title: Left-insular damage, autonomic instability, and sudden unexpected death in epilepsy.
abstract: We analyzed the only two sudden unexpected death in epilepsy (SUDEP) cases from 320 prospectively recruited patients in the three-year Prevention and Risk Identification of SUDEP Mortality (PRISM) project. Both patients had surgically refractory epilepsy, evidence of left insular damage following previous temporal/temporo-insular resections, and progressive changes in heart rate variability (HRV) in monitored evaluations prior to death. Insular damage is known to cause autonomic dysfunction and increased mortality in acute stroke. This report suggests a possible role for the insula in the pathogenesis of SUDEP. The presence of intrinsic insular lesions or acquired insular damage in patients with refractory epilepsy may be an additional risk factor for SUDEP.
authors.affiliation: Epilepsy Center, UH Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA; Department of Neurology, Vall d'Hebron University Hospital, Passeig Vall d'Hebron, 119-129, 08035 Barcelona, Spain; Department of Medicine, Universitat Autonoma of Barcelona, Passeig Vall d'Hebron, 119-129, 08035 Barcelona, Spain. Electronic address: nuria.lacuey@uhhospitals.org.
authors.forename: Nuria
authors.initials: N
authors.lastname: Lacuey
authors.affiliation: Epilepsy Center, UH Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
authors.forename: Bilal
authors.initials: B
authors.lastname: Zonjy
authors.affiliation: Department of Electrical Engineering and Computer Sciences, Case Western Reserve University, Cleveland, OH 44106, USA.
authors.forename: Wanchat
authors.initials: W
authors.lastname: Theerannaew
authors.affiliation: Department of Electrical Engineering and Computer Sciences, Case Western Reserve University, Cleveland, OH 44106, USA.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Loparo
authors.affiliation: Department of Electrical Engineering and Computer Sciences, Case Western Reserve University, Cleveland, OH 44106, USA.
authors.forename: Curtis
authors.initials: C
authors.lastname: Tatsuoka
authors.affiliation: Department of Cardiology, UH Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
authors.forename: Jayakumar
authors.initials: J
authors.lastname: Sahadevan
authors.affiliation: Epilepsy Center, UH Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA; NINDS Center for SUDEP Research (CSR), USA.
authors.forename: Samden D
authors.initials: SD
authors.lastname: Lhatoo
mesh_terms: D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D002540:Cerebral Cortex / Q000473:pathology* / Q000503:physiopathology; D003645:Death, Sudden / Q000209:etiology* / Q000473:pathology; D004827:Epilepsy / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D012307:Risk Factors
keywords: Autonomic; Heart rate variability; Insula; Parasympathetic; Postictal bradycardia; SUDEP