Monday, April 3, 2017

Sudden Unexpected Death in Epilepsy - SUDEP.

Hello everybody,

Let's today learn about Sudden  Unexpected  Death  in  Epilepsy.

It is the most common epilepsy related  mortality in patients with chronic  epilepsy.

Incidence: ranges  from  1-5 per 1000 patients.

Etiology:  unknown, but some of the risk factors include :

1)Polypharmacology, 
2) Poorly controlled generalized  tonic clonic seizures
3) Male gender, 
4) Age  younger than 16 yr, 
5) Long duration of epilepsy, and  frequent seizures. 

Potential mechanisms include :
1) Respiratory  arrest  or  dysfunction, 
2) Drug-induced  cardiac  toxicity, 
3) CNS dysfunction  (hypoventilation,  arrhythmia,  suppression  of  brain  electrical  activity)
4) Pulmonary  edema.

Patients are usually found dead in their  bed in prone  position  with  evidence  suggestive of a recent seizure.   

Some of the Preventive measures include:

1)Reduction of tonic–clonic seizures:  optimum  treatment,  good drug  compliance,  lifestyle  advice  (e.g. avoiding sleep deprivation)

2)Treatment changes: change drugs in a  gradual staged manner; when switching, introduce the new drug before  withdrawing the old one.

3)Supervision at night for patients at high risk.

4) Choice of drugs:  caution  with  antiepileptic drugs with potential cardiorespiratory adverse  effects.
 
5) Action on ictal warning signs: 
tonic–clonic  seizures  that  are prolonged, associated  with  marked  cyanosis, severe bradycardia or apnea,    complex  partial seizures with marked  atonia  (drop  attacks); 

Lastly counseling on the risks, lifestyle modifications. The treatment  decisions are the patient’s  prerogative, the physician’s role is to provide a risk-vs-benefit analysis.

Hope it was informative.

Let's learn together!
-Medha!

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