Medicolegal Approach to Sudden Unexpected Death in Epileptic Patients
DOI:
https://doi.org/10.17986/blm.200493557Keywords:
epilepsy, sudden unexpected death, forensic medicineAbstract
Sudden unexpected death in epilepsy (SUDEP) is defined as sudden, unexpected, witnessed or unwitnessed, non-traumatic and non-drowning death in patients with epilepsy, with or without evidence for a seizure and excluding documented status epilepticus, in which post-mortem examination does not reveal a toxicological or anatomical cause for death. SUDEP has long been recognised although excess mortality in epilepsy has not always been accepted. In the 1960’s it was suggested that there is no reason why an epileptic should not live as long as one who did not have epilepsy. SUDEP’s occurrence is still not widely recognised and epidemiological studies to evaluate risk factors are fraught with problems. It has been estimated that the risk of sudden death for someone with epilepsy is almost 24 times higher than for someone without epilepsy. Although SUDEP has been reported since the turn of the century, the incidence and pathophysiology of this phenomenon are not well understood. The incidence of SUDEP, possible mechanisms involved, potential risk factors and current research strategies are reviewed and examined with a perspective of forensic science practice in our country.
Key Words: Epilepsy, sudden unexpected death, forensic medicine.
Downloads
References
Spratling WP. Prognosis. In: Epilepsy and its treatment. Philadelphia: WB Saunders, 1994:304.
Hauser WA, Hesdorfer DC. Mortality. In: Epilepsy: frequency, causes and consequences .MD Epilepsy Foundation of USA, 1990:269-326.
Appleton RE. Sudden, unexpected death in epilepsy in children. Seizure 1997; 6:175-177.
Wannamaker BB. A perspective on death of persons with epilepsy. In: Lathers CM, Schaeder PL, eds. Epilepsy and sudden death. New York: Marcel Dekker, 1990:27-37.
Leestma JE, Annegers JF, Brodie MJ, Brown S, Schraedser, Siscovick D, Wannamaker BB, Tennis PS, Cierpial MA and Earl NL. Sudden unexplained death in epilepsy: Observations from a large clinical development program. Epilepsia 1997; 38:47-55. DOI: https://doi.org/10.1111/j.1528-1157.1997.tb01076.x
http://www.itfnoroloji.org/epilepsi/Epilep- si.html.Erişim:21.06.2005
Hauser WA, Hesdorfer DC. Mortality. In: Epilepsy: frequency, causes and consequences. MD Epilepsy Foundation of USA, 1990:269-326.
http://www.emedicine.com. Erişim: 2005-06-28
Appleton RE. Sudden, unexpected death in epilepsy in children. Seizure 1997; 6:175-177. DOI: https://doi.org/10.1016/S1059-1311(97)80002-7
1. Basamak için Adli Tıp El Kitabı. Hekimin Yasal Sorumlulukları. TTB ve ATUD. Ankara, 1999, S. 11-23.
Di Maio JMV, Di Maio JD. Forensic Pathology. CRC Press, Florida. 1993:43-83. DOI: https://doi.org/10.1007/BF02844819
Knight B.Forensic Pathology Second Edition. New York: Oxford University Press Inc. 1997: 508.
Ficker DM, So EL, Shen WK et al. Population-based study of the incidence of sudden unexplained death in epilepsy. Neurology 1998; 51(5):1270- 1274. DOI: https://doi.org/10.1212/WNL.51.5.1270
Nashef L and Brown S. Epilepsy and sudden death. Lancet 1996; 348:1324-1325. DOI: https://doi.org/10.1016/S0140-6736(05)65402-5
Terrence CF Jr, Wisotzkey HM, Perper JA. Unexpected, unexplained death in epileptic patients. Neurology 1975; 25(6):594-598. DOI: https://doi.org/10.1212/WNL.25.6.594
Nashef L. Sudden Unexpected Death in Epilepsy: Terminology and Definitions. Epilepsia 1997; 38(Suppl 11):S6-S8. DOI: https://doi.org/10.1111/j.1528-1157.1997.tb06130.x
Wannamaker BB. A perspective on death of persons with epilepsy. In: Lathers CM, Schaeder PL, eds. Epilepsy and sudden death. New York: Marcel Dekker, 1990:27-37.
Dasheiff RM. Sudden unexpected death in epilepsy: a series from an epilepsy surgery program and speculation on the relationship to sudden cardiac death. Journal of Clinical Neurophysiology 1991; 8: 216-222. DOI: https://doi.org/10.1097/00004691-199104000-00010
Cockerell OC, Johnson AL, Sander JWAS, Hart YM, Goodridge DMG, Shorvon SD. Mortality from epilepsy: results from a prospective population-based study. Lancet 1994; 344:918-921. DOI: https://doi.org/10.1016/S0140-6736(94)92270-5
Medical Research Council antiepileptic drug withdrawal study group: prognostic index for recurrence of seizures after remission of epilepsy. British Medical Journal 1993; 306:1374-1378. DOI: https://doi.org/10.1136/bmj.306.6889.1374
Hauser WA, Annegers JF, Elveback LR. Mortality in patients with epilepsy. Epilepsia 1980; 21(4):399-412. DOI: https://doi.org/10.1111/j.1528-1157.1980.tb04088.x
Harvey AS, Nolan T, Carim JB. Community-based study of mortality in children with epilepsy. Epilepsia 1993; 34(4):597-603. DOI: https://doi.org/10.1111/j.1528-1157.1993.tb00434.x
Sperling MR, Feldman H, Kinman J et al. Seizure control and mortality in epilepsy. Ann Neurol 1999; 46(l):45-50. DOI: https://doi.org/10.1002/1531-8249(199907)46:1<45::AID-ANA8>3.0.CO;2-I
Nashef L, Fish DR, Sander JW, Shorvon SD. Incidence of sudden unexpected death in an adult outpatient cohort with epilepsy at a tertiary referral centre. J Neurol Neurosurg Psychiatry 1995; 58(4):462-464. DOI: https://doi.org/10.1136/jnnp.58.4.462
Racoosin JA, Feeney J, Burkhart G, Boehm G. Mortality in antiepileptic drug development programs. Neurology 2001; 56(4):514-519. DOI: https://doi.org/10.1212/WNL.56.4.514
Nashef L, Fish DR, Garner S et al. Sudden death in epilepsy: a study of incidence in a young cohort with epilepsy and learning difficulty. Epilepsia 1995; 36(12): 1187-1194 DOI: https://doi.org/10.1111/j.1528-1157.1995.tb01061.x
Klenerman P, Sander JW, Shorvon SD. Mortality in patients with epilepsy: a study of patients in long term residential care. J Neurol Neurosurg Psychiatry 1993; 56(2): 149-152. DOI: https://doi.org/10.1136/jnnp.56.2.149
Timmings PL. Sudden unexpected death in epilepsy: a local audit. Seizure 1993; 2(4):287-290. DOI: https://doi.org/10.1016/S1059-1311(05)80142-6
Derby LE, Tennis P, Jick H. Sudden unexplained death among subjects with refractory epilepsy. Epilepsia 1996; 37(10):931-935. DOI: https://doi.org/10.1111/j.1528-1157.1996.tb00529.x
Langan Y, NolanN, HutchinsonM. The incidence of sudden unexpected death in epilepsy (SUDEP) in South Dublin and Wicklow. Seizure 1998; 7(5):355-358. DOI: https://doi.org/10.1016/S1059-1311(05)80002-0
Waljzak TS, Leppik IE, D'amelio M et al. Incidence and risk factors in sudden unexpected death in epilepsy: a prospective cohort study. Neurology 2001; 56(4):519-525. DOI: https://doi.org/10.1212/WNL.56.4.519
Antoniouk SA, Oliva LV, Bruck I et al. Sudden unexpected, unexplained death in epilepsy autopsi- ed patients. Arq Neuropsiquiatr 2001; 59(l):40-45. DOI: https://doi.org/10.1590/S0004-282X2001000100009
Nashef L and Sander JWAS. Sudden unexpected deaths in epilepsy - where are we now? Seizure 1996; 5:235-238. DOI: https://doi.org/10.1016/S1059-1311(96)80042-2
Nashef L, Walker F, Allen P, Sander JWAS, Shorvon SD, Fish DR. Apnoea and bradycardia during epileptic seizures: relation to sudden death in epilepsy. Journal of Neurology, Neurosurgery and Psychiatry 1996; 60: 297-300. DOI: https://doi.org/10.1136/jnnp.60.3.297
Blumhardt LD, Smith PEM and Owen L. Electrocardiographic accompaniments of temporal lobe epileptic seizures. Lancet 1986; 1:1051-1056.
Wieling W. Non-invasive continuous recording of heart rate and blood pressure in the evaluation of neurovascular control. In: Bannister R, Mathias CJ, eds. Autonomic failure. 3rd ed. 1992:291-311.
Leestma JE et al. Sudden and unexpected deaths associated with seizures : analysis of 66 cases. Epilepsia 1984 ; 25 : 84-88.
Nei M et al. EKG abnormalities during partial seizures in refractory epilepsy. Epilepsia 2000;41 : 542-548. DOI: https://doi.org/10.1111/j.1528-1157.2000.tb00207.x
Opeskin K et al Sudden and unexpected death in epilepsy in Victoria. J Clin Neurosci 2000;7(l):34-7. DOI: https://doi.org/10.1054/jocn.1999.0137
Leestma JE et al. Sudden and unexpected deaths associated with seizures : analysis of 66 cases. Epilepsia 1984; 25 : 84-88. DOI: https://doi.org/10.1111/j.1528-1157.1984.tb04159.x
Earnest MP et al. The sudden and unexplained death syndrome in epilepsy: Demographic, clinical and post mortem features. Epilepsia 1992;33:310- 316. DOI: https://doi.org/10.1111/j.1528-1157.1992.tb02321.x
Thom M. Pathological findings in SUDEP. CEPR 2001;408-414. DOI: https://doi.org/10.1023/A:1013258200829
Ficker DM. Sudden unexplained death and injury in epilepsy. Epilepsia 2000; 41 Suppl 2:S7- 12:S7/S12. DOI: https://doi.org/10.1111/j.1528-1157.2000.tb01519.x
Thom M. Neuropathologie findings in postmortem studies of sudden death in epilepsy. Epilepsia 1997; 38 (Suppl 11):S32-S34. DOI: https://doi.org/10.1111/j.1528-1157.1997.tb06123.x
Leestma JE et al. A prospective study on sudden and unexpected death in epilepsy. Ann Neurol 1989;26:195-203. DOI: https://doi.org/10.1002/ana.410260203
Dashieff RM et al. Sudden unexpected death of epileptic patients due to cardiac arythmia after seizure. Arch Neurol 1986;43:194-196. DOI: https://doi.org/10.1001/archneur.1986.00520020080028
George JR et al. Comparison of anti-epileptic drug levels in different cases of sudden death. J Forensic Sei 1998;43:598-603. DOI: https://doi.org/10.1520/JFS16186J
Opeskin K et al. Comparison of anti-epileptic drug levels in sudden unexpected deaths in epilepsy with deaths from other causes. Epilepsia 1999;40:1795-1798. DOI: https://doi.org/10.1111/j.1528-1157.1999.tb01600.x
Wilhams J et al. Hair analysis as a potential index of therapeutic compliance in the treatment of epilepsy. Forensic Sei Int 1997;84:113-122 DOI: https://doi.org/10.1016/S0379-0738(96)02053-1
Koç S, Kolusayın Ö. Ölüm. Soysal 2, Çakalır C. Adli Tıp. Cilt 1. Cerrahpaşa Tıp Fakültesi Yayınları, İstanbul. 1999: 103-106.
Downloads
Published
Issue
Section
License
The Journal and content of this website is licensed under the terms of the Creative Commons Attribution (CC BY) License. The Creative Commons Attribution License (CC BY) allows users to copy, distribute and transmit an article, adapt the article and make commercial use of the article. The CC BY license permits commercial and non-commercial re-use of an open access article, as long as the author is properly attributed.
