Abstract
Sudden unexpected death in epilepsy (SUDEP) risk reduction remains a critical aim in epilepsy care. To date, only aggressive medical and surgical efforts to control seizures have been demonstrated to be of benefit. Incomplete understanding of SUDEP mechanisms limits the development of more specific interventions. Periictal cardiorespiratory dysfunction is implicated in SUDEP; postictal electroencephalography (EEG) suppression, coma, and immobility may also play a role. Nocturnal supervision is protective against SUDEP, presumably by permitting intervention in the case of a life-threatening event. Resuscitative efforts were implemented promptly in near-SUDEP cases but delayed in SUDEP deaths in the Mortality in Epilepsy Monitoring Unit Study (MORTEMUS) study. Nursing interventions - including repositioning, oral suctioning, and oxygen administration - reduce seizure duration, respiratory dysfunction, and EEG suppression in the epilepsy monitoring unit (EMU), but have not been studied in outpatients. Cardiac pacemakers or cardioverter-defibrillator devices may be of benefit in a few select individuals. A role for implantable neurostimulators has not yet been established. Seizure detection devices, including those that monitor generalized tonic-clonic seizure-associated movements or cardiorespiratory parameters, may provide a means to permit timely periictal intervention. However, these and other devices, such as antisuffocation pillows, have not been adequately investigated with respect to SUDEP prevention.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 26-34 |
| Number of pages | 9 |
| Journal | Epilepsia |
| Volume | 57 |
| DOIs | |
| State | Published - Jan 1 2016 |
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Keywords
- Periictal cardiorespiratory dysfunction
- Prevention
- Recovery position
- Stimulation
- SUDEP
- Supervision
ASJC Scopus subject areas
- Clinical Neurology
- Neurology
Cite this
From unwitnessed fatality to witnessed rescue : Nonpharmacologic interventions in sudden unexpected death in epilepsy. / Rugg-Gunn, Fergus; Duncan, John; Hjalgrim, Helle; Seyal, Masud; Bateman, Lisa.
In: Epilepsia, Vol. 57, 01.01.2016, p. 26-34.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - From unwitnessed fatality to witnessed rescue
T2 - Nonpharmacologic interventions in sudden unexpected death in epilepsy
AU - Rugg-Gunn, Fergus
AU - Duncan, John
AU - Hjalgrim, Helle
AU - Seyal, Masud
AU - Bateman, Lisa
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Sudden unexpected death in epilepsy (SUDEP) risk reduction remains a critical aim in epilepsy care. To date, only aggressive medical and surgical efforts to control seizures have been demonstrated to be of benefit. Incomplete understanding of SUDEP mechanisms limits the development of more specific interventions. Periictal cardiorespiratory dysfunction is implicated in SUDEP; postictal electroencephalography (EEG) suppression, coma, and immobility may also play a role. Nocturnal supervision is protective against SUDEP, presumably by permitting intervention in the case of a life-threatening event. Resuscitative efforts were implemented promptly in near-SUDEP cases but delayed in SUDEP deaths in the Mortality in Epilepsy Monitoring Unit Study (MORTEMUS) study. Nursing interventions - including repositioning, oral suctioning, and oxygen administration - reduce seizure duration, respiratory dysfunction, and EEG suppression in the epilepsy monitoring unit (EMU), but have not been studied in outpatients. Cardiac pacemakers or cardioverter-defibrillator devices may be of benefit in a few select individuals. A role for implantable neurostimulators has not yet been established. Seizure detection devices, including those that monitor generalized tonic-clonic seizure-associated movements or cardiorespiratory parameters, may provide a means to permit timely periictal intervention. However, these and other devices, such as antisuffocation pillows, have not been adequately investigated with respect to SUDEP prevention.
AB - Sudden unexpected death in epilepsy (SUDEP) risk reduction remains a critical aim in epilepsy care. To date, only aggressive medical and surgical efforts to control seizures have been demonstrated to be of benefit. Incomplete understanding of SUDEP mechanisms limits the development of more specific interventions. Periictal cardiorespiratory dysfunction is implicated in SUDEP; postictal electroencephalography (EEG) suppression, coma, and immobility may also play a role. Nocturnal supervision is protective against SUDEP, presumably by permitting intervention in the case of a life-threatening event. Resuscitative efforts were implemented promptly in near-SUDEP cases but delayed in SUDEP deaths in the Mortality in Epilepsy Monitoring Unit Study (MORTEMUS) study. Nursing interventions - including repositioning, oral suctioning, and oxygen administration - reduce seizure duration, respiratory dysfunction, and EEG suppression in the epilepsy monitoring unit (EMU), but have not been studied in outpatients. Cardiac pacemakers or cardioverter-defibrillator devices may be of benefit in a few select individuals. A role for implantable neurostimulators has not yet been established. Seizure detection devices, including those that monitor generalized tonic-clonic seizure-associated movements or cardiorespiratory parameters, may provide a means to permit timely periictal intervention. However, these and other devices, such as antisuffocation pillows, have not been adequately investigated with respect to SUDEP prevention.
KW - Periictal cardiorespiratory dysfunction
KW - Prevention
KW - Recovery position
KW - Stimulation
KW - SUDEP
KW - Supervision
UR - http://www.scopus.com/inward/record.url?scp=84954176729&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84954176729&partnerID=8YFLogxK
U2 - 10.1111/epi.13231
DO - 10.1111/epi.13231
M3 - Article
C2 - 26749014
AN - SCOPUS:84954176729
VL - 57
SP - 26
EP - 34
JO - Epilepsia
JF - Epilepsia
SN - 0013-9580
ER -