Sudden unexpected death in epilepsy

S. Gollwitzer; H. M. Hamer

doi:10.1055/s-0038-1627711

Nervenheilkunde, Table of Contents

Nervenheilkunde 2014; 33(07/08): 513-518
DOI: 10.1055/s-0038-1627711

Fortbildung Karlsruhe

Schattauer GmbH

Sudden unexpected death in epilepsy

S. Gollwitzer

¹Klinik für Neurologie, Universitätsklinikum Erlangen

,

H. M. Hamer

¹Klinik für Neurologie, Universitätsklinikum Erlangen

› Author Affiliations

Abstract

Zusammenfassung

Der Begriff Sudden Unexpected Death in Epilepsy (SUDEP) beschreibt den plötzlichen, nicht durch organische Erkrankungen, Verletzungen oder Intoxikationen bedingten Tod eines Epilepsie-Patienten. Insbesondere Menschen mit therapierefraktärer Epilepsie sind durch SUDEP gefährdet. Die Frequenz generalisierter tonisch-klonischer Anfälle stellt den Hauptrisikofaktor dar; zu den weiteren Risikofaktoren zählen männliches Geschlecht, früher Beginn und lange Dauer der Epilepsie sowie nächtliche Anfälle. Eine antikonvulsive Polypharmakotherapie stellt nach neueren Erkenntnissen keinen unabhängigen Risikofaktor dar.

Im Rahmen der MORTEMUS-Studie, die SUDEP- Fälle während eines Video-EEG-Monitorings untersuchte, wurde ein gemeinsames Muster der terminalen Ereignisse deutlich: Nach einem generalisierten tonisch-klonischen Anfall mit postiktaler EEG-Suppression entwickelte sich in einem Zeitraum von drei bis elf Minuten aus einer initialen Tachypnoe über eine Bradypnoe schließlich eine Apnoe gefolgt von Bradykardie und Asystolie. Pathophysiologisch scheint demnach ein durch einen tonisch-klonischen Anfall induzierter neurovegetativer Shutdown eine zentral vermittelte kardiale und respiratorische Funktionsstörung auszulösen, die zum Tod des Patienten führt.

Effektivste Maßnahme zur Senkung des individuellen Risikos für SUDEP ist daher die bestmögliche Anfallskontrolle und insbesondere die Reduktion generalisierter tonisch-klonischer Anfälle. Risikopatienten sollten über SUDEP aufgeklärt sein. Inwieweit eine nächtliche Überwachung sinnvoll ist, muss im Einzelfall unter strenger Berücksichtigung der persönlichen Autonomie und Lebensqualität des Patienten entschieden werden.

Summary

The term Sudden Unexpected Death in Epilepsy (SUDEP) refers to an epilepsy patient’s sudden death unexplained by structural organic disease, injury or intoxication. Especially individuals with medically refractory epilepsy are endangered. A high frequency of generalized tonic-clonic seizures represents the main risk factor for SUDEP. The risk of SUDEP is also elevated in male patients, patients with early onset and long duration epilepsy and patients suffering from nighttime seizures. According to the current state of knowledge polytherapy is not regarded as an independent risk factor anymore.

The MORTEMUS study, that analyzed SUDEP cases during EEG monitoring, revealed a consistent pattern of terminal events: Within a time period of three to eleven minutes after a generalized tonic-clonic seizure with postictal EEG suppression bradypnoea and finally apnoea evolved from an initial phase of tachypnoea and followed by terminal cardiac arrest. The pathophysiologic mechanism of SUDEP seems to be a seizure induced neuro - vegetative shutdown, causing a centrally mediated severe alteration of cardiorespiratory function and leading to the patient’s death. Successful seizure control and particularly reduction of generalized tonic-clonic seizures remains the best measure to prevent SUDEP. High-risk patients should be informed about SUDEP. The decision on the usefulness of a nighttime surveillance has to be made individually under strict consideration of the patient’s personal autonomy and quality of life.

Schlüsselwörter

SUDEP - Epilepsie - plötzlicher Tod - MORTEMUS

Keywords

SUDEP - epilepsy - sudden death - MORTEMUS

Full Text

References

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