Sudep sudden unexpected death in epilepsy
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SUDEP (Sudden Unexpected Death in Epilepsy). Rebecca Liu Consultant Neurologist Epilepsy Initiative Group, Royal Free London NHS Foundation Trust. AIMS. Develop greater awareness and understanding of SUDEP Recognise those at high risk Understand possible mechanisms

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SUDEP (Sudden Unexpected Death in Epilepsy)

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Sudep sudden unexpected death in epilepsy

SUDEP(Sudden Unexpected Death in Epilepsy)

Rebecca Liu

Consultant Neurologist

Epilepsy Initiative Group, Royal Free London NHS Foundation Trust


Sudep sudden unexpected death in epilepsy

AIMS

  • Develop greater awareness and understanding of SUDEP

  • Recognise those at high risk

  • Understand possible mechanisms

  • Practical measures that may reduce risk


What is sudep sudden unexpected death in epilepsy

What is SUDEP (Sudden Unexpected Death in Epilepsy)?

  • Sudden and Unexpected death in person with epilepsy

  • Witnessed or unwitnessed

  • May or may not have been related to a recent seizure

  • Not related to trauma

  • Not due to drowning

  • Not due to status epilepticus

  • Definite SUDEP – autopsy shows no anatomical / toxic cause

  • Probable SUDEP – no autopsy


Test your knowledge

TEST YOUR KNOWLEDGE

  • Compared to the general population, premature death in epilepsy is:

  • The same as for the general population

  • 3X greater

  • 10X greater


Test your knowledge1

TEST YOUR KNOWLEDGE

2. The commonest cause of death in epilepsy is:

  • Accidents

  • Drowning

  • Status Epilepticus

  • SUDEP

  • Suicide

  • Medication side effects


Test your knowledge2

TEST YOUR KNOWLEDGE

3. In epilepsy surgery candidates, the risk of SUDEP is approximately:

  • 1 in 10,000 people each year

  • 1 in 1000 people each year

  • 1 in 100 people each year

  • 1 in 10 people each year


Test your knowledge3

TEST YOUR KNOWLEDGE

  • The single greatest risk factor for SUDEP is:

  • Male

  • Seizures at night

  • AED polytherapy

  • Long duration of epilepsy

  • Frequent generalised convulsions


Test your knowledge4

TEST YOUR KNOWLEDGE

  • What is the most important factor in preventing SUDEP?

  • Supervision after seizures

  • Sleeping on your back

  • Cutting down alcohol intake

  • Bed monitor

  • Achieving best seizure control possible

  • Keeping antiepileptic medication to a minimum


Sudep some facts

SUDEP – some facts

  • PWE have 3X increased mortality

  • PWE are 24X more likely to die of sudden death

  • SUDEP is the commonest cause of death in epilepsy

  • Each year, 500 people die from SUDEP in the UK

  • Commonest in age 20-40 years


Risk factors for sudep

RISK FACTORS FOR SUDEP

  • Frequent seizures especially GTCS

  • Long epilepsy duration

  • Early epilepsy onset

  • Poor drug concordance

  • AED polytherapy / change of AED doses

  • Learning disability

  • Young adults 20-40 years

  • Male Sex

  • Alcohol abuse


Why might sudep occur

Why might SUDEP occur?


Heart

Heart

  • Tachycardia during seizures is usual

  • Bradycardia during seizures rare (2%)

  • 16% had sinus arrest resulting in a pacemaker (Rugg Gunn 2004)

  • Gene mutations associated with cardiological conditions have been found postmortem in 13% pts with SUDEP.


Sudep sudden unexpected death in epilepsy

Lung

  • Seizure-related apnoea recorded on VT units and animal models

  • Low oxygen levels are common during seizures

  • Apnoea due to CENTRALhypoventilation > obstructive

  • Patients often lying on their front

  • Hypoxia more in: temporal lobe seizures, long seizures and spread of seizure activity through brain

  • Postictal hypoxaemia may lead to cardiac arrhythmias


Brain

Brain

  • ‘Cerebral electrical shutdown’ seen in SUDEP patients

  • Postictal generalised EEG suppression (PGES) often occurs after generalised convulsions

  • ?PGES longer in patients with SUDEP

  • More likely to be motionless after seizure and need help

  • Does stimulation help?


Interaction between predisposing factors and triggers for sudep

Interaction between predisposing factors and triggers for SUDEP


High risk patients

HIGH RISK PATIENTS

  • Young men

  • Early onsetrefractory seizures

  • Symptomatic focal epilepsy

  • Frequent convulsions

  • Large number of AED drugs


What can we do to help prevent sudep

What can we do to help prevent SUDEP?

  • Control seizures as best we can!

    • Encourage good drug concordance

    • Avoid seizure triggers

    • Consider specialist referral

  • Stay with patient during recovery period

  • Ensure nothing obstructing their breathing

  • Position - Lie in recovery position, sleep on back

  • Stimulate patient after a seizure

  • Administer oxygen if necessary

  • Consider nocturnal alarm, monitoring device, supervision


The aftermath

THE AFTERMATH

  • Contact their GP, epilepsy specialist

  • Emotional support / Counselling

  • Put in touch with Epilepsy Bereaved


  • Login