Pulmonary and cardiac pathology in sudden unexpected death in epilepsy (SUDEP).

Details

Serval ID
serval:BIB_98BA342D0937
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Pulmonary and cardiac pathology in sudden unexpected death in epilepsy (SUDEP).
Journal
Epilepsy & behavior
Author(s)
Nascimento F.A., Tseng Z.H., Palmiere C., Maleszewski J.J., Shiomi T., McCrillis A., Devinsky O.
ISSN
1525-5069 (Electronic)
ISSN-L
1525-5050
Publication state
Published
Issued date
08/2017
Peer-reviewed
Oui
Volume
73
Pages
119-125
Language
english
Notes
Publication types: Journal Article ; Review
Publication Status: ppublish
Abstract
To review studies on structural pulmonary and cardiac changes in SUDEP cases as well as studies showing pulmonary or cardiac structural changes in living epilepsy patients.
We conducted electronic literature searches using the PubMed database for articles published in English, regardless of publication year, that included data on cardiac and/or pulmonary structural abnormalities in SUDEP cases or in living epilepsy patients during the postictal period.
Fourteen postmortem studies reported pulmonary findings in SUDEP cases. Two focused mainly on assessing lung weights in SUDEP cases versus controls; no group difference was found. The other 12 reported descriptive autopsy findings. Among all SUDEP cases with available descriptive postmortem pulmonary examination, 72% had pulmonary changes, most often pulmonary edema/congestion, and, less frequently, intraalveolar hemorrhage. Eleven studies reported on cardiac pathology in SUDEP. Cardiac abnormalities were found in approximately one-fourth of cases. The most common findings were myocyte hypertrophy and myocardial fibrosis of various degrees. Among living epilepsy patients, postictal pulmonary pathology was the most commonly reported pulmonary abnormality and the most common postictal cardiac abnormality was transient left ventricular dysfunction - Takotsubo or neurogenic stunned myocardium.
Cardiac and pulmonary pathological abnormalities are frequent among SUDEP cases, most commonly pulmonary edema/congestion and focal interstitial myocardial fibrosis. Most findings are not quantified, with subjective elements and undefined interobserver reliability, and lack of controls such as matched epilepsy patients who died from other causes. Further, studies have not systematically evaluated potential confounding factors, including postmortem interval to autopsy, paramedic resuscitation and IV fluids administration, underlying heart/lung disease, and risk factors for cardiac or pulmonary disease. Prospective studies with controls are needed to define the heart and lung changes in SUDEP and understand their potential relationship to mechanisms of death in SUDEP.

Keywords
Death, Sudden/epidemiology, Death, Sudden/pathology, Epilepsy/diagnosis, Epilepsy/mortality, Female, Heart Diseases/diagnosis, Heart Diseases/mortality, Humans, Male, Prospective Studies, Reproducibility of Results, Risk Factors, Autopsy, Epilepsy, Forensic pathology, SUDEP
Pubmed
Web of science
Create date
18/09/2017 15:08
Last modification date
20/08/2019 15:00
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