We read with interest a very comprehensive review article titled “The relationship
between sleep and epilepsy: evidence from clinical trials and animal models” by Matos
et al. [
[1]
] published in the August issue of Journal of the Neurological Sciences. Given the dearth of published data about the relation of sleep disturbances and
sudden unexpected death in epilepsy (SUDEP) occurrence, we applaud Dr. Matos and her
colleagues for pursuing this topic, but we also find it necessary to address some
purposes regarding their comments. Epilepsy is associated with a two- to three-fold
increase in mortality, compared to the general population, and SUDEP is the most important
direct epilepsy-related cause of death [
[2]
]. In general terms, SUDEP is defined by precise criteria that were approved in 1997
by an expert panel and is designed as sudden, unexpected, witnessed or unwitnessed,
nontraumatic and nondrowning deaths in patients with epilepsy, with or without evidence
of a seizure and excluding documented status epilepticus, in which post mortem examination does not reveal a toxicological or anatomical cause
of death [
[3]
]. Currently, the incidence of SUDEP differs due to differences in the study populations,
level of documentation, and SUDEP definitions [
[4]
]. Generally, SUDEP is responsible for 7.5% to 17% of all deaths in epilepsy and has
an incidence among adults between 1:500 and 1:1000 patient-years [
[5]
]. To date, information concerning risk factors for SUDEP is conflicting, but potential
risk factors include: refractoriness of the epileptic condition, presence of generalized
tonic–clonic seizures, antiepileptic medication (polytherapy with antiepileptic drugs),
young age, duration of the seizure disorder, early onset of epilepsy and winter temperatures
[
4
,
5
,
6
,
7
]. Although different mechanisms may play separate roles in different cases [
[6]
], the two major domains of potential mechanisms of SUDEP are autonomic, i.e., cardiovascular,
and respiratory [
[8]
]. Following this line of reasoning, discover and carefully evaluate how abnormalities
during sleep may contribute to the onset of autonomic disturbances in people with
refractory epilepsy may be capable of preventing the occurrence of fatal events in
these individuals.To read this article in full you will need to make a payment
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References
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- Sudden unexpected death in epilepsy: from mechanisms to prevention.Curr. Opin. Neurol. 2006; 19: 194-199
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Article info
Publication history
Published online: September 14, 2010
Accepted:
August 5,
2010
Received:
July 16,
2010
Identification
Copyright
© 2010 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
