SUDEP Mechanisms: The pathway to prevention #MMPMID24752120
Massey CA; Sowers LP; Dlouhy BJ; Richerson GB
Nat Rev Neurol 2014[May]; 10 (5): 271-82 PMID24752120show ga
Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in patients with refractory epilepsy, and yet many physicians do not know about this high risk of sudden death. It has been widely believed that SUDEP is due to cardiac abnormalities during the post-ictal period. However, recent studies have demonstrated that respiratory depression is common following a seizure, and can be severe enough to cause a substantial decrease in oxygen saturation. In this review we summarize evidence for cardiac, respiratory, and arousal abnormalities during the ictal and post-ictal period and potential mechanisms for these abnormalities. We discuss mouse models of seizure-induced death and how these models are useful for understanding the mechanisms that underlie SUDEP. Some of these are due to genetic mutations that have counterparts in human syndromes. Controversy remains regarding the relative importance of cardiac failure versus respiratory arrest as the primary cause of death. Resolving this controversy will require simultaneous monitoring of cardiac and respiratory parameters during cases of near SUDEP in humans and detailed pathophysiological data from animal models during seizure-induced death. Effective preventive strategies in high-risk patients will rely on defining the mechanisms that initiate the sequence of events that lead from seizures to death.
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Nat+Rev+Neurol 2014 ; 10 (5): 271-82
