Sudden Unexpected Death in Epilepsy or Voodoo Heart: Analysis of Heart/Brain Connections
- PDF / 189,898 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 6 Downloads / 157 Views
STROKE (C SILA, SECTION EDITOR)
Sudden Unexpected Death in Epilepsy or Voodoo Heart: Analysis of Heart/Brain Connections Narges Moghimi & Samden D. Lhatoo
Published online: 12 October 2013 # Springer Science+Business Media New York 2013
Abstract Sudden unexpected death in epilepsy (SUDEP) affects up to 5000 patients a year in the United States alone. The exact pathophysiologic processes of are unknown. Profound autonomic dysregulation driving cardiac and respiratory dysfunction is likely. Available evidence from monitored deaths suggests that fatal tachyarrhythmias are not primarily responsible although near deaths due to ventricular arrhythmias have been reported. Genetic “neuro-cardiac” channelopathies affecting brain function, central respiratory processes, and cardiac rhythm have been hypothesized. These, as well as serotonergic mechanisms affecting brainstem homeostasis of cardiac and respiratory function are important areas of current and future SUDEP research. Keywords SUDEP, sudden unexpected death in epilepsy . Seizure . Cardiac arrhythmia . Meta-analysis . Systematic review . HRV, heart rate variability . Neuro-cardiogenic syndromes . LQTS . Voodoo heart . Heart . Brain
Introduction In 1904, Spratling provided an early, historical insight into sudden unexpected death in epilepsy (SUDEP) as a process that “destroys life suddenly and without warning through a single, brief attack…” [1]. The lack of a pathognomonic autopsy signature and its often unwitnessed nature pose difficulties with regard to definitions, which describe a phenomenon rather than a mechanism. In many respects, similarities with Sudden This article is part of the Topical Collection on Stroke N. Moghimi (*) : S. D. Lhatoo Epilepsy Center, Department of Neurology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA e-mail: [email protected]
Infant Death Syndrome (SIDS) are striking. A populationbased study found the rate of sudden unexplained death in the epilepsy population to exceed the expected rate in the general population by nearly 24 times [2]. Approximately 1/100 of intractable epilepsy patients fall victim every year to SUDEP [3], with up to 5000 annual deaths in the USA alone. It is defined as a “sudden, unexpected, witnessed or unwitnessed, nontraumatic and nondrowning death in a patient with epilepsy, with or without evidence of a seizure and excluding documented status epilepticus where autopsy does not reveal an anatomic or toxicological cause of death” [4•]. Risk factors consistently highlighted by case control studies include: refractory generalized tonic–clonic seizures, antiepileptic drug polytherapy, young adulthood, and longer durations of epilepsy [2]. The precise phenomenology of SUDEP is debated; cardiac arrhythmias, central or peripheral hypoventilation, and “brain shutdown” are among the main candidate hypotheses [5•]. Epidemiological studies have made their contribution and there is increasing research emphasis on individualized, id
Data Loading...
