need for vigorous management of patients with epilepsy in the effort to control seizures.