Difference between revisions of "An electroclinical case-control study of sudden unexpected death in epilepsy"
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A major proposed mechanism of SUDEP is the concept of electro-cerebral shutdown, seen on scalp EEG as prolonged post-ictal generalized EEG suppression (PGES). | A major proposed mechanism of SUDEP is the concept of electro-cerebral shutdown, seen on scalp EEG as prolonged post-ictal generalized EEG suppression (PGES). | ||
| − | In this case-control study, Dr. Lhatoo reports that prolonged PGES (>50 seconds) appears to identify refractory epilepsy patients who are at risk of SUDEP and risk of SUDEP may be increased in direct proportion to duration of PGES. | + | In this case-control study, Dr. Lhatoo reports that prolonged PGES (>50 seconds) appears to identify refractory epilepsy patients who are at risk of SUDEP and risk of SUDEP may be increased in direct proportion to duration of PGES. However, the evidence has been inconsistent in determining the role played by PGES in SUDEP (Surges et al 2011). PGES is seen most often after generalized tonic-clonic seizures, which is a well-known risk factor for SUDEP but it is not a consistent post-ictal finding. |
| − | + | Ryvlin et al 2013 reported that PGES was found to be more common at night and suggested that nocturnal PGES may reflect post-ictal cardio-pulmonary dysfunction. Two other studies failed to support this hypothesis (Lee et al 2013, Mosley et al 20113).The significance of PGES in SUDEP and its possible role as a bio-marker of increased SUDEP risk remains to be established. | |
| − | Ryvlin et al 2013 reported that PGES was found to be more common at night and suggested that nocturnal PGES may reflect post-ictal cardio-pulmonary dysfunction. Two other studies failed to support this hypothesis (Lee et al 2013, Mosley et al 20113). | ||
| − | The significance of PGES in SUDEP and its possible role as a bio-marker of increased SUDEP risk remains to be established. | ||
Surges R1, Strzelczyk A, Scott CA, Walker MC, Sander JW. Postictal generalized electroencephalographic suppression is associated with generalized seizures. | Surges R1, Strzelczyk A, Scott CA, Walker MC, Sander JW. Postictal generalized electroencephalographic suppression is associated with generalized seizures. | ||
Revision as of 22:39, 15 April 2018
A major proposed mechanism of SUDEP is the concept of electro-cerebral shutdown, seen on scalp EEG as prolonged post-ictal generalized EEG suppression (PGES).
In this case-control study, Dr. Lhatoo reports that prolonged PGES (>50 seconds) appears to identify refractory epilepsy patients who are at risk of SUDEP and risk of SUDEP may be increased in direct proportion to duration of PGES. However, the evidence has been inconsistent in determining the role played by PGES in SUDEP (Surges et al 2011). PGES is seen most often after generalized tonic-clonic seizures, which is a well-known risk factor for SUDEP but it is not a consistent post-ictal finding.
Ryvlin et al 2013 reported that PGES was found to be more common at night and suggested that nocturnal PGES may reflect post-ictal cardio-pulmonary dysfunction. Two other studies failed to support this hypothesis (Lee et al 2013, Mosley et al 20113).The significance of PGES in SUDEP and its possible role as a bio-marker of increased SUDEP risk remains to be established.
Surges R1, Strzelczyk A, Scott CA, Walker MC, Sander JW. Postictal generalized electroencephalographic suppression is associated with generalized seizures. Epilepsy Behav. 2011 Jul;21(3):271-4.
Ryvlin P, Nashef L, Lhatoo SD, Bateman LM, Bird J, Bleasel A, et al. Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS): a retrospective study. Lancet Neurol 2013;12:966–77.
Moseley BD, So E, Wirrell EC, Nelson C, Lee RW, Mandrekar J, et al. Characteristics of postictal generalized EEG suppression in children. Epilepsy Res 2013;106(1–2):123–7
Lee A, Wu S, Zhou X, Liebenthal J, Rose S, Tao JX. Periictal autonomic dysfunction and generalized postictal EEG suppression in convulsive seizures arising from sleep and wakefulness. Epilepsy Behav 2013;28:439–43