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Zeitschrift für Epileptologie

, Volume 32, Issue 1, pp 52–58 | Cite as

Epilepsie, Schlaf und plötzlicher unerwarteter Tod

  • Max Christian Pensel
  • Rainer SurgesEmail author
Leitthema
  • 59 Downloads

Zusammenfassung

Hintergrund

Der plötzliche unerwartete Tod stellt eine seltene, aber schwerwiegende Komplikation für Epilepsiepatienten dar. Das Risiko hierfür ist u. a. nachts und bei Menschen mit nächtlichen Anfällen erhöht, weshalb das Verständnis der Beziehungen zwischen SUDEP („sudden unexpected death in epilepsy“) und Schlaf von hoher Bedeutung ist.

Ziel der Arbeit

Der Artikel stellt die bisher bekannten pathophysiologischen Aspekte und spezifischen Gefahrenpotenziale für SUDEP dar, wobei der Schwerpunkt auf schlafbezogene Zusammenhänge gelegt wird. Darauf aufbauend wird skizziert, welche Präventions- und Gegenmaßnahmen infrage kommen.

Material und Methoden

Aktuelle wissenschaftliche Untersuchungen zu dem Themenkomplex SUDEP und Schlaf werden analysiert und in Form einer narrativen Übersichtsarbeit präsentiert.

Ergebnisse

SUDEP tritt insbesondere bei jungen Erwachsenen und häufiger bei Männern auf. Die meisten dokumentierten SUDEP-Fälle beginnen mit einem nächtlichen epileptischen Anfall, auf den ein neurovegetativer Zusammenbruch mit respiratorischer und kardialer Dekompensation folgt, der von einem flachen EEG begleitet wird.

Diskussion

Eine frühe Wiederherstellung von Atmungs- und Kreislauffunktionen kann im akuten Fall diese potenziell tödliche Kaskade durchbrechen. Eine wirksame Anfallskontrolle durch Antiepileptika, Epilepsiechirurgie oder Neurostimulation zur Vermeidung insbesondere von generalisierten tonisch-klonischen Anfällen stellt das wichtigste präventive Element dar.

Schlüsselwörter

Nächtliche Anfälle Asystolie Apnoe Plötzlicher unerwarteter Tod bei Epilepsie (SUDEP) 

Epilepsy, sleep and sudden unexpected death

Abstract

Background

Sudden unexpected death is a rare but severe complication in patients with epilepsy. The risk for sudden unexpected death in epilepsy (SUDEP) is increased at night and in people with nocturnal seizures, justifying a closer look into the relationship between sleep and SUDEP.

Objective

This article presents the current knowledge on the underlying pathophysiology and specific potential hazards for SUDEP, with a particular focus on sleep-related aspects. Furthermore, possible countermeasures and strategies for the prevention of SUDEP are described.

Material and methods

Relevant current scientific reports and studies related to the topic of SUDEP and sleep are analyzed and are presented in this narrative review.

Results

The occurrence of SUDEP is predominantly in young male adults. Most documented cases of SUDEP begin with a nocturnal epileptic seizure followed by a neurovegetative breakdown encompassing respiratory and cardiac decompensation, accompanied by a generalized suppression of EEG amplitudes.

Conclusion

An early restoration of ventilation and cardiovascular circulatory functions in acute cases can interrupt the potentially fatal cascade. The prevention of epileptic seizures, especially generalized tonic-clonic seizures, by means of effective pharmacotherapy, epilepsy surgery or neurostimulation is of utmost importance for prevention.

Keywords

Nocturnal seizures Asystole Apnoea Sudden unexpected death in epilepsy (SUDEP) 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

M.C. Pensel gibt an, dass kein Interessenkonflikt besteht. R. Surges hat in den letzten 5 Jahren Honorare für Vorträge oder als Berater von Bial, Cyberonics, Desitin, Eisai, LivaNova, Novartis und UCB Pharma erhalten.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Sektion Epileptologie, Klinik für NeurologieUniklinik RWTH AachenAachenDeutschland

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