Sudden unexpected death in epilepsy (SUDEP): pathology

Evidence-based neurology checklist on sudden unexpected death in epilepsy (sudep): pathology: Pathophysiological mechanisms Terminal generalised tonic-clonic seizure lasting ≥ 30 minutes Post ictal generalized EEG suppression (PGES) Cardiac dysfunction and brady-arrhythmias Arousal failure Primary…

Pathophysiological mechanisms

  • Terminal generalised tonic-clonic seizure lasting ≥ 30 minutes
  • Post ictal generalized EEG suppression (PGES)
  • Cardiac dysfunction and brady-arrhythmias
  • Arousal failure
  • Primary respiratory dysfunction: this is due to seizure-induced hypoventilation
  • The insula cortex: this may play a role in SUDEP

Pathological features

References

  1. Devinsky O, Hesdorffer DC, Thurman DJ, Lhatoo S, Richerson G. Sudden unexpected death in epilepsy: epidemiology, mechanisms, and prevention. Lancet Neurol 2016; 15:1075-1088. 
  2. Lhatoo SD, Nei M, Raghavan M, et al. Nonseizure SUDEP: sudden unexpected death in epilepsy without preceding epileptic seizures. Epilepsia 2016; 57:1161-1168.
  3. Dlouhy BJ, Gehlbach BK, Richerson GB. Sudden unexpected death in epilepsy: basic mechanisms and clinical implications for prevention. JNNP 2016; 87:402-413.
  4. Ryvlin P, Nashef L, Lhatoo SD, et al. Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS): a retrospective study. Lancet Neurol. 2013; 12:966-977.
  5. Li J, Ming Q, Lin W. The insula lobe and sudden unexpected death in epilepsy: a hypothesis. Epileptic Disord 2017; 19:10-14.
  6. And 3 more. Subscribe to see the full list

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