Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS): a retrospective study
Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS): a retrospective study
复制标题
DOI：
10.1016/s1474-4422(13)70214-x
复制
发表时间：
2013-10-01
期刊：
影响因子：
48
通讯作者：
Tomson, Torbjorn
中科院分区：
文献类型：
--
作者：
Ryvlin, Philippe;Nashef, Lina;Tomson, Torbjorn
背景 癫痫猝死（SUDEP）是慢性难治性癫痫患者死亡的主要原因。 SUDEP 很少发生在癫痫监测单位，为其仍然难以捉摸的病理生理学提供了信息丰富的数据。 MORTEMUS研究通过对全世界癫痫监测单位发生的心肺骤停的综合评估扩大了这些数据。方法在2008年1月1日至2009年12月29日期间，我们对位于欧洲、以色列、澳大利亚和新西兰的癫痫监测单位进行了系统的回顾性调查，以检索这些单位记录的所有心肺骤停的数据并估计其发生率。邀请其他地区癫痫监测单位报告类似病例，进一步探讨其机制。专家小组审查了数据，包括视频脑电图 (VEEG) 和心肺骤停时的心电图材料（只要有）。调查结果显示，160 个单位中有 147 个单位（92%）对调查做出了回应。据报道，共有 29 例心肺骤停，其中 16 例 SUDEP（夜间 14 例）、9 例接近 SUDEP，以及 4 例因其他原因死亡。十个 SUDEP 病例的心肺数据显示出一致且以前未被识别的模式，即继发性全身强直阵挛发作后出现快速呼吸（每分钟 18-50 次呼吸），随后在 3 分钟内出现短暂或终末心肺功能障碍。如果是短暂的，这种功能障碍随后会复发，并在癫痫发作结束后 11 分钟内出现终末呼吸暂停，随后出现心脏骤停。成人癫痫监测单位中的 SUDEP 发生率为每 1000 名患者年 5.1 (95% CI 2.6-9.2)，每 10 000 次 VEEG 监测的风险为 1.2 (0.6-2.1)，可能因监管欠佳和抗癫痫药物停药而加剧。 解释 癫痫监测单位中的 SUDEP 主要遵循早期发作后集中监测全身强直阵挛发作引起的呼吸和心脏功能的严重改变，导致立即死亡或心肺功能短期部分恢复，随后出现终末呼吸暂停，然后心脏骤停。癫痫监测单位需要加强监督，特别是在夜间。
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 10 000 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.