Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS): A retrospective study

Philippe Ryvlin, Lina Nashef, Samden D. Lhatoo, Lisa M. Bateman, Jonathan Bird, Andrew Bleasel, Paul Boon, Arielle Crespel, Barbara A. Dworetzky, Hans Høgenhaven, Holger Lerche, Louis Maillard, Michael P. Malter, Cecile Marchal, Jagarlapudi M K Murthy, Michael Nitsche, Ekaterina Pataraia, Terje Rabben, Sylvain Rheims, Bernard SadzotAndreas Schulze-Bonhage, Masud Seyal, Elson L. So, Mark Spitz, Anna Szucs, Meng Tan, James X. Tao, Torbjörn Tomson

Research output: Contribution to journalArticle

387 Citations (Scopus)

Abstract

Background: Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in people with chronic refractory epilepsy. Very rarely, SUDEP occurs in epilepsy monitoring units, providing highly informative data for its still elusive pathophysiology. The MORTEMUS study expanded these data through comprehensive evaluation of cardiorespiratory arrests encountered in epilepsy monitoring units worldwide. Methods: Between Jan 1, 2008, and Dec 29, 2009, we did a systematic retrospective survey of epilepsy monitoring units located in Europe, Israel, Australia, and New Zealand, to retrieve data for all cardiorespiratory arrests recorded in these units and estimate their incidence. Epilepsy monitoring units from other regions were invited to report similar cases to further explore the mechanisms. An expert panel reviewed data, including video electroencephalogram (VEEG) and electrocardiogram material at the time of cardiorespiratory arrests whenever available. Findings: 147 (92%) of 160 units responded to the survey. 29 cardiorespiratory arrests, including 16 SUDEP (14 at night), nine near SUDEP, and four deaths from other causes, were reported. Cardiorespiratory data, available for ten cases of SUDEP, showed a consistent and previously unrecognised pattern whereby rapid breathing (18-50 breaths per min) developed after secondary generalised tonic-clonic seizure, followed within 3 min by transient or terminal cardiorespiratory dysfunction. Where transient, this dysfunction later recurred with terminal apnoea occurring within 11 min of the end of the seizure, followed by cardiac arrest. SUDEP incidence in adult epilepsy monitoring units was 5·1 (95% CI 2·6-9·2) per 1000 patient-years, with a risk of 1·2 (0·6-2·1) per 10000 VEEG monitorings, probably aggravated by suboptimum supervision and possibly by antiepileptic drug withdrawal. Interpretation: SUDEP in epilepsy monitoring units primarily follows an early postictal, centrally mediated, severe alteration of respiratory and cardiac function induced by generalised tonic-clonic seizure, leading to immediate death or a short period of partly restored cardiorespiratory function followed by terminal apnoea then cardiac arrest. Improved supervision is warranted in epilepsy monitoring units, in particular during night time. Funding: Commission of European Affairs of the International League Against Epilepsy.

Original languageEnglish (US)
Pages (from-to)966-977
Number of pages12
JournalThe Lancet Neurology
Volume12
Issue number10
DOIs
StatePublished - Oct 2013

Fingerprint

Epilepsy
Retrospective Studies
Incidence
Sudden Death
Seizures
Apnea
Heart Arrest
Cause of Death
Electroencephalography
Israel
New Zealand
Anticonvulsants
Electrocardiography
Respiration

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Ryvlin, P., Nashef, L., Lhatoo, S. D., Bateman, L. M., Bird, J., Bleasel, A., ... Tomson, T. (2013). Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS): A retrospective study. The Lancet Neurology, 12(10), 966-977. https://doi.org/10.1016/S1474-4422(13)70214-X

Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS) : A retrospective study. / Ryvlin, Philippe; Nashef, Lina; Lhatoo, Samden D.; Bateman, Lisa M.; Bird, Jonathan; Bleasel, Andrew; Boon, Paul; Crespel, Arielle; Dworetzky, Barbara A.; Høgenhaven, Hans; Lerche, Holger; Maillard, Louis; Malter, Michael P.; Marchal, Cecile; Murthy, Jagarlapudi M K; Nitsche, Michael; Pataraia, Ekaterina; Rabben, Terje; Rheims, Sylvain; Sadzot, Bernard; Schulze-Bonhage, Andreas; Seyal, Masud; So, Elson L.; Spitz, Mark; Szucs, Anna; Tan, Meng; Tao, James X.; Tomson, Torbjörn.

In: The Lancet Neurology, Vol. 12, No. 10, 10.2013, p. 966-977.

Research output: Contribution to journalArticle

Ryvlin, P, Nashef, L, Lhatoo, SD, Bateman, LM, Bird, J, Bleasel, A, Boon, P, Crespel, A, Dworetzky, BA, Høgenhaven, H, Lerche, H, Maillard, L, Malter, MP, Marchal, C, Murthy, JMK, Nitsche, M, Pataraia, E, Rabben, T, Rheims, S, Sadzot, B, Schulze-Bonhage, A, Seyal, M, So, EL, Spitz, M, Szucs, A, Tan, M, Tao, JX & Tomson, T 2013, 'Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS): A retrospective study', The Lancet Neurology, vol. 12, no. 10, pp. 966-977. https://doi.org/10.1016/S1474-4422(13)70214-X
Ryvlin, Philippe ; Nashef, Lina ; Lhatoo, Samden D. ; Bateman, Lisa M. ; Bird, Jonathan ; Bleasel, Andrew ; Boon, Paul ; Crespel, Arielle ; Dworetzky, Barbara A. ; Høgenhaven, Hans ; Lerche, Holger ; Maillard, Louis ; Malter, Michael P. ; Marchal, Cecile ; Murthy, Jagarlapudi M K ; Nitsche, Michael ; Pataraia, Ekaterina ; Rabben, Terje ; Rheims, Sylvain ; Sadzot, Bernard ; Schulze-Bonhage, Andreas ; Seyal, Masud ; So, Elson L. ; Spitz, Mark ; Szucs, Anna ; Tan, Meng ; Tao, James X. ; Tomson, Torbjörn. / Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS) : A retrospective study. In: The Lancet Neurology. 2013 ; Vol. 12, No. 10. pp. 966-977.
@article{bd105c8d38ea4f11a129d16614e21b3b,
title = "Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS): A retrospective study",
abstract = "Background: Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in people with chronic refractory epilepsy. Very rarely, SUDEP occurs in epilepsy monitoring units, providing highly informative data for its still elusive pathophysiology. The MORTEMUS study expanded these data through comprehensive evaluation of cardiorespiratory arrests encountered in epilepsy monitoring units worldwide. Methods: Between Jan 1, 2008, and Dec 29, 2009, we did a systematic retrospective survey of epilepsy monitoring units located in Europe, Israel, Australia, and New Zealand, to retrieve data for all cardiorespiratory arrests recorded in these units and estimate their incidence. Epilepsy monitoring units from other regions were invited to report similar cases to further explore the mechanisms. An expert panel reviewed data, including video electroencephalogram (VEEG) and electrocardiogram material at the time of cardiorespiratory arrests whenever available. Findings: 147 (92{\%}) of 160 units responded to the survey. 29 cardiorespiratory arrests, including 16 SUDEP (14 at night), nine near SUDEP, and four deaths from other causes, were reported. Cardiorespiratory data, available for ten cases of SUDEP, showed a consistent and previously unrecognised pattern whereby rapid breathing (18-50 breaths per min) developed after secondary generalised tonic-clonic seizure, followed within 3 min by transient or terminal cardiorespiratory dysfunction. Where transient, this dysfunction later recurred with terminal apnoea occurring within 11 min of the end of the seizure, followed by cardiac arrest. SUDEP incidence in adult epilepsy monitoring units was 5·1 (95{\%} CI 2·6-9·2) per 1000 patient-years, with a risk of 1·2 (0·6-2·1) per 10000 VEEG monitorings, probably aggravated by suboptimum supervision and possibly by antiepileptic drug withdrawal. Interpretation: SUDEP in epilepsy monitoring units primarily follows an early postictal, centrally mediated, severe alteration of respiratory and cardiac function induced by generalised tonic-clonic seizure, leading to immediate death or a short period of partly restored cardiorespiratory function followed by terminal apnoea then cardiac arrest. Improved supervision is warranted in epilepsy monitoring units, in particular during night time. Funding: Commission of European Affairs of the International League Against Epilepsy.",
author = "Philippe Ryvlin and Lina Nashef and Lhatoo, {Samden D.} and Bateman, {Lisa M.} and Jonathan Bird and Andrew Bleasel and Paul Boon and Arielle Crespel and Dworetzky, {Barbara A.} and Hans H{\o}genhaven and Holger Lerche and Louis Maillard and Malter, {Michael P.} and Cecile Marchal and Murthy, {Jagarlapudi M K} and Michael Nitsche and Ekaterina Pataraia and Terje Rabben and Sylvain Rheims and Bernard Sadzot and Andreas Schulze-Bonhage and Masud Seyal and So, {Elson L.} and Mark Spitz and Anna Szucs and Meng Tan and Tao, {James X.} and Torbj{\"o}rn Tomson",
year = "2013",
month = "10",
doi = "10.1016/S1474-4422(13)70214-X",
language = "English (US)",
volume = "12",
pages = "966--977",
journal = "The Lancet Neurology",
issn = "1474-4422",
publisher = "Lancet Publishing Group",
number = "10",

}

TY - JOUR

T1 - Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS)

T2 - A retrospective study

AU - Ryvlin, Philippe

AU - Nashef, Lina

AU - Lhatoo, Samden D.

AU - Bateman, Lisa M.

AU - Bird, Jonathan

AU - Bleasel, Andrew

AU - Boon, Paul

AU - Crespel, Arielle

AU - Dworetzky, Barbara A.

AU - Høgenhaven, Hans

AU - Lerche, Holger

AU - Maillard, Louis

AU - Malter, Michael P.

AU - Marchal, Cecile

AU - Murthy, Jagarlapudi M K

AU - Nitsche, Michael

AU - Pataraia, Ekaterina

AU - Rabben, Terje

AU - Rheims, Sylvain

AU - Sadzot, Bernard

AU - Schulze-Bonhage, Andreas

AU - Seyal, Masud

AU - So, Elson L.

AU - Spitz, Mark

AU - Szucs, Anna

AU - Tan, Meng

AU - Tao, James X.

AU - Tomson, Torbjörn

PY - 2013/10

Y1 - 2013/10

N2 - Background: Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in people with chronic refractory epilepsy. Very rarely, SUDEP occurs in epilepsy monitoring units, providing highly informative data for its still elusive pathophysiology. The MORTEMUS study expanded these data through comprehensive evaluation of cardiorespiratory arrests encountered in epilepsy monitoring units worldwide. Methods: Between Jan 1, 2008, and Dec 29, 2009, we did a systematic retrospective survey of epilepsy monitoring units located in Europe, Israel, Australia, and New Zealand, to retrieve data for all cardiorespiratory arrests recorded in these units and estimate their incidence. Epilepsy monitoring units from other regions were invited to report similar cases to further explore the mechanisms. An expert panel reviewed data, including video electroencephalogram (VEEG) and electrocardiogram material at the time of cardiorespiratory arrests whenever available. Findings: 147 (92%) of 160 units responded to the survey. 29 cardiorespiratory arrests, including 16 SUDEP (14 at night), nine near SUDEP, and four deaths from other causes, were reported. Cardiorespiratory data, available for ten cases of SUDEP, showed a consistent and previously unrecognised pattern whereby rapid breathing (18-50 breaths per min) developed after secondary generalised tonic-clonic seizure, followed within 3 min by transient or terminal cardiorespiratory dysfunction. Where transient, this dysfunction later recurred with terminal apnoea occurring within 11 min of the end of the seizure, followed by cardiac arrest. SUDEP incidence in adult epilepsy monitoring units was 5·1 (95% CI 2·6-9·2) per 1000 patient-years, with a risk of 1·2 (0·6-2·1) per 10000 VEEG monitorings, probably aggravated by suboptimum supervision and possibly by antiepileptic drug withdrawal. Interpretation: SUDEP in epilepsy monitoring units primarily follows an early postictal, centrally mediated, severe alteration of respiratory and cardiac function induced by generalised tonic-clonic seizure, leading to immediate death or a short period of partly restored cardiorespiratory function followed by terminal apnoea then cardiac arrest. Improved supervision is warranted in epilepsy monitoring units, in particular during night time. Funding: Commission of European Affairs of the International League Against Epilepsy.

AB - Background: Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in people with chronic refractory epilepsy. Very rarely, SUDEP occurs in epilepsy monitoring units, providing highly informative data for its still elusive pathophysiology. The MORTEMUS study expanded these data through comprehensive evaluation of cardiorespiratory arrests encountered in epilepsy monitoring units worldwide. Methods: Between Jan 1, 2008, and Dec 29, 2009, we did a systematic retrospective survey of epilepsy monitoring units located in Europe, Israel, Australia, and New Zealand, to retrieve data for all cardiorespiratory arrests recorded in these units and estimate their incidence. Epilepsy monitoring units from other regions were invited to report similar cases to further explore the mechanisms. An expert panel reviewed data, including video electroencephalogram (VEEG) and electrocardiogram material at the time of cardiorespiratory arrests whenever available. Findings: 147 (92%) of 160 units responded to the survey. 29 cardiorespiratory arrests, including 16 SUDEP (14 at night), nine near SUDEP, and four deaths from other causes, were reported. Cardiorespiratory data, available for ten cases of SUDEP, showed a consistent and previously unrecognised pattern whereby rapid breathing (18-50 breaths per min) developed after secondary generalised tonic-clonic seizure, followed within 3 min by transient or terminal cardiorespiratory dysfunction. Where transient, this dysfunction later recurred with terminal apnoea occurring within 11 min of the end of the seizure, followed by cardiac arrest. SUDEP incidence in adult epilepsy monitoring units was 5·1 (95% CI 2·6-9·2) per 1000 patient-years, with a risk of 1·2 (0·6-2·1) per 10000 VEEG monitorings, probably aggravated by suboptimum supervision and possibly by antiepileptic drug withdrawal. Interpretation: SUDEP in epilepsy monitoring units primarily follows an early postictal, centrally mediated, severe alteration of respiratory and cardiac function induced by generalised tonic-clonic seizure, leading to immediate death or a short period of partly restored cardiorespiratory function followed by terminal apnoea then cardiac arrest. Improved supervision is warranted in epilepsy monitoring units, in particular during night time. Funding: Commission of European Affairs of the International League Against Epilepsy.

UR - http://www.scopus.com/inward/record.url?scp=84884155544&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84884155544&partnerID=8YFLogxK

U2 - 10.1016/S1474-4422(13)70214-X

DO - 10.1016/S1474-4422(13)70214-X

M3 - Article

C2 - 24012372

AN - SCOPUS:84884155544

VL - 12

SP - 966

EP - 977

JO - The Lancet Neurology

JF - The Lancet Neurology

SN - 1474-4422

IS - 10

ER -