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Simeone KA, Martenz DM, Iyer SH, Booth CP, Herr SE, Matthews SA, Draves SB, Heinemann LL, Greenberg PL, Lhatoo SD, Donner E, Simeone TA. Personalization of SUDEP risk: A survey of transient subclinical comorbid changes. Epilepsy Res 2024; 199:107259. [PMID: 38086218 DOI: 10.1016/j.eplepsyres.2023.107259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 10/29/2023] [Accepted: 11/13/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE Preclinical data report within subject modifiable ailments emerge weeks prior to SUDEP, including sleep disorders and cardiorespiratory changes; findings which support anecdotal clinical data. Here, we bridge preclinical findings with future clinical/preclinical studies, and survey whether caretakers or family members of victims noticed transient changes prior to SUDEP. The aim of this pilot study is to identify potential modifiable changes that may synergistically increase SUDEP risk for future research. METHODS A mobile electronic survey was posted on SUDEP community websites. The survey queried whether changes in seizures, sleep, physical well-being, emotional well-being, cognition, breathing, or heart rate were noticed before SUDEP. RESULTS The most profound finding was that 85% of victims had multiple transient ailments prior to SUDEP. Changes in seizures (28/54), and sleep (30/58) occurred in more than 50% of the victims and represent the most influential changes identified. The second and third most influential changes were a reduction in physical well-being (25/57) and emotional well-being (26/56). Changes were observed within the last two months of life in approximately one third of the cases, and more than four months prior to SUDEP in approximately one third of cases, indicating a potential time frame for proactive preventative strategies. Respondents also noted changes in cognition (16/55), breathing (9/54) or heart rate (8/55). Data indicate these changes may be associated with increased SUDEP risk within subject. Study limitations include the responses were based on memory, there was a potential for data to be over reported, and caretakers were not prompted to observe changes a priori, thus some existing changes may have gone unnoticed. SIGNIFICANCE Data support the preclinical findings that transient, subclinical (i.e., not severe enough to require medical intervention), modifiable ailments may increase risk of SUDEP. This suggests that just as an epilepsy type can change over a lifetime and epilepsy type-specific treatments can reduce SUDEP risk, further personalization of SUDEP risk will improve our understanding as to whether variables contribute to risk differently across lifespan. Thus, with a dynamic capacity to change, differing factors may contribute to the distribution of risk probability within an individual at any given time. Understanding whether different combinations of transient changes are specific to epilepsy type, age, or sex needs to be determined to move the field forward in hopes of developing a personalized approach to preventative strategies.
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Affiliation(s)
- Kristina A Simeone
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, United States.
| | | | - Shruthi H Iyer
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, United States
| | - Cameron P Booth
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, United States
| | - Shelby E Herr
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, United States
| | - Stephanie A Matthews
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, United States
| | - Samantha B Draves
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, United States
| | - Laura L Heinemann
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, United States
| | - Pierce L Greenberg
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, United States
| | - Samden D Lhatoo
- Department of Neurology, University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, United States
| | - Elizabeth Donner
- Department of Paediatrics, Division of Neurology, Hospital for Sick Children, Canada
| | - Timothy A Simeone
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, United States
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Gu L, Yu Q, Shen Y, Wang Y, Xu Q, Zhang H. The role of monoaminergic neurons in modulating respiration during sleep and the connection with SUDEP. Biomed Pharmacother 2022; 150:112983. [PMID: 35453009 DOI: 10.1016/j.biopha.2022.112983] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/04/2022] [Accepted: 04/14/2022] [Indexed: 11/25/2022] Open
Abstract
Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death among epilepsy patients, occurring even more frequently in cases with anti-epileptic drug resistance. Despite some advancements in characterizing SUDEP, the underlying mechanism remains incompletely understood. This review summarizes the latest advances in our understanding of the pathogenic mechanisms of SUDEP, in order to identify possible targets for the development of new strategies to prevent SUDEP. Based on our previous research along with the current literature, we focus on the role of sleep-disordered breathing (SDB) and its related neural mechanisms to consider the possible roles of monoaminergic neurons in the modulation of respiration during sleep and the occurrence of SUDEP. Overall, this review suggests that targeting the monoaminergic neurons is a promising approach to preventing SUDEP. The proposed roles of SDB and related monoaminergic neural mechanisms in SUDEP provide new insights for explaining the pathogenesis of SUDEP.
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Affiliation(s)
- LeYuan Gu
- Department of Anesthesiology, The Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou 310006, China; Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Qian Yu
- Department of Anesthesiology, The Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou 310006, China; Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Yue Shen
- Department of Anesthesiology, The Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou 310006, China; Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - YuLing Wang
- Department of Anesthesiology, The Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou 310006, China; Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Qing Xu
- Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - HongHai Zhang
- Department of Anesthesiology, The Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou 310006, China; Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China; Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou 310006, China.
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Verducci C, Hussain F, Donner E, Moseley BD, Buchhalter J, Hesdorffer D, Friedman D, Devinsky O. SUDEP in the North American SUDEP Registry: The full spectrum of epilepsies. Neurology 2019; 93:e227-e236. [PMID: 31217259 PMCID: PMC6656646 DOI: 10.1212/wnl.0000000000007778] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 03/15/2019] [Indexed: 11/23/2022] Open
Abstract
Objective To obtain medical records, family interviews, and death-related reports of sudden unexpected death in epilepsy (SUDEP) cases to better understand SUDEP. Methods All cases referred to the North American SUDEP Registry (NASR) between October 2011 and June 2018 were reviewed; cause of death was determined by consensus review. Available medical records, death scene investigation reports, autopsy reports, and next-of-kin interviews were reviewed for all cases of SUDEP. Seizure type, EEG, MRI, and SUDEP classification were adjudicated by 2 epileptologists. Results There were 237 definite and probable cases of SUDEP among 530 NASR participants. SUDEP decedents had a median age of 26 (range 1–70) years at death, and 38% were female. In 143 with sufficient information, 40% had generalized and 60% had focal epilepsy. SUDEP affected the full spectrum of epilepsies, from benign epilepsy with centrotemporal spikes (n = 3, 1%) to intractable epileptic encephalopathies (n = 27, 11%). Most (93%) SUDEPs were unwitnessed; 70% occurred during apparent sleep; and 69% of patients were prone. Only 37% of cases of SUDEP took their last dose of antiseizure medications (ASMs). Reported lifetime generalized tonic-clonic seizures (GTCS) were <10 in 33% and 0 in 4%. Conclusions NASR participants commonly have clinical features that have been previously been associated with SUDEP risk such as young adult age, ASM nonadherence, and frequent GTCS. However, a sizeable minority of SUDEP occurred in patients thought to be treatment responsive or to have benign epilepsies. These results emphasize the importance of SUDEP education across the spectrum of epilepsy severities. We aim to make NASR data and biospecimens available for researchers to advance SUDEP understanding and prevention.
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Affiliation(s)
- Chloe Verducci
- From the Comprehensive Epilepsy Center (C.V., F.H., D.F., O.D.), New York University School of Medicine, NY; Division of Neurology (E.D.), The Hospital for Sick Children, Toronto, Ontario, Canada; Epilepsy Center (B.D.M.), Gardner Neuroscience Institute, University of Cincinnati Health, OH; Department of Pediatrics (J.B.), University of Calgary, Alberta, Canada; and Gertrude H. Sergievsky Center (D.H.), Division of Epidemiology, Columbia University Medical Center, New York, NY
| | - Fizza Hussain
- From the Comprehensive Epilepsy Center (C.V., F.H., D.F., O.D.), New York University School of Medicine, NY; Division of Neurology (E.D.), The Hospital for Sick Children, Toronto, Ontario, Canada; Epilepsy Center (B.D.M.), Gardner Neuroscience Institute, University of Cincinnati Health, OH; Department of Pediatrics (J.B.), University of Calgary, Alberta, Canada; and Gertrude H. Sergievsky Center (D.H.), Division of Epidemiology, Columbia University Medical Center, New York, NY
| | - Elizabeth Donner
- From the Comprehensive Epilepsy Center (C.V., F.H., D.F., O.D.), New York University School of Medicine, NY; Division of Neurology (E.D.), The Hospital for Sick Children, Toronto, Ontario, Canada; Epilepsy Center (B.D.M.), Gardner Neuroscience Institute, University of Cincinnati Health, OH; Department of Pediatrics (J.B.), University of Calgary, Alberta, Canada; and Gertrude H. Sergievsky Center (D.H.), Division of Epidemiology, Columbia University Medical Center, New York, NY
| | - Brian D Moseley
- From the Comprehensive Epilepsy Center (C.V., F.H., D.F., O.D.), New York University School of Medicine, NY; Division of Neurology (E.D.), The Hospital for Sick Children, Toronto, Ontario, Canada; Epilepsy Center (B.D.M.), Gardner Neuroscience Institute, University of Cincinnati Health, OH; Department of Pediatrics (J.B.), University of Calgary, Alberta, Canada; and Gertrude H. Sergievsky Center (D.H.), Division of Epidemiology, Columbia University Medical Center, New York, NY
| | - Jeffrey Buchhalter
- From the Comprehensive Epilepsy Center (C.V., F.H., D.F., O.D.), New York University School of Medicine, NY; Division of Neurology (E.D.), The Hospital for Sick Children, Toronto, Ontario, Canada; Epilepsy Center (B.D.M.), Gardner Neuroscience Institute, University of Cincinnati Health, OH; Department of Pediatrics (J.B.), University of Calgary, Alberta, Canada; and Gertrude H. Sergievsky Center (D.H.), Division of Epidemiology, Columbia University Medical Center, New York, NY
| | - Dale Hesdorffer
- From the Comprehensive Epilepsy Center (C.V., F.H., D.F., O.D.), New York University School of Medicine, NY; Division of Neurology (E.D.), The Hospital for Sick Children, Toronto, Ontario, Canada; Epilepsy Center (B.D.M.), Gardner Neuroscience Institute, University of Cincinnati Health, OH; Department of Pediatrics (J.B.), University of Calgary, Alberta, Canada; and Gertrude H. Sergievsky Center (D.H.), Division of Epidemiology, Columbia University Medical Center, New York, NY
| | - Daniel Friedman
- From the Comprehensive Epilepsy Center (C.V., F.H., D.F., O.D.), New York University School of Medicine, NY; Division of Neurology (E.D.), The Hospital for Sick Children, Toronto, Ontario, Canada; Epilepsy Center (B.D.M.), Gardner Neuroscience Institute, University of Cincinnati Health, OH; Department of Pediatrics (J.B.), University of Calgary, Alberta, Canada; and Gertrude H. Sergievsky Center (D.H.), Division of Epidemiology, Columbia University Medical Center, New York, NY
| | - Orrin Devinsky
- From the Comprehensive Epilepsy Center (C.V., F.H., D.F., O.D.), New York University School of Medicine, NY; Division of Neurology (E.D.), The Hospital for Sick Children, Toronto, Ontario, Canada; Epilepsy Center (B.D.M.), Gardner Neuroscience Institute, University of Cincinnati Health, OH; Department of Pediatrics (J.B.), University of Calgary, Alberta, Canada; and Gertrude H. Sergievsky Center (D.H.), Division of Epidemiology, Columbia University Medical Center, New York, NY.
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de Lima C, Arida RM, Andersen ML, Polesel DN, de Alvarenga TAF, Vancini RL, Matos G, Tufik S. Effects of acute physical exercise in the light phase of sleep in rats with temporal lobe epilepsy. Epilepsy Res 2017; 136:54-61. [PMID: 28772197 DOI: 10.1016/j.eplepsyres.2017.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 04/20/2017] [Accepted: 07/20/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Our aim was to investigate the influence of an acute exercise session on sleep pattern in rats with temporal lobe epilepsy (TLE). METHODS Twenty male Wistar rats were randomly assigned to 4 groups: control (C); acute exercise (EX); epilepsy (E) and epilepsy acute exercise (EEX). Two sleep electrocorticography recordings were performed during the light phase [baseline and day 2 (after the acute physical exercise session)]. After baseline recording, the exercise groups (EX and EEX) were submitted to an exercise session on a motor-driven treadmill at 12m/min for 30min. Twelve hours later, the rats were submitted to the second sleep recording. RESULTS At baseline, the E group showed a higher wakefulness and a lower Total sleep time, Slow Wave Sleep and REM sleep compared with the C group. After acute exercise, there was an increase in Total sleep time and Slow Wave Sleep and a decrease of wakefulness in EEX (+11.10%, +20.29% and -11.25%, respectively) and EX (+5.20%, +11.60% and -8.12%, respectively) groups. CONCLUSION These findings suggest that acute physical exercise positively impacts the sleep pattern of rats with TLE, inducing a more consolidated sleep.
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Affiliation(s)
- Cristiano de Lima
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Ricardo Mario Arida
- Department of Physiology, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Monica Levy Andersen
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | | | | | - Rodrigo Luiz Vancini
- Center of Physical Education and Sports, Universidade Federal do Espírito Santo, Vitória, ES, Brazil.
| | - Gabriela Matos
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
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