Terminal seizure frequency and its relation to SUDEP
Terminal seizure frequency and its relation to SUDEP
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DOI：
10.1016/j.yebeh.2017.02.002
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发表时间：
2017-05-01
影响因子：
2.6
通讯作者：
Zhou, Dong
中科院分区：
文献类型：
--
作者：
Chen, Deng;Si, Yang;Zhou, Dong
背景：癫痫猝死（SUDEP）是癫痫患者死亡的主要原因。涉及几个风险因素，包括发病年龄较早、强直阵挛性癫痫发作和抗癫痫药物。然而，死于SUDEP的患者在死亡前几个月内癫痫发作的频率是否更高尚不清楚。我们调查了终末发作频率及其与SUDEP的关系，在一个大的强直-阵挛性发作的患者在中国西部农村。方法：我们使用的数据库，从中国西部，常规提供苯巴比妥（PB）作为治疗惊厥性癫痫的惊厥性癫痫控制和管理计划。根据预先设定的标准，纳入可能发生SUDEP的患者。对每个案件进行了口头尸检。通过匹配每个患者的年龄，性别，加入计划的日期，随访时间和基线癫痫发作频率，我们建立了1：5的比例对照组。应用SPSS21.0统计软件比较疑似SUDEP患者与对照组在SUDEP发生前3个月癫痫发作频率的差异。结果：7844例SUDEP患者中，有41例在10年的随访中死于疑似SUDEP。SUDEP组在死亡前3个月的强直阵挛发作频率显著高于对照组（p = 0.023）。同时，其无瘤率低于对照组（p = 0.025）。随访超过12个月的可能SUDEP患者作为一个亚组进行进一步研究。与对照组相比，他们在死亡前3个月有更多的强直-阵挛性癫痫发作（p = 0.010）。与早期阶段（3-6个月前）相比，他们在终末期（3个月前）的癫痫发作频率也有所增加（p = 0.029）。此外，在SUDEP组的PB终末剂量高于对照组（p = 0.002）。结论：死于SUDEP的患者在死亡前3个月更频繁地出现强直-阵挛性发作。较高的癫痫发作频率增加了发作期病理生理事件的暴露，这可能与SUDEP有关。这种现象可能是由于这些患者的耐药潜力或高剂量的PB。需要进一步的研究来确定SUDEP的潜在机制。(C)2017爱思唯尔公司All rights reserved.
Background: Sudden unexpected death in epilepsy (SUDEP) is a major cause of death in patients with epilepsy. Several risk factors have been implicated, including early age of onset, tonic-clonic seizures and antiepileptic drugs. However, whether patients who die from SUDEP have a greater frequency of seizures in the few months before death is unclear. We investigated the terminal seizure frequency and its relation to SUDEP among a large group of patients with tonic-clonic seizures in rural West China.Methods: We used the database from the Convulsive Epilepsy Control and Management Program in West China, which routinely provides phenobarbital (PB) as a treatment for convulsive epilepsy. Patients with probable SUDEP were included according to pre-set criteria. A verbal autopsy was undertaken for each case. By matching each patient's age, sex, date of joining the program, time in follow-up, and baseline seizure frequency, we set up a 1:5 ratio control group. SPSS 21.0 statistics were applied to compare the differences in seizure frequency 3 months prior to SUDEP between patients with probable SUDEP and controls. Furthermore, the dynamic changes of terminal seizure frequency 6-9 months, 3-6 months, and 3 months prior to SUDEP was also analyzed.Results: A total of 41 patients who died from probable SUDEP were identified out of 7844 patients during 10 years of follow-up. The SUDEP group had a significantly higher tonic-clonic seizure frequency 3 months before their deaths than the control group (p = 0.023). At the same time, their seizure-free rate was lower than the control group (p = 0.025). Patients with probable SUDEP who were followed up over 12 months were further studied as a subgroup. They had more tonic-clonic seizures 3 months prior to death compared to the control group (p = 0.010). They also had an increase in seizure frequency in their terminal phase (3 months prior) compared to an earlier stage (3-6 months prior) (p = 0.029). Furthermore, the terminal PB dose in the SUDEP group was higher than the control group (p = 0.002).Conclusion: Patients who died from SUDEP had more frequent tonic-clonic seizures 3 months before their deaths. Higher seizure frequency increases the exposure to peri-ictal pathophysiological events, which possibly relate to SUDEP. This phenomenon may be due to the drug resistance potential of these patients or the high dose of PB. Further research is required to ascertain the underlying mechanisms of SUDEP. (C) 2017 Elsevier Inc. All rights reserved.