Postictal central apnea as a cause of SUDEP: Evidence from near-SUDEP incident

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So E, Sam M, and Lagerlund T(2000) Postictal central apnea as a cause of SUDEP: Evidence from near-SUDEP incident. Epilepsia 41:11 1494–1497.

Link to Article

Abstract: While undergoing video-EEG monitoring, a 20-year-old woman had a 56-second convulsive seizure, after which she developed persistent apnea. The rhythm of the electrocardiogram complexes was unimpaired for approximately 10 seconds, after which it gradually and progressively slowed until it stopped 57 seconds later. Evaluation after successful cardio-respiratory resuscitation showed no evidence of airway obstruction or pulmonary edema. The patient had a previous cardio-respiratory arrest after a complex partial seizure without secondary generalization. Although epileptic seizures are known to be potentially arrhythmogenic to the heart, our observations strongly suggest that one probable mechanism of sudden unexplained death in epilepsy is the marked central suppression of respiratory activity after seizures.

Keywords: Epilepsy, Sudden death, Sudden unexplained death in epilepsy, Apnea.

Context

  • Single-case report of a patient undergoing monitoring who suffered a seizure, then apnea, then bradycardia and asystole. The patient had had several previous episodes of postictal apnea, and at these times health care providers noticed loss of the pulse. The authors argue that seizure-induced apnea could cause bradycardia through the cardiorespiratory reflex (Nashef et al.). They point to findings of Kaada and Jasper and Nelson and Ray as evidence that respiratory arrest due to stimulation of the amygdala could be the cause of the apnea, and point to the fact that both SUDEP and the cardiorespiratory reflex decrease with age as corroborative evidence. Additional evidence for amygdalar contribution to respiratory arrest is present in a number of studies (Frysinger et al., 1984; Frysinger and Harper, 1989, 1990; Hadziefendic and Haxhiu, 1999; Harper et al., 1984; Hopkins and Holstege, 1978).

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