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Sudden Unexpected Death in Epilepsy (SUDEP) — What Pediatricians Need to Know

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Abstract

Sudden unexpected death in epilepsy (SUDEP) is a devastating complication in children with epilepsy. Children with generalized tonic-clonic convulsions, nocturnal seizures, and co-morbid developmental delay/intellectual disability are at higher risk of SUDEP. The pathogenic mechanisms are incompletely understood and involve cardiac, respiratory, autonomic and cerebral dysfunction. Prone positioning is also significantly associated with SUDEP and may be a target for SUDEP prevention. Good epilepsy control also attenuates the risk; hence, it is important to provide adequate antiepileptic drug therapy with stress on drug compliance as well as early surgical referral for seizure control, wherever necessary. It is recommended that parents of children with epilepsy be counseled about the risk factors for SUDEP and potential measures of SUDEP prevention. We herein provide a pediatric perspective of the problem and guidance about parental counselling for its prevention.

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References

  1. Appleton R. Mortality in paediatric epilepsy. Arch Dis Child. 2003;1091-4.

  2. Gaitatzis A, Johnson AL, Chadwick DW, Shorvon SD, Sander JW. Life expectancy in people with newly diagnosed epilepsy. Brain. 2004;127:2427–32.

    Google Scholar 

  3. Nashef L. Sudden unexpected death in epilepsy: Terminology and definitions. Epilepsia. 1997;38:S6–8.

    CAS  Google Scholar 

  4. Nashef L. E. So P. Ryvlin T. Tomson. Unifying the definitions of sudden unexpected death in epilepsy. Epilepsia. 2012;53:227–33.

    Google Scholar 

  5. Sillanpää M, Shinnar S. Long-term mortality in childhood-onset epilepsy. N Engl J Med. 2010;363:2522–9.

    Google Scholar 

  6. Weber P, Bubl R, Blauenstein U, Tillmann BU, Lütschg J. Sudden unexplained death in children with epilepsy: A cohort study with an eighteen-year follow-up. Acta Paediatr. 2005;94:564–7.

    Google Scholar 

  7. Sillanpää M, Shinnar S. SUDEP and other causes of mortality in childhood-onset epilepsy. Epilepsy Behav. 2013;28:249–55.

    Google Scholar 

  8. Harden C, Tomson T, Gloss D, Buchhalter J, Cross JH, Donner E, et al. Practice Guideline Summary: Sudden Unexpected Death in Epilepsy Incidence Rates and Risk Factors. Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2017;88:1674–80.

    Google Scholar 

  9. Berg AT, Nickels K, Wirrell EC, Geerts AT, Callenbach PM, Arts WF, et al. Mortality risks in new-onset childhood epilepsy. Pediatrics. 2013;132:124–31.

    Google Scholar 

  10. Shinnar S, Pellock JM. Update on the epidemiology and prognosis of pediatric epilepsy. J Child Neurol. 2002; 17: S4–S17.

    Google Scholar 

  11. Nickels KC, Grossardt BR, Wirrell EC. Epilepsy-related mortality is low in children: A 30-year population-based study in Olmsted County, MN. Epilepsia. 2012;53:2164–71.

    Google Scholar 

  12. Hesdorffer DC, Tomson T, Benn E, Sander JW, Nilsson L, Langan Y, et al. Combined analysis of risk factors for SUDEP. Epilepsia. 2011;52:1150–9.

    Google Scholar 

  13. Tao JX, Yung I, Lee A, Rose S, Jacobsen J, Ebersole JS. Tonic phase of a generalized convulsive seizure is an independent predictor of postictal generalized EEG suppression. Epilepsia. 2013;54:858–65.

    Google Scholar 

  14. Lamberts RJ, Gaitatzis A, Sander JW, Elger CE, Surges R, Thijs RD. Postictal generalized EEG suppression: An inconsistent finding in people with multiple seizures. Neurology. 2013;81:1252–6.

    Google Scholar 

  15. Skluzacek JV, Watts KP, Parsy O, Wical B, Camfield P. Dravet syndrome and parent associations: The IDEA League experience with comorbid conditions, mortality, management, adaptation, and grief. Epilepsia. 2011;52:95–101.

    Google Scholar 

  16. Buchanan GF. Impaired CO2-induced arousal in SIDS and SUDEP. Trend Neurosci. 2019:42:242–50.

    CAS  Google Scholar 

  17. Moseley BD, Wirrell EC, Nickels K, Johnson JN, Ackerman MJ, Britton J. Electrocardiographic and oximetric changes during partial complex and generalized seizures. Epilepsy Res. 2011;95:237–45.

    Google Scholar 

  18. Mukherjee S, Tripathi M, Chandra PS, Yadav R, Choudhary N, Sagar R, et al. Cardiovascular autonomic functions in well-controlled and intractable partial epilepsies. Epilepsy Res. 2009;85:261–9.

    Google Scholar 

  19. Zijlmans M, Flanagan D, Gotman J. Heart rate changes and ECG abnormalities during epileptic seizures: Prevalence and definition of an objective clinical sign. Epilepsia. 2002;43:847–54.

    Google Scholar 

  20. Ryvlin P, Nashef L, Lhatoo SD, Bateman LM, Bird J, Bleasel A, et al. Incidence and mechanisms of cardio-respiratory arrests in epilepsy monitoring units (MORTEMUS): A retrospective study. Lancet Neurol. 2013;12:966–77.

    Google Scholar 

  21. Li MCH, O’Brien TJ, Todaro M, Powell KL. Acquired cardiac channelopathies in epilepsy: Evidence, mechanisms and clinical significance. Epilepsia. 2019:60: 1753–67.

    CAS  Google Scholar 

  22. Toczek MT, Carson RE, Lang L, Ma Y, Spanaki MV, Der MG, et al. PET imaging of 5HT1A receptor binding in patients with temporal lobe epilepsy. Neurology. 2003;60:749–56.

    CAS  Google Scholar 

  23. Tortella FC, Long JB, Holaday JW. Endogenous opiate systems: Physiological role in the self-limitation of seizures. Brain Res. 1985;332:174–8.

    CAS  Google Scholar 

  24. Paterson DS, Trachtenberg FL, Thompson EG, Belliveau RA, Beggs AH, Darnall R, et al. Multiple serotonergic abnormalities in sudden infant death syndrome. JAMA. 2006;296:254–32.

    Google Scholar 

  25. Langan Y, Nashef L, Sander JW. Case-control study of SUDEP. Neurology. 2005;64;1131–3.

    CAS  Google Scholar 

  26. Faingold CL, Tupal S, Randall M. Prevention of seizure-induced sudden death in a chronic SUDEP model by semichronic administration of a selective serotonin reuptake inhibitor. Epilepsy Beh. 2011;22:186–90.

    Google Scholar 

  27. Bateman LM, Li CS, Lin TC, Seyal M. Serotonin reuptake inhibitors are associated with reduced severity of ictal hypoxemia in medically refractory partial epilepsy. Epilepsia. 2010;51:2211–4.

    Google Scholar 

  28. Volpicelli JR, Alterman AI, Hayashida M, O’Brien CP. Naltrexone in the treatment of alcohol dependence. Arch Gen Psych. 1992;49:876–80.

    CAS  Google Scholar 

  29. Maguire MJ, Jackson CF, Marson AG, Nolan SJ. Treatments for the prevention of sudden unexpected death in epilepsy (SUDEP). Cochrane Database Syst Rev. 2016;7:CD011792.

    Google Scholar 

  30. Srivastava K, Sehgal R, Konanki R, Jain R, Sharma S, Mittal R. Association of Child Neurology-Indian Epilepsy Society Consensus Document on Parental Counseling of Children with Epilepsy. Indian J Pediatr. 2019;86:608–16.

    Google Scholar 

  31. Ramachandrannair R, Jack SM, Meaney BF, Ronen GM. SUDEP: What do parents want to know? Epilepsy Beh. 2013;29:560–4.

    Google Scholar 

  32. Fong CY, Lim WK, Kong AN, Lua PL, Ong LC. Provision of sudden unexpected death in epilepsy (SUDEP) information among Malaysian parents of children with epilepsy. Epilepsy Behav. 2017;75:6–12.

    Google Scholar 

  33. Gayatri NA, Morrall MC, Jain V, Kashyape P, Pysden K, Ferrie C. Parental beliefs regarding the provision and content of written sudden unexpected death in epilepsy (SUDEP) information. Epilepsia. 2010;51:777–82.

    Google Scholar 

  34. Radhakrishnan DM, Ramanujam B, Srivastava P, Dash D, Tripathi M. Effect of providing sudden unexpected death in epilepsy (SUDEP) information to persons with epilepsy (PWE) and their caregivers experience from a tertiary care hospital. Acta Neurol Scand. 2018;138:417–24.

    Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, Lady Hardinge Medical College, New Delhi, India

    Divyani Garg

  2. Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India

    Suvasini Sharma

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  1. Divyani Garg
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  2. Suvasini Sharma
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DG performed the literature review and wrote the first draft which was critically revised by SS. Both authors approved the final version of the submitted manuscript.

Corresponding author

Correspondence to Suvasini Sharma.

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None stated.

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Garg, D., Sharma, S. Sudden Unexpected Death in Epilepsy (SUDEP) — What Pediatricians Need to Know. Indian Pediatr 57, 890–894 (2020). https://doi.org/10.1007/s13312-020-1986-4

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  • DOI: https://doi.org/10.1007/s13312-020-1986-4

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