Sudden unexpected death in epilepsy: is carbamazepine implicated?

摘要: Sudden unexpected death in epilepsy (SUDEP) has been recognised for centuries. The precise frequency of occurrence is not well defined. Education medical professionals needed, so that certificates and coronial inquests may appropriately, correctly consistently record SUDEP as the case death. Correct identification will then allow further investigation this misunderstood, often ignored, complication. incidence be increasing, either a result increased recognition, or possibly due to real increase incidence. All currently available antiepileptic drugs (AEDs) have associated with SUDEP, current opinion assumes relative proportion patients suffering representative average AED usage type particular time locality, however, recently analysed data suggest strong bias towards carbamazepine. A review Cardiff Epilepsy Unit shows carbamazepine was disproportionately represented SUDEP. In series, 11 14 were taking at This calculated 79% all patients, compared by other 38%. also indicate one patient any drug therapy, died during his first seizure, reducing number evaluable 'drug usage' 13, increasing 85%, (P < 0.01). Possible mechanisms include induced lengthening ECG Q-T interval combined mild pro-arrhythmic effect epileptic seizure discharges, consequent transient cardiac instability leading arrhythmic Or alternatively, excessive post-seizure brainstem inhibition might blunting abolition central hypoxic hypercarbic respiratory drive, post-ictal arrest, subsequent exacerbation hypoxia, destabilisation hypoxia/failed re-establishment respiration terminal arrhythmia. Current knowledge about remains poor. needed ascertainment can documented. Delineation involved should lead definitive prevention strategies. Evaluation significant causative factor needed.