Sudden unexpected death in epilepsy: from mechanisms to prevention
Sudden unexpected death in epilepsy: from mechanisms to prevention
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DOI：
10.1097/01.wco.0000218238.90711.f4
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发表时间：
2006-04-01
影响因子：
4.8
通讯作者：
Kahane, P
中科院分区：
文献类型：
--
作者：
Ryvlin, P;Montavont, A;Kahane, P
综述目的探讨癫痫猝死的病理生理及预防措施。几个月的长期心电图监测在20例难治性癫痫患者中检测到3例（15%）的骤停，这表明难治性癫痫患者发生高危骤停的比例比以前认为的要大。在病例对照研究中，发现癫痫患者的突然意外死亡与频繁的全身性强直-阵挛性发作和更大的最大心率有关，特别是在夜间发作时。相反，夜间监督与较低的发生风险相关。癫痫手术对癫痫患者死亡和意外猝死风险的影响尚不清楚，与未接受手术的难治性癫痫患者的匹配人群相比，癫痫手术队列的长期生存率相当。术前心率变异性降低与术后不良癫痫发作结果之间的关联可能在一定程度上混淆了先前的结果。突发性心律失常可能是癫痫患者猝死的一个比以前认为的更为普遍的原因。除了对难治性癫痫患者进行夜间监护外，文献中还没有关于预防该事件的最适当治疗策略的明确建议。
Purpose of review To discuss the pathophysiology and potential prevention of sudden unexpected death in epilepsy.Recent findings Long-term electrocardiogram monitoring over several months has detected ictal asystole in three out of 20 (15%) patients with refractory epilepsy, suggesting that high-risk ictal arrhythmias occur in a greater proportion of patients with refractory epilepsy than previously thought. In case-control studies, sudden unexpected death in epilepsy was found to be associated with frequent generalized tonic-clonic seizures and greater ictal maximal heart rate, especially during nocturnal attacks. Conversely, supervision at night was associated with a lower risk of occurrence. The impact of epilepsy surgery on the risk of death and sudden unexpected death in epilepsy remains unclear, with comparable long-term survival in an epilepsy surgery cohort compared with a matched population of patients with refractory epilepsy who did not undergo surgery. Previous results may have been partly confounded by the association observed between preoperative decreased heart rate variability and poor postoperative seizure outcome.Summary Ictal arrhythmias may represent a more prevalent cause of sudden unexpected death in epilepsy than previously thought. No clear recommendations have emerged from the literature regarding the most appropriate therapeutic strategies to prevent the event, apart from the supervision at night of patients with refractory epilepsy.