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


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Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS): a retrospective study
Lancet Neurol
Ryvlin P., Nashef L., Lhatoo S. D., Bateman L. M., Bird J., Bleasel A., Boon P., Crespel A., Dworetzky B. A., Hogenhaven H., Lerche H., Maillard L., Malter M. P., Marchal C., Murthy J. M., Nitsche M., Pataraia E., Rabben T., Rheims S., Sadzot B., Schulze-Bonhage A., Seyal M., So E. L., Spitz M., Szucs A., Tan M., Tao J. X., Tomson T.
1474-4465 (Electronic)
Statut éditorial
Date de publication
Ryvlin, Philippe
Nashef, Lina
Lhatoo, Samden D
Bateman, Lisa M
Bird, Jonathan
Bleasel, Andrew
Boon, Paul
Crespel, Arielle
Dworetzky, Barbara A
Hogenhaven, 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, Torbjorn
Multicenter Study
Research Support, Non-U.S. Gov't
Lancet Neurol. 2013 Oct;12(10):966-77. doi: 10.1016/S1474-4422(13)70214-X. Epub 2013 Sep 4.
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. FUNDING: Commission of European Affairs of the International League Against Epilepsy.
Adult, Australia/epidemiology, Child, Death, Sudden, Cardiac/epidemiology/*etiology, Epilepsy/*complications/epidemiology/physiopathology, Europe/epidemiology, Female, Heart Arrest/epidemiology/*physiopathology, *Hospital Units/statistics & numerical data, Humans, Incidence, Israel/epidemiology, Male, Middle Aged, New Zealand/epidemiology, Retrospective Studies, Seizures/epidemiology/physiopathology, Young Adult
Création de la notice
29/11/2018 13:37
Dernière modification de la notice
20/08/2019 16:18
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