Neuroimaging Could Prevent Sudden Unexpected Death in Epilepsy

Generalized tonic-clonic seizure appears to be the main risk factor for sudden unexpected death in epilepsy (SUDEP), according to a new review. In turn, neuroimaging and molecular genetic studies can be an important step in identifying individuals who are at-risk for SUDEP and preventing their premature death.

Because the etiology of SUDEP—the leading cause of premature death among patients with epilepsy, especially among younger individuals—is unclear, a team of researchers analyzed past studies to determine risk factors for SUDEP.

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While some cases of SUDEP can be attributed to cardiac causes, the researchers found that most are linked to epilepsy-related disruption of the functional connectivity of certain brain structures. Those structures are associated with the central autonomic control of cardio-respiratory function. And so, there is a neuro-cardio-respiratory connection in SUDEP.

Individuals who are at-risk for SUDEP have been found to have altered brain structure, function, and connectivity; this disruption of the central autonomic control could have an impact in SUDEP.

Analyzing the pathophysiologic mechanisms behind this disruption is crucial, the researchers say. Past studies that have done so suggest that the neuronal networks that produce the generalized tonic-clonic seizures suppress brainstem respiratory or autonomic control centers, which can lead to hypoventilation, apnea, and cardiovascular collapse.

“Advancing our knowledge on the pathophysiologic mechanisms of SUDEP is a most important first step towards preventing and reducing its incidence,” the researchers concluded. “Neuroimaging and molecular genetic studies may provide insights into the causes of SUDEP and identify potential biomarkers for risk stratification of patients susceptible to SUDEP that may help reduce the individual patient’s risk of SUDEP.”

For now, seizure control is the most effective preventative for SUDEP, the researchers say.

—Colleen Murphy

Reference:

Manolis TA, Manolis AA, Melita H, Manolis AS. Sudden unexpected death in epilepsy: the neuro-cardio-respiratory connection [published online December 13, 2018]. Seizure. https://doi.org/10.1016/j.seizure.2018.12.007.