Cardiovascular protective effect of melatonin in sudden unexpected death in epilepsy: A hypothesis

Primary sleep disorders in people with epilepsy: clinical questions and answers

The questions facing clinicians with patients with sleep disorder and epilepsy are addressed in this article. Both adult and child epilepsy are discussed in the context of the most typical questions a clinician would have, such as "Are parasomnias more common in people with epilepsy?", "Is sleep architecture abnormal in children with epilepsy", along with outcomes of numerous questionnaire-based, case-based, and double-blind placebo studies on such aspects as sleep duration, daytime sleepiness, anxiety and fears, limb movement, nocturnal seizures, agitation, behavioral disorders, and learning disorders.

Does the lunar phase have an effect on sudden unexpected death in epilepsy?

The incidence of sudden unexpected death in epilepsy (SUDEP) in our epilepsy unit over an 8-year period was analyzed to determine a possible association between phase of the moon and SUDEP. Analysis revealed that the number of SUDEPs was highest in full moon (70%), followed by waxing moon (20%) and new moon (10%). No SUDEPs occurred during the waning cycle. These preliminary findings suggest that the full moon appears to correlate with SUDEP.

A review of sudden unexpected death in epilepsy: prediction of patients at risk

This review attempts to provide up-to-date quantitative data from published reports on sudden unexpected death in epilepsy (SUDEP) appearing on Medline and, especially, to provide a means to predict the probability of SUDEP in a given patient. The mean incidence of SUDEP was 1.8/1000, similar to the median of 1.5. The mean standardized mortality ratio was 6.8, and the mean percentage of SUDEP cases among deaths from epilepsy was 16.6. Seventeen risk factors were identified, each given a value according to the number of studies in the literature that specified that condition as a significant risk. The addition of these 17 values then indicated the risk for a given patient. The author calculated these for a group of 91 patients who died of SUDEP and also for 91 live patients. Many of their values for the different risks were significantly different. The sensitivity of these SUDEP values was 71.3%, the specificity 81.8%, and the positive predictive value 84.6%. A discussion includes the question of whether the death in SUDEP is primarily cardiac or pulmonary and the suggestion that it may be either or both in a given patient. The most important risk factor in this study was noncompliance with antiepileptic medication, and the main message of this study to caregivers is that therapeutic drug levels are crucial to avoid SUDEP.