title: From unwitnessed fatality to witnessed rescue: Nonpharmacologic interventions in sudden unexpected death in epilepsy.
abstract: Sudden unexpected death in epilepsy (SUDEP) risk reduction remains a critical aim in epilepsy care. To date, only aggressive medical and surgical efforts to control seizures have been demonstrated to be of benefit. Incomplete understanding of SUDEP mechanisms limits the development of more specific interventions. Periictal cardiorespiratory dysfunction is implicated in SUDEP; postictal electroencephalography (EEG) suppression, coma, and immobility may also play a role. Nocturnal supervision is protective against SUDEP, presumably by permitting intervention in the case of a life-threatening event. Resuscitative efforts were implemented promptly in near-SUDEP cases but delayed in SUDEP deaths in the Mortality in Epilepsy Monitoring Unit Study (MORTEMUS) study. Nursing interventions--including repositioning, oral suctioning, and oxygen administration--reduce seizure duration, respiratory dysfunction, and EEG suppression in the epilepsy monitoring unit (EMU), but have not been studied in outpatients. Cardiac pacemakers or cardioverter-defibrillator devices may be of benefit in a few select individuals. A role for implantable neurostimulators has not yet been established. Seizure detection devices, including those that monitor generalized tonic-clonic seizure-associated movements or cardiorespiratory parameters, may provide a means to permit timely periictal intervention. However, these and other devices, such as antisuffocation pillows, have not been adequately investigated with respect to SUDEP prevention.
authors.affiliation: Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom.|Chalfont Centre for Epilepsy, Chalfont St. Peter, United Kingdom.
authors.forename: Fergus
authors.initials: F
authors.lastname: Rugg-Gunn
authors.affiliation: Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Duncan
authors.affiliation: Danish Epilepsy Center, Filadelfia, Dianalund, Denmark.
authors.forename: Helle
authors.initials: H
authors.lastname: Hjalgrim
authors.affiliation: Department of Neurology, University of California Davis, Sacramento, California, U.S.A.
authors.forename: Masud
authors.initials: M
authors.lastname: Seyal
authors.affiliation: Department of Neurology, Columbia University, New York, New York, U.S.A.
authors.forename: Lisa
authors.initials: L
authors.lastname: Bateman
mesh_terms: D001237:Asphyxia / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial; D016887:Cardiopulmonary Resuscitation; D003645:Death, Sudden / Q000517:prevention & control*; D046690:Deep Brain Stimulation; D017147:Defibrillators, Implantable; D004569:Electroencephalography; D004827:Epilepsy / Q000628:therapy*; D006801:Humans; D058542:Implantable Neurostimulators; D008991:Monitoring, Physiologic; D010102:Oxygen Inhalation Therapy; D010138:Pacemaker, Artificial; D056888:Patient Positioning; D012151:Resuscitation; D013396:Suction
keywords: Periictal cardiorespiratory dysfunction; Prevention; Recovery position; SUDEP; Stimulation; Supervision